Applying Addie Model in Developing Educational Program about Depressive Symptoms among Older Residents for Nurses in Long-Term Care Facilities

The prevalence of depression in the long-term care facilities (LTCFs) is high and is around 36.3%-81.8% in Taiwan. Nurses are the main healthcare professionals in LTCFs and should have adequate knowledge and skills to provide appropriate care for residents with depressive symptoms. Literature has indicated that LTCFs carers were lack of knowledge about depression; could not accurately recognize the residents with depression or depressive symptoms; and had insufficient confidence in providing care for them. The majority of studies have suggested that in-service training about depression should be developed for LTCFs carers. However, most studies used only one-group pretest-posttest design to examine the effects of the related training program; did not use the theoretical framework to guide the development of the program; and did not design the program for LTCFs nurses. Therefore, this 3-year project will use ADDIE instructional design model which include the process of analysis, design, development, implementation, and evaluation, to guide the development and evaluation of the educational program about depression among older adults for nurses. The methods of this project are presented as follows. Stage 1 (analysis) National survey and stratified sampling will be applied in this study. The inclusion criteria for the nurses will: (1) be 20 years old and over, (2) have worked in the nursing homes for over 1 month, (3) can read Chinese, (4) agree to participate in the study. There are no exclusion criteria. Sample size will be 371 nurses. Data analysis will be conducted by performing percentage, mean, t-test, one-way ANOVA, Pearson r, and stepwise multiple regression through SPSS 18.0 software. Additionally, the qualitative research design will be used to explore LTCFs nurses’ experiences and difficulties of taking care of the older residents with depressive symptoms. One-to-one in-depth interviews will be conducted using semi-structured interview guide. The sample size will be determined by the saturation of information and content analysis will be used for data analysis. Stage 2 (design and development) Based on the literature review, researcher’s experiences, and the findings of the Stage 1, the educational program about depression among older adults will be developed. Except for the training workshops, the related website and information and reminding messages delivered by smart phone will be included in the program according to Information Processing Theory in order to enhance nurses’ learning. Seven experts will be invited to review and validate the contents of the educational program and a pilot test will be conducted. Stage 3 (implementation and evaluation) Quazi-experimental design will be applied. Ten long-term care facilities will be purposively selected. Five institutions will be randomly selected into intervention group, and the other will become the comparison group. The inclusion and exclusion criteria are the same as Stage 1. The required sample size will be 98 nurses. The nurses in the intervention group will have three 30-min workshops, need to log in website and review it, and receive the messages sent by smart phone. The comparison group will receive the paper-based learning materials about depression. Data will be collected at baseline, one month, and three months after the intervention using a questionnaire (knowledge, recognition of depression, attitudes, and confidence about depression care among older adults). Data analysis will be conducted by performing percentage, mean, t-test, chi-square, one-way ANOVA, Pearson r, and generalized estimating equations (GEE) through SPSS 18.0. The developed educational program will provide nursing managers as a reference for future nurse’s training. Moreover, the website will be accessed by all interesting LTCFs care providers in Taiwan or other countries after completing the study. It is hoped that older resident’s quality of life can be ensured through nurses having correct knowledge and skills about depression care, successfully recognizing depressive symptoms and depression, and providing appropriate care.