Qian Tu, PhD, DNP, ARNP, is a recent alumni of the UW School of Nursing’s DNP-Adult Gerontology Primary Care Nurse Practitioner program. She received the de Tornyay Center’s 2020 DNP Pathways to Healthy Aging Award.
All interviews have been edited for length and clarity.
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What is your Doctor of Nursing Practice (DNP) project?
I developed a depression toolkit for an adult family home, with screening tools and prevention and treatment activities. Adult family homes function similarly to nursing homes, but they use houses in the neighborhood to provide care to up to six residents. They provide 24-hour care service, but while nursing homes at least have LPNs or RNs on board, this type of adult family home only has what are called home aides.
I looked at the literature to see what interventions have been shown to help depression, especially focusing on what has been done on the community level. Most of the literature is focused on patients 65 or above, but there are a few studies that are 60 or above. Studies use all kinds of activities, including video conferencing, laughter yoga, and animal assistive programs. The interventions I suggested in my project all proved to be effective in at least one study, although they do not compare to the standard of care for depression, cognitive behavioral therapy.
One intervention stood out — physical activity. It doesn’t necessarily have to be cardio physical activity, it can be more focused on helping them to improve their stability, flexibility and ability to get around. Physical activity is the only one of the interventions in the scientific literature with a randomized control study showing that they have similar effects to the standard treatment of depression with cognitive behavioral therapy.
Why is this project important?
In the literature, researchers found that depression is very significant among older populations, but at the same time it’s generally underdiagnosed and undertreated. The symptoms for depression are different in older adults compared to younger people. They may have some memory issues. They don’t feel well. That’s why it’s kind of hard to detect if you don’t have effective tools.
How did you suggest detecting depression in older adults as a part of your project?
The first screening tool I use is very simple, it only asks two questions: During the last month, have you been bothered by feeling down, or depressed or hopeless? Have you often been bothered by having little interest or pleasure in doing things? It’s very straightforward.
If they answer yes to any of those questions, then we will do a more detailed geriatric depression scale. That will differentiate them from mild to moderate to severe depression. All the interventions I proposed are non-pharmacological, no medication involved. This project is more focused on reducing mild and moderate depression or preventing depression in someone who hasn’t developed it. If the patient has severe depression, we will refer them to the mental health professionals, because that’s above and beyond the scope of what we can do using non-pharmacological methods.
Why it important to have non-pharmacological interventions?
Older adults often have other health conditions and already may be on other medications. The more medications you take, the more adverse side affects you may have, and there are more chances of drug to drug interactions. That’s why we, if possible, want some non-pharmacological methods to help older adults. Depression particularly, it can sometimes be treatable with non-pharmacological methods if it’s in the early stage.
Was there anything that surprised you while you were working on this project?
One thing that surprised me is that simply improving social interaction with another person can help decrease depression. Small steps, like making handmade crafting projects as a group will work too, including for patients with dementia. The interaction doesn’t even have to be face to face. There’s a program where the participant used video conferences with family or friends, once a week for ten weeks, and there’s a big improvement in their depression.
What interested you about this project?
I really love geriatrics, my first nursing job in this country was working in a nursing home. I feel like this population sometimes gets neglected by society, and they don’t get the care they deserve. I want to do more to help them have a better quality of life.
I also have a personal preference for older adults because I was brought up by my grandmother. When I was born, both of my parents were working full time, and my grandma was retired so she took care of me until I went to elementary school. Then when I was in third grade my grandma had a stroke and she moved in with us until she passed away at the age of 87. In her last couple of years, she got dementia, she couldn’t recognize any people around, and they were just strangers to her. She would eat a meal and then forget once you took the plate away. That stuck in my mind a lot, when choosing nursing as a career. I felt very satisfied by taking care of her at home.
It’s fun to work with the older population, they are filled with so much wisdom from their lives, so you learn so much by talking with them.
Why did you choose nursing?
I feel so satisfied and fulfilled in nursing. My mom worked in a hospital, so I grew up with the hospital as my playground. Back then you could bring your kid to work. So, we — a bunch of doctor’s kids, nurse’s kids, administrator’s kids — just played in the hospital during the summer or winter vacation. I was immersed in the medical field at a very young age. When I went to high school, we had a general college entrance exam, and before the exam you have to fill out what school you want to go to. All my desired schools were medical schools. We have medical universities in China within which there are all specialties under the health sciences, such as medicine, nursing, pharmacy, dentistry, nutrition, etc. My teacher asked if I wanted to consider something else, and I said no. I cannot imagine choosing a career out of the medical field. It’s not an option in my eyes.
Anything else about your work or background that you’d like to share?
I originally came to the US from China to get my PhD in Nursing Science. My DNP is my second doctoral degree. I choose primary care because after I worked in long term care and the hospital, I saw a lot of patients come in because they lacked primary care. They delayed treatment for too long and ended up in the hospital. There’s a huge need for primary care.
What made you come back for your DNP?
With a research degree, you basically have two routes to go, one, you can go teach in a four year college or community college, and the second route is you continue research in a research focused school like UW. The first route you have to have extensive clinical experience, but I came from another county, so I had zero clinical experience in the U.S.. The second route, if I want to do research and go to a research- intensive school, I have to go through post doc training, and for my field of PhD research, I would have to move across the country. At the time I had a baby to raise, so I wanted to stay and go get my clinical experience first. But while doing my clinical work, I found my true love. I still enjoy research, but I feel like direct interaction with patients, that makes me feel more fulfilled.