CAPSTONE 2 LORI

1

Capstone Part 1: PICOT Assignment

Student’s name: Yaneisy Loriga

Instructor: Carmen Lazo

Course: MSN Capstone Project-DBX-DL01

Date: March 18, 2026

Introduction to the Practice Problem

Overview of Major Depressive Disorder

Major Depressive Disorder is one of such mental health disorders, a serious and widespread mental health disorder, which is typified with constant sadness, lack of interest in all activities, impaired functioning, and in severe cases, suicidal thoughts (Fisher et al., 2024). It impacts millions of adults globally and has an expansive influence on the quality of life, productivity, and a general outcome of health. Depression has been ranked among the leading causes of disability in the United States and the world health organization has announced them as one of the leading causes of burden of diseases in the world.

The treatment-resistant depression (TRD) is a partial version of the Major Depression Disorder and it is expressed when the patients fail to respond positively to two or more antidepressant medications (McIntyre et al., 2023). The given condition poses a significant issue in clinical practice because it is connected with a long-lasting disease, enhanced healthcare care, and a greater likelihood of the patient becoming hospitalized.

Importance of the Practice Problem.

The importance of treatment-resistant depression is that it is very prevalent, economically expensive, and affects patient outcomes (Lundberg et al., 2023). In the US, an estimated 7-10 percent of adults suffer depression every year, with almost a third of them coming with the treatment resistant variations. Depression cost to the economy is more than 300 billion a year in terms of health care cost, time lost cause of work and disability benefit. On a local level, in Miami-Dade County, the issue of mental health disorders is one of the most common morbidity factors, and underserved populations experience an extra barrier to care due to a lack of access to special treatment and socioeconomic differences.

The expenses of treating Treatment-resistant depression are far higher as compared to those of non-resistant where there is repetition of medication trials, more outpatient visits, and hospitalization. More complicated procedures like Transcranial Magnetic Stimulation (TMS) will open the possibility of lowering the expenses in the long-term by enhancing the results of the treatment process and lowering the rates of the relapse (Seewoo et al., 2022).

Purpose Statement

The aim of the proposed study is to determine the efficacy of Transcranial Magnetic Stimulation treatment in the minimization of depressive symptoms and enhancement of functional outcomes in a sample of adults with outpatient treatment-resistant Major Depressive Disorder in Miami-Dade County. The result that is proposed is quantifiable using validated depression scales including Patient Health Questionnaire-9 (PHQ-9), in 12 weeks of treatment. The project will prove that TMS is a safe and evidence-based approach to alternative continued pharmacologic management.

PICOT Question

Overview

The PICOT question used when developing this project consists of the following: “ In adults aged 21–65 diagnosed with treatment-resistant Major Depressive Disorder in an outpatient mental health clinic in Miami-Dade County (P), how does Transcranial Magnetic Stimulation (TMS) therapy (I), compared to continued pharmacologic management alone (C), affect depressive symptom reduction and functional improvement (O) over a 12-week treatment period (T)?” The question is designed to fill a very crucial gap in depression treatment, especially in cases when a person does not respond to the conventional methods of pharmacologic interventions (Seewoo et al., 2022).

Population (P)

The sample population will be comprised of adults with Major Depressive Disorder found in outpatient mental health clinics within Miami-Dade County whose treatments are resistant to treatment. This population is a vulnerable one because of being a chronic illness due to functional impairment and exposed to comorbid conditions.

Intervention (I)

The treatment method is the Transcranial Magnetic Stimulation which is a non-invasive treatment program that employs magnetic fields to stimulate the nerve cells in the brain. TMS is approved in depressed patients who failed to respond to the medication and is becoming more widespread in the outpatient medical facilities.

Comparison (C)

The comparison intervention is maintained pharmacologic management itself, which implies antidepressant drugs and periodic psychiatric follow-ups. Although medication is the treatment defense, a large portion of treatment-resistant depression patients will fail to have remission using pharmacologic therapies alone.

Outcome (O)

The main results are observed to be the lessening of symptoms of depression as well as enhancing of the functional status. The measurement of these will be done through standardized instruments like PHQ-9 and functional assessment scales. The aim of defining improvement is the clinically significant decrease in the scores of depressions and the enhanced capacity to engage with such daily activities.

Timeframe (T)

This project is planned to last 12 weeks in accordance with the common TMS treatment regimens and provide enough time to measure the clinical results.

At Risk Population and Environment.

The population size is another aspect that should be described. The target population consists of adults having treatment-resistant depression in Miami-Dade County, which is a diverse urban neighborhood with very high socioeconomic inequalities (Seewoo et al., 2022).

Social Determination of Health.

Poor mental health is caused by factors including low income, unemployment, low level of education and inaccessibility of health care services among others. The unequal access to healthcare in Miami-Dade County imbalances against the minority and underserved population unjustly scales the number of people with untreated or poorly managed depression.

Vulnerability and Risk Factors.

This group is susceptible because these issues associated with treatment-resistant depression such as chronic stress, trauma history, comorbidity, and insufficient access to mental health can trigger the aggravation of the symptoms, reduced life quality, and even the probability of their hospitalization. The necessity of the change is acute because the existing methods of treatment might not be sufficient to meet the needs of such a group of people. TMS and other evidence-based interventions provide a chance to enhance both results and discrepancies in care.

Evidence-Based Proposal

Proposed Intervention

The suggested intervention is to carry out a Transcranial Magnetic Stimulation therapy in outpatient mental health clinic environment to patients with treatment-resistant depression (Seewoo et al., 2022). TMS is confirmed by the accumulating evidence of its usefulness in decreasing the level of depressive symptoms and enhancing functional outcome.

Resources and Implementation.

The implementation of TMS is a procedure that requires solitary devices, schooling of medical staff and clinical pertinent guidelines. The choice of patients, educating them, and observing them throughout the treatment process is one of the areas where the advanced practice nurses (APNs) play a significant role. It is necessary to collaborate with psychiatrists and other mentally-focused professionals with the aim of seeking comprehensive care.

Feasibility

The fact that the option of this intervention is a possibility is explained by the increase in the access to TMS in outpatient facilities and non-invasive nature of the procedure. The initial costs may be high but in the long run, it will result to reduced healthcare utilization and improved patient outcomes hence its usefulness in the long run.

Timeline

The proposed plan will include the stages of patient recruitment, pre-interrogation, 12 weeks of the TMS application and the post interventions. The periodical follow-up appointment will be made to monitor the progress and respond to questions.

Theoretical Framework

Application of Nursing Theory.

Self-Care Deficit Nursing Theory by Orem will be used in this case. TMS is arguably considered in the framework of the treatment-resistant depression, as a means to increase the functional capacity and self-care activity of patients in question (Isik & Fredland, 2021).

Integration into Practice

The theory will be incorporated into the project with the focus on the patient-centered care, education, and empowerment. Nurses will play a critical role in assessing the needs of the patients, providing a helping hand, and promoting self-compliance with the treatment. These are directed towards the provision of improved clinical results as well as maximizing the competency of their patients in managing their condition.

Conclusion

The problem of Major Depressive Disorder is a huge healthcare problem that has become a challenge to people, society and even healthcare institutions and is becoming resistant to drugs. The proposed project demonstrates the opportunities of the Transcranial Magnetic Stimulation therapy as an effective intervention approach to improve the outcomes of this group. This project will enhance patient care by closing the gaps in available treatment options and combining the evidence-based practices that can result in the reduction of the cost involved in the healthcare services and the health equity. Nursing leadership and advocacy can be instrumental in bringing these changes and guaranteeing their success to ensure high-quality of care provided to patients.

References

Fisher, D., Dunn, J. T., & Dong, H. (2024). Distinguishing features of depression in dementia from primary psychiatric disease. Discover Mental Health, 4(1). https://doi.org/10.1007/s44192-023-00057-y

Isik, E., & Fredland, N. M. (2021). Orem’s self-care deficit nursing theory to improve children’s self-care: An integrative review. The Journal of School Nursing, 39(1), 6–17. https://doi.org/10.1177/10598405211050062

Lundberg, J., Cars, T., Lööv, S.-Å., Söderling, J., Sundström, J., Tiihonen, J., Leval, A., Gannedahl, A., Björkholm, C., Själin, M., & Hellner, C. (2023). Association of Treatment-Resistant Depression With Patient Outcomes and Health Care Resource Utilization in a Population-Wide Study. JAMA Psychiatry, 80(2), 167–175. https://doi.org/10.1001/jamapsychiatry.2022.3860

McIntyre, R. S., Alsuwaidan, M., Baune, B. T., Berk, M., Demyttenaere, K., Goldberg, J. F., Gorwood, P., Ho, R., Kasper, S., Kennedy, S. H., Ly-Uson, J. T., Mansur, R. B., McAllister-Williams, R. H., Murrough, J. W., Nemeroff, C. B., Nierenberg, A. A., Rosenblat, J. D., Sanacora, G., Schatzberg, A. F., & Shelton, R. C. (2023). Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry, 22(3), 394–412. https://doi.org/10.1002/wps.21120

Seewoo, B. J., Rodger, J., Demitrack, M. A., Heart, K. L., Port, J. D., Strawn, J. R., & Croarkin, P. E. (2022). Neurostructural Differences in Adolescents With Treatment-Resistant Depression and Treatment Effects of Transcranial Magnetic Stimulation. International Journal of Neuropsychopharmacology, 25(8), 619–630. https://doi.org/10.1093/ijnp/pyac007