Degree Name
Nursing Practice, DNP
Publication Date
4-28-2026
First Advisor
Sandy King
Second Advisor
Beverly Clark
Abstract
Gaps in provider and nurse confidence in identifying and managing anxiety disorders in outpatient family clinic settings contribute to underdiagnosis, delayed intervention, and reduced psychiatric referrals. This quality improvement project evaluated the impact of provider education and implementation of the Generalized Anxiety Disorder-7 (GAD-7) screening tool on provider and nurse confidence and appropriate psychiatric referral rates, with the goal of improving clinical decision-making and standardizing anxiety screening practices. The project was guided by Lewin’s Change Theory and the Iowa Model of Evidence-Based Practice. Using a quasi-experimental pre- and post-intervention design, providers and nurses in an outpatient family clinic received structured, evidence-based education on anxiety screening and use of the GAD-7 tool over a six-week period. Provider and nurse confidence was measured using a validated self-report instrument, while clinical outcomes, including screening rates and psychiatric referrals, were evaluated using de-identified electronic health record data. Normality was assessed using the Shapiro–Wilk test, and a two-tailed paired-sample t-test was conducted to evaluate changes in confidence scores. Results demonstrated a statistically significant improvement in provider and nurse confidence (p < .001), with mean scores increasing from 9.6 to 20.9. Screening rates improved to 62.7%. Among patients with moderate to severe anxiety (n = 77), 57.1% were referred for psychiatric care, 15.6% initiated pharmacologic treatment, and 27.3% declined intervention. Limitations included a small sample size, a short implementation period, and variability in participation. Findings support the use of education and standardized screening tools to improve confidence, early identification, and referral, supporting sustainable integration of evidence-based mental health practices in primary care.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Check, Maceline E., "Impact of Provider Confidence and Psychiatric Referrals Through Education and Implementation of the GAD-7 Anxiety Screening Tool in an Outpatient Family Clinic" (2026). Doctor of Nursing Practice Projects. 337.
https://arch.astate.edu/dnp-projects/337
