Doctor of Nursing Practice (DNP) Projects

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Open Access

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Degree Program

Doctor of Nursing Practice

Degree Track

Public Health Nurse Leader

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Month Degree Awarded



Skinnerian, operant conditioning, depression, isolation, elderly, senior depression


Jeungok Choi, RN, PhD, MPH

DNP Project Chair

Jeungok Choi, RN, PhD, MPH



The aim of this project was to decrease depression of those socially isolated, and/or homebound seniors, through behavioral activation by using CHEER and emotional support, along with bridging access to programs and the needs of seniors in the community.


As we age we face functional, medical, and social complexities that frequently become hard to manage. Depression is a problem that is present but often goes unrecognized in society. It is more prevalent in younger adults, however, depression has more acute affect in older persons. Depression can potentially be debilitating and increase adverse events with other health issues such as being an associated factor in frequent readmissions. There is no current existing intervention to intervene and impact the elderly who are homebound, depressed, and/or socially isolated in a rural county in the state of New York. Center Based Help for Elder Depression and Emotional Reinforcement (CHEER) based on the evidence-based practice (EBP) national guideline summary: Depression in older adults, the goal was to improve the quality of life for those socially isolated and/or homebound seniors- and bridge access to programs and the needs of seniors in the community


This countywide project involved seven participants between the ages of 79-94. Implying the Polenick and Flora’s Behavioral Activation for Depression in Older Adults, three weekly home visits were completed, each an hour in length. The activities in each visit varied from playing cards, completing puzzles, or simple conversation. The Geriatric Depression Scale (GDS) was administered on the first and last visits. Information for access to needed care was provided from the County Office for Aging’s Elder Services Guide.


Four out of the seven participants (57 %) screened positive for depression on the first visit. This was determined using the GDS of a score greater than five. On the final CHEER visit, only one out of seven (14 %) scored positive for depression. The groups mean depression score was 5.28 (SD=0.7) on the first visit, and 4.28 (SD=0.7) on the final visit.

Every participant reported that the CHEER visits were enjoyable and meaningful at the end of the project. Participant’s also verbalized that the community resources provided to them were found to be useful.

Discussion/ Implications to Practice.

The CHEER visits were determined to have a beneficial effect on the participants depression scores, and each participant reported positive feedback at the end of the project. This demonstrates that if put into practice there could be a noted improvement in the quality of life of those homebound, depressed, and/or socially isolated seniors. The CHEER program also bridges access to programs and the needs in the community, promote independent behaviors and activity engagement, and improve other chronic health issues by minimizing depression.


Depression consequences include inferior quality of life, social deprivation, loneliness, and increased use of health and home care services. CHEER visits improved depression status, promoted socialization, encouraged participation, and assisted with behavioral activation which leads to reduction in health care use by minimizing negative effects on chronic conditions.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.