Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Karen Burritt, Ph.D., RN, FNP-BC

Second Advisor

Anne McKay, DNP, ANP-BC

Third Advisor

Carrie Mull, DNP, RN

Fourth Advisor

Kevin Hengeveld, DNP, RN & Jane Visser, FNP, RN


Introduction: 66% of individuals in the United States who experienced a major depressive episode in the last year saw a general practitioner or family doctor and not a psychiatrist or psychotherapist (Center for Behavioral Health Statistics and Quality, 2018). Many primary care providers treat with medication, however, a combination of medication and psychotherapy is associated with better results (Anxiety and Depression Association of America, n.d.). A Midwestern faith-based healthcare organization implemented a pilot cognitive behavioral therapy program at a family medicine residency clinic to improve mental health care.

Objectives: The purpose of this project was to evaluate if the implementation of Creating Opportunities for Personal Empowerment (COPE) by primary care providers was beneficial and sustainable at the clinic.

Methods: Using the Consolidated Framework for Implementation Research, a DNP student analyzed data collected from electronic health records, observed behaviors and systems within the clinic, and conducted semi-structured interviews with the COPE providers.

Results: Care as usual data from the clinic suggested the need for additional anxiety and depression interventions. Nine individuals participated in COPE and experienced decreases in PHQ-9 and GAD-7 scores. Providers experienced barriers related to completing COPE training and scheduling COPE appointments. Three providers participated in COPE sessions, but it was not well adopted.

Conclusions: COPE was beneficial for patient anxiety and depression, but it is not sustainable in the family medicine residency clinic primarily due to busy provider schedule, and lack of organizational support.

Implications: COPE may be used by individual providers but there are difficult barriers to overcome when implementing clinic wide.