Systemic assessment of depressive symptoms among registered nurses: A new situation-specific theory Ratchneewan Ross, PhD, RN, FAAN a, *, Susan Letvak, PhD, RN, FAAN a , Francine Sheppard, PhD, RN, CNE b , Marjorie Jenkins, PhD, RN, NEA-BC, FACHE a , Monir Almotairy, MSN, APRN, AGACNP-BC a a School of Nursing, University of North Carolina Greensboro, Greensboro, NC b Francine Sheppard’s affiliation to Western Carolina University, Cullowhee, NC ABSTRACT Background: A mentally-healthy nursing workforce is vital to providing quality healthcare. While there has been research conducted internationally on depres- sive symptoms in nurses, most studies have lacked a theoretical framework. Purpose: The purpose of this article is to describe the development of a situation- specific theory, the Systemic Assessment of Depressive Symptoms among Registered Nurses (SAD-RN). Methods: The SAD-RN was developed through theory synthesis using the Roy’s Adaptation Model (RAM) as a framework. Sixty-four research articles were selected to abstract relevant concepts based on a priori RAM concepts. Findings: Using depressive symptoms as the anchor concept, related emergent concepts of SAD-RN include context, stressors, protective factors, negative health outcomes, and low patient care quality. Discussion: SAD-RN is an evidence-based comprehensive model that offers researchers a guiding theory to be used in their future research on depressive symptoms among RNs. Cite this article: Ross, R., Letvak, S., Sheppard, F., Jenkins, M., & Almotairy, M. (2019, xxx). Systemic assess- ment of depressive symptoms among registered nurses: A new situation-specific theory. Nurs Outlook, 00 (00), 1À13. https://doi.org/10.1016/j.outlook.2019.08.007. ARTICLE INFO Article history: Received 23 February 2019 Received in revised form 9 August 2019 Accepted 25 August 2019 Keywords: Depressive symptoms Nurses Situation-specific theory Roy’s Adaptation Model Stressors Patient care quality Health outcomes Introduction A healthy nursing workforce is imperative for the deliv- ery of safe, high quality health care. Although the Ameri- can Nurses Association (ANA) launched a Healthy Nurse, Healthy Nation (HNHN) Grand Challenge initiative in 2017 to improve the health of the U.S. nation by first improving the health of nurses, its main focus is on the physical health of nurses; mental health (specifically, depressive symptoms) and wellness are not well addressed in this important undertaking (American Nurses Association, 2018). Internationally, prevalence rates of depressive symptoms in nurses are alarming: 18% to 40% in the United States (Davidson, Zisook, Kirby, DeMichele, & Norcross, 2018; Letvak, Ruhm, & McCoy, 2012); 22% in Iran (Saeedi Shahri et al., 2017); 33% in Brazil (Machado et al., 2018); 38% to 57.2% in China (Fang et al., 2018; Gong et al., 2014); and 69.1% in Japan (Matsuzaki, Uemura, & Yasui, 2014). It has been reported that nurses with * Corresponding author: Ratchneewan Ross, School of Nursing, University of North Carolina Greensboro, Greensboro, NC 27412. E-mail address: r_ross2@uncg.edu (R. Ross). 0029-6554/$ -see front matter Ó 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.outlook.2019.08.007 ARTICLE IN PRESS Available online at www.sciencedirect.com Nurs Outlook 0 0 0 (2019) 1 À13 www.nursingoutlook.org