DNP Practice Inquiry Projects
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The Doctor of Nursing Practice (DNP) is a terminal degree in nursing focusing on nursing leadership and application of research into practice. The DNP program is also designed to prepare the nurse at an advanced level of nursing practice specifically as a Family Nurse Practitioner (FNP) and as leaders and administrators for health care organizations. The program emphasizes the development of the student’s capacity to impact the clinical setting as leaders and educators and to utilize clinical research to improve and transform health care. Our program is based on the understanding that nurses provide services which include the direct care of individual clients, transcultural nursing care, management of care for rural populations, administration of nursing systems, and development and implementation of health policy. The program encompasses health economics, cultural diversity, chronic care management, health promotion, and disease prevention in rural communities and will create a cadre of new nursing faculty who can immediately address the nursing faculty shortage. Advanced practice nurses with practice doctorates will address significant practice issues in a scholarly way, adopt broad system perspectives for health promotion and risk reduction, and act as agents of change that transform client/community care, participate in the on-going evaluation of health care outcomes, and assist in the translation of research that leads to positive nursing practice changes.
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ItemUse of an Evidence-Based Tool in Improving Communication to Decrease Falls( 2023-06-01)Inpatient falls with major injuries resulting in 63% death was among the top ten sentinel events reported in 2015, according to The Joint Commission (TJC). Other factors to consider in fall prevention initiatives include (1) the ability of patients to return to previous living situations and (2) the economic burden of cost. In Hawaii, the out-of-pocket cost for equipment and rehabilitation after a fall is $28,000,0000 (CDC, 2020a). On a medical-surgical unit, fall prevention interventions included fall identification wristbands, non-skid socks, gait belt use, no-toileting alone, bed and chair alarm use, and video monitoring when indicated. Despite the processes and interventions in place, the unit could not meet the national benchmark, which allows only one fall without injury per month. Fall prevention initiative is a significant priority for the unit as the patient population is at an increased risk for falls and fall-related complications due to chronic and acute conditions, medication effects, age, and surgery. An evidence-based tool called Fall Tailoring Intervention for Patient Safety (Fall TIPS) was piloted to improve communication among care providers and increase knowledge and confidence in fall prevention practices. The quality improvement initiative resulted in a decreased number of falls/falls with injury on the unit during the education and trial period and has the potential for integration into practice. The mean level of confidence of staff also increased from 7.65 to 8.55 for the pre and post-test survey. However, the staff's knowledge level did not significantly increase post-test compared to the pre-test knowledge assessment survey indicating a targeted education or other means of improving fall prevention knowledge.
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ItemImproving the Awareness of Medication Administration at a Primary Care Clinic( 2023-05-30)Medication errors occur too frequently in healthcare. As such, a medication administration framework was created to help prevent such errors. The medication administration framework was initially called the five rights of medication administration. A practice improvement project stemmed from these rights as medication administration errors continued to occur among staff in a Primary Care Clinic. The overall goal of this project was to increase awareness and knowledge among the medical staff of a Primary Care Clinic with an educational in-service, which would ideally reduce medication errors. An educational program was created using a PowerPoint presentation. Participating staff were asked to complete a pre-questionnaire before the program started and a post-questionnaire after the presentation. A paired t-test found no statistical significance, p > 0.05, among the sessions. However, despite not having statistical significance, aggregate data showed improvement in each pre- and post-session for the educational program. Furthermore, despite the educational sessions and improvement in post-scores, the medication rights framework is still not ingrained within daily medical staff practice, which could result in future medication errors. This aspect may continue to threaten patient safety and should be further reviewed by the Primary Care Clinic.
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ItemBlood Pressure Management with the use of Technology in Rural Hawaii( 2023-05-27)The health care delivery system has evolved over centuries with the use of technology to manage care for those who live in rural communities. Due to the COVID-19 pandemic a public health emergency (PHE) has extended insurance policies so telehealth services (THS) could become available for primary care clinics. Although it became the new norm, and despite the benefits of THS, health care centers will continue to face challenges as new policies are in effect which may limit the delivery of health care options for primary care providers. Without innovative solutions to utilize technology as a part of primary care services, patient care will continue to be inadequate making it less cost-effective. One major challenge that providers will continue to encounter is the health literacy issues related to chronic disease management (CDM). One of the major risk factors for life threatening events is hypertension (HTN). Otherwise known as high blood pressure (HBP). The purpose of this project is to develop and deliver an interventional educational program (IEP) with the use of zoom and PowerPoint applications that focus on managing HBP among adults who reside within a rural community where access to primary care is limited. The chronic care model (CCM) and logic model (LM) was used as a guide to develop and design a project plan to implement the IEP in effort to increase health literacy core measures of one’s knowledge and confidence levels. Pre- and post- Hypertension Evaluation Lifestyle Management (HELM) scores and Blood Pressure Management Self Efficacy scale (BPMSES) scores were compared. The results indicated an increase in knowledge and confidence levels in all areas of managing HBP through lifestyle and treatment goals, the use of an automatic blood pressure monitor (ABPM), recognizing the 5 levels of BP numbers, and partnering with providers to manage HBP.
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ItemStandardizing Medical Clearance of Behavioral Health Patients: Implementation and Evaluation of Adapted SSVMS SMART Form at a Rural Community Hospital Emergency Department( 2023-05-17)The number of inpatient psychiatric beds has decreased by over 500,000 beds since the 1950s. This has led to many patients seeking mental health care through emergency departments (ED) and a high percentage of ED hours are utilized by patients experiencing mental and/or behavioral crises, in turn leading to overcrowded EDs across the country. The Sierra Sacramento Valley Medical Society (SSVMS) implemented the SMART Form in 2015 to standardize and assist ED providers with the process of ‘medical clearance’ of mental/behavioral health patients. SSVMS SMART Form use led to a 14.9% decrease in ED length of stay (LOS). In the current study, the SMART Form was adapted for use in a rural hospital to evaluate effects on ED LOS, number of blood draws, and number of ancillary tests ordered. Other metrics evaluated were the utilization rate of the SMART Form and staff satisfaction. During the one-month implementation period, it was found that the adapted SMART Form was not utilized, yet staff satisfaction with measures regarding ED workflow, communication between the ED and BHU, and the ED LOS of patients admitted to the BHU shifted from a dissatisfied position to a neutral position. Future steps to continue to improve staff satisfaction measures would be to require that the adapted SMART Form be completed prior to ordering psychiatric consults, evaluating if the SMART Form reduces length of time for patients with a mental and/or behavioral chief complaint to be evaluated by psychiatry, and continuing to assess how increased hospital census affects both departments to develop creative solutions to address increased LOS.
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ItemQuality of Life of Community Elderly And Mindfulness Meditation/Mindfulness Training( 2023-05-15)Poor mental health can affect an older person's quality of life. The researchers found that older adults are at higher risk for depression. Negative stress significantly impacts older person's quality of life across physical, psychological, and social domains resulting in suffering and distress to older individuals. More effective interventions for improved quality of life for older persons are needed. Mindfulness meditation training can be beneficial in reducing symptoms of depression and stress and improving quality of life. (Amadpanah study, 2017). The goal of my PIP was to determine if older individuals (65 years or older) residing in the community can improve their quality of life by adding a mindfulness meditation program. The research question was "Can the introduction of the six weeks one-hour weekly mindfulness meditation class improve the quality of life of community-based older individuals?". The results of my PIP were lower perceived stress and depression reported by the participants after six weeks of mindfulness meditation class. Mindfulness meditation can help improve the quality of life of older individuals. Some participants stated that mindfulness meditation helped them become more "patient", sleep better, and have less pain (low back pain e.g., sciatica), and recent shoulder injuries).
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ItemExploring Burnout Among Long-Term Care Staff( 2022-06-07)Burnout is a mixture of exhaustion and perceived inadequacy caused by long-term job stress. Health care professional burnout is a widespread phenomenon characterized by a reduction in the staff's energy that displays in emotional exhaustion, lack of drive, and feelings of frustration and may lead to reductions in work efficacy. This Practice Inquiry Project (PIP) was conducted to assess burnout among long-term care staff members in a rural hospital and investigated the influence of Areas of Work-life (AWS) playing an essential role in occupational wellbeing and burnout. The Maslach Burnout Inventory (MBI) and Areas of Work-life (AWS) instrument tools were employed to collect participants' data about organizational factors relevant to developing burnout. This project included educational training which highlighted the importance of mindfulness, characterized as a practice of learning to focus attention on moment-by-moment experiences with a mindset of openness and acceptance in managing stress. The Allostatic Load theory and Demand-Control support model concept were a vital part of the development of this project. Based on the data collected, high levels of Personal Accomplishments are affected by one's ability to loosen up at work and feeling of bringing a positive impact on others. The survey data also revealed that one's values and perception of reward at work play a significant factor in contributing to or managing burnout. The survey results in this project emphasized the role of nurse leaders in improving work conditions through empowerment and motivation by providing education support and recognition to decrease staff members' feelings of burnout and turnover rates and improve the quality of nursing care.
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ItemSuicide Prevention in Primary Care( 2022-06-07)Suicide is a complex and challenging topic to openly discuss with others, let alone discuss with healthcare providers. It is often talked about in private or not at all. Suicide is a crucial topic that is essential for healthcare providers and patients to talk through. A provider’s ability to readily identify and treat patients considering suicide is a critical skill that is often overlooked. This project aimed to improve healthcare providers’ confidence and competence to readily identify suicidal warning signs and ideations and increase the providers' knowledge on preventing their patients from self-harm. The evidence-based educational tool utilized in this project was the QPR Online Gatekeeper Training module. A logic model was used to guide the design and planning of the project, and the John Hopkins, PET Management Guide, aided the implementation and evaluation of this project. Participants completed an online educational module and a pre/post-survey. The results from the post-survey were then compared to pre-survey results to determine if the module successfully increased the knowledge regarding suicide prevention amongst HCPs that participated in the training.
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ItemNurse Planner Modules to Expand Continuing Nursing Education Capacity in Hawai’i( 2022-06-02)The State Board of Nursing mandated continuing education competency requirements for nursing re-licensure in 2017. Nurses need continuing education that is affordable, accessible, and culturally sensitive. The Hawaiʻi State Center for Nursing (HSCN) obtained direct American Nurses Credentialing Center’s (ANCC) CNE provider status to provide quality CNE programs. The nurses working in underserved agencies and living in rural areas have a higher need for CNE than those who have more resources. Objective: HSCN aimed to extend the reach and impact of CNE programs by developing more nurses (Nurse Planners) skilled in delivering quality programs. The goal of this project was to expand professional opportunities for nurses in Hawai’i. Method: A provider-directed learner-paced modular process was developed to train participants. Five modules were constructed, reviewed, edited, administered and evaluated. Each module included a pre-test, PowerPoint slide presentation, and post-test measure of learning. Results: The six nurses from a convenience sample of HSCN Board members and their delegates completed a total of 10 module evaluations, 12 pre-tests, and 12 post-tests. Overall effectiveness was high (4.8 on a 5-point scale), pace was “just right” (M=3, SD=0), and difficulty was not too easy or difficult (M=3.08, SD=0.319). The post-test score (91.1%) significantly improved over the pre-test score (71.3%), t (22) = 5.66, p=0.0007, 95% CI= (30.76, 8.57). Conclusion: The Nurse Planner modules were a highly effective format for delivering content on the educational design process. This provider-directed, learner-paced model will provide an efficient, quality sustainable format for the Nurse Planners at HSCN to use to train additional Nurse Planners.
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ItemEND-OF-LIFE CONVERSATIONS: IMPROVING PROVIDERS’ COMPETENCE IN EOL CONVERSATIONS THROUGH AN EDUCATION MODULE( 2022-05-27)Death and dying is complex, individual in nature, and often an intimidating topic for many. It is frequently a subject that is avoided or only discussed in private. However, it is essential for patients and providers to understand the resources available at the end of one’s life to help facilitate patient centered care and increased quality of life. Hospice is an end of life (EOL) service that provides comfort care and support for individuals and their family members. Comprehensive comfort care and psychosocial and emotional support for both the patient and their family members are provided with EOL care services. One major barrier to receiving EOL care services is inadequate communication between providers and patients. This is often due to a lack of provider education on difficult conversations, which leads to a lack of confidence and competence in one’s EOL discussion skills. The purpose of this Practice Inquiry Project (PIP) was to provide education for providers on strategies to engage in difficult conversations. The goal was to increase providers’ confidence and competence in initiating conversations about EOL care through an educational module. A logic model was used to guide the designing and planning of the project and the Knowles’ Theory of Andragogy theoretical framework helped guide the implementation and evaluation of this project. Participants completed an online education module. Pre- and post-surveys, pre- and post-Palliative Care Self Efficacy (PCSE) scale and pre- and post-Thanatophobia Instrument (TI) results were compared to determine if the education module was successful in increasing provider confidence and competence in EOL discussions. After providers completed the education module, there was an improvement in both PCSE and TI scores, which indicate an improvement in knowledge and confidence in EOL strategies, skills, and application in practice.
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ItemAccess to Care: Investigating the Perception and Experience of Native Hawaiian During COVID-19( 2021-06-08)Native Hawaiian data collection and dissemination continue to be underrepresented and often inaccurate. While there is progress in how the government collects data on Native Hawaiian Pacific Islander (NHPI) populations, there is still a lack of accurate and reliable health data to assess access to care and healthcare utilization in the Native Hawaiian community. The COVID-19 pandemic exposed the need for data disaggregation and appropriate funding for Native Hawaiians and the organizations that serve them. Native Hawaiian health outcomes have been highly affected by the pandemic, and there is limited data to address access to care and health inequities. This project's scope is to pilot a screening tool to collect and analyze data from the Native Hawaiian population regarding their perception and experiences to access care during the COVID-19 pandemic.