School of Nursing

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https://hdl.handle.net/10790/2425

The philosophy of UHH SON is to educate professional nurses to lead change and translate science into practice in a dynamic global health care environment. Our school promotes transcultural nursing with a focus on rural populations and communities where each person has the right to participate in making decisions that affect their health. Our emphasis includes deepening commitments to social justice, improving the quality of healthcare, and advancing access to the underserved. Our vision is a world where our graduates will strive to promote health, alleviate suffering, provide service to the community, and become leaders at local and global levels.

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Access to Care: Investigating the Perception and Experience of Native Hawaiian During COVID-19
(2021-06-08) Paikai, Kawailehua; Pagan, Joan; Daub, Katharyn
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.
AN ORGANIZATIONAL APPROACH TO BURNOUT IN ADULT FOSTER HOME CAREGIVERS IN HAWAI`I
(2021-05-18) Supnet, Kimberly; Daub, Katharyn; Norris-Taylor, Joyce
Caregiver burnout is an adverse psychological event that a person experiences in relation to long-term and emotional stress that is brought about by work that entails helping other people. Caregiver burnout may compromise patient safety by affecting patients’ mortality rates and increasing their risk for abuse and neglect, and it may impact the physical and mental health of caregivers, reduce their eagerness to help patients, and increase caregivers’ turnover rates. Clients living in adult foster homes are a vulnerable population who are often explicitly dependent on their caregivers; they are unable to perform ADLs, prepare their own meals, comply with medications, and/or verbally express their needs. Caregiver burnout in adult foster home caregivers must be investigated especially as the elderly population increases and as more adults with disabilities are placed in adult foster homes. This project examined burnout in adult foster home caregivers in Hawai`i, determined its effects on caregivers and client care, and identified organizational means for its prevention and management. Adult foster home caregivers from three case management agencies in Hawai`i were asked to complete an anonymous sociodemographic online survey on Survey Monkey and to participate in three online focus groups through Zoom. The online survey contained five Likert-scale questions that inquired about caregivers’ age, sex, number of adult foster home clients in their homes, years of caregiving experience, and the number of hours spent caregiving per week. Three (N=3) caregivers responded to the survey, and their responses were not analyzed. Thirteen (N=13) caregivers participated in the online focus groups. These caregivers were asked to respond to ten questions about burnout, job demands and resources, and case management agencies’ management of burnout. Their responses were manually transcribed verbatim, manually analyzed using thematic analysis, and electronically analyzed using MAXQDA. Four themes were identified: caregivers’ impression of burnout, relief, training, and support. Data gathered from the focus groups were combined with data from the literature to develop a presentation about the organizational management of burnout in adult foster home caregivers. The presentation was sent to 21 case management agencies in Hawai`i. These agencies were asked to respond to anonymous online pre- and post-tests on Survey Monkey before and after reviewing the presentation. The surveys contained two Likert-scale questions about agencies’ knowledge about burnout and their likelihood of implementing interventions to manage burnout among adult foster home caregivers. Three (N=3) responses were collected and analyzed using paired-samples t-test with JASP 0.14.1 software. The results from the pre-test and post-test indicate that case management agencies’ review of the burnout presentation did not result in any significant improvement in their knowledge or likelihood of implementing organizational methods of managing burnout. Based on the data collected in this study, a combination of the JD-R model and the action research framework is recommended in the development of organizational interventions to manage burnout among adult foster home caregivers. Case management agencies should identify adult foster home caregivers’ most valuable job resources and provide enough of these resources to caregivers on an ongoing basis to manage burnout and to protect caregivers and clients from the consequences of caregiver burnout.
ARCH/E-ARCH & RACCP-AFH Integration
(2016-12-27) Arzaga, Noemi; Daub, Katharyn
Assuming the role of caregiving is never an easy task whether it is done out of love, devotion or simply being responsible for honoring the familial obligation. Decisions to care may occur suddenly due to emergent reasons, or it may be planned, but whatever the reason may be, long-term care decisions should be seamless and not cumbersome. The better equipped the individual is in knowing the available resources, the less anxiety and burdensome it will be for the patient and their family. As life expectancy improves along with the unprecedented rate of baby boomers reaching retirement age, there is a great need for workers or caregivers to care for the elderly. Trends have shown that long-term care services that the elderly tend to utilize are those less restrictive than nursing homes. Thus, a rapid growth and demand in supply for alternative services such as those provided in a residential care setting in an Adult Residential Care Home (ARCH) or Adult Foster Home (AFH) are seen. The historical separation of ARCH & AFH for the State of Hawaii, however, has long created overwhelming inefficiencies to care and management that are burdening the consumers, providers, and the state alike. A need of a polished integrated system that improves residents’ quality of care, lowers operating cost, improves coordination of care, and helps caregivers and providers with the most vulnerable fragile persons, the elderly in the community, is greatly needed. All and all, policy engagement through education, evaluation, examination, and the development of new process methodologies with adaptation of new concepts for integration are key initiatives to taking a stand and making a difference. Community-based care services that fit the needs of the consumers without a major overhaul in their livelihoods and budgets are vital today and in the future.
Changing the Stigma of the Homeless in Nursing Students
(2019-05-16) Ohara, Laura; Daub, Katharyn; Ayers-Kawakami, Jeanette
Stigmatization of individuals and groups of people can directly affect their health. Ideally, health professionals are blind to stigmatizing patients in their care and would provide them with the same attention, resources, and care. However, many studies have observed that stigma exists among healthcare providers and that stigmatization affects the care provided. Stigmatizing patients by healthcare workers leads to poorer health outcomes and social isolation. A review of the literature discovered a recurrent theme of how nurses’ negative perception of the homeless client acted as a barrier to them accessing healthcare. Given that Hawai‘i has the highest homeless rate per capita in the U.S. and that homeless individuals have multiple health needs, healthcare professionals will encounter homeless people in their practice. It is therefore imperative to train future healthcare providers to deliver ethical, compassionate care without prejudice and stigma to persons who are homeless. Interventions to decrease stigmatization from healthcare providers of vulnerable population would theoretically increase compassionate care and improve health outcomes. The purpose of this project was to develop and pilot a multi-modal education seminar in an undergraduate nursing program to alter perceptions of homeless persons and decrease stigmatization. An analysis of the participants’ perceptions of the homeless before and after the education seminar demonstrated a statistically significant decrease in stigma of the homeless particularly in the 20-30 year-old age range. The pilot project provided evidence that a multi-modal educational seminar can impact stigma perceptions. Further expansion to a larger sample group of students is recommended.
Chronic pain patient perceptions of primary care provider pain education
(2021-01-11) Gallegos, Angelina; Pagan, Joan; Daub, Katharyn
Chronic pain in the U.S. affects millions of adults and the numbers are expected to continue rising, alongside rates of chronic disease which often accompany chronic pain. It has become increasingly complex to manage chronic pain which is only further complicated by the opioid epidemic. While the primary care setting is most often where chronic pain patients are treated, the focus is often primarily on the physical complaints. Current best practices suggests primary care provider education incorporate a biopsychosocial approach to support the best possible outcomes. Current evidence suggests that holistic primary care provider education is necessary to achieve optimal outcomes and efforts should be focused on improving self-management. This project examined chronic pain management education delivery by primary care providers to identify potential gaps in education from the patient's perspective. A survey was developed with 40 items based on the Pain Assessment Screening Tool and Outcomes Registry (PASTOR), currently used by the military. The electronic survey was completed entirely online, with a total sample of 26 adult participants. The survey research revealed the largest deficits in pain education related to areas of behavioral change. The results indicated a need for improving education delivery to include a broader range of topics affecting chronic pain. Increasing knowledge of pain influencing factors can support more successful self-management in patients. The survey results informed practice improvement recommendations, using a two-pronged educational approach to improve chronic pain care education delivery in the primary care setting. Prong one was the development of a comprehensive patient pain education poster for primary care offices. Prong two was a provider education brochure detailing survey results and pain practice resources.
Development of a Nurse Practitioner Preceptor Training Program to Increase Readiness to Become a Preceptor
(2019-05-20) Miura, Miki; Daub, Katharyn; Hensley, Patricia; Chino-Kelly, Michelle
An increasing demand for nurse practitioners (NPs) to cope with a shortage of physicians has highlighted the urgency for expansion of NP programs. However, an insufficient number of preceptors limits the ability of NP programs to accept more students. Preceptor training not only increases NPs’ competency in teaching, but it also enhances their self-efficacy. Based on Bandura’s self-efficacy theory, improvement of NPs’ self-efficacy is likely to lead to positive changes in behavior, thus, it can enhance their willingness to participate in preceptorship and ultimately increase the NP’s readiness for a preceptor role. Preceptor training is highly desired by NPs, yet, there are a limited number of preceptor training for NPs available. The aims of this a practice inquiry project (PIP) were to develop a NP preceptor training program based on a literature review and to evaluate the program after implementing a pilot program. Literature shows that the One Minute Preceptor (OMP) model has been used among other healthcare disciplines and can promote effective and efficient communication between preceptors and students. An NP preceptor training program that teaches NPs about the OMP was created based on the literature review. For the second part of this project, a pilot test of the program was conducted and evaluated. A total of nine NPs participated in this pilot study. Four surveys were administered at three different points (pretest, posttest and three-month follow-up) to examine if the participants’ self-efficacy as a preceptor and willingness to become a preceptor improves after the piloted program. The results demonstrated that the piloted preceptor training improved multiple aspects of their self-efficacy and brought positive effects on preceptors’ decision to participate in preceptorship. Future studies should employ more participants to increase the power of the results.
Exploring Burnout Among Long-Term Care Staff
(2022-06-07) Abaro, Paola; Ayers-Kawakami, Jeanette; Daub, Katharyn
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.
Healthcare Communication Tailored to the Health Needs of Alaska Natives and American Indians
(2019-12-31) Arteaga, David; Hensley, Patricia; Pagan, Joan; Daub, Katharyn
Healthcare in Alaska has been challenging throughout history due to the size of the state, the remoteness of Alaska Native villages, and the uniqueness of the different indigenous tribes. Numerous federal and national reports acknowledge that culturally sensitive healthcare can be achieved through partnership with patients and their families to meet the unique needs of each individual. Lack of congruent cultural communication with American Indian and Alaska Native (AI/AN) populations have continuously put these vulnerable populations at the highest risk for adverse health outcomes. The participants for this culturally congruent educational session were healthcare providers that care for AI/AN patients in Anchorage, Alaska. Participants of the educational session included physicians, nurses, mid-level providers, and healthcare administrators. The assessment tool was a pre and post-survey that identified common themes such as a desire to learn more about AI/AN cultures and the lack of culturally congruent education. The results of the session post-survey indicated increased in participant perception and the knowledge of AI/AN culture and culturally congruent Patient and Family-Centered Care (PFCC) methods.
Impact of a Cultural Awareness Educational Intervention to Improve Cultural Safety to Minorities in Hawai'i
(2020-06-19) Chow-Rule, Kimberly U'ilani; Ayers-Kawakami, Jeanette; Daub, Katharyn
Globalization has resulted in cultural diversity across the nation. In healthcare, people of minority cultures and ethnicities experience a more significant effect on negative health issues. Health care has evolved into an evidence-based science that does not always take into account the culture of the patient. Culture plays a role in how people interact with others. Cultural safety is a concept that describes the dismissive treatment of native peoples that is not respectful or inclusive of their values and customs. The trust built within these relationships helps to create expectations and cooperation that is mutually beneficial for both parties. Cultural humility is the goal of cultural safety and is a critical factor in building a foundation for a trusting, beneficial relationship. Project participants will receive a three-hour online educational module along with a pre and post-test. The goal for this project is to increase the awareness of the importance that creating a culturally safe atmosphere is an integral part of providing quality health care to Native Hawaiians and other minorities in Hawai'i. It is the assumption that the outcome of this project will result in improved therapeutic relationships between providers and patients, which will translate into improved health outcomes for their patients. The project recruited a small number of participants and as a result, statistical significance was not found. Comments from the participants found the educational module to be timely, important and useful.
Improvement of Patient Education Practice in Home Health Care Using the Teach-Back Method
(2019-12-31) Della, Joyce; Ayers-Kawakami, Jeanette; Daub, Katharyn
Patient education is essential in promoting patient-empowerment. It empowers the patient to take ownership of their health and supports patient-centered care. Effective patient education improves engagement in self-care, compliance with medications and treatments, and optimal patient outcomes. Patient education is an essential aspect of home health care (HHC). The HHC providers consist of interdisciplinary healthcare professionals, including licensed nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers. These professionals educate patients on how to manage their disease and illness in their home setting. It is fundamental for healthcare providers to utilize best practices in patient education. The teach-back method is an evidence-based strategy to ensure effective learning has been achieved. The primary goal of this quality improvement (QI) practice inquiry project (PIP) was to improve patient education practice in HHC through the integration of the teach-back method.
Improving Self-Efficacy Strategies of Health Maintenance in Post-Incarcerated Women: Implementing Healthcare Access and Education
(2019-06-03) Akau, Lehuanani; Daub, Katharyn; Thompson Pagan, Joan
According to the World Health Organization, social determinants of health are, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. Social determinants of health in medically underserved and underrepresented population such as incarcerated women are discussed. According to evidence-based research, incarcerated individuals have commonalities stating, women incarcerated have displayed higher rates of poverty, lack of housing stability, are from a disadvantaged background and typically fall in the category of being Native Hawaiian, African American or Pacific Islander. In addition, literature shows that many of these women have reported a presence of violence and/or trauma exposure, with the abuser typically being a family member, family-friend, acquaintance or significant other. Furthermore, the lack of connectivity and access to health care providers increases their risk of morbidity and mortality. The objectives of this project were to build an awareness of health disparities, apply culturally sensitive lessons learned through direct demonstrations of self-care knowledge and improve healthcare within the justice system for better health outcomes.
Improving the Awareness of Medication Administration at a Primary Care Clinic
(2023-05-30) Fernando, Tracy Lynne; Daub, Katharyn; Ayers-Kawakami, Jeanette
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.
Incorporating an Oral Health Curriculum in a Nursing Program
(2019-09-23) Kihara, Leanne; Daub, Katharyn; Chino-Kelly, Michelle
Oral health is an essential but often forgotten health care need. Oral health disparities are more prevalent in ethnic minorities, low income, and lower socioeconomic status populations. In most cases, oral health problems are not a priority until it becomes emergent. Barriers to receiving dental services are the cost of preventive care and treatment, the limited number of dental providers, and a lack of access to dental care. Nontraditional strategies are needed to address the growing health concerns that poor dental health create and explore different avenues in delivering dental services. In reviewing the literature, several initiatives were explored. Building inter-professional collaborations between medical and dental providers can help to identify dental concerns and make appropriate referrals earlier. A consideration of training non-dental healthcare professionals to provide oral health preventative services would help to fill the gap of lack in dental services. Adding evidence based oral health curricula to nursing schools would increase the oral health knowledge and skills of nurses to provide oral health preventive services that can decrease dental caries and improve overall health. The purpose of this pilot project was to increase oral health knowledge and skills of nursing students by incorporating an oral health curriculum into undergraduate and graduate-level nursing programs. Ten participants agreed to complete eight oral health modules that included a pre/posttest and a survey, during the Spring semester. The data analysis revealed an increase in all participants’ oral health knowledge. Discussion of the results with implications for nursing practice and future recommendations for implementation are proposed.
Increased self-management in type-two diabetes mellitus and pre-diabetic patients with the use of social media
(2019-05-28) Connally-Robinson, Patricia; Daub, Katharyn; Chino-Kelly, Michelle
The number of people in the United States that are diagnosed with type two diabetes mellitus (T2DM) is approximately30.3 million, while another 84.1 million (1/3 of the U.S. population) are either pre-diabetic or have not yet been diagnosed. If these pre-diabetic people don’t change, they will likely become a T2DM within five years. The methods of education and self-management currently being used in the United States is clearly not working as hoped. Diabetes remains the seventh leading cause of death in the U.S. and is a major comorbidity in patients suffering from heart disease, stroke, and poor circulation. T2DM is a chronic disease that can be controlled with diet and lifestyle adaptations. Support in initiating and maintaining changes is mandatory. The National Diabetic Prevention Program was a yearlong program that included a behavior change program. End results showed better eating habits and increase in daily exercise, which means a reduced risk of T2DM. When people are shown what and how to change, with encouragement they can succeed. A social support system that provides true, proven ways to decrease blood sugar is a great way to assist T2DM patients in becoming healthier, with fewer complications A readily available tool to help people self-manage DM needs to be utilized. A tool that is used frequently and is readily by their side most hours a day. A survey from 2017 (Smith, 2017), indicates nearly all Americans aged 18 – 50 own a smart phone (96 percent), and ownership only decreases slightly with age. The vast majority (75 percent) of Americans, aged 50-64 years old and over 50% of people over 65 years old own a smartphone. This project looks at the potential of using social media as a tool to enable a better self-management in patients with pre-diabetes and T2DM.
Management of Chronic Obstructive Pulmonary Disease Exacerbations Using the Global Initiative for Chronic Obstructive Lung Disease Guidelines
(2021-06-01) Abe, Jamie; Daub, Katharyn; Norris-Taylor, Joyce
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. An intermittent acute aggravation of symptoms characterizes COPD's natural progression termed acute exacerbations of COPD (AECOPD). AECOPD is defined as a “sustained worsening of the patient’s condition, from stable state and beyond normal day-to-day variations, that is, acute in onset and necessitates a change in regular medication.” Greater than 80% of exacerbations are managed in the outpatient setting with pharmacological therapies that include bronchodilators, corticosteroids, and antibiotics. Treatment variability results in adverse health outcomes and necessitates a need to standardize care. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were developed by worldwide experts and provide unbiased reviews of the latest evidence to assess, diagnose, and manage COPD. The GOLD guidelines provide evidence-based recommendations and should be integrated into practice. Purpose: The overarching goal of this Practice Inquiry Project (PIP) was to determine the likelihood of adopting the GOLD guidelines, which could inform practice and improve the management of AECOPD. Methods: A qualitative, survey-based study was undertaken that involved data collection, analysis, and a review of the literature. The PICO framework was utilized to define the research question. Roger’s diffusion of innovation model served as the theoretical framework used for understanding the degree of readiness or stage of change. Due to the small sample size (n= 10), nonparametric tests were used to analyze ranked, ordinal, dichotomous, and nominal data. The data was collected via survey and statistically analyzed to determine the readiness to adopt and establish the current standards of care. Results: A convenience sample of 10 providers (n=10) in the state of Hawaii completed the anonymous survey in the form of a multiple-choice questionnaire during a 30-day period in 2021. The questionnaires were analyzed by individual questions, and findings focused on key themes (demographics, experience, and readiness to adopt). The results of the provider’s readiness to adopt the GOLD standard were inconclusive. While providers acknowledged a high interest in adopting the GOLD guidelines, their likelihood of adopting the guidelines was not likely. The most significant barrier to adoption was Organizational/Institutional (70%, seven respondents). Conclusion: Ultimately, adoption of the GOLD guidelines was not likely. The data identified potential barriers to adoption and informed practice by raising awareness of the GOLD guidelines. Further research is needed to better understand specific Organizational barriers to adopting the GOLD guidelines.
Needs Assessment for Practice Change in Chronic Lower Back Pain Management
(2020-03-23) Speth, Laura; Daub, Katharyn; Hensley, Patricia
Problem: Treatment of chronic lower back pain is challenging and results in a significant economic burden of direct and indirect costs. Health care delivery that is aimed to treat acute diseases does not always address the needs of individuals experiencing chronic conditions. Aims/Objectives: Assess the current management of chronic lower back pain by utilizing quality improvement surveys and provide improvement recommendations based on the results of the surveys. Design: Project design and methods were guided by the use of the Chronic Care Model (CCM). Participants: A convenience sample of 50 chronic lower back pain patients and one pain management physician. Setting: A private practice pain management clinic with two locations on the island of O’ahu in Hawai’i. Data Collection: Paper and pen surveys were used for descriptive and quantitative analysis of likert-scale and demographic survey answers. Surveys used for data collected included the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Results: The PACIC results indicated a need for improvement in follow-up/coordination of care. The ACIC results indicated a need for improvement in decision support for clinicians. Recommendations: Improving communication between interdisciplinary team members and providers associated with chronic lower back pain management would improve both the follow-up/coordination of care and decision support for clinicians.
Nurse Planner Modules to Expand Continuing Nursing Education Capacity in Hawai’i
(2022-06-02) Jensen, Sharon; Daub, Katharyn; Ayers-Kawakami, Jeanette
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.
Post-Acute Care Management of Patients with Angiostrongyliasis: A Guideline in Caring for Patients Who Suffer Long Term Sequelae of Rat Lungworm Disease
(2020-05-15) Otsuka, Chayata; Hensley, Patricia; Daub, Katharyn
Angiostrongyliasis, also known as rat lungworm disease (RLWD), is a parasitic infection caused by the nematode Angiostrongylus cantonensis. Anecdotal experience in Hawaii has shown that many patients diagnosed with RLWD develop chronic neurological sequelae which can last for years and possibly a lifetime (Hawaii’s Joint Task Force, 2018). Currently, there is no available literature or guidelines on chronic care treatment of RLWD. Previous and current literature focuses on RLWD acute manifestation and treatments. Through a rigorous literature search and critical analysis of evidence-based information on possible treatment options of the chronic symptoms of RLWD, an evidence-based guideline was created. Ten Hawaii island primary care providers participated in a project aimed at educating providers on the guideline. The providers’ knowledge level of RLWD chronic care management strategies was assessed before and after the guideline was presented to them. Data analysis showed increased knowledge in all participants. Ninety percent of participants stated that the guideline was significantly effective in increasing their knowledge about the long-term sequelae of RLWD. Limitations of the project included a small sample size and participants’ limited practice experience. Primary care providers who are not familiar with RLWD or are new to the Hawaii community should familiarize themselves with the chronic health effects of RLWD, especially those practicing in endemic regions such as East Hawaii. This evidence-based guideline could serve as a basic introduction to the chronic care aspect of RLWD.
Prevention of Catheter Acquired Urinary Tract Infection in Long Term Care Facility
(2019-05-31) Javier, Leeah; Ayers-Kawakami, Jeanette; Daub, Katharyn
Patients of nursing home facilities are vulnerable to acquiring catheter associated urinary tract infection (CAUTI). This healthcare acquired infection is a safety hazard causing unnecessary pain, discomfort, extended hospital stay, complications and puts the facility at risk for non-reimbursement. According to the Centers for Disease Control and Prevention (CDC, 2017), 75% of CAUTIs are acquired during hospitalization associated with indwelling urinary catheters. Although highly preventable, the prevalence of CAUTI remains in healthcare facilities. The Joint Commission announced National Patient Safety Goal (NSPG07.06.01) in 2017 as guidelines for healthcare facilities in CAUTI prevention. This practice inquiry project aims to prevent CAUTI in long-term care facility using performance elements stated in NSPG07.06.01 which primarily focus on establishing evidence based practices in the nursing facilities. Result of this project aims to prevent CAUTI, improve patient’s quality of life, reduce risk of complications, establish culture of safety and maximize facility reimbursements.
Prevention Strategies for High Blood Pressure: A Rural Community Approach
(2019-05-29) Wagner, Jasmine; Daub, Katharyn; Ayers-Kawakami, Jeanette
High blood pressure (HBP) increases the risk for dangerous and potentially fatal health conditions. HBP is a leading cause for heart disease and stroke in the United States (U.S.). Heart disease and stroke are among the top causes of mortality in the U.S. HBP is known as the “silent killer” because signs and symptoms are not always apparent. Individuals who live in rural communities and lack education and access to medical services are at a higher risk for developing HBP and are more likely to die from heart related complications compared to individuals living in suburban or urban communities. According to literature, 15% of the American population lives in rural areas. There are modifiable risk factors, which can lower the risk of HBP. The outcome of this project is to increase awareness of HBP and identify modifiable risk factors to reduce the incidence of HBP among rural community members. Evidence-based education was provided to the community to improve outcomes. The project setting was held at Honolulu Community Action Program (HCAP) on the Leeward Coast of Oahu. A convenience sample was used for this project. A quantitative research design was used to gather data. Materials used included a pre-questionnaire, a post-questionnaire, and an open-ended questionnaire. Data was analyzed and organized in an Excel spreadsheet. This project was also evaluated for validity and accuracy. The goal of this Practice Inquiry Project (PIP) was to identify risk factors for HBP among community members, and to use this evidence-based information to educate on effective strategies to reduce the risk of HBP.

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