UH System Repository :: Browsing by Author "Ayers-Kawakami, Jeanette"

Browsing by Author "Ayers-Kawakami, Jeanette"

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Access to Healthcare in Hawai’i: Entrepreneurship for Advanced Practice Nurses
(2020-04-01) Green, Kelly; Ayers-Kawakami, Jeanette; Hensley, Patricia
It is undeniable that Advanced Practice Nurses (APNs) have the knowledge, skill, and leadership ability that are valuable for meeting the healthcare challenges of rural communities. They can be instrumental in solving the shortage of primary care providers in underserved areas of Hawai’i through entrepreneurship. In 2013, over 807 Advanced Practice Nurses lived and worked in the State of Hawaii; however, only 3.6% or 308 are considered self-employed (LeVasseur, 2013; LeVasseur & Qureshi, 2015). If more APNs practiced independently in either ambulatory clinics or privately owned practice, this could alleviate the shortages seen in rural communities. The literature describes areas that prevent APNs from private practice including, legal and regulatory obstacles, ethical and personal barriers, and limited knowledge in entrepreneurship. The purpose of this project was to develop and pilot an entrepreneurial workshop to increase entrepreneurial intentions among APNs/DNP students. Through educational offerings will APNs seek out entrepreneurship to design independent practices that include, but not limited to, improving accessibility, affordability, quality, patient safety, and patient outcomes. Two independent groups were analyses and compared for their entrepreneurial intentions, the nurses’ group and the University of Hawai’i at Hilo business students. The educational offering suggests that the entrepreneurial curriculum needs to exist at all graduate-level of nursing programs to increase more APNs working independently in rural and underserved areas. Recommendation for future project design includes incorporating a larger sample size.
Advance Directives: Educating via Learning Modules
(2019-05-28) Lovell, Joyce; Thompson Pagan, Joan; Ayers-Kawakami, Jeanette
Advance directives are legal documents that express an individual’s medical choices for life-sustaining treatment when the individual cannot speak for himself. A health care agent is someone who will execute the medical choices when the individual is incapacitated. The documents must be completed when the individual is of clear mind. Without an advance directive, the medical staff must do everything to prolong life. It is important to have an advance directive speak for you when you cannot. It is well-known that families suffer when forced to make life and death decisions. An advance directive will alleviate the stressful decisional-burdens associated with the end-of-life phase. In other words, an individual can reduce their family’s suffering by completing an advance directive which will allow an individual’s end-of-life wishes to be known. Despite the availability of advance directives and end-of-life planning resources, completion rates for advance directives remain low with less than 25% of Americans completing advance directives. It has been found that interactive education increases an individual’s drive and comprehension of the subject matter. The aim of this Practice Inquiry Project (PIP) was to create an electronic learning module that would increase an individual’s understanding of advance directives, their uses, their importance, and to increase the motivation needed to complete the said documents.
Blood Pressure Management with the use of Technology in Rural Hawaii
(2023-05-27) Dowling, Autumn; Ayers-Kawakami, Jeanette; Pagan, Joan
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.
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.
Decreasing Fluid Overload in Hemodialysis Patients in a Rural Clinic: Providing Multilingual Educational Brochure with Images
(2024-05-30) Cremer, Alma; Ayers-Kawakami, Jeanette; Hensley, Patricia
Fluid overload is a common issue for hemodialysis (HD) patients due to required fluid restrictions. Maintaining fluid restriction can be very difficult for this population. Chronic kidney disease is defined as kidney injury or damage resulting in an inability to filter the blood efficiently. Kidney damage results in waste and fluid accumulation in the body, which causes other organs to malfunction. With end-stage renal disease (ESRD) or kidney failure, patients without kidney transplants who receive HD treatment have regimented fluid and diet restrictions. The alteration of fluid intake and diet modifications are often very challenging for ESRD patients. With the coexistence of other diseases, such as diabetes and hypertension, these patients take many different types of medications concurrently. This often creates a substantial financial burden, depression, and other personal issues for these patients. Fluid overload in patients undergoing HD treatment is common due to difficulty managing fluid intake, which may be related to language barriers. Filipino patients with language barriers may not completely understand the English language during educational orientation regarding fluid and sodium restrictions. Providing a brochure with images and translations into Tagalog (Philippines national language) dialects could be very helpful. There are approximately 60 Filipino HD patients served by the project clinic, and Tagalog is primarily spoken by approximately 50% of these patients. The brochure should aid HD patients in understanding fluid intake restrictions. Education of fluid and sodium restrictions should be performed with HD patients frequently and continuously each treatment reinforcing the patient’s knowledge of the previous teaching with a multilingual educational brochure with images.
Effects of Weight Loss on Diabetes: A Practice Inquiry Project
(2018-12-21) Brewer, Emily; Pagan, Joan; Ayers-Kawakami, Jeanette; Chino, Michelle
Purpose: The purpose of this practice inquiry project was to evaluate the impact of weight loss on type 2 diabetes mellitus (T2DM). The overall goal of this project was to learn improved ways of treating diabetes and how to better achieve glycemic control in these individuals. The expected primary outcome was improved hemoglobin A1c (HbA1c) as weight loss was achieved. Expected secondary outcomes included decreased serum glucose, weight, BMI, blood pressure, and waist circumference. Methods: A secondary analysis of quantitative data from the initiation of a weight management program and throughout patient participation was conducted. This information was collected and documented, and a series of statistical tests were conducted to examine the overall impact of the intervention on key indicators and test relationships between certain variables. The study sample included 21 patients, studied over a 90-day program. All participants had a diagnosis of T2DM, obesity, and hypertension. Measurements were taken at baseline, 30 days, 60 days, and 90 days. Measurements included weight in pounds, body mass index (BMI), blood pressure, body fat percentage, waist circumference, HbA1c, and glucose levels. Results: The participants experienced a significant reduction in these measurements at each of the four measurements (Baseline, 30, 60, 90 days), though not all were considered statistically significant. Conclusion: The weight loss program improved patient outcomes by decreasing weight, BMI, body fat percentage, waist circumference, glucose, and HbA1c levels. This reduction of risks and complications of diabetes improves the quality of life of patients with diabetes.
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.
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 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.
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.
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.
Routine Screening for Obstructive Sleep Apnea Risk in Hawaii’s Adults in the Primary Care Setting
(2021-05-21) Nakano, Jenny; Ayers-Kawakami, Jeanette; Hensley, Patricia
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder affecting millions of US adults, yet remains substantially underdiagnosed and undertreated. Untreated OSA can result in significant health consequences, compromises quality of life, and increases the overall burden upon public health. Early identification of undiagnosed OSA is essential, as those with OSA can be effectively screened and identified prior to the manifestation of adverse outcomes. However, there are often barriers to screening and early identification in primary care that contribute to the prevalence of undiagnosed OSA. Current evidence calls for more effective screening at the primary care level to identify patients at risk for OSA. This pilot project sought to increase identification of Hawaii adults at risk for OSA through the implementation of an evidence-based OSA screening tool as a routine screening measure in a primary care setting. One primary care provider piloted implementation of the STOP-Bang Questionnaire (SBQ) as the selected screening tool and screened adult patient participants for OSA risk during telehealth visits. The change in OSA screening rates and identification of patients at risk, as well as the provider’s perception of the project, was assessed following screening tool implementation. Data analysis indicated increases in OSA screening and identification of patients at risk by 651.9% and 533%, respectively, improving the quality of patient care and raising awareness of the prevalence of Hawaii’s adults at risk for OSA. Early identification of patients at risk through routine screening in the primary care setting can help to address the problem and extent of undiagnosed OSA cases, and has the potential to lead to referrals to sleep specialists for early diagnosis and treatment, thereby improving health outcomes and quality of life for those with OSA.
Saline Compresses to Reduce Nipple Pain and Nipple Injury in Breastfeeding Mothers
(2024-05-29) Sasha Williams, Alexandra; Thompson-Oagan, Joan; Ayers-Kawakami, Jeanette
Purpose: Between 80-100% of breastfeeding mothers experience nipple pain starting in the first week after birth, and as many as 35-50% of mothers will go on to develop macroscopic tissue injury to the nipple-areolar complex (NAC). This morbidity can lead to premature breastfeeding cessation in the first six weeks after birth. Current standard of care lacks routine nursing assessment and treatment of NAC pain and tissue injury. Methods: An Interventional Pilot Study for a Randomized Controlled Trial was conducted with 40 breastfeeding mothers to evaluate whether application of a 0.9% sterile saline compress applied to the NAC after breastfeeding reduces maternal pain scores and/or macroscopic tissue injury during the first week postpartum. Results: Saline compresses reduced acute nipple pain scores at 1 minute after breastfeeding by 0.8 points, a statistically significant improvement with a p-value of 0.0011. The saline treatment group also had gross reductions in signs of NAC inflammation and tissue injury, but results trended only toward significance. Conclusion: Application of a 0.9% saline compress to the nipple-areolar complex within 30 seconds after de-latching reduces acute nippleareolar complex pain scores and increases maternal comfort during breastfeeding initiation, but more research is needed to understand its potential impacts on reducing tissue inflammation and macroscopic tissue injury.
Use of an Evidence-Based Tool in Improving Communication to Decrease Falls
(2023-06-01) Davo-Otomo, Sharon; Ayers-Kawakami, Jeanette; Hensley, Patricia
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.

Browsing by Author "Ayers-Kawakami, Jeanette"

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