UH System Repository :: Browsing by Author "Hensley, Patricia"

Browsing by Author "Hensley, Patricia"

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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.
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.
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.
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.
Increasing Adult Awareness of Hawai’i Youth Vaping
(2020-06-08) Buck, David; Hensley, Patricia; Pagan, Joan
Vaping is a novel socially acceptable form of nicotine consumption used by youth as an alternative to traditional cigarettes. Electronic cigarette (e-cig) use in Hawaii County (HC) middle and high school students is higher than state and national rates. Due to the novel onset of youth e-cig use, long-term health implications are unknown. However, numerous federal, national and other evidence-based studies acknowledge the concerns of nicotine exposure to the developing brain, and e-cigs being a socially acceptable gateway to traditional cigarette and other drug use. Numerous studies indicate high youth e-cig rates amongst specific populations (i.e., rural, low socioeconomic status), the strong influence parents and adults have on youth tobacco abuse, and that current youth e-cig preventative strategies are unsuccessful. The rural Puna District has the highest users of both e-cigs and combustible cigarettes in the state of Hawaii. Thus, innovative strategies are needed to improve e-cig health literacy in this high risk population. Thirty participants participated in a project aimed at improving e-cig health literacy in the rural population through a community farmer’s market e-cig information booth. Participants’ level of concern, e-cig knowledge, and the resources utilized to obtain e-cig or other health information were assessed before and after project interventions. Data analysis indicated that for the majority of participants, project interventions changed perception, increased level of concern, knowledge, potential future advocacy against e-cigs, and potential future attendance to convenient health literacy booths. Convenient educational booths have the potential to improve health literacy in rural populations thus leading to improved prevention or management of community health issues.
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.
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.
Reducing the Harm Associated with Clinical Alarm Systems: Meeting the Joint Commission National Patient Safety Goal.06.01.01 Performance Elements
(2016-12-16) Hensley, Patricia; Mukai, Cecilia
Problem: Clinicians and patients are vulnerable to alarm fatigue (AF). AF is a patient safety hazard and the leading cause of alarm-related sentinel events. The Joint Commission proclaimed reducing the harm associated with clinical alarm systems as a 2014 National Patient Safety Goal (NPSG.06.01.01). Aims/Objectives: Develop and implement a survey to assess AF amongst Intensive Care Unit (ICU) clinicians; Complete STEP 2 of NPSG.06.01.01 for an ICU which includes to “identify the most important alarm signals to manage…”. Design: Project design/methods were derived from an AF Conceptual Framework and the Iowa Model. Participants: Convenience sample of 28 ICU clinicians. Setting: An 11-bed medical-surgical ICU located in a 276 bed community hospital in Hawaii. Data Collection: NPSG.06.01.01 Clinical Alarm Management Questionnaire. Participants completed the survey electronically/anonymously via “Survey Monkey”. Electronic databases used for a literature review included Cochrane Reviews, National Guideline Clearinghouse, Agency for Healthcare Research and Quality, Dynamed, PubMed, CINAHL, MEDLINE. Data Analysis: “Survey Monkey” was used for descriptive/quantitative analysis of demographic and likert-scale survey measures. There was one qualitative survey response. Results: The majority of participants appear to be affected by AF on 78% of the AF survey measures. Thus, AF is likely a problem in this ICU. Additionally, results indicate that physiologic monitor alarms are most important to manage followed by ventilator, IV infusion pump, and bed exit alarms. Recommendations: Management can use these results when proceeding to NPSG.06.01.01 STEP 3 and STEP 4, which include establishing policies for managing alarms identified in STEP 2 and educating staff.
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.
Screening for Disparities to Promote Diabetic Control
(2019-05-21) Kiefer, Chandi-Nicole Ka'imaili; Daub, Katharyn; Hensley, Patricia
Incidence of type 2 diabetes is higher among minorities, those of low socioeconomic status, and those with lower education levels. Nearly half of the modifiable risk factors associated with diabetes are attributed to social determinants of health inequities. Social determinants of health (SDH) are the conditions in which we live and are highly influenced by the distribution of money, power, and resources. SDH disparities result in higher rates of hospitalization, suboptimal quality of life, and decreased life expectancy. The goal of this practice inquiry project is to improve the health of patients with diabetes by implementing a screening tool to identify SDH disparities in the primary care setting. There is growing evidence supporting primary care intervention to reduce SDH disparities. Without systematic screening, these barriers may never be revealed, resulting in care that is inappropriate and ineffective. This study consisted of 95 diabetic patients with an A1c of 8 or higher. Sixty-nine percent of participants had an A1c between 8-11.9 The remaining 31% had an A1c of 12 or higher. Baseline SDH screening revealed a total of 145 disparities at an average of 1.53 disparities per person. The prevalence of disparity was highest in those with an A1c 12 or above at an average of 1.9. Patients that screened positive for disparity were connected with community agencies to bridge gaps in care. Through systematic screening and follow up, the prevalence of disparity was reduced 24.13%. The total number of SDH disparities decreased from 145 to 110 and the average disparity prevalence went from 1.53 to 1.16 per person. A1c was reduced in 56% of the population that was retested during course of this study. Ten percent lowered their A1c below 8. Systematically screening for and addressing SDH disparities can be effectively incorporated into primary care practices, resulting in lower rates of disparity and improved A1c control.
Standardizing Medical Clearance of Behavioral Health Patients: Implementation and Evaluation of Adapted SSVMS SMART Form at a Rural Community Hospital Emergency Department
(2023-05-17) Sedig, Megan Elizabeth Barter; Hensley, Patricia; Daub, Katharyn
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.
Suicide Prevention in Primary Care
(2022-06-07) Miho, Lauren; Pagan, Joan; Hensley, Patricia
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.
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 "Hensley, Patricia"

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