UH System Repository :: Browsing by Author "Van Hoose, Diane"

Browsing by Author "Van Hoose, Diane"

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Bridging the Knowledge Gap in Ostomy Management
(2021-05-06) Iwamoto, Jaryn; Van Hoose, Diane; Norris-Taylor, Joyce
Inadequate ostomy patient education leads to poor post-operative adjustment and lower quality of life for ostomates. Many factors contribute to the insufficient preparation of ostomates to manage their stomas after hospital discharge; these factors include shortened hospital length of stays, limited availability of Certified Wound, Ostomy, and Continence Nurses (CWOCNs), and inadequate nursing knowledge, confidence, and skills in ostomy management. Staff nurses are an essential part of ostomate’s post-operative adjustment because they are present during every aspect of the care continuum and are able to educate patients to attain their healthcare goals. The purpose of this Practice Inquiry Project (PIP) was to develop a continuing education (CE) ostomy management course and test this new platform by 1) opening the conversation between nurses on ostomy care, 2) establishing mentoring opportunities between the instructors and learners, and 3) exploring nurses’ learning and support needs and preferences. The goal was to improve staff nurses’ ability to care for ostomy patients by addressing the gap in ostomy knowledge, confidence, and skills. This CE ostomy course evaluated if participants gained a better understanding of ostomy concepts and higher levels of confidence in managing ostomy patients. Shrigley’s Theory of Attitude Concept and Science Teaching was integral in the design of this project as it describes the relationship between cognition and behavior in contributing to changes in attitude. A Logic Model was used to plan and evaluate this project. In comparing the results from the pre-tests, post-tests, 2-week post-tests, and surveys; the intervention was successful in teaching registered nurses how to care for ostomy patients.
DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF A NATIVE HAWAIIAN CULTURALLY APPROPRIATE TYPE 2 DIABETES INFORMATIONAL POSTER
(2020-06-02) Kam, Saba; Van Hoose, Diane; Norris-Taylor, Joyce
Native Hawaiians are disproportionately diagnosed with diabetes and have higher rates of diabetes-related morbidity and mortality compared to the rest of Hawai’i and the United States at large. Waianae Coast Comprehensive Healthcare Center (WCCHC) is a Federally Qualified Healthcare Center (FQHC) in the largest predominantly native Hawaiian community in Hawaii. WCCHC also serves surrounding underserved communities such as Nanakuli, Waiola, Waipahu and Kapolei. Health literacy is low among native Hawaiians in the Waianae and surrounding communities. Previous studies have demonstrated the improved effectiveness of tailoring native Hawaiian and Pacific Islander health initiatives to be culturally relevant. Culturally relevant interventions include aspects such as native and traditional foods, imagery, and language. The purpose of this Practice Inquiry Project (PIP) was to develop a culturally appropriate diabetes informational tool, or poster. The poster was then evaluated to determine if it helped participants gain a better understanding of diabetes recommendations and goals, and to determine if it increased intention for improved diabetes self-care behaviors. The Social Cognitive Learning Theory was instrumental in shaping the expected outcomes of this intervention, because it describes the relationship an individual has with environmental and cognitive factors in predicting behavior. The Logic Model was used as a planning and evaluation tool for this project, and addressed the potential impacts that the results of this project could have. Ultimately, the poster tool was found to be effective in promoting diabetes self-care knowledge and intention towards behavior. Furthermore, participants expressed gratitude that an informational tool was tailored to their traditional foods, culture and language.
END-OF-LIFE CONVERSATIONS: IMPROVING PROVIDERS’ COMPETENCE IN EOL CONVERSATIONS THROUGH AN EDUCATION MODULE
(2022-05-27) Sumida, Paige; Van Hoose, Diane; Thompson Pagan, Joan
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.
Evaluation Of A Self-Care Journal And Its Impact On Compassion Fatigue In Hospice
(2024-04-09) Todd-Hesse, Janelle; Van Hoose, Diane; Thompson Pagan, Joan
Background: The foundation of the nursing profession is caring, compassion, and creating authentic transpersonal relationships with patients. Compassion fatigue is a professional concern due to its impact on nurses' mental and physical health, professional quality of work satisfaction, and patient care interactions. Compassion fatigue, defined as emotional exhaustion, can profoundly impact the nurse-patient relationship. The literature defines self-care as the most common and effective strategy. For hospice organizations to deliver high-quality care, nurses need organizational initiatives to engage nurses in self-care to prevent compassion fatigue and to continue engaging in authentic, compassionate nurse-patient relationships. Methods: A quantitative descriptive design was applied to evaluate a self-care journal's impact on compassion fatigue in hospice nurses. Hospice nurses consented to use a monthly self-care journal, which allowed them to define their self-care activities with supported engagement through self-reflection, intention setting, habit tracking, cognitive and behavioral therapy, positive psychology, and journaling. The ProQOLv5 scale was completed to measure compassion fatigue through subscales of compassion satisfaction, burnout, and traumatic stress. Results: Data was analyzed using the Wilcoxon signed-rank test. The pre-intervention data reflected moderate levels of compassion satisfaction, low to moderate levels of burnout, and low to moderate levels of secondary traumatic stress. The impact of the self-care journals was statistically significant for the subscale of secondary traumatic stress (p = .039) but not significant for compassion satisfaction (p = .461) or burnout (p = .144). Although the nurses did not report extensive use of the journals, they evaluated the project as increasing their knowledge of compassion fatigue and would support future organizational initiatives.
Improving Prenatal Breastfeeding Education in a Baby-Friendly Facility in Hawai`i County: A Quality Improvement Project
(2019-08-06) Hanapi, Amy; Shmina, Kimberly; Van Hoose, Diane
Problem: Recommendations from international and national organizations include promoting exclusive breastfeeding for the first six months. While Hawai`i is one of the states with the highest breastfeeding rates, we still fall short of recommendations. North Hawai`i Community Hospital (NHCH) has Baby-Friendly designation, and a policy following the Ten Steps to Successful Breastfeeding, however, the education provided to patients is inconsistent and non-standardized. This leads to some patients being admitted for labor having potentially conflicting, limited, or no breastfeeding knowledge. Purpose: The purpose of this project was to address this gap in care by creating a prenatal breastfeeding education packet. By increasing and improving prenatal education, the hope is to then increase exclusive breastfeeding rates. Methods: A prenatal breastfeeding education packet was created, and presented twice. It was first presented to providers in an educational session, which also addressed current recommendations regarding breastfeeding, as well as the facility’s infant feeding policy, and basic breastfeeding knowledge. The packet was then presented to prenatal patients in multiple, informal educational sessions. Analysis: Both groups were given pre- and posttests to evaluate knowledge of the materials before and after each educational session, and each group was asked four evaluation questions. Demographic data was also collected from each participant. Each group’s data were analyzed separately, via paired t-tests and descriptive statistics. Results: While the provider group’s mean test score difference was not statistically significant, they all found great value in the education packet. The patient group’s mean test scores showed statistically significant improvement, and they also found great value in the packet for prenatal patients.
Modifying DASH and Improving Dietary Habits to Reduce Hypertension Among Micronesian
(2019-05-16) Nadeau, Gulnara; Van Hoose, Diane; Thompson Pagan, Joan
Hypertension is an important risk factor for developing cardiovascular diseases. Though hypertension is a common condition, which affects all ethnicities, Micronesians develop complications of untreated hypertension at a younger age. Many of these complications could be avoided with implementation of lifestyle modifications, including dietary approaches. This project introduced the Dietary Approaches to Stop Hypertension (DASH) plan to Micronesians living on the Big Island of Hawai‘i and evaluated effectiveness of the DASH plan. Concepts from the Health Belief Model and from Rogers’ Diffusion of Innovations Theory helped in guiding interventions during the development of the project. Thirty adult Micronesian participants were recruited during the Health Fest in Hilo in 2018. Blood pressure among participants in the hypertensive category was lowered after four weeks (mean systolic blood pressure and mean diastolic blood pressure changes were 18.9 mmHg and 10.3 mmHg, respectively). Thirty six percent reported that they had increased their consumption of vegetables. Twenty five percent recorded daily consumption of vegetables. This project identified several modifiable risk factors for hypertension and barriers to adherence to the DASH plan. Self-efficacy is a modifiable behavior, and the Health Belief Model could be targeted in future projects aimed at enhancing adherence to the DASH plan.
Self-Assessment of the Clinical Healthcare Services at the University of Hawaii at Hilo Student Medical Services
(2019-04-25) Hirata, Heather; Pagan, Joan; Van Hoose, Diane
The purpose of this project was to assess the University of Hawaii Hilo (UHH) Student Medical Services using multiple methods, as a single assessment method is not enough to assess competencies. The American College Health Association’s (ACHA) Council for the Advancement of Standards (CAS) in Higher Education tool for Clinical Health Services was used for administrative program assessment. The findings were used to identify areas that administrators need to strengthen to comply with Federal, State and University regulations and increase program efficacy. The ACHA 2016 survey Health Assessment II 2016 survey for the University of Hawaii at Hilo (UHH), was used to determine the health status on campus, health information received and health information that students wanted was compared against self reported academic impacts. The ACHA 2016 survey of UHH students and the ACHA national reference group were used to determine how UHH student compared to national average in health issues. The basis of the literature review was current health concerns that seemed to affect university students .UHH students and the results of the survey served as a guide and context in which to assess the current program.
The Effectiveness of Action Plan Implementation by Primary Care Providers on the Frequency of Preventable Acute Care Visits for Adults with COPD
(2018-09-12) Fried, D. Michiko; Davis, Alice; Thornett, Tracy; Van Hoose, Diane
COPD is the 3rd leading cause of death in the U.S. and 4th in the world. The economic burden of COPD in the U.S. in 2010 was almost $50 billion, which included almost $30 billion in direct healthcare costs due primarily to hospitalizations following exacerbations. Selfmanagement skills fostered in a patient-centered primary care setting are essential for symptom control and the prevention or early detection of the exacerbations and complications that lead to healthcare utilization. However, adequate self-management is difficult due to the complex heterogeneity of COPD. Poor symptom control results in more frequent but preventable hospital visits and an accelerated functional decline. Patients with COPD often have increased health risks due to chronic co-morbid conditions and wide variations in clinical, functional, and behavioral patient presentations that challenge practitioners to develop, modify, and reinforce components of effective care plans whose success depends upon patient self-management. This paper describes the design and implementation of BREATHE for a Better Life, a primary care pilot program for adults focused on self-management. As a practice inquiry project (PIP), BREATHE sought to demonstrate the effectiveness of an action plan on controlling the symptoms of COPD or COPD with asthma to optimize daily function and quality of life. Quality measures included the frequency of acute medical visits for respiratory complaints, spirometry values, and COPD Assessment Test (CAT) scores tracked over a two-month implementation period. Despite the brief nature of the intervention, results revealed gaps in care, provided opportunities for workflow improvements, and substantiated the need to evaluate and incorporate patients’ self-perceptions of health into a comprehensive care plan. The PIP’s supervising physician committed to continuing BREATHE for a minimum of one year and will continue to collect data in anticipation of significant results to support its value and sustainability.

Browsing by Author "Van Hoose, Diane"

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