School of Nursing

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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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Development of an Evidence-Based Pediatric Asthma Program for a Nonprofit Clinic Serving Underserved, Uninsured, and Underinsured Populations in Southern Nevada
(2016-11-29) Sarmiento, Armando; Davis, Alice
The purpose of this Practice Inquiry Project was to create a pediatric asthma management program for children age five and older, based on up-to-date evidence-based guidelines. The program was developed for the First Person Care Clinic, a free clinic that serves the underserved, uninsured, and underinsured population in Nevada. A microsystems analysis was performed to understand the clinic’s workflow and protocols for treating pediatric asthma patients. Analysis of current literature and vignette surveys helped in identifying topics included in the asthma management guide. Topics involved general asthma management and areas that needed to be improved in order to be consistent with current national asthma guidelines. An asthma management guide was developed and evaluated by an interdisciplinary team using the AGREE II methodology. Results from the evaluation indicated that providers recommended the management guide for use, but with an additional section that assists in the identification of comorbidities.
The Feasibility of a Resistance Training (RT) Program in Targeting Obesity of Women in Low Socioeconomic Status (SES) Environments.
(2016-11-29) Garnett, Melissa; Flood, Jeanie
Problem. Obesity of women in low Socioeconomic Status (SES) environments ranges from 34% to 49% of America’s low SES female population. Many barriers to weight loss and health management exist for low SES obese women. Risks for health problems, such as Diabetes, Stroke and Cancer, rise with obesity. Health programs, which extend beyond low SES barriers, are lacking. Many women do not know of resistance training’s benefits for improving health and aiding weight management. Objectives. The aim of this project is to formulate and evaluate the feasibility of a financially reasonable, time allowable, and research based weight reduction and health improvement program through the use of in-home resistance training for obese low SES women. Methods. The project employed an epidemiological approach an evidence-based design (EBD). The findings from a literature review and study analysis were compiled to build a weight reduction and health improvement program extending beyond low SES barriers. Questionnaires on the feasibility of the program were answered by five target population women, five health care providers, and five fitness professionals. Data Analysis. Studies included in the review were analyzed for inclusion criteria, which was used in the design of the Lift for Health program. Likert results from the questionnaires were tallied and a mean for each question was determined. Common themes in the qualitative responses were summarized. Expected Results. The proposed resistance training based wellness program will be effective for weight management and health improvement in obese women in low SES environments.
Increasing Sexually Transmitted Disease Education for Adolescents with Social Media
(2016-11-29) Napoleon, Tammie; Davis, Alice
At the turn of the century, the millennium adolescent was immersed into a digitally-saturated world. Digital media and social networking sites have been both instrumental and influential to an adolescent’s development. During this time of adolescent development and transitions to adulthood, reproductive health issues become a major health concern. National, state and local statistics continue to demonstrate that adolescents aged 15 to 24 years of age account for 10 million new sexually transmitted diseases in the United States each year. The Kaua`i Community College Campus Wellness Center has been providing family planning services for adolescents for nearly a decade. Incorporating Urie Bronfenbrenner’s Ecological Systems Theory as an assessment framework, the Campus Wellness Center assesses both microsystems and macrosystems influences on adolescents and plans implementation strategies aimed at increasing reproductive health and decreasing disparities amongst its adolescent clientele. This Practice Inquiry Project focused on developing a pilot project aimed at utilizing aspects of the adolescents’ chronosystem and influence of the digital era. In partnership with the Campus Wellness Center, a Teen Health Educational website that highlighted the sexually transmitted disease, Chlamydia, was developed and linked to the Campus Wellness Center Facebook Website. Adolescents reviewed the Teen Health site and completed surveys and questions related to access, confidentiality, likability, and knowledge. This Practice Inquiry Project reviews the creation and development of the project, data collected during a one-month period, and the analysis of its results and recommendations with implications for practice.
Alternative Healthcare Institute in Tai Chi Qigong
(2016-11-30) Chen, Hui; Davis, Alice
Compelling evidence in Alternative / Complementary Healthcare practices, such as in Tai Chi and Qigong (TCQ) studies has demonstrated consistent health improvements in population health. If the evidence can be utilized to reduce health risks and improve the health of adult population in Hawai’i, this may lead to advancing the chronic healthcare management in Hawai’i, and in turn, this may also lead to reducing billions of dollars in medical costs to treating disease. The Alternative Healthcare Institute (AHI) proposes the establishment of an AHI TCQ program based on (1), the most current evidence based research studies, (2) the evaluation of participants from an existing TCQ program, (3) feedbacks from a TCQ practitioner and local primary care providers, and (4) feedback from potential TCQ participants. The program will aim to advocate and create options for alternative healthcare practices in Hawai’i.
Antipsychotic Medication-Associated Weight Gain: Development of an Evidence-Based Management Algorithm and Practice Guideline for Primary Care Providers
(2016-11-30) Thornett, Tracy; Davis, Alice
Obesity is a growing public health concern. Although people from all walks of life are affected by obesity, rates of this chronic disease are especially high among individuals with mental illness. Of particular concern are patients who take antipsychotic medications, as weight gain is a well-established side effect of many of these drugs. This practice inquiry project investigated the problem of antipsychotic medication-associated weight gain by applying the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to develop a preliminary evidence-based practice guideline and algorithm for use by primary care providers. As part of the project, an interdisciplinary panel of key stakeholders evaluated the proposed guideline for both quality and applicability. The results of this evaluation are discussed with future revision and expansion of the guideline in mind. Additionally, implications for advanced nursing practice are examined and strategies for promoting safe, effective, patient-centered, and equitable health care are suggested.
Improving Women’s Awareness of Cardiovascular Disease Through Primary Prevention The Wahine Heart Wellness Program: A Community Approach
(2016-12-01) Bourgette-Henry, Sandra; Davis, Alice
Cardiovascular disease remains the leading cause of death for women in the United States. Despite increases in awareness over the past decade, only 54% of women recognize heart disease as their number one killer (CDC, 2013). Although Hawaii has relatively low rates of death from heart disease and stroke, Native Hawaiians are plagued with disproportionately higher rates of chronic disease. The purpose of this Practice Inquiry Project was to identify Cardiovascular Disease (CVD) risk early and to improve health literacy on cardiovascular disease in women. The plan was to screen and educate Asian, Native Hawaiian, and other Pacific Island women living on the Leeward Coast of Oahu, Hawaii about the risk factors for developing cardiovascular disease. The specific aim of this study was to: (a) assess the current level of awareness of CVD as the leading cause of death in rural Asian, Native Hawaiian, and Pacific Island women; (b) implement a CVD Risk Program; and (c) evaluate program effectiveness to decrease CVD risk. The study design used a mixed methods approach involving qualitative and quantitative data collection to address the project study aims. The methods included; a cardiovascular awareness questionnaire (pre-test and post-test); a screening process using the Life’s Simple 7 matrix; and six educational sessions to improve health literacy on primary prevention of cardiovascular risks. Evaluating knowledge levels, health perceptions, and behavioral performance underline the research methodology used in this study. A convenience sample of 20 predominantly Asian, Native Hawaiian, and Pacific Island women, were recruited from the Makeke Market in Kapolei, Hawaii. Data from the research aims were compiled, and descriptive statistics and charts were used to present the results. At the conclusion of the program, none of the women scored in the low range (4-6 points) on the Life’s Simple 7 matrix; 5% of the women scored in the intermediate range (7-8 points); while 95% scored in the ideal range (9-14 points) on their post-program score. Ninety percent of the participants scored an 80% or above on the Risk Awareness Questionnaire post-test. This study showed that an increase in awareness can improve cardiovascular disease (CVD) risk and encourage women to make behavioral changes to decrease cardiovascular risk. The study also demonstrated that collaboration and partnerships between local schools of nursing and existing community organizations, community-based integrated approaches, incorporating health literacy, and infusing cultural knowledge into practice are essential to successful, innovative, and sustainable solutions when working with rural Asian, Native Hawaiian, and other Pacific Island women.
Improving Health Awareness Through an Education and Health Screening Program
(2016-12-02) Kealoha-Wong, Yvonne; Davis, Alice
In Healthy People 2010: Understanding and Improving Health (U.S. Department of Health and Human Services, 2000a), access to quality health services (which includes rural health care awareness) was rated as the top ranking rural health priority. Rural is described as a slower pace of life, a sense of community, and a closer connection to nature and tradition, characteristics commonly associated with rural areas. Rural is defined more formally as an area within a particular geographical, political, or economic status. In an effort to appreciate the health care needs of a rural community on Hawaii Island, results from a combination of focus groups, residents’ participation in common health screening recommendations and residents’ health awareness were analyzed. The Health Literacy Skills Framework (Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012) was used to analyze the results. In addition to the common challenges identified in rural communities, such as provider shortages, isolation, long distance travel, poor access to health care, scarcity of specialty care, and under-resourced infrastructure, this project revealed unique influences on use, understanding, and participation in health care. These included the strong spiritual beliefs of the community, use of Hawaiian healing practices, a strong sense of ohana (family), and the importance of trust in participating in health care outside of the community.
Promoting Awareness of Autism Spectrum Disorders and Resources to Diverse Stakeholders in Rural Hawaii: a Community Based Approach
(2016-12-07) Tostenson, Lisa; Davis, Alice
Autism Spectrum Disorders (ASD) are a group of developmental brain disorders with a wide range of individual symptom and impairment expressions from mild to severely disabling. Data from 2010 indicated one in 68 children have an autism spectrum disorder (CDC 2014). An updated surveillance report confirms incidence rates have remained the same (Christensen, Baio, Braun, et al, 2016). Morrier, Hess, & Heflin (2008) found that Native Hawaiians and multiracial children are under-identified with ASD 99% of the time. Many people associate ASD with severe repetitive behaviors such as hand flapping or significant communication problems and unfortunately disregard other subtle cues. Mandell, Ittenbach, Levy, and Pinto-Martin (2007) found a high prevalence of initial incorrect diagnosis in children with ASD prior to eventual correct diagnosis. Research has confirmed that diagnosis of children as young as two years old is reliable, valid, and stable, yet most children are not diagnosed until age four or older (Lord et al., 2006; CDC, 2015). Early intervention has been shown to be the most effective means of improving a child’s development and functional status, however intervention at any age is beneficial. Incorrect and under-diagnosis contributes to under use of intervention services that results in negative impact on IQ, functional ability, and adult productivity. Current research is focused on finding the earliest signs of autism as early intervention may prevent disabling ASD behavior expression (NIMH, 2012). However, this research may be ineffective without consistent early childhood screening and evidence-based (EB) interventions.
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.
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.
Controlling Diabetes - Are Clinical Practice Guidelines the Answer?
(2017-01-13) Wong, Allyson; Davis, Alice
Diabetes is a challenging disease that affects almost every organ system in the body. Every 17 seconds, someone is diagnosed with diabetes (Awareness Matters, n.d.). The World Health Organization (WHO, 2003) predicts that 350 million people worldwide will have type 2 diabetes by 2030. Meanwhile, the International Diabetes Federation (IDF) believes nearly 400 million people have some form of diabetes today, and this number is expected to climb to 600 million over the next 25 years. To paint a clearer picture, this means one in ten people will be diagnosed with diabetes by 2035 (American Broadcasting Company [ABC], 2013). According to the Hawai’i Island Beacon Community website (2013), Hawai’i island is approximately the same size as the state of Connecticut; and while Connecticut has 34 major hospitals, the Big Island of Hawai’i has three. Sixteen percent of Hawai’i island residents report not having a primary-care provider (North Hawaii Outcomes Project, 2011). Hawai’i island providers are overwhelmed with patient loads, and patients experience long wait periods when trying to see a provider. The global epidemic of type 2 diabetes requires an innovative approach to prevention and treatment. The role of culture and socioeconomics must be acknowledged in the development of new interventions to prevent and control the disease. A clinical practice guideline (CPG) is essential to providing the best evidence-based care to patients with type 2 diabetes. The state of Hawai’i faces a significant healthcare problem. There is an overwhelming prevalence of type 2 diabetes in Hawai’i and a severe lack of primary-care providers to handle the diagnosis and management of this disease.
Preventing the Unnecessary Use of Psychotropic Medications in Dementia Patients with Accentuation of Caregiver Training in Long-Term Care
(2017-06-30) Butac, Leo-Daniel; Davis, Alice
Behavioral and Psychological Symptoms in Dementia is a widely misunderstood concept especially in geriatric patients with dementia. The challenge that most healthcare practitioners face when it comes to the care of geriatric patients with dementia is how to effectively address these behaviors with individualized interventions that utilize non-pharmacologic methods rather than utilizing psychotropic medications. The use of psychoactive medications significantly impact the quality of life of dementia patients due to their side effect profiles and the increased risk for death while on these medications. This practice inquiry project aimed to determine the effectiveness of a modified Geriatric Mental Health Training Series (GMHTS) program in a long-term care facility to determine its effectiveness in assisting facility staff to more effectively assess and address the causes of behavior problems in patients with dementia from a non-pharmacological standpoint.
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.
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.
Traditional Dance as an Exercise Regimen for Marshallese Patients with Type 2 Diabetes Mellitus
(2019-01-10) Walker, Brayden; Davis, Alice; Shmina, Kimberly
Diabetes is a global health care problem. It is associated with several health complications such as overweight/obesity, cardiovascular complications, vision complications, and renal complications among others. Some groups are more disproportionally affected by diabetes and one of these such groups are the Marshallese people (Naseem, 2010). Exercise can be a useful way for patients to manage their diabetes. The problem is about 65% of Marshallese do not exercise at all or only exercise for less than 20 minutes a day which does not meet the recommended weekly value of 150 minutes per week (Reddy, Shehata, Smith, & Maskarinec, 2005; WHO, 2011). Culturally appropriate exercise may be a better fit for these people as compared to other forms of exercise such as running or weight-lifting. The purpose of this project was to develop a dance regimen which was culturally appropriate. Once the regimen was recorded, it was evaluated by a group of stakeholders for feasibility, cultural appropriateness and whether it met the current recommendations for physical activity. It was designed to target the East Hawai’i Marshallese adult population who have been diagnosed with type 2 diabetes mellitus (DM2). Results include the creation of a culturally appropriate dance exercise regimen which met recommendations for physical activity overall and that this regimen is a tool to aid providers and patients meet and exceed their diabetes management goals.
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.
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.
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.
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.
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.

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