DNP Practice Inquiry Projects

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https://hdl.handle.net/10790/2426

The Doctor of Nursing Practice (DNP) is a terminal degree in nursing focusing on nursing leadership and application of research into practice. The DNP program is also designed to prepare the nurse at an advanced level of nursing practice specifically as a Family Nurse Practitioner (FNP) and as leaders and administrators for health care organizations. The program emphasizes the development of the student’s capacity to impact the clinical setting as leaders and educators and to utilize clinical research to improve and transform health care. Our program is based on the understanding that nurses provide services which include the direct care of individual clients, transcultural nursing care, management of care for rural populations, administration of nursing systems, and development and implementation of health policy. The program encompasses health economics, cultural diversity, chronic care management, health promotion, and disease prevention in rural communities and will create a cadre of new nursing faculty who can immediately address the nursing faculty shortage. Advanced practice nurses with practice doctorates will address significant practice issues in a scholarly way, adopt broad system perspectives for health promotion and risk reduction, and act as agents of change that transform client/community care, participate in the on-going evaluation of health care outcomes, and assist in the translation of research that leads to positive nursing practice changes.

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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.
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.
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.
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.
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.
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.
Quality of Life of Community Elderly And Mindfulness Meditation/Mindfulness Training
(2023-05-15) Kim-Sunada, Cera; Pagan, Joan; Daub, Katharyn
Poor mental health can affect an older person's quality of life. The researchers found that older adults are at higher risk for depression. Negative stress significantly impacts older person's quality of life across physical, psychological, and social domains resulting in suffering and distress to older individuals. More effective interventions for improved quality of life for older persons are needed. Mindfulness meditation training can be beneficial in reducing symptoms of depression and stress and improving quality of life. (Amadpanah study, 2017). The goal of my PIP was to determine if older individuals (65 years or older) residing in the community can improve their quality of life by adding a mindfulness meditation program. The research question was "Can the introduction of the six weeks one-hour weekly mindfulness meditation class improve the quality of life of community-based older individuals?". The results of my PIP were lower perceived stress and depression reported by the participants after six weeks of mindfulness meditation class. Mindfulness meditation can help improve the quality of life of older individuals. Some participants stated that mindfulness meditation helped them become more "patient", sleep better, and have less pain (low back pain e.g., sciatica), and recent shoulder injuries).
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.
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.
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.
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.
Access to Care: Investigating the Perception and Experience of Native Hawaiian During COVID-19
(2021-06-08) Paikai, Kawailehua; Pagan, Joan; Daub, Katharyn
Native Hawaiian data collection and dissemination continue to be underrepresented and often inaccurate. While there is progress in how the government collects data on Native Hawaiian Pacific Islander (NHPI) populations, there is still a lack of accurate and reliable health data to assess access to care and healthcare utilization in the Native Hawaiian community. The COVID-19 pandemic exposed the need for data disaggregation and appropriate funding for Native Hawaiians and the organizations that serve them. Native Hawaiian health outcomes have been highly affected by the pandemic, and there is limited data to address access to care and health inequities. This project's scope is to pilot a screening tool to collect and analyze data from the Native Hawaiian population regarding their perception and experiences to access care during the COVID-19 pandemic.
Management of Chronic Obstructive Pulmonary Disease Exacerbations Using the Global Initiative for Chronic Obstructive Lung Disease Guidelines
(2021-06-01) Abe, Jamie; Daub, Katharyn; Norris-Taylor, Joyce
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. An intermittent acute aggravation of symptoms characterizes COPD's natural progression termed acute exacerbations of COPD (AECOPD). AECOPD is defined as a “sustained worsening of the patient’s condition, from stable state and beyond normal day-to-day variations, that is, acute in onset and necessitates a change in regular medication.” Greater than 80% of exacerbations are managed in the outpatient setting with pharmacological therapies that include bronchodilators, corticosteroids, and antibiotics. Treatment variability results in adverse health outcomes and necessitates a need to standardize care. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were developed by worldwide experts and provide unbiased reviews of the latest evidence to assess, diagnose, and manage COPD. The GOLD guidelines provide evidence-based recommendations and should be integrated into practice. Purpose: The overarching goal of this Practice Inquiry Project (PIP) was to determine the likelihood of adopting the GOLD guidelines, which could inform practice and improve the management of AECOPD. Methods: A qualitative, survey-based study was undertaken that involved data collection, analysis, and a review of the literature. The PICO framework was utilized to define the research question. Roger’s diffusion of innovation model served as the theoretical framework used for understanding the degree of readiness or stage of change. Due to the small sample size (n= 10), nonparametric tests were used to analyze ranked, ordinal, dichotomous, and nominal data. The data was collected via survey and statistically analyzed to determine the readiness to adopt and establish the current standards of care. Results: A convenience sample of 10 providers (n=10) in the state of Hawaii completed the anonymous survey in the form of a multiple-choice questionnaire during a 30-day period in 2021. The questionnaires were analyzed by individual questions, and findings focused on key themes (demographics, experience, and readiness to adopt). The results of the provider’s readiness to adopt the GOLD standard were inconclusive. While providers acknowledged a high interest in adopting the GOLD guidelines, their likelihood of adopting the guidelines was not likely. The most significant barrier to adoption was Organizational/Institutional (70%, seven respondents). Conclusion: Ultimately, adoption of the GOLD guidelines was not likely. The data identified potential barriers to adoption and informed practice by raising awareness of the GOLD guidelines. Further research is needed to better understand specific Organizational barriers to adopting the GOLD guidelines.
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.
SMARTPHONE APPLICATION USE PROMPTS AN EVIDENCE-BASED INTERVENTION TO IMPROVE MEDICATION ADHERENCE IN THE FAMILY PRACTICE OUTPATIENT SETTING
(2021-05-18) Anahu, Jessica; Norris-Taylor, Joyce
Background: Medication adherence is defined as whether a person takes their prescribed medication at the frequency it is prescribed as well as whether it is continuously taken for as long as prescribed. Medication nonadherence is a complex and multidimensional public health challenge due to the increasing number of chronically ill individuals. Research has shown that average nonadherence rates for persons taking long-term medications for chronic conditions are between 25%-50%. Avoidable healthcare costs attributed to nonadherence account for $100 to $300 billion annually. Medication adherence can be improved at many different levels and points of contact in the healthcare system utilizing multidisciplinary and technology-based approaches. There is researched evidence that supports the use of smartphone applications (apps) to improve self-management and medication adherence rates in the United States. However, the use of such has not been studied in the State of Hawai’i. Methods: A mixed methodology pilot study was conducted to evaluate the use of the Medisafe® Medication Management smartphone app on improving medication adherence rates of individuals from an outpatient Family Practice setting. The Medisafe® app was chosen for its comprehensive design that is intended for persons who are on multiple medications for chronic diseases who have a hard time complying with their medication regimen. Participants utilized the app as their primary reminder system for three consecutive weeks. Data before and following app use were collected via survey and statistically analyzed to determine if a medication reminder app is useful for persons in Hawai’i to improve medication adherence rates. Results: Ten participants completed the 3-week intervention and completed the post-survey. Descriptive statistics evaluated pre- and post-survey results, which showed that medication adherence rates improved from 40% pre-intervention to 70% post-intervention and that the average number of days medications were missed was reduced with daily use of the Medisafe® app. Evaluation of participant experience indicated overall positive feedback: the app was easy to use, the app was useful, they were 100% “very likely” to continue use after the pilot study, and were “very likely” to recommend its use to others (90%). Feedback from the family medicine clinic providers and staff specified that participants seemed more likely to show interest in participation when the Primary Care Provider (PCP) themselves directly recommended or “prescribed” the app use as part of their treatment plan. Conclusion: Data from this study are reflective of other previously conducted studies in that the use of smartphone medication reminder apps improves medication adherence rates. Individuals who utilize self-management tools to engage in health-promoting behaviors retain autonomy in realizing the outcome of their own goals towards their “ideal health.” Clinicians are encouraged to recommend and support the use of smartphone medication reminder apps to patients to support the long-term goal of improving medication adherence rates population-wide and decreasing the incidence of adverse events related to nonadherence, including avoidable hospital admissions to ultimately lower total healthcare costs.
AN ORGANIZATIONAL APPROACH TO BURNOUT IN ADULT FOSTER HOME CAREGIVERS IN HAWAI`I
(2021-05-18) Supnet, Kimberly; Daub, Katharyn; Norris-Taylor, Joyce
Caregiver burnout is an adverse psychological event that a person experiences in relation to long-term and emotional stress that is brought about by work that entails helping other people. Caregiver burnout may compromise patient safety by affecting patients’ mortality rates and increasing their risk for abuse and neglect, and it may impact the physical and mental health of caregivers, reduce their eagerness to help patients, and increase caregivers’ turnover rates. Clients living in adult foster homes are a vulnerable population who are often explicitly dependent on their caregivers; they are unable to perform ADLs, prepare their own meals, comply with medications, and/or verbally express their needs. Caregiver burnout in adult foster home caregivers must be investigated especially as the elderly population increases and as more adults with disabilities are placed in adult foster homes. This project examined burnout in adult foster home caregivers in Hawai`i, determined its effects on caregivers and client care, and identified organizational means for its prevention and management. Adult foster home caregivers from three case management agencies in Hawai`i were asked to complete an anonymous sociodemographic online survey on Survey Monkey and to participate in three online focus groups through Zoom. The online survey contained five Likert-scale questions that inquired about caregivers’ age, sex, number of adult foster home clients in their homes, years of caregiving experience, and the number of hours spent caregiving per week. Three (N=3) caregivers responded to the survey, and their responses were not analyzed. Thirteen (N=13) caregivers participated in the online focus groups. These caregivers were asked to respond to ten questions about burnout, job demands and resources, and case management agencies’ management of burnout. Their responses were manually transcribed verbatim, manually analyzed using thematic analysis, and electronically analyzed using MAXQDA. Four themes were identified: caregivers’ impression of burnout, relief, training, and support. Data gathered from the focus groups were combined with data from the literature to develop a presentation about the organizational management of burnout in adult foster home caregivers. The presentation was sent to 21 case management agencies in Hawai`i. These agencies were asked to respond to anonymous online pre- and post-tests on Survey Monkey before and after reviewing the presentation. The surveys contained two Likert-scale questions about agencies’ knowledge about burnout and their likelihood of implementing interventions to manage burnout among adult foster home caregivers. Three (N=3) responses were collected and analyzed using paired-samples t-test with JASP 0.14.1 software. The results from the pre-test and post-test indicate that case management agencies’ review of the burnout presentation did not result in any significant improvement in their knowledge or likelihood of implementing organizational methods of managing burnout. Based on the data collected in this study, a combination of the JD-R model and the action research framework is recommended in the development of organizational interventions to manage burnout among adult foster home caregivers. Case management agencies should identify adult foster home caregivers’ most valuable job resources and provide enough of these resources to caregivers on an ongoing basis to manage burnout and to protect caregivers and clients from the consequences of caregiver burnout.
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.
Chronic pain patient perceptions of primary care provider pain education
(2021-01-11) Gallegos, Angelina; Pagan, Joan; Daub, Katharyn
Chronic pain in the U.S. affects millions of adults and the numbers are expected to continue rising, alongside rates of chronic disease which often accompany chronic pain. It has become increasingly complex to manage chronic pain which is only further complicated by the opioid epidemic. While the primary care setting is most often where chronic pain patients are treated, the focus is often primarily on the physical complaints. Current best practices suggests primary care provider education incorporate a biopsychosocial approach to support the best possible outcomes. Current evidence suggests that holistic primary care provider education is necessary to achieve optimal outcomes and efforts should be focused on improving self-management. This project examined chronic pain management education delivery by primary care providers to identify potential gaps in education from the patient's perspective. A survey was developed with 40 items based on the Pain Assessment Screening Tool and Outcomes Registry (PASTOR), currently used by the military. The electronic survey was completed entirely online, with a total sample of 26 adult participants. The survey research revealed the largest deficits in pain education related to areas of behavioral change. The results indicated a need for improving education delivery to include a broader range of topics affecting chronic pain. Increasing knowledge of pain influencing factors can support more successful self-management in patients. The survey results informed practice improvement recommendations, using a two-pronged educational approach to improve chronic pain care education delivery in the primary care setting. Prong one was the development of a comprehensive patient pain education poster for primary care offices. Prong two was a provider education brochure detailing survey results and pain practice resources.
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.

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