DNP Practice Inquiry Projects
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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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ItemExploring Burnout Among Long-Term Care Staff( 2022-06-07)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.
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ItemSuicide Prevention in Primary Care( 2022-06-07)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.
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ItemNurse Planner Modules to Expand Continuing Nursing Education Capacity in Hawai’i( 2022-06-02)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.
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ItemEND-OF-LIFE CONVERSATIONS: IMPROVING PROVIDERS’ COMPETENCE IN EOL CONVERSATIONS THROUGH AN EDUCATION MODULE( 2022-05-27)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.
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ItemAccess to Care: Investigating the Perception and Experience of Native Hawaiian During COVID-19( 2021-06-08)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.
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ItemManagement of Chronic Obstructive Pulmonary Disease Exacerbations Using the Global Initiative for Chronic Obstructive Lung Disease Guidelines( 2021-06-01)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.
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ItemRoutine Screening for Obstructive Sleep Apnea Risk in Hawaii’s Adults in the Primary Care Setting( 2021-05-21)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.
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ItemSMARTPHONE APPLICATION USE PROMPTS AN EVIDENCE-BASED INTERVENTION TO IMPROVE MEDICATION ADHERENCE IN THE FAMILY PRACTICE OUTPATIENT SETTING( 2021-05-18)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.
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ItemAN ORGANIZATIONAL APPROACH TO BURNOUT IN ADULT FOSTER HOME CAREGIVERS IN HAWAI`I( 2021-05-18)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.
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ItemBridging the Knowledge Gap in Ostomy Management( 2021-05-06)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.
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