Humanities class , a compare/contrast analysis essay

DNPpelog xDNP.PElog_Professorcomments xFinalCapstone x

 This is a comparative study paper. You will offer a compare/contrast analysis between Mesopotamian and Ancient Greek civilizations. You are required to explore and compare at least three different distinct aspects of each culture (e.g., social, political, economic, artistic, cultural). 2. Write a 1500-2000 word paper, exploring your topic in an analytical form. This is not a survey paper and you must go beyond describing your subjects and offer analytic interpretation. 3. Use only academically reliable sources for research and discussion. Wikipedia and the dictionary are not accepted as sources. But websites such as The Stanford Encyclopedia of Philosophy (

https://plato.stanford.edu/

are reliable sources. Cite all your sources! 4. You are required to use minimum of 2 other sources ( books, journals, or online reliable sources), the textbook, and all videos in Modules as your resources. Note: Using other sources DOESN′T mean ″copy-pasting″ from internet into your entire work except images or videos (if applicable). 

Student: _____

D

aniela Londono_____________

C

ourse: ______NUR

7

9

9______________ Semester: ____Summer________

E

ach DNP Student is required to complete a minimum of

1

2

5

hours in NUR 702, a minimum of

125

hours in NUR 70

4

and a minimum of

250

hours in NUR 799. Students will maintain a different log for each course.

A

ll completed practice e

x

perience (PE) hours must be typed in the Microsoft Word Table (page

3

), adding additional lines as needed. Students should designate the corresponding letter of the PE Category Type (per the appropriate course table below) and record a detailed narrative for each entry.

Approved DNP Practice Experience Categories by Course

I

. Course – NUR702

Problem Identification

Problem Identification

Literature Review

Literature Review

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

Problem Identification

A

Collaborating with experts in practice to identify a clinical problem.

I, V I

1, 2, 6

B

Applying advanced communication skills to identify a quality improvement initiative in a health care setting.

II

7

C

Analyzing health care data to identify gaps of care for individuals, aggregates, or populations.

VII

4

Literature Review

D

Engaging in scholarly inquiry to develop a PICO question.

I

2, 6

E

Engaging in scholarly inquiry to identify evidence-based practice to utilize to improve patient outcomes.

I, III

2, 3, 6

F

Collaborating with experts in practice using analytic methods to critically appraise research to determine best evidence for practice.

II, III, VI

1, 3, 7

Advanced Nursing Practice

G

Attending a conference to gain insight on evidence-based practice in relation to identified clinical problem (possible activity for Essential VIII ).

VIII

5

II. Course – NUR704

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

A

II

7

Project Planning [Assessments]

B

Project Planning [Assessments]

C

VII

4

Project Planning [Assessments]

D

I

2, 6

Project Planning [Assessments]

Employing principles of health policy to develop effective plans for a practice-level change to improve quality of care.

Employing leadership skills within interprofessional teams to analyze organizational issues.

VI

1

Evaluating a care delivery model to identify gaps of care for individuals, aggregates or populations.

Using analytical skills to assess the relationships among practice, process, fiscal, and policy issues at an organization.

V, VIII

5, 9

Project Design

E

Integrating theory into practice through the development of a quality improvement project.

III. Course – NUR704 (continued)

Project Design

F

Project Design

G

Advanced Nursing Practice

VIII

5

Applying findings generated through scholarly inquiry to design a quality improvement project.

III

3

Designing an evaluative plan to monitor outcomes of a quality improvement project through the use of health care information systems.

III, IV

3, 8

H

Attending a conference in relation to identified clinical problem to gain insight on how to inform practice decisions and support the understanding of patient care consequences (possible activity for Essential VIII).

IV. Course – NUR799

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

A

III

3

Project Implementation

B

II

7

Project Implementation

C

D

VIII

5

Project Implementation

E

VIII

5

F

G

V

9

Project Dissemination

H

III

3

Advanced Nursing Practice

I

VIII

5

			Project Implementation	Functioning as a practice specialist through the implementation of a quality improvement project.
Applying advanced communication skills to lead a quality improvement initiative in a health care setting.
Providing leadership to influence health policy within the health care system through demonstrating evidence-based practice.		V		9
Project Implementation	Mentoring health care professionals to enhance patient outcomes through the use of evidence-based practice.
Educating health care professionals regarding the transitioning to evidence based practice.
Project Evaluation	Demonstrating advanced levels of clinical judgement through the evaluation of evidence-based initiatives to improve patient outcomes.	IV, VIII	5, 8
	Project Dissemination	Providing leadership to influence health policy within the health care system through the dissemination of findings from quality improvement project.
Functioning as a practice specialist through the dissemination of findings from quality improvement project.
Attending a conference to disseminate findings from quality improvement project to facilitate optimal care and patient outcomes across diverse settings (possible activity for Essential VIII).

DNP Practice Experience Log

DNP PE Log Template-Categories by Course_2020_07 2

DNP Practice Experience Log

10 min

A

x

A

02/28/21

x

7

A

x

I

x

A

x

x

A

x

A

x

A

x

1

A

x

1

A

x

D

x

3

B

04/23/21

8a-10a

x

2

D

x

1

Date

Start Time – End Time

On- Site

Off- Site

Daily Hours Accumulated

Cumulative Hours

PE Category Type

Practice Experience Activity – Narrative

01/18/21

7p-7:10p

x

10 min

Contacted the IRB advisor via Chatham email

02/01/21-

02/ 28 /21

5p-11p

6

6h 10m

An IRB exempt form submission was initiated via Cayuse. All the required fields and categories were inputted electronically. The research plan, procedures, list of materials, were described and the cover letter were attached. The IRB reliance agreement and the site permission was attached. The main study design and the pretest and posttest was attached in English and Spanish. The recruitment, data collection, storage and release were described and inputted. The consent, risk and benefits and additional documents were attached for IRB review.

8a-3p

13h 10m

Received feedback from the IRB advisor regarding the submitted IRB Exempt documents and electronic form. On 02/28/21, all the corrections were reviewed and revised. The clinical site was contacted on the same day to request the permission letter to attach to Cayuse.

02/27/21

9am-3pm

6 hours

19h 10m

Attended a national conference: 2021 ACG/FGS Virtual Annual Spring Symposium about current issue facing the industry regarding colorectal cancer, discussed the risk factors, the options for screenings and background.

03/02/21 03/03/21

8:32pm-9:32p 7:00p-8:00p

1 1

21 hr 10m

Received multiple emails from the IRB advisor regarding the additional corrections that were needed. The documents and corrections were reviewed and revised in Cayuse. An email from manager at the clinical site was received with the permission form. The form was attached to Cayuse for review. On 03/03/21, the IRB advisor and the project leader (PL) both certified the submission.

03/23/21

9p-9:10p

10m

21h 20m

Approval from the IRB was obtained.

04/12/21

8a-2 p

6h 40m

28

Reviewed the Poster Presentation guidelines in the Nursing Student site. After thorough review of the guidelines, the poster presentation was developed. Scholarly inquiry review to identify published evidence on clinical problem, background, literature review summary. The additional information included the implementation steps, timeline, outcomes, plans for dissemination.

04/19/21

11a-4:30p

5hr 30 min

33h 30m

Participated in DNP residency and scholarly exchange with peers and faculty. The presentations were broken down into small groups and all questions were answered regarding the future implementation of the projects and information regarding the start of NUR799.

04/23/21

8a-8:30a

30 min

34

Prepared a summary of key items and list of activities that were needed and could be addressed prior to presenting to the clinical site (site is different from current workplace).

0 4/21/21

8:30a-9:30a

35

Attended a scheduled phone meeting with the preceptor. Prior to the meeting, the preceptor had received and reviewed the pre/posttest questionnaire, cover letters, site permission form, flyers, bilingual telephone scripts and all questions were answered prior to presenting to the clinical site.

4/21/21

9:30a-10:30a

36

Collaborated with the office manager at Alvior Medical Clinic to retrieve specific report of patient data for prospective review data organization.

0 4/22/21

8a-10a

2

38

Presented to the clinical site (different from current workplace) and met with the medical director and the office manager to discuss the plan for the implementation, all the materials were reviewed in the conference room. Met with the office staff to review and educate on the flyers, cover letters, inclusion and exclusion criteria and discussed verbal consent will be needed prior to the start of the educational program. All questions were answered. DNP Project preparation of materials: making copies of patient education handouts and staff instructions.

4/22/21

8p-11p

41

Prepared the PowerPoint presentation for the educational sessions regarding colorectal cancer amongst Hispanics. The educational session covered statistics, warning signs of colon cancer, the signs and symptoms, screening age, preventative measures, and screening options.

43

Met with the medical director to discuss findings from initial scholarly inquiry and provide update on gap in care to identify the best evidence of clinical solutions to advance practices as it related to improving colorectal knowledge and screening amongst Hispanics.

04/26/21 Week 1

8a-9a

44

A, B , C

Recruitment began by placing flyers in the waiting area and exam rooms. Verbal consent has been obtained by PL of four patient who meet the inclusion criteria.

8a-3p

x

8a-9a

x

1

x

C

05/03/21

x

30m

A

x

8

04/29/21		8	52		A, B, D	Four participants who already gave verbal consent were approached and screened. All four participants agreed to participate in the educational program face-to-face. Prior to each patient arriving, from 8am-8:30 the PL called the patients to confirm the appointment times that day. The first patient arrived and was taken into the small conference room for privacy. While in the room, the patient filed out the pretest survey that took 10 minutes and the educational session began right after ( 20 m inutes). Each participant was reminded of the project, and its outcomes. The patient completed a 10-minute posttest. Four participants were educated throughout the day for a total of 40 minutes each = 2.40 hours. During each break between the participants, the information was analyzed and inputted into Excel for documentation. The primary care provider provided approval to review all the patients that were presenting to the clinic that day that met criteria. 25 charts were reviewed, and 10 patients met criteria. All the patients were seen by the PL to receive verbal consent and to schedule either a zoom meeting and or a face-to-face educational session.
04/30/21	53						A, B, E	Touched based with the office staff to discuss recruiting process and to answer all questions regarding verbal consent.
	05/03/21	7:30a-8a					30m	53h 30m	Meeting Dr. Jonathan Alvior to discuss statistical analysis plan for data.
		7p-7:30p	54	Updated the preceptor regarding the implementation plan.
05/04/21	8a-4p	62	A, C, D	12 patients were approached and screened: 4 were eligible; 2 agreed the same day to participate in the project and education was given.  (Not current workplace; full day seminar). Two patients agreed to participate in the project the same day and two patients were schedule for a later time for a Zoom meeting. Two patients were educated face-to-face including the educational sessions, pre/posttest questions answered. The total time was 1 hour and 20 minutes. The time in between the full day of seminars included answering questions and recruiting patients that were in the clinic the same day and the information was analyzed and inputted into Excel for documentation. The clinics database was accessed and reviewed. Inclusion and exclusion criteria were reviewed, and patients were chosen. All the participants were reviewed and discussed with the medical director prior to approaching the patients on the following seminar day.

8p-11p

x

3

H

8:30a-9:30a

x

1

B

05/05/21

7p-7:30p

x

30m

B

x

7

05/06/21

x

H

x

A, B, C

x

5

A, B, C

x

7

A, B, C, E

05/11/21

7p-7:30p

x

30m

B

x

7

A, B, D

x

5

H

x

4

H

8a-3p

x

7

A, B, E

x

5

A, B, C, E

x

1

A, B, C

x

1

H

05/24/21

x

H

x

6

A, B, E

x

A, B, C

x

5

H

x

1

x

5

A, B, E

x

A, B, C

05/04/21	65	Wrote/submitted Chapter 1-2 drafts of the evidence-based change project. DNP Project (includes preparation, revisions to proposal paper based on DNP Project guidelines, revisions completed by 05/09/21 ).
	05/05/21	66	Met with the primary care provider at the affiliation site to provide overview and update on the status of DNP project design and outcomes.
66h 30m	Discussed the project implementation plan and outcome plan with the preceptor Tara Gilles, DNP, APRN, FNP-BC.
	05/06/21	9a-5p	73 30 m			A, B, C , E	Discussed project information with the patients that were scheduled in the clinic at the primary care doctor’s office (not current workplace). Discussed the project information and explained that the option of face to face and or via Zoom meeting. Three patients met inclusion criteria and the total seminar took 2 hours. The time in between the full day of seminar included answering questions and recruiting patients that were in the clinic the same day. There were 19 patients scheduled for the nurse practitioner and the primary care physician. Eight patients met inclusion criteria. The project leader (PL) presented to each room of the patients that met criteria and provided information regarding the educational program that the PL was going to present. Two patients agreed to schedule an appointment. The patients data pretest and posttest questionnaires were analyzed and inputted into Excel for documentation.
6p-7:30p	1h 30 m	75	Making additional copies of the pretest, posttest, and flyers for the front office staff. Called the preceptor to arrange a time to discuss the project status. Touched based with the office manager to arrange an appointment with the stakeholders.
05/08/21	4p-10p				6	81	Researched additional journals and prepared the information to reinforce the literature review.
05/09/21		6p-11p	86	The journals previously reviewed were formatted/written and summarized into chapters 1 & 2 of the evidence-based practice change project.
	05/11/21	9p-4p	93	Reviewed the patients in the EMR system that were presented to the clinic that day and reviewed all patient who met criteria. Eight patients met criteria; the primary care provider (PCP) was informed of the eligible patients. Two scheduled participants were seen by the PL via Zoom and two patients were seen in person for a total of 2 hours and 40 minutes. The rest of the hours were to analyze the data (pretest and posttest surveys), input it into an Excel spreadsheet and discuss the project with the eight patients that met criteria that day. Each patients’ data/surveys took 15 minutes to review for a total of one hour. Spoke with eight patients that were scheduled in the clinic the same day which took ten minutes to speak to each. The rest of the time was utilized for data entry and to prepare for the next seminar. The preparation included reviewing the EMR charts and scheduling appointments.
93h 30m	Presented post-intervention data and clinical application recommendations to preceptor.
05/12/21	9a-4p	100h 30m	(Full day seminar) Phone calls were made post two-week intervention and to the patients that met inclusion criteria on the days the PL was not in the clinic. The list of interested patients was provided by the front desk staff. The four participants that received the educational session took approximately 15 minutes each for a total of 1 hour. There were eleven patients on the interested list. All patients were called, seven patients answered and received a verbal short education and appointments were arranged. The rest of the patients received voicemails. The total time for these calls were 2 hours. The rest of the time was to analyze the data and typing a one-page update to the preceptor per her request.
05/16/21	7p-12a	105 h 30m	Wrote/submitted Chapters 3-5 drafts of the evidence-based change project for review. DNP Project (includes preparation, revisions to proposal paper based on DNP Project guidelines, revisions completed by 05/16/21).
05/17/21	11a-3p	109h 30m	Received feedback from chapters 1-2 from the professor. The chapters were reviewed, and the revisions were discussed with the preceptor who provided guidance over the phone. Started the corrections of chapters 1-2 during this time.
05/18/21	116h 30m	A follow-up phone call was made within two weeks after the second educational session to answer questions and to collect intent or action on CRC testing (this ranged from a five-minute phone call to 30 minutes, depending on the participants responses). Each new participant reminded of the project, and its outcomes. They also were told to report intent for screening. The completed forms were collected and charted in Microsoft Excel for documentation and data that will be used later. Ongoing communication amongst the team and their insight about the project and participants.   Touched base with staff to answer questions.
05/19/21	1p-6p	12 1h 30m	Participants who already gave verbal consent arrived at the clinic. Each participant was taken into the small conference room for privacy. While in the room, the patient filed out the pretest survey and the educational session began right after. Each participant reminded of the project, and its outcomes. The completed pretest and posttest forms were collected and charted in Microsoft Excel for documentation and data that will be used later. A total of 2 patients were seen via zoom and two patients who met criteria were seen face to face for a total of 2 hours and 40 min. The rest of the time was spent to review and input the data in excel spreadsheet.
05/20/21	9a-10am	122h 30m	Three participants were called after their educational sessions that occurred two weeks prior. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing (these calls took 30 minutes each).
	05/24/21	11a-12p	123h 30m	Received feed from chapters 3-5 from the professor. The chapters were reviewed, and the revisions were discussed with the preceptor who provided guidance over the phone.
7p-8:30p	1h 30m	125	Verification of data for post-intervention prospective cohort of participants
05/25/21	9a-3p	131	14 patients were approved and screened. Three patients agreed to participate the same day. Three patients were educated face-to-face including the educational sessions, pre/posttest questions answered. The total time was 3 hours and 20 minutes. The time in between the full day of seminars included answering questions and recruiting patients that were in the clinic the same day and the information was analyzed and inputted into Excel for documentation.
05/26/21	12p-2:20p	2 h 20 m	133h 20m	Four participants were called after their educational sessions that occurred two weeks prior. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing (these calls took 20 minutes for 4 patients and 30 minutes for two participants who needed questions answered).
05/30/21	5p-10p	138h 20m	Wrote/submitted the final Chapters 1-5 of the evidence-based change project for review. DNP Project (revisions from the professor and based on DNP Project guidelines, revisions completed by 05/30/21).
06/01/21		7p-8p	139h 20m	A, B, C, D	Completed a thorough review of the two outcomes and reviewed the data already collected with the preceptor.
06/02/21	10a-3p	144h 20m	A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing. 4 patients were called to discuss intent for screening. Each new participant reminded of the project, and its outcomes. They also were told to report intent for screening. The completed forms were collected and charted in Microsoft Excel for documentation and data that will be used later. Ongoing communication amongst the team and their insight about the project and participants. Eight patients were called the same time for a total of 2 hours. The rest of the time was spent reviewing the Care Cloud system for eligible patients that were coming that day. 12 patients were seen in the office individually and consented to the educational session. Two of the patients agreed to the seminar the same day for a total of 1 hour and 20 minutes.
06/03/21	8a-9:40a	1h 40 m	146	Four participants were called after their educational sessions that occurred on 05/19/21. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing.

7p-8p

x

1

H

06/04/21

8a-9a

x

1

H

	06/04/21	147	A one-page project status update was written and submitted for review on 06/06/21.
148	Meeting over the phone with DNP preceptor, Dr. Tara Gilles. Submitted chapters 1-5 for her to review.

x

6

x

A, B, E

x

A, B, E

x

5

A, B

6p-11p

x

5

H

x

1

A, B, C

06/15/21

x

6

A, B, C

x

1

H

x

30m

A, B, C

06/4/21	10a-4p	154		A, B	A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing. 4 patients were called to discuss intent for screening, this took 1 hour. 20 patients were approached and screened: 9 patients that were in clinic were eligible; two agreed to participate in the project and education was given. This took approximately 1hour and 40 min. Spent 1 hour discussing the project with the stakeholders regarding the need for additional participants. The two additional hours were spent reviewing the pretest and posttest scores and inputting the data in the Excel Spreadsheet.
06/05/21	8:30a-9a	20 m	154h 20m	Made additional copies of patient Information and surveys.
06/07/21	5-5:40m	40m	155	The time spent was storing the data and scheduling appointments with the potential participants.
06/08/21	8a-1p	160	The rest of the hours were to analyze the data (pretest and posttest surveys), input it into an Excel spreadsheet and discuss the project with the eight patients that met criteria that day. Each patients’ data/surveys took 15 minutes to review for a total of one hour. Spoke with 13 patients that were scheduled in the clinic the same day which took ten minutes to speak to each. The rest of the time was utilized for data entry and to prepare for the next seminar. The preparation included reviewing the EMR charts and scheduling appointments. A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing on two participants that were seen on 06/02/21.
06/11/21	165	Wrote/submitted the final Chapters 6-7 of the evidence-based change project for review. Chapters 6 & 7 Analyzed numerical findings from data analysis to summarize in paragraph/word format.
	06/15/21	7a-8a	166	Presented findings to the medical director via phone call.
8a-2	172	Full day seminar- 2 patients were called to discuss intent for screening, this took 40 min. 18 patients were approached and screened: six patients that were in clinic were eligible; three agreed to participate in the project and education was given. This took approximately 2 hours. Received a call at the practicum site from one of the patients that wanted a family member to be included in the project. The participant wanted a zoom call; thus, the zoom call took extra time as the family member wanted to explain the educational session themselves; despite of the PL speaking the language- this call took 1 hour and 20 min. The two additional hours were spent reviewing the pretest and posttest scores and inputting the data in the Excel Spreadsheet
06/24/21	5p-6p	173	The office manager wanted to discuss the progress of the project. According to the staff and manager, the medical director is pleased with the receptive participants and is interested in the implementation of the educational program by the providers who work in his office.
06/25/21	9a-9:30	173h 30m	1 patient was called to discuss intent for screening from the educational session from 06/04/21, this took 30 min to discuss as the participant wanted additional education regarding screening options.
07/29/21	250	G, H, I	Results shared with the facility staff and questions answered

Student: ___Daniela Londono_______________ Course: __NUR799__________________ Semester: ____Summer________

Student: __Daniela Londono_____________ Course: ________NUR799____ Semester: __Summer____________

DNP PE Log Template-Categories by Course_2020_07 3

MR 2.1.2018; MR 2.7.2018; MR 3.26.2018; GM 3.27.2018

DNP Practice Experience Log

By signing below, you are verifying that the information on this document is accurate and complete. The student has completed the required amount of hours in accordance to the Practice Experience Guidelines and the Student-Preceptor Agreement.

PE Log First Submission

Student Printed Name: __Daniela Londono_________________________________________________

Signature: _______Daniela Londono____________________________________ Date: ___06/06/21______

Preceptor Printed Name: _____Tara Gilles DNP, APRN, FNP-BC_______________________

Signature: _____Tara Gilles DNP, APR, FNP-BC________________________________________________________ Date: __06/06/21________

Do you want to request a conference call with the faculty? YES____ NO__x___ Preceptor Phone No.: _______________________

Notes (if applicable): ____________________________________________________________________________________________________________

PE Log Second/Final Submission

Student Printed Name: ___________________________________________________

Student Signature: ______________________________________________________ Date: ___________

Preceptor Printed Name: _________________________________________________

Preceptor Signature: _____________________________________________________ Date: ___________

Do you want to request a conference call with the faculty? YES____ NO_____ Preceptor Phone No.: ________________________

Notes (if applicable): ____________________________________________________________________________________________________________

Faculty Printed Name: ___________________________________________________

Faculty Signature: _______________________________________________________ Date: ___________

Total Number of Practice Hours Completed: _____________

DNP PE Log Template-Categories by Course_2020_07 4

Student: _____

D

aniela Londono_____________

C

ourse: ______NUR

7

9

9______________ Semester: ____Summer________

E

ach DNP Student is required to complete a minimum of

1

2

5

hours in NUR 702, a minimum of

125

hours in NUR 70

4

and a minimum of 250 hours in NUR 799. Students will maintain a different log for each course.

A

ll completed practice e

x

perience (PE) hours must be typed in the Microsoft Word Table (page

3

), adding additional lines as needed. Students should designate the corresponding letter of the PE Category Type (per the appropriate course table below) and record a detailed narrative for each entry.

Approved DNP Practice Experience Categories by Course

I

. Course – NUR702

Problem Identification

Problem Identification

Literature Review

Literature Review

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

Problem Identification

A

Collaborating with experts in practice to identify a clinical problem.

I, V I

1, 2, 6

B

Applying advanced communication skills to identify a quality improvement initiative in a health care setting.

II

7

C

Analyzing health care data to identify gaps of care for individuals, aggregates, or populations.

VII

4

Literature Review

D

Engaging in scholarly inquiry to develop a PICO question.

I

2, 6

E

Engaging in scholarly inquiry to identify evidence-based practice to utilize to improve patient outcomes.

I, III

2, 3, 6

F

Collaborating with experts in practice using analytic methods to critically appraise research to determine best evidence for practice.

II, III, VI

1, 3, 7

Advanced Nursing Practice

G

Attending a conference to gain insight on evidence-based practice in relation to identified clinical problem (possible activity for Essential VIII ).

VIII

5

II. Course – NUR704

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

A

II

7

Project Planning [Assessments]

B

Project Planning [Assessments]

C

VII

4

Project Planning [Assessments]

D

I

2, 6

Project Planning [Assessments]

Employing principles of health policy to develop effective plans for a practice-level change to improve quality of care.

Employing leadership skills within interprofessional teams to analyze organizational issues.

VI

1

Evaluating a care delivery model to identify gaps of care for individuals, aggregates or populations.

Using analytical skills to assess the relationships among practice, process, fiscal, and policy issues at an organization.

V, VIII

5, 9

Project Design

E

Integrating theory into practice through the development of a quality improvement project.

III. Course – NUR704 (continued)

Project Design

F

Project Design

G

Advanced Nursing Practice

VIII

5

Applying findings generated through scholarly inquiry to design a quality improvement project.

III

3

Designing an evaluative plan to monitor outcomes of a quality improvement project through the use of health care information systems.

III, IV

3, 8

H

Attending a conference in relation to identified clinical problem to gain insight on how to inform practice decisions and support the understanding of patient care consequences (possible activity for Essential VIII).

IV. Course – NUR799

Description of Course Outcome

Category Type

Description of Category

DNP Essential

DNP Program Outcome

A

III

3

Project Implementation

B

II

7

Project Implementation

C

D

VIII

5

Project Implementation

E

VIII

5

F

G

V

9

Project Dissemination

H

III

3

Advanced Nursing Practice

I

VIII

5

			Project Implementation	Functioning as a practice specialist through the implementation of a quality improvement project.
Applying advanced communication skills to lead a quality improvement initiative in a health care setting.
Providing leadership to influence health policy within the health care system through demonstrating evidence-based practice.		V		9
Project Implementation	Mentoring health care professionals to enhance patient outcomes through the use of evidence-based practice.
Educating health care professionals regarding the transitioning to evidence based practice.
Project Evaluation	Demonstrating advanced levels of clinical judgement through the evaluation of evidence-based initiatives to improve patient outcomes.	IV, VIII	5, 8
	Project Dissemination	Providing leadership to influence health policy within the health care system through the dissemination of findings from quality improvement project.
Functioning as a practice specialist through the dissemination of findings from quality improvement project.
Attending a conference to disseminate findings from quality improvement project to facilitate optimal care and patient outcomes across diverse settings (possible activity for Essential VIII).

DNP Practice Experience Log

DNP PE Log Template-Categories by Course_2020_07 2

DNP Practice Experience Log

10 min

A

x

A

*02/28/21

x

7

A

x

I

x

A

x

x

A

x

A

x

A

x

1

A

x

1

A

x

D

x

3

B

8a-10a

x

2

D

x

1

Date *Post 704

Start Time – End Time

On- Site

Off- Site

Daily Hours Accumulated

Cumulative Hours

PE Category Type

Practice Experience Activity – Narrative

*01/18/21

7p-7:10p

x

10 min

Contacted the IRB advisor via Chatham email

*02/01/21-

*02/ 28 /21

5p-11p

6

6h 10m

An IRB exempt form submission was initiated via Cayuse. All the required fields and categories were inputted electronically. The research plan, procedures, list of materials, were described and the cover letter were attached. The IRB reliance agreement and the site permission was attached. The main study design and the pretest and posttest was attached in English and Spanish. The recruitment, data collection, storage and release were described and inputted. The consent, risk and benefits and additional documents were attached for IRB review.

8a-3p

13h 10m

Received feedback from the IRB advisor regarding the submitted IRB Exempt documents and electronic form. On 02/28/21, all the corrections were reviewed and revised. The clinical site was contacted on the same day to request the permission letter to attach to Cayuse.

*02/27/21

9am-3pm

6 hours

19h 10m

Attended a national conference: 2021 ACG/FGS Virtual Annual Spring Symposium about current issue facing the industry regarding colorectal cancer, discussed the risk factors, the options for screenings and background.

*03/02/21 *03/03/21

8:32pm-9:32p 7:00p-8:00p

1 1

21 hr 10m

Received multiple emails from the IRB advisor regarding the additional corrections that were needed. The documents and corrections were reviewed and revised in Cayuse. An email from manager at the clinical site was received with the permission form. The form was attached to Cayuse for review. On 03/03/21, the IRB advisor and the project leader (PL) both certified the submission.

*03/23/21

9p-9:10p

10m

21h 20m

Approval from the IRB was obtained.

*04/12/21

8a-2 p

6h 40m

28

Reviewed the Residency Poster Presentation guidelines in the Nursing Student site. After thorough review of the guidelines, the poster presentation was developed. Scholarly inquiry review to identify published evidence on clinical problem, background, literature review summary. The additional information included the implementation steps, timeline, outcomes, plans for dissemination.

*04/19/21

11a-4:30p

5hr 30 min

33h 30m

Participated in DNP residency and scholarly exchange with peers and faculty. The presentations were broken down into small groups and all questions were answered regarding the future implementation of the projects and information regarding the start of NUR799.

*04/23/21 Comment by Nicole Hoh: Typo?

8a-8:30a

30 min

34

Prepared a summary of key items and list of activities that were needed and could be addressed prior to presenting to the clinical site (site is different from current workplace).

*04/21/21

8:30a-9:30a

35

Attended a scheduled phone meeting with the preceptor. Prior to the meeting, the preceptor had received and reviewed the pre/posttest questionnaire, cover letters, site permission form, flyers, bilingual telephone scripts and all questions were answered prior to presenting to the clinical site.

*4/21/21

9:30a-10:30a

36

Collaborated with the office manager at Alvior Medical Clinic to retrieve specific report of patient data for prospective review data organization.

*04/22/21

8a-10a

2

38

Presented to the clinical site (different from current workplace) and met with the medical director and the office manager to discuss the plan for the implementation, all the materials were reviewed in the conference room. Met with the office staff to review and educate on the flyers, cover letters, inclusion and exclusion criteria and discussed verbal consent will be needed prior to the start of the educational program. All questions were answered. DNP Project preparation of materials: making copies of patient education handouts and staff instructions.

*4/22/21

8p-11p

41

Prepared the PowerPoint presentation for the educational sessions regarding colorectal cancer amongst Hispanics. The educational session covered statistics, warning signs of colon cancer, the signs and symptoms, screening age, preventative measures, and screening options.

*04/23/21

43

Met with the medical director to discuss findings from initial scholarly inquiry and provide update on gap in care to identify the best evidence of clinical solutions to advance practices as it related to improving colorectal knowledge and screening amongst Hispanics.

04/26/21 Week 1

8a-9a

44

A, B , C

Recruitment began by placing flyers in the waiting area and exam rooms. Verbal consent has been obtained by PL of four patient who meet the inclusion criteria. How many patients did you screen?

8a-3p

x

8a-9a

x

1

x

C

05/03/21

x

30m

A

x

8

04/29/21		8	52		A, B, D	Four participants who already gave verbal consent were approached and screened. All four participants agreed to participate in the educational program face-to-face. Prior to each patient arriving, from 8am-8:30 the PL called the patients to confirm the appointment times that day. The first patient arrived and was taken into the small conference room for privacy. While in the room, the patient filed out the pretest survey that took 10 minutes and the educational session began right after ( 20 m inutes). Each participant was reminded of the project, and its outcomes. The patient completed a 10-minute posttest. Four participants were educated throughout the day for a total of 40 minutes each = 2.40 hours. During each break between the participants, the information was analyzed and inputted into Excel for documentation. The primary care provider provided approval to review all the patients that were presenting to the clinic that day that met criteria. 25 charts were reviewed, and 10 patients met criteria. All the patients were seen by the PL to receive verbal consent and to schedule either a zoom meeting and or a face-to-face educational session. Comment by Nicole Hoh: If they already gave verbal consent, weren’t they already approached and screened? Or do you mean something different by gave verbal consent… to learn more about the projets I agree to take part in the project?
04/30/21	53						A, B, E	Touched based with the office staff to discuss recruiting process and to answer all questions regarding verbal consent.
	05/03/21	7:30a-8a					30m	53h 30m	Meeting Dr. Jonathan Alvior to discuss statistical analysis plan for data.
		7p-7:30p	54	Updated the preceptor regarding the implementation plan.
05/04/21	8a-4p	62	A, C, D	12 patients were approached and screened: 4 were eligible; 2 agreed the same day to participate in the project and education was given.  (Not current workplace; full day seminar). Two patients agreed to participate in the project the same day and two patients were schedule for a later time for a Zoom meeting. Two patients were educated face-to-face including the educational sessions, pre/posttest questions answered. The total time was 1 hour and 20 minutes. The time in between the full day of seminars included answering questions and recruiting patients that were in the clinic the same day and the information was analyzed and inputted into Excel for documentation. The clinics database was accessed and reviewed. Inclusion and exclusion criteria were reviewed, and patients were chosen. All the participants were reviewed and discussed with the medical director prior to approaching the patients on the following seminar day.

8p-11p

x

3

H

8:30a-9:30a

x

1

B

05/05/21

7p-7:30p

x

30m

B

x

7

05/06/21

x

H

x

A, B, C

x

5

A, B, C

x

7

A, B, C, E

05/11/21

7p-7:30p

x

30m

B

x

7

A, B, D

x

5

H

x

4

H

8a-3p

x

7

A, B, E

x

5

A, B, C, E

x

1

A, B, C

x

1

H

05/24/21

x

H

x

6

A, B, E

x

A, B, C

x

5

H

x

1

x

5

A, B, E

x

A, B, C

05/04/21	65	Wrote/submitted Chapter 1-2 drafts of the evidence-based change project. DNP Project (includes preparation, revisions to proposal paper based on DNP Project guidelines, revisions completed by 05/09/21 ). Comment by Nicole Hoh: Say something like: Refreshed and updated current statistics regarding the problem of CRC and literature review on culturally based health education to underserved populations.
	05/05/21	66	Met with the primary care provider at the affiliation site to provide overview and update on the status of DNP project design and outcomes.
66h 30m	Discussed the project implementation plan and outcome plan with the preceptor Tara Gilles, DNP, APRN, FNP-BC.
	05/06/21	9a-5p	73 30 m			A, B, C , E	Discussed project information with the patients that were scheduled in the clinic at the primary care doctor’s office (not current workplace). Discussed the project information and explained that the option of face to face and or via Zoom meeting. Three patients met inclusion criteria and the total seminar took 2 hours. The time in between the full day of seminar included answering questions and recruiting patients that were in the clinic the same day. There were 19 patients scheduled for the nurse practitioner and the primary care physician. Eight patients met inclusion criteria. The project leader (PL) presented to each room of the patients that met criteria and provided information regarding the educational program that the PL was going to present. Two patients agreed to schedule an appointment. The patients data pretest and posttest questionnaires were analyzed and inputted into Excel for documentation.
6p-7:30p	1h 30 m	75	Making additional copies of the pretest, posttest, and flyers for the front office staff. Called the preceptor to arrange a time to discuss the project status. Touched based with the office manager to arrange an appointment with the stakeholders.
05/08/21	4p-10p				6	81	Continue to Researched additional journals and prepared the information to reinforce the literature review. Key terms?
05/09/21		6p-11p	86	The journals previously reviewed were formatted/written and summarized into chapters 1 & 2 of the evidence-based practice change project.for dissemination.
	05/11/21	9p-4p	93	Reviewed the patients in the EMR system that were presented to the clinic that day and reviewed all patient who met criteria. Eight patients met criteria; the primary care provider (PCP) was informed of the eligible patients. Two scheduled participants were seen by the PL via Zoom and two patients were seen in person for a total of 2 hours and 40 minutes. The rest of the hours were to analyze the data (pretest and posttest surveys), input it into an Excel spreadsheet and discuss the project with the eight patients that met criteria that day. Each patients’ data/surveys took 15 minutes to review for a total of one hour. Spoke with eight patients that were scheduled in the clinic the same day which took ten minutes to speak to each. The rest of the time was utilized for data entry and to prepare for the next seminar. The preparation included reviewing the EMR charts and scheduling appointments.
93h 30m	Presented post-intervention data and clinical application recommendations to preceptor.
05/12/21	9a-4p	100h 30m	(Full day seminar) Phone calls were made post two-week intervention and to the patients that met inclusion criteria on the days the PL was not in the clinic. The list of interested patients was provided by the front desk staff. The four participants that received the educational session took approximately 15 minutes each for a total of 1 hour. There were eleven patients on the interested list. All patients were called, seven patients answered and received a verbal short education and appointments were arranged. The rest of the patients received voicemails. The total time for these calls were 2 hours. The rest of the time was to analyze the data and typing a one-page update to the preceptor per her request.
05/16/21	7p-12a	105 h 30m	Wrote/submitted Chapters 3-5 drafts of the evidence-based change project for review. DNP Project (includes preparation, revisions to proposal paper based on DNP Project guidelines, revisions completed by 05/16/21).Changed the theoretical underpinning of the intervention to align with the Watson Theory of Human Caring. Researched extensively on the use of Watson theory with providing care for diverse and vulnerable populations. Summarized the perspective for dissemination.
05/17/21	11a-3p	109h 30m	Received feedback from chapters 1-2 from the professor. The chapters were reviewed, and the revisions were discussed with the preceptor who provided guidance over the phone. Started the corrections of chapters 1-2 during this time.Worked with Faculty and Preceptor to utilize feedback to improve communication and dissemination of the project purpose and literature review.
05/18/21	116h 30m	A follow-up phone call was made within two weeks after the second educational session to answer questions and to collect intent or action on CRC testing (this ranged from a five-minute phone call to 30 minutes, depending on the participants responses). Each new participant reminded of the project, and its outcomes. They also were told to report intent for screening. The completed forms were collected and charted in Microsoft Excel for documentation and data that will be used later. Ongoing communication amongst the team and their insight about the project and participants.   Touched base with staff to answer questions.
05/19/21	1p-6p	12 1h 30m	Participants who already gave verbal consent arrived at the clinic. Each participant was taken into the small conference room for privacy. While in the room, the patient filed out the pretest survey and the educational session began right after. Each participant reminded of the project, and its outcomes. The completed pretest and posttest forms were collected and charted in Microsoft Excel for documentation and data that will be used later. A total of 2 patients were seen via zoom and two patients who met criteria were seen face to face for a total of 2 hours and 40 min. The rest of the time was spent to review and input the data in excel spreadsheet.
05/20/21	9a-10am	122h 30m	Three participants were called after their educational sessions that occurred two weeks prior. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing (these calls took 30 minutes each).
	05/24/21	11a-12p	123h 30m	Worked with Faculty and Preceptor to utilize feedback to improve communication and dissemination of the project theoretical foundations, project management including SWOT analysis and refining the methodology of the project in preparation for dissemination.Received feed from chapters 3-5 from the professor. The chapters were reviewed, and the revisions were discussed with the preceptor who provided guidance over the phone.
7p-8:30p	1h 30m	125	Verification of data for post-intervention prospective cohort of participants
05/25/21	9a-3p	131	14 patients were approved and screened. Three patients agreed to participate the same day. Three patients were educated face-to-face including the educational sessions, pre/posttest questions answered. The total time was 3 hours and 20 minutes. The time in between the full day of seminars included answering questions and recruiting patients that were in the clinic the same day and the information was analyzed and inputted into Excel for documentation.
05/26/21	12p-2:20p	2 h 20 m	133h 20m	Four participants were called after their educational sessions that occurred two weeks prior. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing (these calls took 20 minutes for 4 patients and 30 minutes for two participants who needed questions answered).
05/30/21	5p-10p	138h 20m	Wrote/submitted the final Chapters 1-5 of the evidence-based change project for review. DNP Project (revisions from the professor and based on DNP Project guidelines, revisions completed by 05/30/21).Continue to refine project problem, literature review, theorical underpinnings, and project management and design for dissemination to faculty and peers.
06/01/21		7p-8p	139h 20m	A, B, C, D	Completed a thorough review of the two outcomes and reviewed the data already collected with the preceptor.
06/02/21	10a-3p	144h 20m	A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing. 4 patients were called to discuss intent for screening. Each new participant reminded of the project, and its outcomes. They also were told to report intent for screening. The completed forms were collected and charted in Microsoft Excel for documentation and data that will be used later. Ongoing communication amongst the team and their insight about the project and participants. Eight patients were called the same time for a total of 2 hours. The rest of the time was spent reviewing the Care Cloud system for eligible patients that were coming that day. 12 patients were seen in the office individually and consented to the educational session. Two of the patients agreed to the seminar the same day for a total of 1 hour and 20 minutes.
06/03/21	8a-9:40a	1h 40 m	146	Four participants were called after their educational sessions that occurred on 05/19/21. The follow-up phone call was made to answer questions and to collect intent or action on CRC testing.

7p-8p

x

1

H

06/04/21

8a-9a

x

1

H

	06/04/21	147	A one-page project status update was written and submitted for review on 06/06/21.
148	Meeting over the phone with DNP preceptor, Dr. Tara Gilles. Submitted chapters 1-5 for her to review.

x

6

x

A, B, E

x

A, B, E

x

5

A, B

6p-11p

x

5

H

x

1

A, B, C

06/15/21

x

6

A, B, C

x

1

H

x

30m

A, B, C

06/4/21	10a-4p	154		A, B	A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing. 4 patients were called to discuss intent for screening, this took 1 hour. 20 patients were approached and screened: 9 patients that were in clinic were eligible; two agreed to participate in the project and education was given. This took approximately 1hour and 40 min. Spent 1 hour discussing the project with the stakeholders regarding the need for additional participants. The two additional hours were spent reviewing the pretest and posttest scores and inputting the data in the Excel Spreadsheet.
06/05/21	8:30a-9a	20 m	154h 20m	Made additional copies of patient Information and surveys.
06/07/21	5-5:40m	40m	155	The time spent was storing the data and scheduling appointments with the potential participants.
06/08/21	8a-1p	160	The rest of the hours were to analyze the data (pretest and posttest surveys), input it into an Excel spreadsheet and discuss the project with the eight patients that met criteria that day. Each patients’ data/surveys took 15 minutes to review for a total of one hour. Spoke with 13 patients that were scheduled in the clinic the same day which took ten minutes to speak to each. The rest of the time was utilized for data entry and to prepare for the next seminar. The preparation included reviewing the EMR charts and scheduling appointments. A follow-up phone call was made within two weeks after the educational session to answer questions and to collect intent or action on CRC testing on two participants that were seen on 06/02/21.
06/11/21	165	Wrote/submitted the final Chapters 6-7 of the evidence-based change project for review. Chapters 6 & 7Prepared and initial draft of the revisions to project design in response to the needs for variations and troubleshooting obstacles. Verified data analysis, prepared tables and figures for dissemination to faculty and peers . Analyzed numerical findings from data analysis to summarize in paragraph/word format.
	06/15/21	7a-8a	166	Presented findings to the medical director via phone call.
8a-2	172	Full day seminar- 2 patients were called to discuss intent for screening, this took 40 min. 18 patients were approached and screened: six patients that were in clinic were eligible; three agreed to participate in the project and education was given. This took approximately 2 hours. Received a call at the practicum site from one of the patients that wanted a family member to be included in the project. The participant wanted a zoom call; thus, the zoom call took extra time as the family member wanted to explain the educational session themselves; despite of the PL speaking the language- this call took 1 hour and 20 min. The two additional hours were spent reviewing the pretest and posttest scores and inputting the data in the Excel Spreadsheet
06/24/21	5p-6p	173	The office manager wanted to discuss the progress of the project. According to the staff and manager, the medical director is pleased with the receptive participants and is interested in the implementation of the educational program by the providers who work in his office.
06/25/21	9a-9:30	173h 30m	1 patient was called to discuss intent for screening from the educational session from 06/04/21, this took 30 min to discuss as the participant wanted additional education regarding screening options.

Student: ___Daniela Londono_______________ Course: __NUR799__________________ Semester: ____Summer________

Student: __Daniela Londono_____________ Course: ________NUR799____ Semester: __Summer____________

DNP PE Log Template-Categories by Course_2020_07 3

MR 2.1.2018; MR 2.7.2018; MR 3.26.2018; GM 3.27.2018

DNP Practice Experience Log

By signing below, you are verifying that the information on this document is accurate and complete. The student has completed the required amount of hours in accordance to the Practice Experience Guidelines and the Student-Preceptor Agreement.

PE Log First Submission

Student Printed Name: __Daniela Londono_________________________________________________

Signature: _______Daniela Londono____________________________________ Date: ___06/06/21______

Preceptor Printed Name: _____Tara Gilles DNP, APRN, FNP-BC_______________________

Signature: _____Tara Gilles DNP, APR, FNP-BC________________________________________________________ Date: __06/06/21________

Do you want to request a conference call with the faculty? YES____ NO__x___ Preceptor Phone No.: _______________________

Notes (if applicable): ____________________________________________________________________________________________________________

PE Log Second/Final Submission

Student Printed Name: ___________________________________________________

Student Signature: ______________________________________________________ Date: ___________

Preceptor Printed Name: _________________________________________________

Preceptor Signature: _____________________________________________________ Date: ___________

Do you want to request a conference call with the faculty? YES____ NO_____ Preceptor Phone No.: ________________________

Notes (if applicable): ____________________________________________________________________________________________________________

Faculty Printed Name: ___________________________________________________

Faculty Signature: _______________________________________________________ Date: ___________

Total Number of Practice Hours Completed: _____________

DNP PE Log Template-Categories by Course_2020_07 4

IMPLEMENTATIONOF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CANCER KNOWLEDGE AMONG HISPANICS

by

Capstone Paper submitted in partial fulfillment of the

requirements for the degree of

Doctor of Nursing Practice

June 03,

2

021

Signature Faculty Reader Date

Signature Program Director Date

Acknowledgments

Abstract

Start typing here…

.

Key words:

2

Table of Contents

Acknowledgments X

Abstract X

Chapter One: Overview of the Problem of Interest X

Background Information X

Significance of the Problem X

Question Guiding Inquiry (PICO) X

Variables of the PICO question X

Summary X

Chapter Two: Review of the Literature/Evidence X

Methodology X

Sampling strategies X

Inclusion/Exclusion criteria X

Literature Review Findings X

Discussion X

Limitation of literature review. X

Conclusions of findings X

Potential practice change X

Summary X

Chapter Three: Theory and Model for Evidence-based Practice X

Theory X

Application to practice change X

Model for Evidence-Based Practice X

Application to practice change X
Summary X

Chapter Four:

Project Management X

Project Purpose X

Project Management X

Organizational Readiness for Change X

Inter-professional Collaboration X

Risk Management Assessment X

Organizational Approval Process X

Use of Information Technology X

Materials Needed for Project X

Plans for Institutional Review Board Approval X

Summary X

Chapter Five: Plan for Project Implementation…………………………………………….X

Planned Project………………………………………………………………………X

High Level Goals for Population Health……………………………………………X

Planned Outcomes…………………………………………………………………..X

Plan for Project Evaluation X

Plan for Demographic Data Collection X

Plan for Outcome Data Collection and Measurement X

Plan for Evaluation Tool X

Plan for Data Analysis X

Plan for Data Management X

Summary……………………………………………………………………………..X

Chapter Six: Actual Implementation Process

Setting X

Participants X

Recruitment X

Implementation Process X

Plan Variation X

Summary X

Chapter Seven: Evaluation and Outcomes of the Practice Change X

Participant Demographicsf X

Table or Figure X X

Table or Figure X X

Outcome Findings X

Outcome One X

Table or Figure X X

Table or Figure X X
Summary X

Chapter Eight: Discussion and Summary………………………………………………….X

Recommendations for Site to Sustain Change X

Plans for Dissemination of Project X

Project Links to Health Promotion/Population Health X

Role of DNP-Prepared Nurse Leader in EBP X

Future Projects Related to Problem X

Implications for Policy and Advocacy at All Levels X

Final Conclusions X

References X

Appendix A: XXXXXX X
Appendix B: XXXXXX X
Appendix C: XXXXXX X
Appendix D: XXXXXX X
Appendix E: XXXXXX X
Appendix F: XXXXXX X
Appendix G: XXXXXX X

Chapter One: Overview of the Problem of Interest

According to the Centers for Disease Control and Prevention (CDC, 2021), in 2017 approximately 141,425 Americans were diagnosed with colorectal cancer (CRC), making it the fourth-most prevalent type of cancer in the country (representing a rate of 36.8 diagnosis per 100,000 people). Among other cancers affecting adults, CRC was the third most common in the United States (US) and the second most diagnosed cancer among Hispanic adults. According to Brenner et al. (2016), CRC incidence and mortality rates in the US have declined since the 1980s, which is attributed to removal of rectal polyps, increased screening rates, and behavior modification, which address potential risk factors.

As Brenner et al. (2016) noted, increased screening rates are inversely correlated with CRC mortality and positively correlated with CRC detection, but the lower screening rates of Hispanics (Briant et al., 2018) have resulted in racial inequity in decline in CRC rates (Martinsen et al., 2016). Martinsen et al. noted that both Hispanics and non-Hispanic whites (NHWs) have experienced steadily declining mortality from CRC, but there is still a gap between these racial groups; Hispanic mortality from CRC is not declining as rapidly as NHW mortality from CRC (Barzi et al., 2017; Martinsen et al., 2016). Thus, the purpose of this EBP change project was to increase CRC awareness among Hispanic populations in both an urban and surrounding rural areas through education and screening in a primary care setting. The purpose of this chapter is to provide background information and explain the clinical significance of the problem. This chapter will also detail the PICO statement and its variables.

Background Information

Early CRC diagnosis and detection increase treatment success and survival outcomes. Underutilization of screening plays a significant role in staging and diagnosis of CRC, where the unscreened are at a higher risk of diagnosis in the advanced stages (Martinsen et al., 2016). Disparities in the rates of CRC screening and adherence to screening guidelines contribute to a slower decline in CRC incidence among Hispanics. Hispanics have not typically received linguistically, and culturally tailored interventions designed to encourage them to engage in CRC testing (Briant et al., 2018; Jackson et al., 2016; Martinsen et al., 2016), and it is likely that this gap in testing encouragement accounts for the slower rate (Barzi et al., 2017; Martinsen et al., 2016) of CRC decline among Hispanics in comparison to NHWs. As supported by Shokar et al. (2015), there are also more barriers for rural-dwelling Hispanics, such as long-distance traveling in search of care, inability to access PCPs and specialists, and lack of insurance. Those with a lower income and lower education levels will rarely follow the screening guidelines for CRC. Finally, the COVID pandemic disrupted routine processes of care for tens of millions of Americans (Moroni et al., 2020), meaning that CRC and other types of screening became even more challenging as Americans avoided non-COVID-related physician visits.

Hispanics represent one of the fastest-growing minorities in the US, responsible for 52% of US population growth from 2010 to 2019, growing by nearly 10 million people (Noe-Bustamante, 2020). According to the United States Census Bureau (USCB, 2020), the U.S. population is now 18.5% Hispanic, making Hispanics the largest ethnic minority group in the United States. Unfortunately, Hispanics also have higher metastatic CRC death rates when compared to NHWs (Barzi et al., 2017). Hispanics make up 45% of the population where the change project was implemented; however, no existing statistics track their CRC mortality and incidence rates on a racial basis. Such statistics could be extracted from records in compliance with HIPAA guidelines, but they do not currently exist.

The term Hispanic refers to an ethnicity that represents individuals sharing a common language (Spanish), originating from Spain or Latin America. Hispanics have roots in different countries sharing cultural, social, political, and economic practices (Arias et al., 2020). However, the Hispanic demographic is not homogeneous; the different ethnic groups under the Hispanic demographic label have different cultures, attitudes, and beliefs that influence health (Arias et al., 2020). For instance, Cuban Americans smoke at a higher rate than other communities, increasing their rates of cancer and other smoking-related illnesses (Briant et al., 2018). The prevalence of specific health conditions is influenced by various sub-group cultures within the Hispanic community. To increase screening and reduce mortality, it is important to identify the reasons Hispanics are less likely to be screened and address those root causes.

Significance of Clinical Problem

Reducing preventable deaths from cancer is a major public health goal (Briant et al., 2018). Hispanics represent nearly 1 in 5 Americans (USCB, 2020) and continue to have lower CRC screening rates than NHWs (Briant et al., 2018), leading a correspondingly slower level of decline in CRC-related mortality. While CRC-related mortality among non-Hispanic Whites decreased by 15.1% between 2000 and 2011, the decline was only 5.9% in Hispanic communities (Viramontes et al., 2020). Screening rates among Hispanics are also lower: 63.7% of Whites are up to date with CRC screening, compared to 47.4% for Hispanics. Decreased screening rates, leading to delayed diagnosis, contribute to higher metastatic CRC-related mortality among Hispanics (Viramontes et al., 2020). The problem is therefore a significant failure of public health and social equity with regards to a large sub-population in the United States.

Delayed diagnosis and detecting CRC in later stages has significant cost implications, both in terms of money spent on healthcare and lost income for patients. Present guidelines for 2020 Healthy People on adult percentage for individuals aged 50-75 years reveals that people who received screening for CRC is 70%. The national survey data indicates that the US is currently at 62 % (Briant et al., 2018). However, when this data is systematically analyzed by ethnicity/race, the disparities become so evident. Hispanic adult men and women (48.5%) rarely go for CRC screening in comparison to whites (63%) and Black Americans (60.5%). The rates are much lower among Spanish-speaking Hispanics (30.5%) and uninsured Hispanics (11%) (Bryant et al., 2018). Similarly, based on our facility’s statistics, there exist disparities in the incidence and mortality rates of CRC among ethnic and racial minority groups. CRC-related mortality and morbidity are even worse among ethnic and racial minority groups living in rural areas, more so Hispanics.

CRC is a significant cause of mortality among Hispanics in the US. It accounts for 22% of deaths among Hispanics who suffer a high burden of cancer compared to other ethnic minority groups. Research shows that a diagnosis of CRC among Hispanics has implications for patients, families, and the nation. According to the National Cancer Institute, the approximate direct medical and mortality costs and indirect morbidity costs of cancer in 2016 were more than $260 billion, and CRC constitutes more than 10% of this burden (Wittich et al., 2019). As more Hispanics get diagnosed in late stages and require more expensive treatment, it is expected that these costs will continue to increase. Evidence also suggests that the patient costs of treating CRC in a lifetime exceed $4,500. Today, apart from direct medical costs, these costs include travel and out-of-pocket expenses and time.

Other costs for Hispanic CRC patients and their families are emotional costs. Families and patients are at high risk of suffering from depression, anger, or anxiety. The complex nature of both conditions results in a very poor prognosis. Combining the financial and emotional costs reduces income for most patients already with a poor social-economic status. This has wide-ranging consequences, including an inability to meet financial commitments, reducing general spending in a household, and reduced income.

Question Guiding Inquiry (PICO)

Evidence-based practice (EBP) change is a systematic approach that uses problem-solving techniques and applies them to committed nursing practice. There are several steps to developing and implementing an EBP change project, including asking a PICO formatted question. PICO provides a framework for structuring a project idea, outlining the relevant variables – Population, Intervention, Comparison, and Outcome. By utilizing a PICO question, project managers and clinicians can recognize, create, and implement opportunities to translate valid research into practice. The PICO question also helps target the literature review at the most relevant sources.

Variables of the PICO Question

In a clinical setting, nurses and providers need to educate patients on CRC management and screening. Capturing opportunities to communicate and educate can provide patients with the highest quality of care, a wealth of information, and help establish positive patient outcomes regarding the need for screenings (Rice, 2013). The
population
for this EBP change project was Hispanic patients 45 years and older. The
interventions
consisted of Zoom meetings or face-to-face CRC education/counseling and telephone outreach. Also, this EBP project included a
comparison
the group’s pre-intervention scores with the post-intervention scores (Wang, Thrift, Zarrin-Khameh, Wichmann, Armstrong, Thompson & Musher, 2017). The expected
outcomes
were increased patient knowledge, a reduction in behaviors that were putting patients at a higher risk of developing colorectal cancer, and increased patient intent to get CRC screening (Rice, 2013). The PICO question identified for this literature review was: “For Hispanic adults in Tampa, Florida, what is the effect of the implementation of primary care-based education to promote Colorectal Cancer knowledge and screening rates after comparing one group’s pre-intervention with the post-intervention scores?”

Overview of the EBP Project

The population included Hispanic people aged 45-75 years old who were not up to date with colorectal cancer screening. The EBP change project was implemented in a geographic area with a population of 399,700 residents. The project aimed to increase CRC screening rates of Hispanics. The primary care clinic that serves this area has patient rooms and a lobby, which were used for recruitment by placing flyers in the rooms to inform patients of the CRC educational sessions being offered. Using Zoom and face-to-face interactions, the project manager (PM) conducted XX CRC education sessions with XX patients. Patients’ CRC knowledge and intent to screen before and after the educational session was evaluated.

Summary

This chapter introduced the problem identified for this EBP change project, the need to increase CRC screening rates among Hispanics. While CRC screening rates have increased in the US across demographic groups, the increase among Hispanics has been slower than among non-Hispanic Whites, potentially leading to increased risk of late-stage CRC diagnosis. Late-stage diagnosis is associated with increased mortality. To address this critical public health concern, this project provided a primary care based education intervention to increase patients’ CRC knowledge and intent to be screened, and to decrease risky behaviors. The next chapter will focus on literature review of primary-based education interventions that serve as the intervention for the PICO.

Chapter Two: Review of the Literature

Current studies reveal that Hispanics are at the highest risk of metastatic colorectal cancer (CRC)-associated morbidities and mortalities, due to high poverty rates, limited access to healthcare services, and low levels of literacy, particularly with respect to English-language materials (Martinsen et al., 2016). To address this health disparity, current evidence emphasizes that the most effective prevention approach that also improves health outcomes is to offer programs to create awareness and improve screening rates. Studies show that healthcare disparities that impede access to CRC awareness persist among Hispanics, so patient education targeted at this demographic group is needed to increase CRC screening. The purpose of this chapter is to explain the methodology used for the literature review and to highlight the most relevant findings, which were used to inform the evidence-based practice (EBP) change project.

Methodology

A comprehensive literature review was performed to inform an evidence-based intervention to increase CRC screening rates. Studies selected were based on a keyword search, age of the article, and inclusion and exclusion criteria, such as socioeconomic status, Hispanic demographic, and age of the participants; age of the articles; and language of publication.

Sampling Strategies

The databases used for this search were Cochrane and PubMed. The keywords selected were CRC education, CRC knowledge, CRC screening, and Hispanics. For a more refined search outcome, Boolean search operators ‘or’ and ‘and’ were used. A search of the Cochrane database resulted in four articles. Two of these articles were excluded since they focused on screening Hispanic community members for CRC, not providing an educational intervention. Another search in the PubMed database using the same keywords also employed the following filters: RCTs and systematic reviews published within the past 5 years in English. This search yielded 26 articles. A further search using ‘or’ and ‘and’ search operators, reduced the number of articles returned to eight.

The articles’ reference lists were searched for other potentially relevant articles. Additionally, a similar search strategy was used to obtain more articles from PubMed’s weekly search updates. The searches all focused on studies with both non-experimental and experimental designs with increased CRC screening rates and low CRC incidence as the primary outcome measures. The search also incorporated systematic reviews that were associated with early CRC screening through primary care-based education. All of the articles obtained were then assessed based on their relevance to the PICO question: “For Hispanic adults in Tampa, Florida, what is the effect of the implementation of primary care-based education to promote Colorectal Cancer knowledge and screening rates after comparing one group’s pre-intervention with the post-intervention scores?”

Inclusion/Exclusion Criteria

The overall search incorporated peer-reviewed articles published in English. The articles had either non-experimental or experimental designs, including RCTs and systematic reviews. The search was specific to articles whose primary intervention was to provide primary care-based education on CRC with improved knowledge on CRC and increased CRC screening rates as the primary outcome measures. Thus, the search excluded all articles published in languages other than English, articles published beyond the past five years, and those that discussed interventions other than educating communities on CRC.

Literature Review Findings

Early screening for CRC is essential for early detection and increased survival. Hispanics underutilize screening, which contributes to late-stage diagnosis. Based on the recommendations given by the United States Preventive Services Task Force, adults aged 50-75 years old should undergo CRC screening using fecal occult blood tests, colonoscopy, and sigmoidoscopy (Shokar, 2015). However, Hispanics are less likely to undergo screening due to limited health literacy and thus present with late-stage CRC. Additionally, disparities in access to healthcare and specialized services contribute to Hispanics’ lower rates of screening and must be considered in order to understand the many contextual factors that influence their health behaviors and decision-making. The literature review also considered patient education approaches that could inform this project’s model.

General Findings

Health Literacy. Low health literacy needs among Hispanics reduces awareness that CRC screening significantly decreases mortality rates. In some instances, individuals prefer not to know a diagnosis of CRC, indicating a need for enhanced communication strategies to discuss CRC disease and screening among Hispanics, such as using culturally tailored, salient, and relevant messages integrated into multi-component interventions (Wittich et al., 2019). The media is an influential tool to advocate for CRC screening, as it influences Hispanics’ decision to undergo screening (Wittich et al., 2019). These findings underscore the importance of clear, culturally tailored communication in improving patients’ health literacy and healthy behaviors. In the context of the practice site and setting, there is neither funding not precedent for conducting media outreach, but the lesson of culturally competent communication can still be learned and applied to the CRC screening needs, behaviors, and challenges of Hispanic patients.

Barriers to CRC Treatment. The management of local, regional, or distant colorectal cancer depends on the appropriate use of combined therapies. The management of local colon cancer involves surgical resection while that of regional colorectal cancer is adjuvant radiation and chemotherapy. For distant colorectal cancer, specialists use chemotherapy and only a fraction of patients undergoes extensive surgeries (Barzi et al., 2017). The gradual development of surgical techniques used in CRC has generally resulted in better outcomes. However, most Hispanics are uninsured and cannot access specialists, factors that contribute to slower declines in mortality rate (Barzi et al., 2017). Hispanics also experience delays in receiving adjuvant chemotherapy and this leads to reduced therapeutic benefits, especially in patients with regional colorectal cancer.

Transportation and healthcare accessibility also contribute to Hispanics’ difficulties with obtaining CRC screening and to reducing Hispanics’ CRC-related mortalities at a more rapid rate. For instance, patients whose colonoscopy is performed by a gastroenterologist have a lower risk of dying in comparison to those with colonoscopies done by primary care surgeons and physicians (Wittich et al., 2019). Another barrier is that of a lack of health insurance due to low income. In the Hispanic population, a low-income status is problematic since, to undergo screening for CRC, there are directly associated costs of screening and wages lost in time offs to undergo screening (Wittich et al., 2019). It is important to consider these well-documented barriers to treatment for the purposes of this project, since addressing these potential obstacles will help participants develop mitigation strategies, they can use to overcome the challenges.

Educational Programs to Raise CRC Awareness and Screening

Briant et al. (2018) designed and implemented an educational program designed to increase CRC awareness, self-screening rate, and knowledge among Hispanic adults. The authors drew a convenience sample of 101 Hispanic adults in rural Washington state, the majority of whom (69.3%) were female. With the assistance of a local cancer research center, Briant et al. implemented what they described as a promotor (the Spanish word for promoter) model in which the study subjects would receive CRC education from bilingual promotors’ in a convivial, discussion-based setting that also includes rich question-and-answer (Q&A) opportunities. Briant et al. found that actual usage of a self-screening CRC test that had already been available to study subjects before the start of the intervention increased from 52% to 80%, a relative increase of 53.8%. There were also statistically significant (at p < .001) increases in subjects’ screening awareness and screening knowledge, as well as, at p < .010, a significant increase in subjects’ intent to screen. Collectively, the findings of Briant et al.’s study suggest the efficacy of linguistically and culturally specific, community-level interventions to increase CRC screening, awareness, and knowledge among Hispanics in rural areas of the United States. Such interventions appear to require the institutional support of hospitals or clinics as well as the availability of bilingual experts who work within Hispanic communities to provide education as well as opportunities for discussion.

Briant et al. (2018) further contended that this educational program is particularly important because it will help solve the healthcare disparity that has excluded Hispanic adults residing in rural settings from early screening for CRC. By eliminating these persistent disparities in CRC screening, adults in rural areas will receive services at similar rates as their urban counterparts, thereby promoting the effective diagnosis of advanced CRC.

Cruz-Correa et al.’s (2016) Puerto Rican study triangulated the findings of Briant et al.’s (2018) study by emphasizing the relationship between knowledge, outreach, and CRC screening behaviors among Hispanic adults in the United States. First, Cruz-Correa et al. established that only slightly over half of the 301 Hispanics in their study who were over 50 years old (and thus in a high-risk category) had been screened for CRC. Moreover, Cruz-Correa et al. found that those older Hispanics who had not had a CRC screening were dissuaded by either a lack of information or not having had the issue brought up by their doctors. Briant et al. also found that a lack of information was the main factor in reduced CRC screening rates among Hispanic adults in rural Washington state; once such information was provided (in Spanish as well as in English) in a community-based setting that was culturally comfortable for participants, they spontaneously increased their screening behaviors. Although Cruz-Correa et al. measured screening intentions instead of actual screening behaviors, their findings triangulated those of Briant et al. in noting a statistically significant increase in the percentage of study subjects willing to undergo various forms of CRC screening. Cruz-Correa et al. offered participants the opportunity to select more than one form of CRC screening which they were likely to pursue in the wake of the intervention, and 77.7% of participants indicated that they would undertake a colonoscopy.

Dominic et al. (2020) have argued that it is not merely the provision of education (whether in English or Spanish) but also the presence of social support. Dominic et al. conducted a CRC screening promotion program targeted to Hispanic adults in rural Pennsylvania. Like Briant et al. (2018), but like Cruz-Correa et al. (2016), Dominic et al. were primarily interested in actual screening behavior—in particular, participants’ return or non-return of a take-home fecal immunochemical (FIT) test. Dominic et al. randomly assigned 108 of the studies 264 participants to a control group that was given a FIT kit and demo, an education session, and an educational brochure. The 156 members of the experimental group were given access to the exactly the same materials, with the only difference between the experimental and the control groups being that the experimental group participants were enrolled in a social support group that also contained a social pledge. Individuals in the experimental group who had come together (for example, spouses or siblings) were asked to sign a pledge indicating that they would help and encourage their loved one to take and return the FIT test. Individuals who came alone were asked to self-pledge, that is, to commit to giving themselves the test. Dominic et al. found that only 47.2% of the participants in the control group returned the FIT test, versus 66% of the individuals in the experimental group, and this difference was statistically significant at p < .001. A more explanatorily powerful statistic that the raw comparison of percentages was that of an odds ratio (OR). Dominic et al. reported an OR of 2.17, indicating that someone in the experimental group was 2.17 times more likely to return the FIT kit than someone in the control group (a statistically significant finding at p < .01). On the basis of this finding, Dominic et al. concluded that Hispanic adults in rural Pennsylvania—the setting for their study—require not only access to materials (including Spanish-language materials) but also social support as part of the encouragement framework for CRC screening.

Discussion

The literature review findings illustrate that Hispanics encounter multiple barriers to receiving CRC screening and treatment. An evidence-based practice change project that intends to increase CRC awareness and screening must take these barriers into account to help patients identify ways to overcome the challenges they face. Additionally, the literature review underscored that CRC education approaches increase Hispanics’ CRC knowledge and awareness which ultimately improves their screening rates. Among those already diagnosed with CRC, education promotes emotional and social support from close friends and family and promotes consistency and adherence to management. The findings also demonstrated several approaches to educating the population on CRC (e.g., TTT, community-based health promotors, and targeting rural patients) can effectively raise awareness and screening rates.

Limitations of Literature Review

A major limitation of this literature review is that most of its articles used a convenience sample and this may limit the generalizability of the findings to the wider Hispanic population. However, the articles included both urban and rural populations, which reflects the project site’s patient population, which consists of some urban- and some rural-dwelling Hispanic patients. The articles of Briant et al. (2018) and Dominic et al. (2020) sampled Hispanics from rural areas in the United States and reached statistically significant conclusions. Given that the practice setting (in Tampa, Florida) also serves many rural clients in addition to its urban client base, there is reason to believe that the findings from the literature—despite limitations—support the use of a culturally specific CRC promotion program at the practice site. Additionally, some of the studies used self-reported CRC screening measures, rather than through corroboration by medical records. Although this potentially increases the likelihood of bias, evidence suggests that CRC self-screening reports are a valid and reliable source.

Conclusion of Findings

These studies sought to establish whether education on CRC among Hispanics increases CRC knowledge, awareness, and screening rates, and what factors influence Hispanic populations’ knowledge and intent to screen. A significant finding was that health disparities influence CRC knowledge and screening among Hispanics. Studies highlighted the need to address cultural, socioeconomic, transportation, and language barriers that may decrease access to CRC education, screening, and treatment. The literature review demonstrated that integrating education programs alongside ‘no-cost’ screening for underserved populations resulted in screening rates higher than the 70.5% goal of Healthy People 2020.

These findings can be used to inform future research exploring educational programs on CRC among other minority populations in urban and rural settings facing disparities in screening for CRC. Further studies can examine the effectiveness of educators’ experiences with screening for CRC since it has a significant influence on their performance. Future studies should also establish the most effective strategies of addressing barriers related to screening and follow-up.

Potential Project

The available sources on this subject support educating Hispanics on CRC. If individuals and families do not receive the relevant information on CRC, most cases can go undiagnosed, undetected, or diagnosed when cancer has already advanced, which results in poor health outcomes. Lack of CRC knowledge not only affects individuals, but also families and entire communities. Lack of knowledge leads to inability to distinguish between CRC and other, less serious colorectal conditions, especially hemorrhoids, which in turn can lead to patients waiting too long to seek assessment and diagnosis.

Drawing on the findings from this literature review, the DNP project will employ a culturally appropriate CRC education approach. This approach will was used with Hispanic patients 45 years old and above at clinic in Tampa, Florida, that serves both urban and rural population. Since previous studies indicate that education programs increase both CRC awareness and screening, the project expects to see an increase in CRC knowledge and intent after implementing the education intervention.

Summary

CRC is associated with morbidity and mortality among Hispanics. It also leads to poor health outcomes, prolonged admissions, complications, and additional medical costs when diagnosed in the advanced stages. The findings of this literature review highlight the importance of educating Hispanics on CRC, as it decreases the risk of late diagnosis when the disease is in its advanced stages and encourages early intervention. Overcoming well-documented barriers to healthcare and CRC assessment and treatment also need to be incorporated into any CRC education program targeting the Hispanic population. The next chapter will present the theory and evidence-based practice model that undergird this DNP project.

Chapter Three: Theory and Model for Evidence-Based Practice

Theoretical framework and evidence-based practice models have been developed to guide implementation of evidence-based practice (EBP) (Melynk and Fineout-Overhold, 2015). Existing research suggests that educational programs that focus on outreach education about colorectal cancer (CRC) improves knowledge and screening rates. The clinical problem of low CRC screening rates among Hispanics was identified at a local primary care clinic in Tampa, Florida. This chapter focuses on discussing the Jean Watson Theory of Human Caring (THC), which was used to guide the implementation of this EBP change project. Additionally, the Iowa Model by Marita G. Titler was used to support the development of the project and provided the EBP change project framework.

Theory

The Theory of Human caring focuses on caring science. Caring science is developing a knowledge of caring grounded in an interpersonal relation of being that embraces connectedness among clinical sciences, arts, and humanities. Incorporating theory, philosophy, and ethics while integrating technology and practicality are key principles of the THC (Watson & Smith, 2002). Components of the theoretical framework can be applied to support clinical decision making. According to Watson (2009), economics and caring are not mutually exclusive, but rather, through the THC, providers can ensure caring and healing for the public and decrease costs to the healthcare system.

According to Watson (2011), THC assumes that caring is distinct from—although it can lead to—curing, research suggests that encouraging Hispanics to engage in CRC screening in a manner that can lead to curing (through early intervention) requires practicing care. Dominic et al. (2020) found that it was not the provision of information alone, but, rather, the addition of social support that resulted in high rates CRC. THC, too, is designed under the assumption that people do not make decisions on the sole basis of rationality and information; rather, caring implies that the nurse’s emotional and social support of the patient is the key factor in encouraging the patient to engage in self-caring behaviors and comply with medical best practices (Watson, 2011).

Watson’s THC can be incorporated in any physical environment where nursing takes place. Watson’s “Caritas Caring” is defined as a caring-healing environment dependent on interrelationships and partnerships with open communication (Watson & Foster, 2003). According to Watson (2012) the original human science context has expanded to a caring science framework encompassing any health, healing, or illness occurrence in human beings (Watson & Foster, 2003). Watson identified 10 “Carative Factors,” contrasting them with medicine’s traditional focus on curative approaches (Watson, 2020). The 10 factors are as follows,

1. Forming value systems. In this factor, nurses help to establish values of humanism and altruism.

1. Creating faith and/or hope. Nurses encourage both faith and hope among individuals who might not have reasons to be hopeful—for example, because of systemic racism in the healthcare environment.

1. Building sensitivity, for both self and others. Nurses are encouraged to understand and care for themselves and be receptive to their patients’ emotional signals. The nurse listens closely and respectfully to what patients say and feel.

1. Establishing a helpful, trusting relationship. Nurses demonstrate that they are on the patient’s side and are there to help the patient achieve desirable outcomes.

1. Encouraging sharing of feelings. Nurses are open about their own feelings and solicit frank communication from their patients as well. Nurses accept and cherish their own emotions as well as those of their patients.

1. Making decisions using problem-solving approaches. This component of THC is closely related to EBP, which also seeks to identify and address measurable problems (University of Iowa, 2021).

1. Fostering learning and teaching. Nurses are open to learning, and they are also committed to teaching patients—in sensitive and appropriate ways, so that patients do not feel as if they are the targets of impersonal lectures, but, rather, that they are receiving information that they understand in a context that is comfortable for them.

1. Creating a supportive environment. Nurses not only commit their own caring resources but also ensure that the care setting is one in which the patient has other sources of support.

1. Helping meet human needs. Recognizing patient needs as human needs means refusing the mechanistic approach of depersonalizing needs and problems. Nurses recognize and value the human face of each problem.

1. Making space for “existential-phenomenological” experiences in patient care. What patients themselves feel, experience, and report counts more than they someone else thinks they should feel or experience.

Of these 10 factors of THC, this project especially focused on (a) fostering learning and teaching, (b) creating a supportive environment, (c) making decisions using problem-solving approaches, and (d) establishing a helpful / trusting relationship, as described in greater detail in the next section.

Application to Practice Change

The EBP change project was shaped by Watson’s (2011) 10 Carative Factors, outlined above. In particular, the factors of (a) fostering learning and teaching, (b) creating a supportive environment, (c) making decisions using problem-solving approaches, and (d) establishing a helpful / trusting relationship were pillars of the practice change. These factors were chosen because of their relevance to the previous literature on encouraging Hispanics to seek CRC screening.

· Fostering learning and teaching: Interventions that were associated with increases in rural area-dwelling Hispanics’ self-administered CRC screening rates or desires to obtain screening all contained some element of learning and teaching. In these interventions, Hispanic participants were taught (through both English and Spanish-language materials) what CRC is, what the risk factors for CRC are, and why screening is important (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020).

· Creating a supportive environment: Dominic et al. (2020) explicitly build social support into their interventional model, and Briant et al. (2018) recruited bilingual health promoters to work directly with Hispanic communities at risk for CRC. Creating a supportive environment through these kinds of measures is, according to Dominic et al., even more important than providing information, because support creates more of an impetus to change and self-care.

· Making decisions through problem-solving approaches. In previous interventions (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020), CRC screening among Hispanic communities was first identified as a problem, then the problem was systematically addressed by (a) understanding and (b) remediating the roots of lower rates of Hispanic CRC screening. In other words, these interventions engaged in a rigorous and sequential process of problem definition and problem-solving that should serve as a model to similar interventions.

· In all three of the previous interventions (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020), there was an explicit assumption that Hispanics who are at risk for CRC are being insufficiently helped in the context of existing healthcare encounters. In the other interventions (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020), Hispanic participants were helped using Spanish-language materials, culturally competent healthcare promoters and teachers, and environments designed to feel safe, comfortable, and informative. These approaches demonstrate the need for establishing a helpful / trusting relationship as a basis for promoting CRC screening among Hispanics.

Evidence-Based Practice Change Model

Marita G. Titler developed the Iowa EBP model the year 1994 when she was Director for Outcomes Management and Quality in the patient care and nursing services department at the  University of Iowa Hospitals and Clinics (Brown, 2014). The model’s primary purpose was to guide nurses and other health professionals how best to utilize research to improve care. The model was later revised in 2002. Since its inception, the Iowa model has been used in different settings to improve care. It focuses on collaboration and organization, incorporating the use of research alongside other types of evidence. The model enhances nurses’ ability to focus on problem- or knowledge-based triggers and strive to improve care using applied evidence.  

Application to Practice Change

The Iowa Model particularly highlights importance of incorporating an entire healthcare system, starting with a healthcare provider and patients, and moving to infrastructure and utilizing research to make decisions in practice (Buckwalter et al., 2017). This clearly illustrates that the EBP concept in the Iowa Model goes beyond a patient and nurse to become part of the culture of an organization, forming a multiple systems-level commitment. The model is especially useful in quality improvement initiatives where nurses establish ways of reviewing recent research findings to determine their clinical significance and relevance to specific populations using a PICO framework (Buckwalter et al., 2017).

In response to the first Iowa Model’s question of whether the identified topic is a priority, both national statistics and the local context were considered to establish that Hispanics in the United States are being underserved with respect to encouragement to undertake CRC screenings. Second, in response to the Iowa Model’s question of whether there is sufficient evidence to design a practice change, the previous literature (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020) was considered and related to four specific pillars—(a) fostering learning and teaching, (b) creating a supportive environment, (c) making decisions using problem-solving approaches, and (d) establishing a helpful / trusting relationship—of practice change.

Summary

This chapter introduced the Jean Watson THC and the Iowa Model, which guided this EBP change project. Watson’s theory encourages nurses to be compassionate, caring, and kind so that patients can achieve inner harmony. From this perspective, implementing a successful educational intervention to educate Hispanic patients on the benefits of CRC screening is critical to ensure ones well-being, both physical and social-emotional. The Iowa Model provides a framework for identifying research findings relevant to a specific practice problem and then applying those findings to improve clinical practice and outcomes. Regarding this project, providing CRC education to a Hispanic population in a primary care clinic where CRC screening rates are low, and patients’ demonstrated inadequate knowledge about CRC was paramount. Both the THC and the Iowa Model formed the basis of this patient centered EBP change project.

Chapter Four: Project Management

According to the Centers for Disease Control and Prevention (CDC, 2021), among other cancers affecting adults, colorectal cancer (CRC) is the third-most common in men and women in the United States (US) and the second-most diagnosed among Hispanic adults. According to Brenner et al. (2016), the US has witnessed a gradual decline in the incidences and mortalities of CRC since the 1980s, this decline is attributed to the removal of rectal polyps, increased screening rates, and behavior modification, which address potential risk factors. However, the rate of this decline is not even across all demographic groups.

Existing research suggests that Hispanics are at risk of CRC-related mortality and morbidity due to lower education levels, high rates of poverty, being uninsured, and not being able to access healthcare services (Jackson et al., 2016). These disparities are evident in the rates of CRC and screening rates. To address this issue, this evidence-based practice (EBP) change project’s goal was to increase CRC knowledge and screening rates among established Hispanic patients of a primary care office in Tampa, Florida, and surrounding rural areas, by providing CRC education in a primary care setting.

Project Purpose

The primary objective of this project was to raise CRC awareness and screening through culturally tailored education directed towards an underserved adult Hispanic in a primary care setting, between the ages of 45 to 75 years old, in Tampa, Florida. This project used a tailored education program to increase CRC knowledge and screening to reduce the incidence and mortality (Brenner et al., 2016). While the scope of this short-term project was to increase knowledge and awareness of CRC and intent to screen among the Hispanic population, the longer-term goals would be to see an increase in actual screening, increase in diagnosis and treatment of early CRC, and a decrease in mortality. The project’s larger motive was to provide a foundation for future CRC research and health care interventions among Hispanics, with the hope of saving thousands of Hispanic lives.

Project Management

Project management ensures that the set research objectives are delivered efficiently and productively within the designated time frame. Project management is the process of ensuring that everything that is required for a project to be completed is in place and that the time and resources available are sufficient for the project to be completed successfully. Project management goes through several distinct phases that are namely (Villanova University, 2019):

1) Project initiation

2) Project planning

3) Project execution

4) Project monitoring and control

5) Project evaluation and closure

Project Initiation

The initiation of this capstone project started with the identification of the problem, which was determined to be the disproportionate rate of decrease of CRC among Hispanic people in the US. Possible interventions and solutions to this problem were researched via a comprehensive review of published academic sources to provide guidelines on how to tackle CRC using educational outreach programs. Further, consultative, and interactive conversations were held with various medical practitioners to establish a suitable mechanism to make the project more effective and result oriented (Martinsen et al., 2016). The evidence-based literature review and interviews indicated that education and screening most effectively create CRC awareness among Hispanics. For instance, through education, it would be possible to evaluate the participant’s level of awareness regarding colorectal cancer by carrying out a CRC Knowledge Assessment Survey. Similarly, the collected data of interested participants would be used to estimate the number of patients presenting for CRC screening (Martinsen et al., 2016). Therefore, the effectiveness of this project involved formulating achievable objectives before initiating the project or investing valuable resources.

Project Planning

Project planning provides a comprehensive and proactive framework on how the project achieved its set objectives. In this case, the project plan included where the implementation was going to take place and what intervention would be conducted. The project plan also assessed the readiness of the target entity for change, change awareness, change agility, change reaction, and change mechanisms. During this project planning phase, obtaining the approvals from the site to carry out the project was essential. Lastly, this project plan also included a situational SWOT analysis to identify the project’s potential strengths, weaknesses, opportunities, and threats.

Project Execution

The third phase of this capstone project was the implementation. This is where the actual implementation of the suggested educational program took place. The project consisted of the following steps:

The evidence-based change project included a combination of face-to-face education or a Zoom meeting in a primary care setting and telephone follow-up outreach. The project manager is bilingual in English and Spanish was able to provide the education, pre/ posttest, and follow-up in the patient’s preferred language. Participants expected a 35-minute time commitment depending on their responses to open-ended questions. The education sessions included a self-developed ten-question pre-test (10 minutes were allotted); educational presentation (15 minutes); and a post-test (10 minutes) both in English and Spanish at the end of the session. A follow-up phone call was made within two weeks of the education session to answer questions and to collect intent or action on CRC testing (this ranged from a five-minute phone call to 30 minutes, depending on the participants responses). The total timeframe of the project was eight weeks.

Project Monitoring and Control

The fourth stage was monitoring and control, conducting a close assessment of whether the right education about colorectal cancer is given to the patients (Martinsen et al., 2016). The information provided to the patient was based on the National Cancer Institute’s (NCI, 2021) overview of CRC. Patients were given an overview of this material in the 15-minute PowerPoint educational session. A score of 80% or more on the 10-item test designed to measure patient knowledge on CRC / CRC screening was taken as an indication that the patients were sufficiently informed about colorectal cancer.

Project Evaluation and Closure

The capstone project ended after eight weeks ascertaining that the project goals were achieved as per the timeframe. The goals were as follows:

First, at least XXX patients had to be identified as being available for the intervention and meeting the knowledge threshold. At least XXX completed questionnaires had to be received to determine if the outcomes met the benchmarked standards of change in participants’ (a) knowledge of CRC and (b) intent to obtain CRC screenings. The threshold of 30 was chosen as a recommended (Campbell, Machin, & Walters, 2010) minimum sample size to meet the benchmark. A 20% increase in CRC screening after completion of education intervention was the identified benchmark.

Organizational Readiness for Change

The project site was a primary care clinic that serves members of the Hispanic community in Tampa, Florida and surrounding rural areas. The clinic was ready for change, due to the large numbers of CRC cases among Hispanic patients. The medical director and the office manager were both supportive about the idea to address this clinical problem. An interview with the organizational leadership revealed that they also wanted to improve patient outcomes and therefore the intervention was welcomed by them. The medical director offered resources to support this effort, including screening kits, laboratory analysis instruments, and needed medical expertise. The project leader also met with the nurse practitioners, nurse managers, and registered nurses at the center. All the healthcare workers at the center resolved to effectively manage both patient and staff reactions to the impending change. Lastly, the center’s medical director provided approval on December 2, 2020, to implement the EBP change project.

Inter-professional Collaboration

Interprofessional project teams include individuals from multiple clinical and cultural backgrounds. There was a total of 10 team members, comprised of all staff in the clinic, helped implement this EBP change. The team included the project manager (PM), DNP preceptor, medical director, and primary care physician, as well as one nurse practitioner, two administrative staff, the office manager, and two medical assistants. No other individuals were directly or indirectly involved.

Risk Management Assessment

The risk assessment for this project was achieved through the Strengths, Weaknesses, Opportunities, and Threats (SWOT) paradigm, as outlined in Verboncu & Condurache (2016). Risk assessment helps identify potential internal limitations and external threats that can then be dealt with before project implementation. Identifying these factors helps formulate and implement effective strategies to minimize risks associated with costs, underachievement, and misinterpretation of collected data. Risk assessments also enhance identification of internal strengths and external opportunities that were leveraged to ensure the success of the capstone project. The SWOT analysis results of this capstone project is described below.

Strengths
. The identified intervention is specific, and the identified population of interest was also well defined. In the setting, the PM is bilingual in English and Spanish, facilitating patient to PM interaction. Previous research (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020) suggests that Hispanic patients respond well to being addressed in Spanish; even the provision of Spanish as an option, when English is ultimately utilized, demonstrates to Hispanics that healthcare providers are supportive and thoughtful in ways that encourage behavioral change and compliance among Hispanic patients (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020). In addition, the project was supported by the three key leadership figures, that is, the DNP preceptor, medical director, and primary care physician. Finally, the PM possessed sufficient statistical knowledge to be able to conduct data analysis and measure whether the intervention succeeded in increasing CRC knowledge and screening intentions among the targeted population.

Weaknesses

A weakness identified was the short timespan meant that the most concrete outcome—that of actual changes in CRC screening rates—could not be measured; only changes in intention to obtain CRC screening could be measured. Finally, the setting is relatively small and due to Covid-19 a large-group of patients were not able to be educated at the same time; thus, a smaller sample of patients were education. Previous research (Briant et al., 2018; Cruz-Correa et al., 2016; Dominic et al., 2020) has benefited from large samples and longer timeframes for data collection, allowing for a more robust conclusions about the effects of interventions on CRC screening rates among Hispanics.

Opportunities

Other organizations may also be interested in this kind of project and therefore provide funding for a large-scale version of this teaching project. However, such opportunities are prospective and apply to future interventions, not to the completed intervention. In the context of the intervention that was carried out, the true opportunity is to continue with data collection over a longer timeframe. Several of the participants who sent in completed questionnaires have not yet completed CRC testing. If these participants are contacted again in 6-9 months to determine whether they went through with CRC testing, there is an opportunity to determine whether the intervention was successful not only in increasing an intention to engage in CRC screening but an actual increase in CRC screening rates.

Threats

The main threat to the project is statistical validity. In terms of validity, the absence of longer-term tracking of project participants and a longer intervention means that it is difficult to measure the validity of inferences about the relationship between the intervention and participants’ intent to screen for CRC. For instance, given the constraints of the project, there is no means of determining whether changes in participants’ intent to have themselves screened for CRC is a function of exposure to the intervention or self-initiated healthcare information searching.

Organizational Approval Process

The PM developed the EBP change project, based on the observed need to increase CRC knowledge and screening among patients at the project site. The medical director and the office manager were informed of the change project. The PM provided an overview of the identified problem and proposed intervention and answered questions from the medical director and office manager. After consideration, they agreed that the project was a good opportunity for practice improvement and the official approval from the organization was received on December 2, 2020.

Use of Information Technology

The use of technology was an integral part of this EBP change project. The team and patients communicated via emails, zoom meeting, cellphones, and Care Cloud instant messenger, which is the office’s secure system. Flyers and educational information was created by using Canva design and the PowerPoint presentation was made with Microsoft PowerPoint application. Education sessions were provided either face-to-face or via Zoom online meeting platform. Data were entered, stored, and analyzed using Excel software.

Materials Needed for Project

The materials needed for this project included standard office supplies (pencil, pens, paper); color printer; headset; and a laptop with internet connectivity, the Zoom™ application installed, and Microsoft Office (Word, Excel, and Power Point). A private room in the facility was utilized for the face-to-face education and to provide the Zoom™ session. A lock box was purchased to store the paper documents returned by the participants. Telephone service was provided by the clinic, as the follow up calls were made from the facility.

Plans for Institutional Review Board Approval

Institutional review board (IRB) approval was requested through Chatham University review board, as the project site is a primary clinic and does not have its own IRB. An exempt IRB application was submitted. This type of application was put forward based on the minimal or no risk to participants. The IRB proposal was submitted February 28, 2021 under exempt status at Chatham University’s IRB Chair in Pittsburgh, Pennsylvania. Approval was obtained on March 22, 2021.

Summary

This change project was designed to improve CRC knowledge among Hispanics via a face-to-face or Zoom™ meeting call. This chapter outlined the project management processes that helped ensure the EBP change project’s success. These processes included identifying the project’s purpose, project management approach, organizational readiness for change, inter-professional collaboration, risk management assessment, organization approval process, use of information technology, materials needed for the project and IRB approval process. Each of these steps create a fully formed EBP change project management plan, which helps increase the likelihood of project success, protect participants from avoidable risks, ensure adequate support and participation from project site staff.

Chapter Five: Plan for Project Implementation Process

Research suggests that Hispanics are at high risk of CRC-related mortality and morbidity due to lower education levels, high rates of poverty, being uninsured, and not being able to access healthcare services (Jackson et al., 2016). To address this critical public health concern among an underserved population, this evidence-based practice (EBP) change project was implemented to improve CRC prevention among Hispanics by increasing CRC knowledge and screening rates. This chapter will discuss the project, high-level goals for population health, outcomes, project evaluation, demographic data collection, outcome data collection and measurement, evaluation tool, data analysis, and data management.

Planned Project

The EBP change project included a combination of face-to-face education or a Zoom™ meeting in a primary care setting and telephone follow-up outreach. The project manager (PM) was bilingual in English and Spanish and provided the education, pre-/post-test, and follow-up in the patient’s preferred language. Participants were told to expect a 35-minute time commitment, depending on their responses to open-ended questions. The time required for the education session and activities included: a 10-question pre-test (10 minutes); educational presentation (15 minutes); and a post-test (10 minutes) at the end of the session. A follow-up phone call was made within two weeks of the education session to answer questions and to collect intent or action on CRC testing (phone calls ranged from five to 30 minutes, depending on participants’ responses). 

High-Level Goals for Population Health

The scope of this short-term project was to increase knowledge and awareness of CRC and intent to screen among a limited Hispanic population, composed only of patients at a primary care clinic in Tampa, Florida. The longer-term goals for project participants would be to see an increase in actual screening, diagnosis, and treatment of early CRC, and a decrease in mortality. Beyond this limited participant population, however, the project aimed to provide a foundation for future CRC research and health care interventions among the wider Hispanic demographic in the United States, with the hope of saving thousands of Hispanic lives. By providing a culturally tailored, short-duration education session, this project demonstrated that such interventions do not need to be expensive or complicated to have an impact on CRC knowledge and screening intent.

Planned Outcomes

The primary planned outcomes were to evaluate the effectiveness of a CRC education session to increase knowledge and intent of doing a screening test. In both cases, the desired outcome was an increase, that is, (a) an increase in knowledge of CRC and (b) an increase in the intention to be screened for CRC. Bilingual flyers explaining the project were displayed in the waiting area and exam rooms, and flyers were mailed to patients who had previously agreed to be contacted regarding intended project. The flyers announced the educational session and its positive impact of colorectal cancer prevention with the information of who to contact if interested in the screening. See Appendix A and B for flyer information in Spanish and English. The pre- and post-test was a self-developed 10-item knowledge survey in Spanish and English that took an average of 10 minutes to complete. The question validity was verified by the primary care physician at the primary care clinic. The educational session covered statistics, warning signs of colon cancer, the signs and symptoms, screening age, preventative measures, and screening options. A copy of the survey instrument is included in Appendix C and D. A score of 80% was the benchmark for “adequate CRC knowledge,” since it demonstrated that patients could correctly respond to 80% of CRC questions. Patients were asked about their intent to screen for CRC immediately after the education session and again during a two-week follow-up telephone call; these responses were recorded as Yes/No. See appendix E and F for telephone call script in Spanish and English.

Plan for Project Evaluation

Project evaluation provides a practical and comprehensive platform for evaluating whether the implemented plan productively achieved the expected outcomes and helps align the set goals with the predicted outcome (University of Iowa, 2021). By incorporating evidence and a results-oriented monitoring system, the following assessments were carried out to align the project objectives and expected outcomes. First, scores from the educational and screening measures, gathered from project participants’ pre- and post-tests, were analyzed. To do this, scores were entered into an Excel spread sheet. From their aggregate, mean percent change in knowledge was calculated and a paired t-test was conducted to determine if the difference between pre- and post-intervention knowledge was statistically significant. The same approach was used to analyze change in intent to screen from pre- to post-intervention: patients’ Yes or No responses were coded in Excel, aggregated, and assessed for significant difference using a paired t-test.

Plan for Demographic Data Collection

The participants for this project were Hispanic adults in Tampa, Florida, and surrounding rural areas. The project focused on participants (male and female) between the ages of 45 to 75. Participants were recruited when they came for an appointment. Participants’ demographic information was collected via patient records with their consent. The collected data was analyzed using means and calculated percentages to determine: the number of targeted participants and responsive ones, the gender balance ratio in terms of total participants, and average participant age. Only aggregate data would be presented.

Plan for Outcome Data Collection and Measurement

The primary planned outcomes were to evaluate the effectiveness of increasing CRC awareness and screening intention through a culturally tailored education session. These outcomes were measured with 1) a pre-/post-test to measure CRC knowledge before and after the educational session; and 2) intent to screen after the education intervention and two weeks later. The collected data was then averaged to estimate the interviewee’s CRC knowledge by analyzing the interviewee pre- and post-test scores. A score of 80% was the benchmark for “adequate CRC knowledge,” since it demonstrated that patients could correctly respond to 80% of CRC questions. A 20% increase in CRC screening after completion of education intervention was the identified benchmark.

Plan for Evaluation Tool.
The participant’s knowledge and intent to follow through the colorectal cancer screening was measured with the use of a pre-/post-test composed of 10 questions related to CRC. The project manager created the multiple-choice questionnaire. The questionnaire is included in Appendix C and D.

Plan for Data Analysis. This step of the data management plan is to analyze the measurement data to check if there have been any changes in the outcome. The pre-test and post-test scores were entered into Excel spread sheet. The plan for data analysis was based data collected before and after the education session from at least 30 individuals.

Table 1

below indicates the data analysis of the project.

Table 1

Data analysis

Participant #

CRC Knowledge Score (Pre-test)

CRC Knowledge Score (Post-test)

CRC Intent to Screen Score (Pre-test)

CRC Intent to Screen Score (Post-test)

1

0 – 100 %

0 – 100 %

1 – 2

1 – 2

2

0 – 100 %

0 – 100 %

1 – 2

1 – 2

3

0 – 100 %

0 – 100 %

1 – 2

1 – 2

4

0 – 100 %

0 – 100 %

1 – 2

1 – 2

5

0 – 100 %

0 – 100 %

1 – 2

1 – 2

6

0 – 100 %

0 – 100 %

1 – 2

1 – 2

7

0 – 100 %

0 – 100 %

1 – 2

1 – 2

8

0 – 100 %

0 – 100 %

1 – 2

1 – 2

9

0 – 100 %

0 – 100 %

1 – 2

1 – 2

10

0 – 100 %

0 – 100 %

1 – 2

1 – 2

11

0 – 100 %

0 – 100 %

1 – 2

1 – 2

12

0 – 100 %

0 – 100 %

1 – 2

1 – 2

13

0 – 100 %

0 – 100 %

1 – 2

1 – 2

14

0 – 100 %

0 – 100 %

1 – 2

1 – 2

15

0 – 100 %

0 – 100 %

1 – 2

1 – 2

16

0 – 100 %

0 – 100 %

1 – 2

1 – 2

17

0 – 100 %

0 – 100 %

1 – 2

1 – 2

18

0 – 100 %

0 – 100 %

1 – 2

1 – 2

19

0 – 100 %

0 – 100 %

1 – 2

1 – 2

20

0 – 100 %

0 – 100 %

1 – 2

1 – 2

21

0 – 100 %

0 – 100 %

1 – 2

1 – 2

22

0 – 100 %

0 – 100 %

1 – 2

1 – 2

23

0 – 100 %

0 – 100 %

1 – 2

1 – 2

24

0 – 100 %

0 – 100 %

1 – 2

1 – 2

25

0 – 100 %

0 – 100 %

1 – 2

1 – 2

26

0 – 100 %

0 – 100 %

1 – 2

1 – 2

27

0 – 100 %

0 – 100 %

1 – 2

1 – 2

28

0 – 100 %

0 – 100 %

1 – 2

1 – 2

29

0 – 100 %

0 – 100 %

1 – 2

1 – 2

30

0 – 100 %

0 – 100 %

1 – 2

1 – 2

Plan for Data Management

A unique identifier (UID) was assigned to each participant for security purposes. The UIDs and participants’ names and phone numbers were kept in an encrypted Excel spreadsheet on a password-protected computer and separated from the dataset or paper instruments. The paper copies of the completed pre-/post-tests, and follow-up response recording sheet, each with a UID, were kept in a lock box; the PM will have the only key and the lock box will be kept in the medical director’s locked office, since the PM does not have a personal office. In accordance with the IRB regulations at Chatham University, both forms of data – paper and electronic – will be retained for five years, after which, the paper data collection forms will be cross-cut shredded and electronic data will be deleted from the computer with the recycle bin emptied.

Summary

This chapter provided an overview of the planned project implementation process. Undertaking these steps helped the PM apply the findings from the Strengths, Weaknesses, Opportunities, and Threat’s analysis and other project management processes to ensure patient privacy is protected and the project has a logical plan for data collection and analysis. Implementation of the capstone project was undertaken through a formal project management approach, complete with all the five phases of project management. The next chapter will detail the actual project implementation.

Chapter Six: Actual Implementation Process

Wittich et al. (2019) considers Educational based practice (EBP) to hold significant value amongst Hispanic people in relation to the need for (CRC) screening. Hispanics with high poverty and illiteracy levels pose a significant challenge and need culture tailored education regarding colorectal cancer to increase knowledge and screenings amongst this group. The subsequent evidence-based change project expounds on the implementation process of EBP and how efficiency and changes were achieved among the urban and rural Hispanic participants that visited the primary care office in Tampa, FL.

Setting

The setting is at a busy primary care office in Tampa, FL. While the clinic is in a city, many of the participants were from surrounding rural areas; thus, the patient population was urban and rural.

Participants

The participants in this project are established patients of Alvior Medical Clinic, specifically Hispanic patients between the ages of 45 and 75, who had not had a colorectal cancer screening. Bilingual flyers explaining the project were displayed in the waiting area and exam rooms. A pamphlet was mailed to patients who have previously agreed to be contacted regarding the intended project. The flyers and pamphlets announced the educational session and its positive impact on colorectal cancer prevention with the information of who to contact if interested in the screening.

Interested participants were educated on various topics regarding CRC, including how to prevent it, detect it through screening, treat it, and proactively manage it. The medical assistant called the interested patients and discussed the next steps in the educational program. The project leader (PL) of the EBP change project set up the appointments and provided the educational flyers and the presentation. The medical director also took part in this venture to ensure that all requirements and health safety measures are adhered to strictly.

Recruitment

The recruitment took place at the primary care clinic. Bilingual flyers explaining the project were displayed in the waiting area and exam rooms. A cover letter was mailed to patients who have previously agreed to be contacted regarding the intended project. The flyers announced the educational session with the information of who to contact if interested in the project.

Implementation Process

The implementation began on April 29, 2021, and the project was discussed face to face with those interested participants that presented to the clinic that day. Colorectal cancer flyers and information were presented throughout the day to the patients interested in viewing the flyers. Those new interested participants gave verbal consent while the PL answered questions that the patients had. The PL communicated with nursing staff on how the setup will be and instructed the staff on the inclusion/exclusion criteria with the staff for the recruitment process. Participants who already gave verbal consent arrived at the clinic on different days, and those who preferred a Zoom meeting chose a date that the PL was going to be in the clinic.

Each participant was taken into the small conference room for privacy. While in the room, the patient filed out the pretest survey and the educational session began right after. Each participant was reminded of the project and its outcomes. The completed pretest and posttest forms were collected and charted in Microsoft Excel for documentation. Also, the face-to-face or zoom call PowerPoint educational session took approximately 20 minutes, including 10 question self-created pretest and a post-test that took approximately 5-10 minutes to complete. Two weeks after the teaching session, a follow-up phone call to check if the patient had made any advances for any colorectal cancer screening (CRCS) was made.

The whole process was categorized into three phases. Phase one involved the recruitment of participants. Participants were introduced to the program and notified of what was expected from them after joining the educational sesssion. Phase two, involved confirmation of attendance of participants to the program. The PL and MA called the participants to confirm their attendance. Phase three involved one-on-one sessions via Zoom or face to face with the recruited participants, organized and analyzed the data and discussed the findings with the office staff.

Phase one: Preparation and recruitment.

Before the participants had been recruited into the program, the PL convened a one hour meeting with the existing team of personnel, including the the manager, medical director, nurse practitioner and the two medical assistants. The main purpose of the meeting was to evaluate the effectiveness of the proposed EBP change project and the effectiveness of using outreach methods to emphasize the need for CRC toward Hispanic people. The board agreed that the project would bear significant results if carried out within eight weeks, according to the distribution of required activities by the PL.

During the first week after the board meeting, recruitment flyers were placed in different areas within the facility. Participants who had not previously received CRC screening were encouraged to join the program. The PL was very particular about protecting the participants’ privacy and accuracy of the collected data. A unique identifier (UID) was assigned to each participant for security purposes. The UIDs and participants’ names and phone numbers were kept in an encrypted Excel spreadsheet on a password-protected computer and separated from the dataset or paper instruments. The paper copies of the completed pre-/post-tests, and follow-up response recording sheet, each with a UID, was kept in a lock box; the PL had the only key and the lock box was kept in the medical director’s locked office, since the PL does not have a personal office. In accordance with the IRB regulations at Chatham University, both forms of data – paper and electronic – will be retained for five years, after which, the paper data collection forms will be cross-cut shredded and electronic data will be deleted from the computer with the recycle bin emptied. In additional, each week, the primary care doctor and the nurse practitioner that worked in the clinic informed the participants of the available educational program and those who were interested were given a flyer to either call to schedule an appointment with the PL or the MA schedule a date with the participant on the same day of his or her appointment. The MA prepared the board room for face-to-face and zoom meetings.

Phase two: Educational face-to-face and or Zoom meetings.

Subsequently, the PL started the face-to-face educational meetings in the conference room. The participants who could not attend the meetings were arranged for the zoom meetings with the PL at a time convenient for both. The PL continued with the face-to-face meetings from week one through week eight. The detailed PowerPoint educational program conducted by PL improved the participant’s confidence toward the CRC screening. The main topics addressed by the PL revolved around the screening options, how to prevent colorectal cancer, treatment options, and how to proactively manage it. The fatality of late diagnosis and the advantages of early scanning of CRC were sensitized to the participants. Early diagnosis of CRC provides patients with survival rates of 80% to 90%. However, survival rates reduce to 11% when the patient is diagnosed with CRC at the IV phase. Consequently, the PL recorded and saved the pretest and posttest data for a later time. A review of each week’s data was done by the PL and documented in a password-coded laptop to protect the participant’s privacy. Each week, the PL called the participants two weeks after the educational session to discuss intent to screen. The PL reminded the participants of the importance screenings and for arrangements for CRC screening.

Phase three: Data Evaluation.

The one-on-one meetings between the PL and the participants continued all through the last week in phase three. The PL discussed the participants on the importance of different methods of CRC screening options. This phase of the project also focused on the data collection, organization, and analysis of the findings. During the last three weeks, the PL conducted team meetings to discuss the data in which outcomes and conclusions were addressed.

Summary

The above-detailed phases were derivatives of the response to the gaps identified during the literature review. The educational session was discovered to be an effective method to increase colorectal cancer screening and awareness. Nevertheless, the EBP project provided the participants with the information needed to make concise and confident decisions regarding CRC testing. However, the activities envisaged in the first phase sensitized the program’s validity and the recruitment of participants. Flyers were prepared through the guidance of the PL, inviting willing Hispanic participants to the project. The second phase involved face-to-face meetings and zoom meetings. The face-to-face meetings were carried out with the available participants from week two to week eight. Participants that would not make it to the face-to-face meeting arranged for a zoom meeting with the PL at their convenience. The third phase played an integral role in data evaluation analysis and reporting. The PL documented, reviewed, and analyzed the collected data.

Chapter Seven: Evaluation of Project Outcomes

Evidence-based medical practices expose health practitioners to myriad advantages, including but not limited to informed decision-making. The use of research helps healthcare professionals identify the objectives, do scholarly research, formulate concise conclusions, design and implementation approach, and analyze information. Analysis and understanding of the identified clinical problem provided an opportunity to formulate informed decisions. This chapter will discuss the findings of this evidence-based change project and its effectiveness of the educational program.

Participant Demographics

The participants in this project are established patients of Alvior Medical Clinic, specifically Hispanic patients between the ages of 45 and 75 years old who have not had a colorectal cancer screening. Bilingual flyers explaining the project were displayed in the waiting area and exam rooms. A pamphlet was mailed to patients who had previously agreed to be contacted regarding the intended project. The flyers and pamphlets announced the educational session and its positive impact on colorectal cancer prevention with the information of who to contact if interested in the screening.

Figure 1

Program Participants by Age

Outcome Findings

The project leader used main valuable outcomes in the analysis of the collected and documented information. The PL analyzed the main aspects of the data by establishing the mean average of the participants who agreed to schedule a screening. The main goal of the educational session was to increase the number of CRC screenings. According to the observation for the general regression analysis. Patients who attended the EBP were more likely to enroll for CRC screening than the patient who understood very little about CRC. Wittich et al. (2019) further established that the mail service was an effective method of contacting and recruiting participant. The recruits contended that the information sent by the Project leader was clear and concise.

Completion of screening was evaluated as participants verbally accepted the two-week follow-up call that they had made an appointment for a screening or had agreed to undergo a FIT or Cologuard test.

Outcome One

The collected data was averaged to estimate the interviewee’s self-efficacy by analyzing the interviewee’s pretest and posttest-knowledge level regarding CRC. An increase in knowledge was expected, and the benchmark in knowledge gain was 80% (n= 24) or better.

The EBP change project concedes with the recommendations of Cruz-Correa et al. (2016) arguing that the primary planned outcome for EBP program should help evaluate the effectiveness of colorectal cancer (CRC) education sessions on adding to participants knowledge on the significance of CRC screening. The pretest and posttest scores were entered into an Excel spreadsheet. The mean percentage in knowledge was calculated and conducted from their aggregate to determine the difference between pretest and post-intervention knowledge and if it was statistically significant.

Table 1

A Breakdown of Participants Knowledge of CRC

45 – 60 Age Group

61-75 Age Group

Number of the Participants

10

20

Had Previous knowledge

1

1

Improved In knowledge

8

16

Outcome Two

Intent to screen was measured by response rate in the two-week follow-up phone call. The benchmark for 25% (n=8) of participants indicated that they scheduled his or her screenings. The benchmark findings are in line with the Cruz-Correa et al. (2016) arguments. The author contends that significant mobilization efforts need to be implemented in the dissemination of knowledge.

Figure 2

Participants Interest in Screening through Phone Follow up

The EBP change project had a total of 30 participants. Fortunately, 25% (n=8) of the population showed interest in the screening program by either scheduling an appointment with the gastroenterologist, agreed to do a FIT test or Cologuard test. However, the focus was to achieve at least a 25% (n=8) response of the participants towards testing. The success was attributed to calling the participants two weeks after the educational sessions. The analyzed results helped the PL understand that patients who attended the program were more likely to enroll in CRC screenings than the new patients who did not participate in the EBP change program.

Summary

Zoom and face to face education used by the PL played an integral role in addressing the evident clinical problem due to the reduced number of CRC screenings amongst Hispanics. According to the literature, CRC is the fourth leading cause of deaths in the United States. The rise in death rates is not attributed to the severely of the condition but by lack of timely testing. The EBP change program played an integral role in filling the knowledge gap. Only two participants had prior knowledge of the need for CRC testing. However, the number rose to 80% after the participants went through the educational program. The EBP change project signifies those participants who had gone through the program were more likely to enroll for CRC testing. The patient exceeded the set expectation of 25% (n=8) of patient acceptance toward CRC testing. This indicates that the PL’s phone follow-ups played a significant role in reminding the participants of the next face-to-face meeting with the PL. From the total participants who were contacted by the PL, 25% (n=8) agreed toward the testing of CRC.

Chapter Eight: Final Conclusions

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Recommendations for Site to Sustain Change

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Plans for Dissemination of Project

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Project Links to Health Promotion/Population Health

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Role of DNP-Prepared Nurse Leader in EBP

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Future Projects Related to Problem

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Implications for Policy and Advocacy at All Levels

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Final Conclusions

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References

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Barzi, A., Yang, D., Mostofizadeh, S., & Lenz, H. J. (2017). HJ;, B. A. Y. D. M. S. L. (n.d.). Trends in colorectal cancer mortality in Hispanics: a SEER analysis. Oncotarget. https://pubmed.ncbi.nlm.nih.gov/29312566/. 

Brenner, A.T., Hoffman, R., McWilliams, A., Pignone, M.P., Rhyne, R.L., Tapp, H., & Reuland, D.S. (2016). Colorectal cancer screening in vulnerable patients: Promoting informed and shared decisions. American Journal of Preventive Medicine, 51(4), 454-462. Doi:10.1016/j.amepre.2016.03.025

Briant, K.J., Sanchez, J.I., Ibarra, G., Escareño, M., Gonzalez, N.E., Gonzalez, V.J., & Thompson, B. (2018). Using a culturally tailored intervention to increase colorectal cancer knowledge and screening among Hispanics in a rural community. Cancer Epidemiology, Biomarkers & Prevention, 27(11), 1283–1288. Doi:10.1158/1055-9965.EPI-17-1092.

Campbell, M. J., Machin, D., & Walters, S. J. (2010). Medical statistics: a textbook for the health sciences. John Wiley & Sons.

CDC. (2021). Data visualizations. CDC.

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Appendix A

Colorectal Cancer Flyer- English Version

Appendix B

Colorectal Cancer Flyer- Spanish Version

Appendix C

Pre and posttest (The same test will be conducted before the educational session and at the end)-English Version

Appendix D

Pre and posttest (The same test will be conducted before the educational session and at the end)-Spanish Version

Appendix E

Telephone Scrip – English Version

Appendix F

Telephone Script- Spanish Version

Appendix G

Appendix title here

Number of the Participants
Number of the Participants 45 Age Group 75 Age Group 10 20

Prarticipants Interested In Screaning

Not Interested Interested Perticipants 0.75 0.25