D.N.P. - Nursing Practice

Permanent URI for this collectionhttps://hdl.handle.net/10125/36917

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Implementation of nonviolent communication training to improve empathy and communication skills among nursing students
(University of Hawai'i at Manoa, 2026) Tsuzaki, Julia; Palakiko, Donna-Marie; Nursing
Incoming nursing students often lack formal instruction in structured, empathy-based communication strategies, which are essential for clinical performance, collaboration, and patient centered care. This project aims to implement and evaluate the effectiveness of a Nonviolent Communication (NVC) training on empathy and communication self-efficacy amongst Graduate Entry Program in Nursing (GEPN) students at the University of Hawai‘i Mānoa during the 2025 fall semester. A single 60-minute NVC training session will be delivered during a scheduled class in the Fall of 2025. The training will incorporate a brief lecture, guided reflection, role play, and group debrief. Students will complete a pre- and post-intervention survey using two validated tools: the Interpersonal Reactivity Index (IRI) and the Nursing Communication Self- Efficacy Scale (NCSES). Post surveys will also include three open-ended questions to gather qualitative data. Data analysis will include descriptive statistics and paired-sample t-tests to evaluate differences between pre and post training survey scores. Qualitative responses will be analyzed based upon similar themes. Results will be presented following implementation. If the training is effective, findings may support integrating a formal, evidence-based communication training such as NVC into nursing education to enhance students’ empathy, communication confidence, and better prepare them for emotionally complex clinical interactions.
A 3-minute mindful breathing exercise intervention to decrease stress in acute care nursing staff
(University of Hawai'i at Manoa, 2026) Augustin, Aurora; Kataoka-Yahiro, Merle; Nursing
Abstract
Implementing strategies to increase case presentations during Hawai‘i State Rural Health Association’s behavioral health ECHO virtual sessions
(University of Hawai'i at Manoa, 2026) Julian, Charnelle; Altman, Molly; Nursing
The Project Extension for Community Healthcare Outcomes (ECHO) model is an evidence-based professional development method for increasing the capacity of primary care providers (PCPs) to meet critical community health needs for patients. The hub-and-spoke model connects specialists with community clinicians to improve care for complex conditions through case-based learning. Case presentations are a central component of the ECHO model because they promote collaborative learning, clinical reasoning, and peer mentorship. However, participation in case presentations within the Hawaiʻi State Rural Health Association’s Behavioral Health (BH) ECHO sessions had declined significantly, with fewer than five case presentations occurring across 152 sessions between 2022 and 2024 (3.2%). The purpose of this project was to implement and evaluate strategies to increase case presentation submissions during weekly BH ECHO sessions. The process was guided by the Johns Hopkins Evidence-Based Practice Model and the FOCUS-PDSA quality improvement framework. Several new interventions were introduced over a 14-week period (May–August 2025). These included simplifying the case submission form to, increasing marketing through email reminders and verbal prompts, offering anonymous case submission options, and allowing moderators to present cases on behalf of participants. Interventions were evaluated by a follow up survey to attendees. During the implementation period, four cases were submitted, increasing the case presentation rate to 28.6% of session, which is a 25.4% improvement from baseline. Survey results indicated that the most effective strategies were clearly outlining expectations for case presentations and regular email reminders. Participants also valued the option for anonymity and reported that case discussions enhanced learning even when they did not present cases themselves. These findings suggest that reducing barriers, clarifying expectations, and creating psychologically safe environments can improve participation in case-based learning within ECHO model. Continued implementation of these strategies may strengthen engagement and sustain the collaborative learning environment essential to the ECHO model. Reducing barriers to participation may increase engagement in case-based learning. Continued use of these strategies may strengthen interprofessional learning and support clinicians managing complex behavioral health cases, and should be considered for all ECHO programs.
Breaking barriers to rapid transmagnetic stimulation adoption: Mapping provider attitudes to improve referral pathways
(University of Hawai'i at Manoa, 2026) Todahl, Samuel Aaron Evans; Nunokawa, Courtnee; Friedman, Brendon; Nursing Practice
Background: Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved treatment for treatment-resistant depression (TRD) that remains underutilized due to limited provider familiarity, misconceptions, and financial barriers. The CLEM Clinic, a new academic psychiatric clinic in Hawai'i, sought to understand local provider attitudes to inform targeted referral development.
Implementing a compliance training program for the clinical, learning, education, and management (CLEM) clinic
(University of Hawai'i at Manoa, 2026) Kagehiro, Shaylah; Nunokawa, Courtnee; Nursing Practice
Problem Statement: The establishment of a new outpatient psychiatric clinic introduces regulatory, safety, and operational demands that require standardized compliance training to support patient safety and regulatory adherence. Newly opened clinics often lack structured onboarding and role-specific compliance processes, increasing risk for safety events, regulatory noncompliance, and inconsistent care delivery, particularly when advanced treatment modalities such as repetitive transcranial magnetic stimulation are introduced.Purpose: The purpose of this quality improvement project was to develop and implement a structured compliance training program for staff at the Clinical, Learning, Education, and Management (CLEM) Clinic, a university-based Psychiatric Mental Health Nurse Practitioner outpatient clinic. Methods: Guided by High-Reliability Organization principles, the intervention included a standardized compliance checklist, a video-based training module grounded in institutional policies and procedures, and pre- and post-intervention surveys assessing staff preparedness and confidence. Descriptive statistics were used to analyze survey data. Results: Seven core clinic team members completed both surveys. Post-intervention results demonstrated improved self-reported confidence and preparedness across multiple compliance domains, including HIPAA awareness, emergency response procedures, and clinic policy knowledge. Discussion: Implementation of a structured compliance training program supported staff preparedness and promoted a sustainable safety infrastructure. Findings highlight the value of standardized, policy-based compliance training in supporting patient safety and regulatory readiness in new outpatient psychiatric clinics.
Lifestyle medicine in motion: Digital lifestyle education at Balanced Brain Hawai’i
(University of Hawai'i at Manoa, 2026) Protacio, Brooke Michi; Hale, Frankie; Nursing Practice
Background/Significance: Preventable chronic diseases highlight the need for health promotionstrategies that complement conventional care. Lifestyle medicine, as defined by the American College of Lifestyle Medicine (ACLM, 2024) addresses disease through six core pillars; however, its integration into outpatient brain health settings remains limited. This project explored asynchronous digital education as a strategy to introduce lifestyle medicine concepts within a private integrative practice. Purpose: This Doctor of Nursing Practice (DNP) project evaluated the feasibility of introducing lifestyle medicine education into the Balanced Brain Hawai‘i wellness clinic through brief (~6-minute) asynchronous videos focusing on physical activity, social connection, and avoidance of risky substances. Methods: Educational modules were distributed to Balanced Brain Hawai’i clients through a targeted email containing a private link to the videos from January to March 2026. Participants were invited to complete brief anonymous post-module surveys through Google Forms to assess perceived understanding and likelihood of adopting recommended lifestyle behaviors. Results: Email outreach yielded 17 unique viewers and 36 survey responses across the three lifestyle medicine modules. The participant group was highly educated, with 100% holding an associate’s degree or higher and 66.7% reporting graduate-level education. Age distribution primarily reflected young to middle-aged adults, with the most frequent responses occurring in the 25–34 and 35–44 age groups. Engagement scores were high across modules, including Physical Activity (M = 3.92), Social Connection (M = 4.09), and Avoidance of Risky Substances (M = 3.42). A high likelihood of behavior change was also reported, with 85% of Physical Activity participants and 91% of Social Connection participants indicating strong intent to adopt recommended behaviors, compared with 42% of participants in the Avoidance of Risky Substances module. Survey responses indicated varying levels of interest in future lifestyle medicine programming. Conclusion: Findings indicate that brief asynchronous education in lifestyle medicine can be feasibly implemented within a private outpatient brain health environment and may enhance patient engagement in preventive health measures. Implications/Recommendations: Digital lifestyle education may offer a scalable approach for introducing preventive health concepts in outpatient care. Future initiatives should evaluate long-term behavior change and explore integration of digital education with additional lifestyle medicine services.
Screening for financial toxicity in outpatient oncology: Comparing the cost-FACIT screening tool and the NCCN distress thermometer to improve referrals to financial navigation services
(University of Hawai'i at Manoa, 2026) Denton, Bradley S.; Nunokawa, Courtnee; Nursing
Problem Statement: Adult oncology patients receiving outpatient cancer care may not be adequately screened for financial toxicity when relying solely on the NCCN Distress Thermometer, resulting in under-identification of patients at risk and missed opportunities for timely referral to financial navigation services.Purpose: This quality improvement project evaluated whether implementing COST-FACIT during the initiation of outpatient cancer treatment improved identification of financial toxicity and increased referrals to financial navigation services compared with the Distress Thermometer alone. Methods: A pre–post quality improvement design was conducted in an adult outpatient oncology clinic. During a 15-day pre-intervention period, patients were screened using the Distress Thermometer. During a 15-day post-intervention period, patients were screened using the Distress Thermometer with the addition of COST-FACIT. Outcomes included screening completion, identification of financial toxicity, referral rates, and concordance between tools. Data were analyzed using descriptive statistics. Results: A total of 88 patients were included (n = 54 pre-intervention; n = 34 post-intervention). Screening completion decreased from 98% to 60% following implementation. The proportion of patients identified at risk increased from 19% endorsing financial concerns on the Distress Thermometer to 47% identified using COST-FACIT. Concordance analysis showed that 34% of patients were identified as at risk by COST-FACIT alone. Referral rates increased from 4% pre-intervention to 47% post-intervention, with all patients identified as at risk receiving referrals. Discussion: Implementation of COST-FACIT improved the identification of financial toxicity and substantially increased referrals to financial navigation services. Although screening completion decreased, findings highlight the importance of workflow integration and electronic health record optimization to support consistent use. These results support the incorporation of standardized financial toxicity screening into routine outpatient oncology care to improve early identification and intervention for patients at risk.
Evaluating digital engagement with lifestyle medicine integration at balanced brain Hawaiʻi
(University of Hawai'i at Manoa, 2026) Dao-Nakamatsu, Theresa; Hale, Frankie; Nursing
Abstract:Background/Significance: Preventable chronic diseases necessitate health promotion strategies that complements conventional treatment. Lifestyle medicine (American College of Lifestyle Medicine, 2024) utilizes six pillars to address disease root causes of disease, yet its application within outpatient holistic brain health remains limited. This project addresses the gap by integrating asynchronous education into specialized outpatient clinical practice.
Effectiveness of education in improving continuous positive airway pressure (CPAP) adherence among bariatric surgery patients.
(University of Hawai'i at Manoa, 2026) Park, Lisa; Dutra, Samia; Nursing Practice
ABSTRACT iv Background: Obstructive sleep apnea (OSA) is highly prevalent among bariatric surgery patients and increases perioperative risk when untreated. Although continuous positive airway pressure (CPAP) therapy reduces complications, adherence remains suboptimal, and education is commonly used to improve adherence. Purpose: This quality improvement project evaluated the effectiveness of a structured OSA/CPAP educational intervention on patient knowledge, CPAP adherence, and satisfaction among bariatric surgery patients with OSA. Methods: A prospective pre- and post-intervention design was conducted in an outpatient bariatric surgery clinic. Participants completed a modified seven-item OSA/CPAP Knowledge Checklist before and immediately after a structured session. Secondary outcomes included CPAP adherence, patient satisfaction, and mental health status measured by PHQ-9 and GAD-7. Objective adherence data were obtained via remote monitoring and chart review; however, follow-up data decreased from 28 to 7 participants due to device interoperability limitations. Data was analyzed using descriptive statistics, paired-sample t-tests, Spearman correlations, and content analysis. Results: Twenty-eight participants completed the intervention. Mean knowledge scores increased from 23.79 (SD = 9.55) to 25.82 (SD = 9.70), but the change was not statistically significant (p = .071). Among participants with retrievable adherence data, minimal change was observed. Satisfaction was high. Significant correlations were identified between ethnicity and body mass index, and between lower education levels and higher anxiety and depression symptoms, highlighting the influence of sociodemographic and psychosocial factors on adherence and patient experiences. Conclusion: Although education resulted in modest knowledge improvement, it did not v significantly enhance CPAP adherence. Findings emphasize the importance of tailoring future educational interventions to address cultural, literacy, and mental health factors, as well as improving CPAP data interoperability to support sustained adherence in bariatric surgery patients with OSA.
Evaluating interpersonal conflict resolution confidence among nurses in a skilled nursing facility
(University of Hawai'i at Manoa, 2026) Oshiro, Kelson Kenji; Palakiko, Donna-Marie; Nursing Practice
Problem Statement: Interpersonal conflict, and incivility reduces nurse well-being, teamwork,and patient safety. No structured conflict-resolution education had ever been offered at this project site.
Food is medicine: Integrating lifestyle nutrition education into nursing curriculum
(University of Hawai'i at Manoa, 2026) Olson, Jennifer; Tse, Alice; Nursing
This Doctor of Nursing Practice project focused on the design, implementation, and evaluationof a system-based Food Is Medicine curriculum within a Graduate Entry Program in Nursing (GEPN). The project was informed by evidence-based Lifestyle Medicine food as medicine principles as outlined by the American College of Lifestyle Medicine (ACLM) and adapted for nursing education. Curriculum content was integrated into the nursing assessment course and delivered by the existing course instructor to align with established course objectives and instructional structure. The intervention consisted of weekly, system-focused educational materials emphasizing nutrition and lifestyle-based approaches to health and chronic disease management.
Advanced mental health care directive facilitation education for residential youth psychiatric care social workers in Hawaii
(University of Hawai'i at Manoa, 2026) Lau, Darien Christian; Tse, Alice; Nursing
Background:Transition-age youth (TAY), ages 15–26, experience high rates of care disruption when transitioning from pediatric to adult mental health systems. These gaps are associated with adverse outcomes, including psychiatric hospitalization, homelessness, and justice system involvement. Although structured transition planning is recommended, standardized tools such as Advance Mental Health Care Directives (AMHCDs) remain underutilized in youth psychiatric settings. Purpose: This evidence-based practice (EBP) project aimed to enhance continuity of care for TAY by training licensed clinical social workers (LCSWs) at Kahi Mohala, a youth residential psychiatric facility, to facilitate AMHCD completion using tools and workflows grounded in the Got Transition framework. The initiative sought to increase provider knowledge and confidence while empowering youth to actively participate in future-oriented mental health care planning. Methods: A 45-minute in-person educational session was delivered to five LCSWs. Content included the purpose, legal considerations, and clinical application of AMHCDs, along with structured strategies for introducing directives to TAY. Participants received a facilitation toolkit containing templates, workflow guides, and implementation resources. A pre-intervention survey assessed baseline knowledge, confidence, and attitudes. A three-month post-intervention survey, paired with an informal group debrief, was used to assess changes in these domains as well as feasibility, acceptability, and implementation barrier. Results: This EBP project demonstrated that a brief educational intervention on AMHCD facilitation was feasible and well received by social workers in a youth residential psychiatric setting. Although no eligible transition-age youths were hospitalized during the three-month follow-up period and no AMHCDs were completed, participants reported improved knowledge and awareness of AMHCDs, early directional gains in confidence and comfort with facilitation, and stronger agreement regarding the utility of AMHCDs in transition planning. These findings suggest that training social workers in AMHCD facilitation may be a promising first step toward strengthening structured transition planning for vulnerable youth, while highlighting the need for longer implementation periods and additional practical resources to support future uptake.
Reducing pediatric asthma triggers at home: A teaching intervention for parents and guardians of children with asthma.
(University of Hawai'i at Manoa, 2026) Kenui, Mary Lopez; Tse, Alice; Nursing
Background/significance: Healthcare providers (HCPs) frequently overlook discussing the significant impact the home environment has on pediatric asthma management. This is concerning as the home is where children spend a substantial amount of time and where many asthma triggers are present. Addressing the home environment is crucial for effective asthma management. Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project was to implement and evaluate an evidence-based educational intervention for Hawai‘i Department of Education (HIDOE) parents and guardians of elementary-aged children with asthma. The project aimed to improve caregiver knowledge of common in-home asthma triggers and increase confidence in implementing exposure-reduction strategies. Methods: Guided by the RE-AIM framework, a standardized asthma trigger education session was offered to caregivers at a HIDOE elementary school. Content focused on identification and mitigation of common household triggers. Caregiver knowledge and self-reported confidence were assessed immediately following the session using a brief paper-based survey. Primary outcomes were increased knowledge of asthma triggers and improved confidence in managing the home environment. Results: The participating caregiver showed measurable gains in both knowledge and confidence after the intervention. Broader anticipated outcomes include reductions in preventable asthma exacerbations and asthma-related school absenteeism. Conclusion: Delivering structured asthma trigger education within a HIDOE elementary school setting can be a feasible and practical strategy to strengthen home-based asthma management. Implications/recommendations: Targeted caregiver education may serve as an important proactive intervention to reduce environmental triggers, improve symptom control, and enhance quality of life for children with asthma.
Conflict resolution amongst nurse aides in long term care
(University of Hawai'i at Manoa, 2026) Yang, Ann V.; Palakiko, Donna-Marie; Nursing Practice
Purpose: To improve communication, teamwork, and confidence amongst nurse aides working in a long term care (LTC) facility using an evidence based conflict resolution training program.Background: Conflict is common in healthcare and challenging in LTC settings. High stress, understaffing, and diverse teams often lead to miscommunication and tension. Globally workforce conflict in healthcare settings is recognized as a leading cause of burnout, reduced quality care, and staff turnover. Interpersonal conflict among nursing home aides in LTC facilities contributes to decreased teamwork, job dissatisfaction, and compromised patient care. National organizations like ANA and CMS advocate for conflict resolution training as essential for improving workplace dynamics and patient outcomes. This project implemented evidence-based strategies, including the Thomas-Kilmann model, to equip nurse aides with skills to manage conflict effectively, enhance team collaboration, and improve care continuity in LTC facilities. Results: Immediate post-training results indicated improved knowledge of conflict resolution strategies, emotional intelligence and confidence in application compared to pre-surveys where average score on surveys increased from 2.2 to 4.42 post intervention amongst 19 nursing aides. Three months post survey average results are 4.08. These quantitative findings demonstrate sustainable training interventions and improvement in conflict management skills. Conclusion/Future Implications: This project suggests that brief and structured conflict resolution training can increase staff communication and workplace peace in LTC settings. This implementation can be upscaled to be assessed in other workplace environments such as hospitals, clinics, and other health organizations where communication is vital to workplace harmony and efficiency.
Pilinahā in practice: Strengthening connection and well-being among nursing students
(University of Hawai'i at Manoa, 2026) Pakani-Tells, Kehaulani Rachael; Palakiko, Donna-Marie; Nursing
Nursing programs are rigorous and demanding which can impact student well-being. With increased stressors through the curriculum and clinical responsibilities, programs integrate mindfulness and reflective practices. This quality improvement project evaluates the implementation of the Pilinahā Framework, an Indigenous health model rooted in Native Hawaiian culture that emphasizes connection to place, community, past and future, and one’s better self, as a self-care strategy for students in an accelerated nursing program at the University of Hawaiʻi at Mānoa. A pre–post intervention design was used in which participants attended a 30-minute workshop introducing the Pilinahā Framework and related personal practices, followed by a three-week implementation period. Data were collected using the Perceived Stress Scale (PSS-10), Likert-scale items, and open-ended reflection questions to assess both quantitative and qualitative outcomes at the group level. Findings indicated improvements in coping ability, self-efficacy, and several Pilinahā connection domains, particularly connection to self, past, and future. Changes in perceived stress and health measures were modest and not statistically significant, although positive trends were observed in the pre–post comparison and participant reflections. Overall, the project suggests that the Pilinahā Framework may be a useful culturally grounded approach for supporting well-being and fostering meaningful connection among nursing students. Future implementation may benefit from longer duration and continued engagement to further explore potential impacts.
Development of obesity and chronic illness prevention teaching materials: An elementary school healthcare provider-focused intervention
(University of Hawai'i at Manoa, 2026) Vaught, Montana Rae; Altman, Molly; Nursing Practice
Background: Childhood obesity and chronic illness (OACI) rates are rising, yet there are limited standardized practices for school healthcare providers (HCPs) to teach OACI prevention.Purpose: To 1) develop standardized teaching materials for school HCPs to teach students obesity and chronic illness prevention, 2) deliver materials to school HCPs in virtual training sessions, demonstrating how to use the provided materials, and 3) evaluate school HCPs’ teaching confidence, feasibility of material use, and likelihood of integration at home after school HCPs have taught at least one session to a fifth grade class using the provided materials. Methods: This project was conducted within the Hawaiʻi Keiki: Healthy and Ready to Learn Program. A slide set and pamphlet were developed as teaching materials for obesity and chronic illness prevention. In two virtual sessions, demonstrations on material usage were provided to 23 HCPs that work with the 174 public elementary schools within the program. After the demonstration, HCPs were asked to teach at least one session to fifth grade students using the provided materials. HCPs were provided a survey prior to the demonstration and after teaching one session to measure confidence, feasibility, and likelihood of integration at home. Results/Outcomes: 13 HCPs completed the pre-teaching survey; however, one health technician was trained but was ultimately not eligible as they were not permitted to teach and was excluded (n1 = 12). 3 HCPs implemented the provided materials and completed the post-teaching survey (n2 = 3). At baseline, HCPs (n1 = 12) had a median confidence rating of 4/5, median feasibility rating of 3/5, and median likelihood of integration rating of 3/5. Post-implementation, HCPs (n2 = 3) had a median confidence rating of 4/5, median feasibility rating of 4/5, and median likelihood of integration rating of 3/5. All three HCPs that taught using the provided materials reported the questions for audience participation were one of the most effective aspects of the materials, and two out of the three HCPs also reported the dance activity at the end of the slide set was also an effective aspect. Two HCPs who were trained but did not teach a session using the provided materials completed a follow-up survey to share their barriers to implementation, which included difficulty coordinating with classroom teachers or completing implementation in the allotted time frame. Conclusions: This project was successful in developing and delivering standardized OACI prevention teaching materials. This project also evaluated HCPs’ confidence, feasibility of material use, and likelihood of integration of the shared interventions at home, although statistical significance of HCPs’ ratings could not be determined due to a small sample size.
Functional medicine: Selecting for high-quality supplementation for balanced brain
(University of Hawai'i at Manoa, 2026) Sasaki, John Hirokazu; Nunokawa, Courtnee; Nursing Practice
Background: Dietary supplement-use is common in the United States, yet clinicians often lack standardized training to evaluate product quality, third-party certification, cognitive-health evidence, and safety. This gap is relevant in functional medicine settings, where patients may seek guidance on B vitamins and omega-3 supplements for memory or cognitive health.Purpose: The purpose was to evaluate whether a targeted educational intervention combined with a structured decision-making tool was associated with changes in clinician confidence and knowledge related to dietary supplement counseling and recommendation. Methods: This practice improvement project used a quasi-experimental one-group pretest-posttest design guided by the Plan-Do-Check-Act practice improvement model. Eight participants from an interdisciplinary functional medicine team completed a single 60-minute educational session. Pre- and post-intervention confidence surveys and knowledge tests were completed during the session, followed by a one-week tool usability survey. Results: Mean confidence increased from 1.73 to 4.16 on a 5-point Likert scale, and responses rated 4 or 5 increased from 5.0% to 78.8%. Mean knowledge scores increased from 7.50 to 9.38 out of 14, representing a descriptive improvement. Conclusion: The intervention was associated with improved short-term clinician confidence and a descriptive increase in knowledge related to supplement counseling and recommendation. Implications: A brief structured educational intervention with decision support may improve preparedness for supplement evaluation, counseling, and recommendation in functional medicine settings. Future evaluation should assess sustained tool use, workflow integration, and longer-term practice outcomes.
Translating functional medicine into practice: Improving health communication and engagement through social media
(University of Hawai'i at Manoa, 2026) Chase, Kai; Nunokawa, Courtnee; Nursing Practice
Translating Functional Medicine into Practice: Improving Health Communication and Engagement Through Social Media
Improving nursing staff understanding, comfort, and confidence in discussing oncology supportive care clinical trials through structured intervention
(University of Hawai'i at Manoa, 2025) Yoon, Hyang McEnerney; Tse, Alice; Nursing
Clinical trials expand supportive care options for oncology patients, yet busy clinic workflows and staff uncertainty often limit discussions about and referrals to trials. This project implemented a brief, site-tailored in-service with a five-week follow-up at the Kapi‘olani Women’s Cancer Center to improve nurses’ understanding, comfort, and confidence discussing supportive care trials and to normalize brief, routine trial conversations in clinic flow. Five registered nurses completed matched pre-implementation, post-implementation, and five-week follow-up using a 5-point Likert scale aligned to three areas: understanding, comfort, and confidence. Scores increased from pre- to post-implementation and were sustained throughout the five-weeks. However, brochure distribution (used as a proxy for referrals) was low, indicating practical barriers. Qualitative feedback indicated nurses’ understanding, comfort, and confidence improved, but highlighted time and access constraints. The intervention consisted of two in-person educational sessions, offered individually or in small groups, which created an approachable and supportive learning environment. Existing brochures and resources were used to facilitate effective clinician-patient communication, and staff were encouraged to practice new skills during patient interactions. Through structured training and ongoing support, the project sought to ensure nurses were well-informed about clinical trials, thus enhancing the quality of care for oncology patients. Despite improvements in nurse-reported measures, findings suggest future efforts should focus on integrating trial discussions into workflow and developing point-of-care tools to bridge the gap between readiness and routine clinical practice.
Patient journey mapping in a new RTMS clinic
(University of Hawai'i at Manoa, 2025) Advincula, Jr., Roland; Nunokawa, Courtnee; Nursing
Major depressive disorder (MDD) remains a significant public health concern, with a subset of patients experiencing treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based, noninvasive treatment option for TRD; however, its success is influenced by patient engagement, understanding, and continuity of care. This Doctor of Nursing Practice project evaluated the use of patient journey mapping (PJM) as a framework to support public education and staff training during the opening of a new outpatient rTMS clinic at the Clinical Learning Education Management (CLEM) Clinic. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model, two interventions were implemented: a public open house featuring a PJM-informed educational flyer and a PJM-based staff training program. Data were collected using post-intervention surveys and analyzed using descriptive statistics. Open house participants demonstrated improved understanding of the rTMS process and endorsed a patient–provider partnership model, with the majority reporting clear comprehension of the patient journey. Stakeholders participating in the staff training intervention reported high satisfaction with the clarity, relevance, and usability of the PJM framework, achieving 100% accuracy on knowledge-retention measures. Findings support PJM as an effective educational and training strategy that enhances patient-centered care, promotes patient engagement, and supports clinical readiness in a newly established rTMS clinic. The project demonstrates PJM’s potential to improve patient experience and satisfaction and supports its broader application within clinical education and practice settings.

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