HPU Digital is Hawai‘i Pacific University’s institutional repository, led by the Library as a center of scholarship and innovation. It preserves and shares the academic work of HPU’s faculty, students, staff, and affiliates, reflecting the university’s diverse, global, and inclusive learning community. This initiative supports access, visibility, and long-term preservation of HPU scholarship and aims to connect the HPU community to academic and professional success.
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Item Implementing a Workplace Mindfulness Campaign to Decrease Burnout Levels in Primary Care(2025)Burnout is a leading cause of employees’ poor job satisfaction and performance; while being a source of poor quality of care, influencing turnover, absenteeism, and low morale. An urban primary care clinic in California was experiencing high burnout levels and lacked an evidencebased strategy to support staff members. The purpose of this quality improvement project was to determine if the Palouse mindfulness-based stress reduction (MBSR) program would decrease burnout levels compared to standard practice among staff members of a primary care clinic located in urban California over eight weeks. Kurt Lewin’s Change Model framework served as the project's foundation, encouraging employees to change their behavior. The project determined that the Palouse mindfulness campaign decreased the burnout level of primary care employees. The median scores in each Maslach Burnout Index (MBI) tool subscale improved between the pre- and post-test. Hence, the implementation of Palouse Mindfulness Strategies may decrease the burnout level of employees, which will positively impact their job performance, increase job engagement, and drive high morale. The primary care will have efficient daily clinic operations with tenured and happy employees. By attaining and sustaining a healthcare system fiscal budget, the population needs access to care, and quality patient care is met.Item Implementing the Stop-Bang Assessment Tool to Impact Perceived Stress Among Clinical Staff(2025)Anesthesia-related airway emergencies, particularly those involving failed intubation or ventilation, are a significant concern and contribute to poor patient outcomes. Obstructive sleep apnea (OSA) increases the risk of difficult airway events, further compromising patient safety. Despite its predictive value, the STOP-BANG questionnaire is not currently used to screen for OSA risk in the endoscopy lab of an urban outpatient gastrointestinal clinic in Chicago, Illinois. This gap in practice can lead to procedural delays and safety concerns due to unanticipated equipment needs, insufficient staff readiness, and lack of postoperative awareness. This quality improvement project aimed to determine the impact of implementing the STOP-BANG questionnaire compared to the current practice on stress perception among outpatient gastrointestinal (GI) clinic staff over 8 weeks. The Knowledge to Action (KTA) framework was used as a guide to facilitate this project. A pre- and post-implementation Perceived Stress Survey-10 (PSS-10) was administered to clinical staff (n =10). Also, the STOP-BANG questionnaire was used to evaluate patients for possible undiagnosed OSA prior to anesthesia (n =103). Results showed that the mean pre-intervention score for PSS-10 was lower (M = 13.9, SD = 5.72) than the post-PSS-10 survey mean score (M = 16.8, SD = 4.32). However, implementing the STOP-BANG questionnaire categorically changed perceived stress levels from low to moderate among clinical staff at a low rate (n = 2; 20%). Nevertheless, perceived stress levels did not improve. STOP-BANG scores for colonoscopy patients were at an average of 3.66, whereas the average STOP-BANG scores for patients undergoing an esophagogastroduodenoscopy (EGD) were 3.06. Airway maneuvers were needed for 40.98% of patients who had a colonoscopy and 37.93% of patients who had an EGD.Item Honoring Patient Wishes: Implementing Physician Orders for Life Sustaining Treatment(2025)Purpose Rising healthcare costs are a growing concern for the nation. There are several factors affecting the increased cost of health care. Two major factors are emergency room visits and hospital admissions. Between 20-40% of these patients will have a preventable admission (Browne et al., 2024). Hospital admission rates and the number of emergency room visits are two factors that are important for long-term care facilities. These elements correlate with quality measures through the Center of Medicare and Medicaid. A long-term care facility in Alaska has noticed an increasing number of hospital admissions and emergency room visits in their population over the last two years. This year hospital admission rates for 2024 were 0.49 hospital admissions per resident day which is up from 0.29 in 2023. Emergency room visits are also on the rise. In 2023 there were 0.73 emergency room visits per resident day, by the end of the fourth quarter in 2024 this was elevated to 1.30. The use of physician orders for life sustaining treatment (POLST) forms have shown to benefit long-term care facilities. Jennings (2022) showed those facilities who used POLST forms had higher star ratings by the Centers for Medicaid and Medicare Services, indicating higher quality. Two quality indicators included in this star rating system are hospital admission rates and emergency room usage. POLST forms will help the long-term care population by preventing unnecessary emergency room visits and hospital admissions. Tark (2021) showed that states with fully developed POLST programs had a 12% increase in those who did not return to the hospital or have emergency room visits at the end-of-life. Demonstrating that POLST form completion decreases unwanted and unnecessary emergency room visits and hospital admissions at end-of-life. The gap in literature is identifying what psychosocial factors can help decrease hospital admissions and emergency room visits. In residents in a long-term care facility how does implementing Physician Orders for Life Sustaining Treatment (POLST) forms compared to prior practice impact the rate of hospital admissions and emergency visits in eight weeks? Implementation Plan Implementation took place over an eight-week period. During the first week of implementation staff were educated on the purpose and use of the POLST form using standardized education material through AK POLST. During weeks one through eight the provider met with residents and families to complete POLST forms. During weeks two through eight the provider met with staff once a week to discuss obstacles, questions, and current use of the POLST forms. There was also a provider on call to address any issues regarding POLST forms. Data Collection Data was collected by the quality improvement team using facility software and is available for review. Data was analyzed using paired T-test collecting before and after POLST implementation data for hospital admissions and emergency room visits using simple descriptive statistics.Item Behavioral Temperature Preference and Physiological Critical Thermal Limits of the Non-Native Indo-Pacific Sergeant Abudefduf Vaigiensis, Endemic Hawaiian Sergeant Abudefduf Abdominalis, and Hybrids from Oʻahu, Hawaiʻi(Hawaii Pacific University, 2025)Sea surface temperatures have been increasing globally as has the frequency of marine heat waves due to climate change. In the Hawaiian Archipelago, sea surface temperatures have been increasing since the 1940s. Tropical marine ectotherms often have a core temperature close to their environmental temperatures and settle in environments near their upper thermal range. Increased sea surface temperature has been shown to threaten coral reef fishes when surpassing their thermal tolerances. I chose to investigate the sergeant major species group (Abudefduf abdominalis, A. vaigiensis, and hybrids) which are an abundant coral reef fish in the Hawaiian Islands. The endemic Hawaiian sergeant, A. abdominalis, and the invasive Indo-Pacific sergeant, A. vaigiensis, first reported in the islands in the 1990s, were formally documented hybridizing in 2007, although hybridization likely occurred before. I assessed differences in thermal biology in relation to genetic similarity to the pure, parental species (A. abdominalis and A. vaigiensis) by using Structure 𝑄𝐴𝑣𝑎 as an estimate of the proportion of the genome in each individual that came from A. vaigiensis versus A. abdominalis. I performed temperature preference (Tpref) experiments, which assessed an individual’s behavioral choice for certain temperatures, in an annular chamber on forty sergeant majors. Additionally, I performed critical thermal maximum (CTmax) experiments, which assess an individual's physiological thermal limit, on thirty-six sergeant majors. There was no effect of genetic similarity to A. vaigiensis on CTmax, but mass had an effect of a 1.4°C decrease on CTmax as mass increased from 8.7 to 124.6 g. Additionally, there was an effect of 1.7°C increase in the size of the thermal preference range, interquartile range (IQR), over the mass range in this study (8.7 to 124.6 g = 116 g). I found genetic similarity to A. vaigiensis to have significant effect of 1.2°C increase in median Tpref, a 2.2 °C increase in lower avoidance temperature (the first quartile), and a 1.5°C decrease in the size of the IQR; moreover, 2 both A. vaigiensis and hybrids showed a preference for temperatures from 26 - 28°C. By using Structure 𝑄𝐴𝑣𝑎 as an estimate of the proportion of the genome in each individual that came from A. vaigiensis versus A. abdominalis, I found genetic similarity to A. vaigiensis lead to higher median Tprefs, higher lower avoidance temperatures, and decreased size of the thermal preference ranges, though there was no effect on CTmax. Although I could not directly compare across species groups, testing for differences in thermal biology in relation to genetic similarity to the pure, parental species suggest that the invasive A. vaigiensis have a preference for warmer temperatures than the native A. abdominalis, which may have aided A. vaigiensis’ expansion into Hawaiian habitats with increasing SST.Item Improving Anemia Outcomes for Erythropoeitin Stimulating Agent Hyporesponsive Hemodialysis Patients(2025)Purpose: To evaluate the effectiveness of the Supplemental Hyporesponse to ESA Checklist in managing anemia among hemodialysis patients who are hyporesponsive to erythropoiesisstimulating agents (ESAs). The checklist aims to improve hemoglobin levels and optimize anemia management by identifying and addressing underlying causes of ESA hyporesponsiveness. Background and Significance: Anemia is a common and serious complication in patients with end-stage renal disease (ESRD), contributing to reduced quality of life, cardiovascular disease, and increased mortality (Bae et al., 2019). While ESA therapy is standard, many patients exhibit suboptimal responses, often requiring high doses that raise cardiovascular risk (Shah et al., 2020) Intervention and Implementation Plan: The intervention was implemented using a multidisciplinary team including nurses and nurse practitioners. Prior to implementation staff undertook a comprehensive training session. The checklist was used to monitor and adjust treatment for hyporesponsive patients. Data collected included hemoglobin levels, ESA dosages, referrals, and post-intervention survey responses evaluating the checklist’s utility. Results and Implications: Use of the checklist was associated with increased hemoglobin levels and reduced ESA doses in most patients. This targeted, individualized approach to anemia management enhanced clinical decision-making and may reduce cardiovascular risks. The positive results support the broader adoption of the checklist to improve anemia outcomes across the ESRD population in other dialysis settings.
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