IMPLEMENTATION OF 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, 2021 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 ...

1. IMPLEMENTATION OF 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, 2021
Signature Faculty Reader Date
Signature Program Director Date
Acknowledgments

2. Abstract
Start typing here….
Key words:
2
Table of Contents

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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-

11. 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

12. 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

13. 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.

14. 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

15. 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

16. 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.

17. 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 i n
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

18. 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

19. 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 addr essing
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

20. 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

21. 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.

22. 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.

23. 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.

24. 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 w
hen 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

25. 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 clini cal
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.

27. 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

28. 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

29. 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

30. 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

31. 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

32. data. Risk assessments also enhance identification of internal
strengths and external opportuni ties 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

33. 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 offici al
approval from the organization was received on December 2,
2020.

34. 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,

35. 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 parti cipants’

36. 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

37. 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

38. 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 analysi s
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)

39. 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 %

40. 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 %

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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.

49. 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

50. 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

51. 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

52. 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
Start introduction here………..
Recommendations for Site to Sustain Change
Start typing here….
Plans for Dissemination of Project
Start typing here…
Project Links to Health Promotion/Population Health
Start typing here….
Role of DNP-Prepared Nurse Leader in EBP
Start typing here…
Future Projects Related to Problem
Start typing here….
Implications for Policy and Advocacy at All Levels
Start typing here….
Final Conclusions
Start typing here…

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Y., Lopez, S. M., Rivera, M.,
Mosquera, R., Carlo-Chevere, V., & Rodriguez-Quilichini, S.
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54. Kambic, D. M., Caicedo, C. H., ... & Lengerich, E. J. (2020).
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Appendix A
Colorectal Cancer Flyer- English Version

56. 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

57. 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
Student: _____Daniela Londono_____________ Course:
______NUR799______________ Semester:
____Summer________
Each DNP Student is required to complete a minimum of 125
hours in NUR 702, a minimum of 125 hours in NUR 704 and a
minimum of 250 hours in NUR 799. Students will maintain a
different log for each course. All completed practice
experience (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
Description of Course Outcome
Category Type
Description of Category
DNP Essential
DNP Program Outcome
Problem Identification

58. A
Collaborating with experts in practice to identify a clinical
problem.
I, VI
1, 2, 6
Problem Identification
B
Applying advanced communication skills to identify a quality
improvement initiative in a health care setting.
II
7
Problem Identification
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
Literature Review
E
Engaging in scholarly inquiry to identify evidence-based
practice to utilize to improve patient outcomes.
I, III
2, 3, 6
Literature Review
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

59. 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
Project Planning [Assessments]
A
Employing principles of health policy to develop effective plans
for a practice-level change to improve quality of care.
II
7
Project Planning [Assessments]
B
Employing leadership skills within interprofessional teams to
analyze organizational issues.
VI
1
Project Planning [Assessments]
C
Evaluating a care delivery model to identify gaps of care for
individuals, aggregates or populations.
VII
4
Project Planning [Assessments]
D
Using analytical skills to assess the relationships among
practice, process, fiscal, and policy issues at an organization.
V, VIII

60. 5, 9
Project Design
E
Integrating theory into practice through the development of a
quality improvement project.
I
2, 6
III. Course – NUR704 (continued)
Project Design
F
Applying findings generated through scholarly inquiry to design
a quality improvement project.
III
3
Project Design
G
Designing an evaluative plan to monitor outcomes of a quality
improvement project through the use of health care information
systems.
III, IV
3, 8
Advanced Nursing Practice
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).
VIII
5
IV. Course – NUR799
Description of Course Outcome
Category Type
Description of Category

61. DNP Essential
DNP Program Outcome
Project Implementation
A
Functioning as a practice specialist through the implementation
of a quality improvement project.
III
3
Project Implementation
B
Applying advanced communication skills to lead a quality
improvement initiative in a health care setting.
II
7
Project Implementation
C
Providing leadership to influence health policy within the health
care system through demonstrating evidence-based practice.
V
9
Project Implementation
D
Mentoring health care professionals to enhance patient
outcomes through the use of evidence-based practice.
VIII
5
Project Implementation
E
Educating health care professionals regarding the transitioning
to evidence based practice.
VIII
5
Project Evaluation
F
Demonstrating advanced levels of clinical judgement through

62. the evaluation of evidence-based initiatives to improve patient
outcomes.
IV, VIII
5, 8
Project Dissemination
G
Providing leadership to influence health policy within the health
care system through the dissemination of findings from quality
improvement project.
V
9
Project Dissemination
H
Functioning as a practice specialist through the dissemination of
findings from quality improvement project.
III
3
Advanced Nursing Practice
I
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).
VIII
5
DNP Practice Experience Log
DNP PE Log Template-Categories by Course_2020_07 2
DNP Practice Experience Log
Date
*Post 704
Start Time - End Time

63. 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
10 min
A
Contacted the IRB advisor via Chatham email
*02/01/21-
*02/28/21
5p-11p
x
6
6h 10m
A
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.

64. The recruitment, data collection, storage and release were
described and inputted. The consent, risk and benefits and
additional documents were attached for IRB review.
*02/28/21
8a-3p
x
7
13h 10m
A
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
x
6 hours
19h 10m
I
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

65. x
1
1
21 hr 10m
A
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
x
10m
21h 20m
Approval from the IRB was obtained.
*04/12/21
8a-2p
x
6h 40m
28
A
Reviewed the Residency Poster Presentation guidelines in the

66. 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
x
5hr 30 min
33h 30m
A
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
x
30 min
34
A
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
x
1
35