ItemPeer Feedbak to Improve Daily Nurse Leader Patient Rounding(2023-08) Cortez, Wendy AnnImproving the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance within the acute care setting is necessary to ensure high-quality care to patients served, maximized reimbursement, and enhanced market share (Al-Amin et al., 2018; Quigley et al., 2021). One approach for improving overall HCAHPS performance is elevating the patient’s perspective of the nurse leader visiting daily (Morton et al., 2014). The nurse managers within a 264-bed acute care facility in southern California consistently perform nurse leader patient rounding, yet the patient perception of the “nurse manager visited daily” shows significant variation. If the trend continues, the hospital will not achieve the target five star rating and is at risk of losing its four star rating, decreasing patient retention, and reducing the market share. Augmenting the approach for patient rounding was necessary. Peer feedback was the primary strategy utilized to augment nursing practice to mitigate the deficits in patients’ perception of the nurse leader visiting daily. Peer feedback is a proven strategy for enhancing practice effectiveness by expanding knowledge, skills, and behaviors (Haag-Heitman & George, 2011; Korkis et al., 2019). Implementing peer feedback required three phases to ensure practitioner uptake: education, paired leader rounding, and reflective learning. With the original plan, the manager rounding responsibility expanded to include nursing managers from the utilization review and the quality service lines. Changes to the executive leadership team resulted in adapting the originally agreed upon leader participants. A reduction in manager participants may have contributed to stalled patient satisfaction outcomes. With the transition of the Senior Vice President and Chief Nurse Executive, the rounding team reverted to the department-level nursing managers. While this represents a short-term setback, system-level goals have been established to extend patient rounding to the ancillary support and non-nursing managers. The nature of the mandate improves the proactive touchpoints with the patient to improve the experience from a system-level perspective instead of nursing alone. The implementation of this project supports the need to generate additional knowledge related to peer feedback as a practice standard among nursing managers and the role of leader rounding to improve overall patient satisfaction. Through developing a refined understanding, an optimized patient care experience is possible. Only through the spirit of inquiry, the rigor of generating new knowledge, and the timely implementation to practice will healthcare professionals realize optimal outcomes for the patients served. ItemFostering an Organizational Culture of Reliability by Nurse-Led Readiness Rounds(2022-08) Putt, LoriOne in every ten patients is harmed by various adverse events, of which nearly 50% are preventable (World Health Organization, 2019). Nurse-led readiness rounds support organizational change through communication and teamwork to improve patient safety and reduce harm (Hendricks et al., 2017). There was a significant need to change the culture around communication and quality of health care and establish a framework focused on a partnership that improves interprofessional collaborations through nurse-led weekly readiness rounds. This project aims to facilitate nurse-led readiness rounds to create a culture of reliability, change the culture around communication, improve cross-disciplinary collaborations through weekly readiness rounds, and continually build a high-reliability organization. Interdisciplinary collaboration in healthcare helps prevent medication errors, improve patient satisfaction, and improve patient outcomes. Two primary outcomes were assessed to determine the success of the project: adverse events reported through the Unusual Occurrence Report (UOR), and performance as measured by patient satisfaction as reported in the Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) surveys. There was a significant decline in adverse events post implementation of this project. Using the most recent two quarters, adverse events declined from 14 in Quarter 1 2022 to only 10 in Quarter 2 2022 (post implementation). Successful implementation of a culture of reliability and nurse-led readiness rounds delivered high-quality care and improved neonatal and pediatric patient safety at the project site. Interdisciplinary collaboration enabled the team to communicate and work together to benefit patients and their families. As a service line, project participants committed to the five principles of collaboration: applying trust, respect, willingness, empowerment, and effective communication to human relationships (Agbanyim, 2015). ItemImproving Triage and Patient Throughput Process With Emergency Department Rapid Triage Protocol and Emergency Severity Index Training(2022-05) Molina-McBride, AntonioObjectives: This project aims to decrease Admission to Physician Times (ATP) to less than 30 minutes and reduce the rate of patients who leave the emergency department without being seen (LWBS) to less than 10%. By implementing an evidence-based emergency department rapid triage protocol (EDRTP), the project will decrease the length of stay/arrival to discharge (ATD) for patients with Emergency Severity Index (ESI) 4 and 5 to less than 2.5 hours. Additionally, the DNP project lead created an EDRTP oversight committee for a continuous assessment and evaluation of the EDRTP. Methods: The project integrated quantitative methods to determine and measure the effectiveness of EDRTP and ESI training for the emergency department and staff. This task was completed with a multi-method approach, including pre-and post-training evaluation tools to assess ED staff knowledge, confidence, and beliefs about ESI Triage and EDRTP. The DNP project lead analyzed all data retrieved and collected. Results: The DNP project outcomes produced up-to-date and evidence-based triage knowledge and skills. The EDRTP and ESI training resulted in a significant decrease in ATP, ATD (ESI level 4&5), and LWBS rates. All DNP project objectives were met. Conclusion: This DNP project demonstrates that emergency department leaders and staff recognize Emergency Severity Index (ESI) Triage and Emergency Department Triage Protocol to be a valuable change of practice to their current department workflow. Additionally, this project prepared nurses to identify and prioritize patients who required urgent interventions while improving the ATP times, LWBS rates, and length of stay for patients with ESI levels 4 and 5. ItemClinical Support for Oncology Nurse Case Writers in Asynchronous Consultation Service(2022-08) Kim, Angela J.Oncology nurse case writers (ONCWs) are integral to the asynchronous consultation service for cancer patients. Their role is to review patients’ medical records and compile oncological history into a patient clinical narrative (PCN), which is sent to a physician for a written second opinion. A case audit at a designated cancer center in California identified a need for improvement in the quality of PCNs. In addition, ONCWs also voiced a need for clinical support and resources to fulfill their roles with competency, confidence, and efficiency. This quality improvement (QI) project focused on providing lung cancer education; utilizing PCN-writing algorithms; and initiating nurse clinical support (NCS) meetings to evaluate changes in the ONCWs’ self-perceived level of clinical competency, confidence, and efficiency in composing lung cancer PCNs, along with improvements in the quality of lung cancer PCNs. A total of nine ONCWs volunteered to participate in the project. Participants attended two 1-hour lung cancer education modules, used lung cancer PCN-writing algorithms, and attended NCS meetings every other week. Of the 12 lung cancer PCN-writing competency criteria, which were developed by the QI leader tailored toward an ONCW’s role on the basis of the National Comprehensive Cancer Network Guidelines® and the Oncology Nursing Society’s Oncology Nurse Generalist Competencies (ONGCs), one criterion had already achieved the target rating of ≥4.5 on a 5-point Likert scale before project implementation. Of the remaining 11 criteria, seven criteria achieved the target rating, and four criteria did not but achieved a rating close to the target. However, all criteria demonstrated positive changes. The self-perceived confidence and efficiency levels in composing a lung cancer PCN improved and achieved the target ratings. The goal of achieving quality level 5 (highest) on 90% of 20 random lung cancer PCNs was not met, but 85% (17/20) of the cases reached quality level 5. This finding is noteworthy, as none of the 20 PCNs were at quality level 5 before project implementation. The lung cancer PCN-writing algorithms and NCS meetings provided the ONCWs with the needed assistance in writing lung cancer PCNs. The project outcomes suggest that clinical support for ONCWs improved self-perceived competency, confidence, and efficiency in composing lung cancer PCNs and enhanced the quality of lung cancer PCNs. Ongoing clinical support may increase the level of satisfaction regarding the extent of clinical support and the retention rate of ONCWs. Additionally, clinical support may potentially increase revenue by increasing ONCWs’ productivity. Moreover, the positive impact on the quality of written second opinions is likely to lead to positive patient outcomes. The recommendations for the organization to maximize the benefit of implementing clinical support for ONCWs include having a dedicated ONCW educator, developing education modules on other cancer diagnoses, uploading voice-recorded learning modules that are easily accessible, and offering continuous learning opportunities. ItemDevelopment and Implementation of a Standardized, Electronic Oncology Nurse Navigator Metrics Tool(2022-08) Jestine, JincyOncology Nurse Navigation aims to reduce cancer morbidity and mortality by eliminating barriers to timely access to cancer care. These barriers may be financial, psychological, social, or logistical, or they may be related to communication, language, literacy, or equity of health care delivery (Oncology Nursing Society, 2018). The Academy of Oncology Nurse and Patient Navigators (AONN+) is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurses and patient navigators. AONN+ identified 35 evidenced-based navigation metrics relevant to cancer patient navigation (Appendix A) and developed a toolkit recommending healthcare organizations evaluate and select the most appropriate metrics. The standardized tool aids in measuring programmatic success and coordinating high-quality, team-based care, which is integral to demonstrating the sustainability of navigation programs. This DNP project aimed to create and implement a standardized, evidence-based, electronic oncology nurse navigator metrics tool for use across various oncology specializations in the ambulatory services department at a university-based healthcare center. The navigation metrics tool was developed after reviewing the AONN+ recommendation. The goal of tool development and implementation was to combat unorganized and non-standardized data collection methods among the navigator team. Furthermore, the tool would inform patient navigation and clinical outcomes, encourage quality improvement initiatives, and inform return on investment, demonstrating the nurse navigator's value and position in the organization. Data were analyzed from 1,156 patients entered from December 7, 2021, to April 25, 2022, demonstrating standardized use of the tool for effective oncology case management. The tool enabled the collection of multiple data points for evaluating navigation program efficiency and for identifying areas for process improvements. Real-time digital data availability provided baseline information to guide quality improvement initiatives, inform patient outcomes, and demonstrate to leadership the value and contributions of oncology nurse navigation in ensuring a seamless cancer patient treatment journey. ItemHourly Rounding Coupled with the 4 Ps(2022-08) Jamison, Edith M.One out of every three adults over age 65 falls annually in the United States (U.S.). This number increases two-fold by age 80 (Hornbrook et al., 1994). Fall injuries account for 2.8 million emergency visits, and 800,000 hospital stays in the U. S. annually (Ganz & Latham, 2020). Despite the existing fall prevention protocols at the Veterans Healthcare Administration (VHA) Community Living Center (CLC), the average number of falls exceeds the national standard for falls in similar facilities. The project objective was to bring the fall rate of the VHA CLC to within or below the national benchmark by initiating and implementing the evidence-based hourly rounding process with the 4 P’s (potty, pain, position, and possession). The fall prevention program focuses on veterans’ safety and well-being in short-term and long-term care environments in collaboration with the frontline nursing staff. By implementing this evidence-based process into already existing fall prevention measures, the CLC was able to decrease falls by fifty percent. ItemCreating Community at Work: Implementing a Nurse Practitioner Practice Council(2022-08) Hamilton, Laura B.Aim and Background: There is a dearth of evidence to support creating a sense of community among advanced practice nurse practitioners (NPs). This quality improvement project (QIP) established a formal strategy to encourage collegiality and instill a sense of community among the nurse practitioner workforce by facilitating teammate collaboration, communication, and connection. The QIP aimed to establish a volunteer-based nurse practitioner council (NPC) consisting of a governing board and four practice-focused committees. Methods: A quasi-experimental designed study was conducted on a convenience sample of 89 nurse practitioners. The study evaluated the sense of community among nurse practitioners by utilizing the Sense of Community Index (SCI-2) tool before and after implementing a nurse practitioner council. Results: Implementation of the NPC resulted in participation by 30% of the NPs. The Sense of Community (SOC) Index scores increased by 4%. The rate of participation and increase in the total SOC scores over the seven months of this pilot project was a positive trend, indicating that the NPC positively impacted the NPs. Conclusions: Implementation of a volunteer-based nursing practice council is an effective strategy to create a sense of community, improve connections, and increase a sense of belonging within a nurse practitioner practice. The NP Council contributes to the evidence and methodology for implementing a community of practice as applied to advanced practice nursing. Implications for Advanced Practice: The concept that work can be empowering, supportive, and within an enjoyable workplace community can transform an organization. Providing a shared governance council signals to the NP workforce that their work matters and is integral to the organization's success. ItemUsing the HIGH 5 Fall Bundle to Reduce Patient Falls in the Medical-Surgical Unit(2022-12) Cox, AnitaBackground: Nurses are responsible for identifying patients at risk of falling and developing a plan of care to reduce risk in the hospital setting. As a result, nurse-driven safety interventions using an interdisciplinary approach can positively influence fall rate indicators. An assessment of unit nursing practice validated barriers to fall prevention and increased fall rates. A thorough examination revealed: 1). an inconsistency in the fall risk assessment documentation upon admission to the medical-surgical unit, and 2). a lack of fall prevention education. This increased the potential for patient harm and decreased staff compliance. Purpose: The purpose was to implement a comprehensive fall prevention program with goals of 1). reduction in patient fall rate, and 2). improvement in nursing compliance through the use of a fall prevention program and nurses' documentation of fall risk assessments each time a patient is admitted to the medical-surgical unit. Methods: The methodology included the development of 1). an interdisciplinary team, and 2). the contents of a "HIGH 5 fall bundle" included key performance indicators and visual cues for each nurse caring for fall-risk patients. 3). a standardized fall prevention process including education for all RNs, and 4). The pre-and post-implementation analyses included monthly fall rates and compliance with fall prevention. Results: The fall rate showed an overall improvement in fall reduction for two consecutive months. The project objective was to increase the number of fall risk assessments completed upon admission to the medical-surgical unit. The project concluded with a positive variance of a 3.5% increase which is statistically significant and exceeds the goal of greater than 90% of patients with a documented fall risk assessment upon admission. The impact of the QI project exceeded the goals. The organization plans to disseminate the training to the entire hospital and make it mandatory for all RNs to participate. Conclusion: Patient fall prevention is critical to decreasing the risk of injury, hospitalization costs, length of stay, disability, and death. To improve fall prevention strategies, reduce the risk of injury, and improve nursing compliance in the medical-surgical unit, a collaborative team approach utilizing a standardized process and improved access to standardized education was required. ItemUse of Technology in the NICU: Impact of Virtual Visitation on Parental Stress and Nursing Workload(2022-12) Brantley, Ashley N.Objective: This project evaluated how implementing a remote streaming webcam system in a tertiary-level neonatal intensive care unit (NICU) impacted parental stress and nursing workload. Methods: 31 parents and 33 nurses completed validated de novo questionnaires about parental and nursing staff perceptions of the remote streaming webcams. Results: Parent participants reported that viewing their infant on a webcam lowered parental stress, anxiety, and feelings of helplessness while increasing hopefulness. Most nursing participants agreed that the webcams increased nursing workload, stress, and parental telephone calls to the unit while the webcams were on. Conclusion: While most parents reported overwhelmingly positive benefits of the remote streaming webcams in the NICU, nurses expressed concerns about increased workload and stress. These findings suggest that webcam technology can improve the overall parental experience in the NICU. However, there still is a need to find successful solutions to increase nurses' acceptance of this technology in the neonatal environment. ItemLifestyle Medicine: An Effective Approach to Hypertension Management(2022-08) Anderson, TaraUncontrolled hypertension is the leading cause of adult mortality in the U.S. Currently, 116 million U.S. adults have uncontrolled hypertension contributing to 1,000 deaths per day. This equates to 46% of the adult population, or one out of every two adults (Kim et al. 2019). Uncontrolled hypertension is the number one underlying cause of mortality regardless of ethnicity, gender, location or where someone is receiving their healthcare (Kochanek et al. 2019). The current primary, or “gold standard” medical intervention to manage hypertension is to provide prescription anti-hypertensive medications. Yet according to the American College of Cardiology and the American Academy of Family Medicine this is only 24% effective at managing hypertension (ACC, 2017). This means that 76% of the time the gold standard treatment for hypertensive management is not effective. There is an alternative, one that for the last three decades, has proven to be far more effective at not only managing hypertension but in most cases reversing hypertension altogether (Mondala et al. 2019). A Lifestyle Medicine approach has been shown to be more clinically effective than the current, gold standard treatment (ACC, 2017). The purpose of this project is to provide training in the Lifestyle Medicine approach, while developing a cost-effective plan to provide the interventions which lead to positive outcomes of controlled, reduced or reversed hypertension. The mission of this project is to advance evidenced-based Lifestyle Medicine as a value-based specialty that transforms, redefines and sustains health by treating, reversing and preventing hypertensive disease. The vision is that initiation of a Lifestyle Medicine approach in one clinic would lead to two, then three and so on, so that Lifestyle Medicine would become the foundation of a transformed system of hypertensive disease management. ItemStandardization in Wound Care Delivery to Reduce Systemic Variation(2021-08) Tolentino, JosephThis is a quality process improvement Doctor of Nursing Practice (DNP) project focusing on the systemic variation of wound care delivery in the healthcare continuum of an organization and the systematic strategy, planning, and implementation conducted to create a standardized wound care process. The standardized wound care process incorporates the expertise of a Wound Ostomy Continence Nurse (WOCN) and virtual technology. Through servant leadership and human-centered design, the DNP project illustrates how creating and implementing a standardized wound care process for nurses to use can reduce variation in wound care delivery, increase patient access to the WOCN, improve overall patient access, and enhance organizational efficiency. ItemTake Me to Your Leader: Building Future Nurse Leaders(2021-12) Soltero Sanchez, PatriciaThis Doctor of Nursing Practice (DNP) project involved the development of a nurse leadership program designed to support, nurture, and grow future nurse leaders for the Los Angeles Country Department of Health Services (DHS) at Rancho Los Amigos National Rehabilitation Center (RLANRC). This project aimed to develop a program that provided RLANRC nurses with the additional leadership education, support, and experience needed to transition into the anticipated future leadership vacancies within the organization. The program supported current national trends in nursing leadership development (Sherman et al., 2013). The program involved developing a leadership curriculum, supporting participants in the form of mentoring opportunities and follow up sessions, developing a charge nurse competency tool, revising the organization's charge nurse policy, creating a standardized charge nurse hand-off tool, and planning for the future development of supporting methods to address identified gaps in the leadership program. Participants were assessed by their nurse managers before program participation to determine leadership skill baselines and after the program completion to identify leadership skill growth. The participants' improvement and professional growth are scheduled to be evaluated annually to monitor performance. The program was successfully implemented and delivered positive outcomes for the participants and the organization. ItemShared Decision-Making in Prostate Cancer Treatment(2021-08) Johnson, Jessy M.This project seeks to develop a patient-centered decision-making toolkit and implement it at a local urology center to empower patients to make educated decisions about treatment choices for men newly diagnosed with localized prostate cancer. The objectives were to evaluate patient satisfaction with their treatment decision process and determine how many patients sought a second medical opinion. During the implementation of the decision-making toolkit, qualitative data from twenty-two patients were collected at three points of care. Verbal and visual responses to a set of open-ended questions were aggregated and analyzed thematically to evaluate the usefulness of the toolkit in empowering patients to be involved in the decision-making process. All patients who participated in the decision-making process using the toolkit expressed confidence with their treatment decisions and their ability to cope with side effects post-treatment. They provided positive feedback about the toolkit, their experience in the process, and decision satisfaction. In addition, no patients stated the need to seek a second medical opinion. All objectives of this project were met. The toolkit and process of care through the decision-making process were well received by patients and physicians at the urology center. Outcomes of this project led to the recommendation that the toolkit and the process of care become usual practice to support men diagnosed with prostate cancer. ItemAn Integrated Approach to Improve Hypertension Management in African Americans(2021-08) Jackson, Shanna S.Objective: To improve blood pressure management of African Americans through culturally adapted patient education classes and improved health care delivery systems. Methods: The 3-part project was developed utilizing the Chronic Care Model’s framework for organizing and improving chronic illness care based on a proactive and planned approach. Part one consisted of physician education on the importance of timely medication titrations using the organization’s hypertension algorithm, measured through 120 chart audits. Part two was the nurse education which reinforced the importance of obtaining accurate blood pressure measurements, measured through ten monthly spot check audits over eight months. Lastly, part three included culturally adapted patient education classes of 80 patients on the importance of hypertension management with weekly follow up over four weeks to review home blood pressure readings and medication titrations as indicated, measured through pre- and post-knowledge assessments and pre- and post-blood pressure measurements. Results: Physician chart audits showed a 65% compliance with medication titrations. The nurse spot check audits revealed 87.5% compliance in performing accurate blood pressure measurements. Outcomes of the patient education classes demonstrated a 22.1% improvement in the blood pressure control rate for the physician whose patients participated and a 10% improvement in the overall clinic control rate for the target population over three months. Additionally, there was an average of 25% knowledge increase from week one to week two based on the pre- and post-knowledge assessments for all eight cohorts. There was also an average reduction of 12mmHg in systolic blood pressure and 5mmHg in diastolic blood pressure. Conclusion: Data supported the inference that using an integrated approach involving nurse and physician education and culturally tailored education classes improved hypertension management in the African American population. The DNP project provided patients with the knowledge and necessary tools to effectively manage their blood pressures at home and increase adherence to their prescribed regimen. ItemImproving Chronic Wound Healing in the Home Health Setting(2021-12) Gay, MarciaThe management of chronic wounds and their sequelae is a significant challenge within healthcare systems in the United States and globally. Chronic wounds negatively impact quality of life and are associated with numerous comorbidities such as diabetes, obesity, hypertension, and vascular disease. Chronic wound management is complex because it is affected by social, economic, clinical, and systems factors that exacerbate challenges in achieving positive healthcare outcomes. To address chronic wound care requires vital stakeholders to come together in a collaborative effort to meet this need (Sen, 2021). The number of patients with chronic wounds cared for in the outpatient and home health settings is increasing (Sen, 2019). According to Mahmoudi and Gould (2020), challenges to healing chronic wounds include lack of provider knowledge regarding broad principles of wound healing, an aging society with complex comorbidities, a lack of standardized treatment regimens, an overwhelming market with competing wound care products, and a lack of care coordination and collaboration. Key stakeholders must meet these challenges, such as durable medical equipment suppliers (DME), home health nurses, primary care/wound care providers, and insurance case managers. If the healthcare system fails to address these multiple factors, adverse outcomes in overall wound healing will continue to be observed (Mahmoudi & Gould, 2020). The mission of this project is to improve wound healing for patients with chronic wounds by enhancing home health nurses' wound care knowledge base and the care coordination and collaboration among home health nurses, physicians/wound care providers, and durable medical equipment suppliers. The vision is to improve acute and chronic wound healing and quality of life for patients while efficiently utilizing health care resources and improving care coordination and collaboration among stakeholders in the home health setting. Translational project objectives include: a) decreasing the delay in obtaining appropriate wound care supplies for patients, b) improving patient status updates to at least biweekly between home health agency nurses and primary providers/wound care providers, c) improving wound healing by increasing nursing knowledge on current wound care management principles, utilizing a validated wound measuring tool to assess wound progression and d) providing a wound care education resource for home health agency use for sustained success in the wound care program. The project scope included improving the collaboration and coordination among all stakeholders so that wound care outcomes and healing could be enhanced. Methods to streamline communications with each stakeholder were developed and implemented. Educational resources were created, implemented, and evaluated. Validated wound measurement tools were utilized for measuring wound characteristics. Wound care supply products and supply chains were considered for standardization of use. Individual nurse and facility-based wound care education were developed and provided to home health nurses and the home health facility. ItemImplementation of Safety Education for Window Fall Prevention in Children(2021-08) Flores, Sarah L.Falls are the most common reason for childhood unintentional injury visits to the emergency department in the United States. Of these, window falls account for the most significant injury and are underrepresented in injury prevention education, leading to a lack of awareness. Anticipatory guidance tools do not consistently address window safety at the peak age of incidence. This quality improvement project employed interprofessional collaboration to address the gap in window safety education and tools while utilizing the Model for Improvement, developed by Associates in Press. This study aims to demonstrate the benefit of aligning primary care anticipatory guidance practices with local trauma injury trends and creating multimodal actionable interventions based on identified risk factors from data collected from 2015-2020. Outcomes for this 18-month initiative were designed to increase awareness of the incidence of pediatric window falls, improve the delivery of window safety education, and provide injury prevention education and window safety resources through interprofessional collaboration. Future recommendations for this study include advancing window safety legislation in California and potentially in the nation for health care providers to implement window safety education, engineering, and enforcement, which are the three E’s of injury prevention. ItemFire Safety for Children: A Simulation Toolkit(2019-06) Anderson, Carie Alise LeilaniEvery year approximately 400-600 children under the age of 18 die in house fires across the United States. Currently, there is no safe simulation activity to educate children about fire safety in the home (without the danger). The goal of the Fire Safety for Children (FSFC): A Simulation Toolkit project is to provide fire safety education for the home in a mobile Simulation environment for children, and to be initially disseminated through Grand Terrace Elementary School. The objective of the Fire Safety for Children (FSFC) project is to provide and evaluate the effectiveness of the fire safety simulation education for the home within a mobile simulation to children through an evidence-based FEMA toolkit. ItemPREPARING PUBLIC HEALTH NURSES FOR DISASTER: INCREASING SELF-EFFICACY & STANDARDIZATION(2017-12) Johnson-Toro, StaceyObjectives: The purpose of this project was to increase disaster self-efficacy and standardization for public health nurses (PHNs) thru implementation of disaster training, specialized disaster certifications, and standardized triage procedures to prepare PHNs as first responders during disasters. The impetus for conducting the project was to address evidence from literature that suggest when PHNs are called on to be first responders in a disaster they do not have the knowledge and skill set to be effective in triage or to follow incident command protocols. Methods: This project incorporated quantitative methods to identify and measure disaster self-efficacy for PHNs. This task was accomplished with a variety of approaches including: pre and post training Disaster Self-Efficacy Surveys (DSES) created by Dr. Catherine Naypaver, demographic questionnaires, simulations, online certifications, and course evaluations. All Data retrieved and collected was analyzed in SPSS software. Results: The results of the dependent sample t-test were substantial, t (16) = -10.68, p < .001, SD 10.70, df 15, and Sig. (2-tailed) = .000 signifying that there was a difference in pre and post DSES tools. Overall 100% of the study participants perceived an increase in their individual level of disaster self-efficacy. Increased disaster self-efficacy was measured by the mean increase from pre-training DSES (55.63=45%) to post-training DSES (84.29=67%) reaching the goal of 20% or greater rise in mean scores. Conclusion: The results of this DNP project demonstrate that PHNs at Riverside County Department of Public Health (RCDOPH) recognize specialized disaster training and certification in Basic Disaster Life Support (BDLS ®) to be a useful addition to their current training and will prepare them to respond to disasters in the role as first responder.