Colorectal Cancer Screening Assignment

The resource that I am sharing with regard to setting goals that are specific, measurable, attainable, realistic and time-bound (SMART) is a peer-reviewed research study by Briant et al. (2018). I have chosen this particular article because it is in line with my capstone project on colorectal cancer screening in the community. The study was conducted from the background that colorectal cancer incidence is higher among poor minority communities such as Hispanics and African Americans. This is compared to the more well-to-do white population. The reason behind this has been found to be lower educational achievement, low socioeconomic status, low purchasing power, lack as access to proper quality healthcare, and poor environmental living conditions as social determinants of health (Briant et al., 2018; Cruz-Correa et al., 2016; Brenner et al., 2016; Martinsen et al., 2016). The aim of the study was to determine the effectiveness of a culturally sensitive community intervention or “house health parties” on the Hispanic community in the sensitization of the community members about colorectal cancer and the importance of early screening. In the process, community members aged 50 years and above were given a free self-administering fecal occult blood test or FOBT kit. The results were impressive in that there was a statistically significant rise in colorectal cancer (CRC) awareness and screening importance for the same. The goal of this study by Briant et al. (2018) was SMART. It was:Colorectal Cancer Screening Assignment

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  • Specific: The intervention targeted the Hispanic community which is a distinct demographic entity.
  • Measurable: The outcome in terms of those who were now aware of the importance of CRC screening could be measured in quantitative terms. After the intervention, CRC screening rates rose from 51% to 80% (Briant et al., 2018).
  • Attainable: The objective of making the local Hispanic community aware of CRC and the importance of being screened for it was an attainable one from the beginning. This was ascertained from the literature review in the study that showed that similar studies had been successfully undertaken.
  • Realistic: Getting the Hispanic community to know about CRC causes and screening was a realistic objective as others had been successfully sensitized in the past too.
  • Time-bound: The study had a specific time period after which it had to end. It was conducted between March and October 2012 (Briant et al., 2018).

My Goal Setting as a Nurse Practitioner in a Gastroenterology Clinic

As a nurse practitioner working in a gastroenterology office, I see patients with illnesses related to the gastrointestinal tract on a daily basis. One of them is colorectal carcinoma (CRC). To carry out my duties and responsibilities properly, I normally set myself goals and objectives that are SMART. This is because I would not want to set an objective that later on turns out to be impossible to achieve. For that reason, the objectives I set for myself at my workplace are always specific, measurable, attainable, realistic, and time-bound. Some of them are:Colorectal Cancer Screening Assignment

  1. To ensure that every patient that I see is given health education and health promotion on the importance of being screened for CRC at the right age.
  2. To increase the number of those who are routinely screened for CRC from the adjacent minority communities.
  • To always make of my patients agents of prevention to the rest of the community in as far as gastrointestinal ailments are concerned.

A SMART Goal Related to My Capstone Project

As stated in the introduction, my capstone project is quite similar to the resource chosen above for analysis in terms of SMART objectives or goals. Just like in Briant et al. (2018) it is going to be about the implementation of a community-based educational intervention with a view to increasing awareness about CRC and increasing the screening rates for the same. For that reason, my SMART goal as far as my capstone project is concerned will be to increase the proportion of my eligible patients that present themselves for CRC screening from the current 70% to 80% within a period of six months from now. This objective is:

  • Specific: It targets only the patients who are eligible for screening for CRC and not the whole population of patients.
  • Measurable: Because the office has an electronic health record (EHR) system, patent data is stored electronically and data can therefore be analyzed anytime with just the click of a mouse. For that reason, it will be possible to determine if the number of patients screened has indeed increased from 70% to 80% in six months or not.
  • Attainable: To avoid being over optimistic, the target of an additional 10% of eligible patients in six months is quite modest and achievable.
  • Realistic: The problem of CRC in minority communities is significant and therefore forecasting a rise in screened patients by 10% is quite realistic.
  • Time-bound: The goal is expected to be achieved within a period of six months. It therefore has a timeframe for realization. Colorectal Cancer Screening Assignment

References

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

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

Cruz-Correa, M., Cordero, F., Betancourt, J.P., Diaz-Algorri, Y., Lopez, S.M., Rivera, M., & Rodriguez-Quilichini, S. (2016). Implementation and outcomes of a community-based educational program for colorectal cancer prevention in Hispanics. Journal of Family Medicine and Disease Prevention, 2(3). http://dx.doi.org/10.23937/2469-5793/1510042

Martinsen, R.P., Morris, C.R., Pinheiro, P.S., Parikh-Patel, A., & Kizer, K.W. (2016). Colorectal cancer trends in California and the need for greater screening of Hispanic men. American Journal of Preventive Medicine, 51(6), e155-e163. https://doi.org/10.1016/j.amepre.2016.05.019

SMART is an acronym that describes effective goal setting and represents goals that are specific, measurable, attainable, realistic/relevant and time sensitive. The first step in goal setting is articulating and writing down one’s goals. Being goal-oriented in crucial in our daily lives and long-term planning. As Leigh (2010) emphasizes “get it in writing,” and he likens the process of goal setting as providing the destination for a trip where one would certainly not embark on the journey or destination without directions. Employing these five characteristics of the SMART acronym set the recipe for successful goal setting and goal attainment.

I want to share with the class an additional resource applying SMART goal setting by Aghera et al. (2018) where the authors evaluated the effectiveness of a SMART goal enhanced debriefing strategy after simulation training. This was a prospective randomized controlled trial among emergency medicine residents across three academic hospitals comparing two different debriefing strategies after simulation scenarios. The control was standard debriefing without explicit dialog about learning goals verses the intervention that entailed debriefing with SMART enhanced goals which promoted the creation of quality, self-directed learning goals that were identified from the clinical scenarios (Aghera et al., 2018).  Findings from the study revealed that after two weeks there was no significant difference in either the mean number or quality of learning goals between the two groups (Aghera et al., 2018). However, an important piece of follow up was that residents were asked after two weeks to list not only learning goals but also educational actions taken in response to their simulation case encounters. Interestingly, residents who received the SMART enhanced debriefing were able after two weeks to complete more educational actions (p=0.03) than those in the control group (Aghera et al., 2018). The authors conclude that the ‘process’ of setting SMART goals served as a subconscious primer for execution of goals with priming increasing motivation, focus and commitment to reach a goal (Aghera et al., 2018). This also facilitates the development of self-directed learning and will ultimately lead to a potentiation of clinical performance (Aghera et al., 2018). Despite no change in number and quality of goals recalled, ultimately SMART goal enhanced debriefing served as a powerful primer “to promote additional self-directed learning through executed educational actions” (Aghera et al., 2018, p. 119).

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In my work environment I set goals and evaluate my goals on an annual basis. This is done as part of my yearly performance evaluation with my superior and program director. We have a very close working relationship and dialog about goal setting. Importantly, this process is bidirectional where my boss articulates short- and long-term goals that she has for me and I do the same for myself. I do have to articulate these goals (in written form) and identify where I currently stand in reaching the established goals. I am required to provide a thoughtful response and plan on my current status and future plans with goal setting and goal achievement. Identification of facilitators and barriers in the process is also required and very helpful. I have not specifically used the SMART acronym thus far, however, I have utilized many of the components while setting each goal just unofficially. Colorectal Cancer Screening Assignment

A Preceptor Observation Tool was designed by the PM with several goals: 1) to provide a mechanism for directing and evaluating the competencies needed by CRNAs to avoid or minimize burnout while precepting and provide high quality healthcare services, 2) to identify areas of growth and development, and 3) to provide for opportunities for ongoing learning (communication skills and strategies to mitigate burnout and optimize wellness) and continuous quality improvement. This tool consists of 10 questions on a five-point Likert scale ranging from 1=Never, 2=Rarely, 3=Sometimes, 4=Most of the time, and 5=Always. The desired outcome is to evaluate (after completion of the four educational sessions and virtual support) through direct observation of the precepting CRNA the ability to apply new knowledge in the clinical arena and minimize burnout producing factors while precepting. Mean, standard deviation, median and range will be reported for each of the ten areas assessed on the Preceptor Observation Tool. Number and percentage of areas with mean greater than or equal (> or =) to a 3 will be reported. An overall mean of the 10 areas will also be calculated for each participant and for the entire group and evaluated for effectiveness if the mean is greater than or equal to a score of 3. The PM will evaluate for the presence and/or reduction of burnout while precepting. The goal will be for only 10% of questions, or 1 out of 10, to be a score of 3 or less. As described above achieving a total mean score of 3 or greater will be a positive outcome.

Specific: After completion of four educational sessions and a virtual support group, the individual precepting CRNA mean score and overall group mean on the Preceptor Observation Tool will be equal or greater than a 3. Additionally, 90% of the questions (or 9 out of 10) questions should be a score of 3 or greater.

Measurable: This goal is measurable through running descriptive statistics on the data. The overall group mean score is calculated along with individual CRNA scores on the Preceptor Observation Tool. Effectiveness of the intervention is measured with a mean score greater than or equal to a 3.

Attainable: This is an achievable and attainable goal for the practice improvement project. Effectiveness of the intervention and sustainability of the practice change is being evaluated with this tool.

Realistic/Relevant: Leigh stresses (2010) having a meaningful goal that provokes an emotional connection in order to further drive motivation and enhance success in goal achievement. I am the scheduling and clinical coordinator for the Nurse Anesthesia Program (NAP) and the clinical preceptor’s experiences are of paramount importance to me in this role. I take personal ownership to provide the CRNAs with education and training in order to best serve the student’s learning, their own well-being and optimize patient care while precepting. Mitigation of burnout producing factors has a clear association with patient safety, overall provider, population and organization health. Colorectal Cancer Screening Assignment

Time sensitive: The observation in the perioperative environment will occur after the participant completes the educational training and four weeks of the virtual support. Feedback will be provided immediately after the observation piece and descriptive statistics will be calculated on the whole data set once the final observation is complete.

I am very excited about the implementation and evaluation of this project improvement process. The application of the SMART goal process has helped to further articulate and refine my overarching goal in improving practice and ultimately patient care. With the aid of the Preceptor Observation Tool the outcome is for the PM to observe the CRNA successfully applying the principles from the education and support group into the perioperative setting to reduce the burnout experience. The PM will evaluate for the presence and/or reduction of burnout while precepting. Colorectal Cancer Screening Assignment