WSU REPOSITORY MSN/DNP Improving Patient's Satisfaction Score by Utilizing My HealtheVet Project Title by Octavia J'Anne Christensen Student's Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 26, 2024 Date Oc.:tzw.ia, 90;wu ~~, BSN, RN, MSN Student Student Name, Credentials (electronic signature) Trish Gibbs DNP, RN, CNE MSN Project Faculty April 26, 2024 Date April 26, 2024 (electronic signature) Date April 26, 2024 Anne Kendrick (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Improving Patient's Satisfaction Score by Utilizing My HealtheVet Octavia J' Anne Christensen, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSNProject 2 Abstract Purposes/Aims: This MSN project aims to implement ways to educate veterans and clinical staff members to utilize the messaging system within the My HealtheVet application to increase patient satisfaction scores by improving communication between patients and clinicians. Rationale/Background: Low patient satisfaction scores commonly act as a catalyst for changes in healthcare. This project explores the impact of implementing commimication technology. It investigates how educating veterans and clinicians increases resource utilization, which has been shown to improve patient outcomes. Methods: Using evidence-based resources and Rosswurm and Larrabee's framework, instructional materials were developed to assist veterans and healthcare providers in increasing the use of My HealtheVet technology. Evaluation methods include qualitative surveys that measure participants ' understanding and comfort level with the educational material. Results: Clinicians' pre- and post-survey testing patient education on navigating the My Healthe Vet application and utilizing it to communicate effectively with patients showed an increased lmowledge base after implementation. Analyzed data differences in veterans' responses to the SHEP pre and post-project implementation showed increased patient satisfaction levels. Conclusions: Proactive communication and collaboration between patients and clinicians are needed to improve patient care outcomes. Through effective commimication and the application of EBP education, nurses can develop the nursing practice to improve patient outcomes and meet the needs of an evolving healthcare system. Keywords: Provider-patient communication, patient education, nursing education, My HealtheVet, personal health application, patient satisfaction surveys. 3 Improving Patient's.Satisfaction Score by Utilizing My HealtheVet Communication is a powerful tool, when combined with compassion and diplomacy, healthcare members can connect with a patient in a life-changing way. Effective nursing communication is as much a science as an art form (Lee, 2022). Improving staff communication skills can increase patient satisfaction scores (D' Antonio, et al., 2022). Patients contact a provider's office because they require health-related information and rely on healthcare staff members to understand their needs and provide solutions. Practical communication skills in healthcare can improve the patient's confidence and empower them with the knowledge to better understand the presented information. When healthcare workers are educated about their organization and what they do, this creates more receptive patients. (Kwarne & Petrucka, 2020). A patient's participation in their care process, taking control of their health with compliance to medications and medical advice, is influenced by the quality of the healthcare staff-patient interactions (Kwame & Petrucka, 2020). With multiple ways to communicate with patients, including face-to-face, telehealth, phone calls, or text messaging applications, healthcare staff members must keep up-to-date on the latest technology and communication tools. Communication systems encourage provider and patient interactions and are recognized for their contribution to safety and quality healthcare (McGonigle & Mastrian, 2022). The Department of Veterans Affairs Medical Center (VAMC) implemented a personal health record communication system, My HealtheVet, in November 2003, which now has over 2.5 million registered users (Digital VA, 2022). However, many Veteran patients and VAMC staff members do not utilize the My HealtheVet application to communicate. The lack of education regarding the tool has led to minimal utilization, 4 exacerbating phone call wait times in provider offices and resulting in lower patient satisfaction scores (R. Totten, personal communication, August 4, 2023). Statement of Problem A podiatry office, located within the U.S. Department of Veterans Affairs Medical Center (VAMC), receives multiple complaints and low patient satisfaction scores regarding patients experiencing long phone call wait times to reach clinic staff (M. Woods, personal communication, July 10, 2023). A clinic employee tested telephone wait times for the clinic by attempting to call from an outside line at different times of day (mid-morning, noon, and afternoon). On three consecutive days, the average wait time was 38.2 minutes before reaching a clinical representative (R. Totten, personal communication, August 4, 2023). The cited organization has a patient personal health portal called My HealtheVet, which includes a patient/provider secure messaging system. Patients frequently report not knowing the resource is available or lacking the knowledge to utilize it effectively (M. Woods, personal communication, July 10, 2023). This MSN project aims to implement ways to educate Veterans and clinical staff members to utilize the messaging system within the My Healthe Vet application to increase patient satisfaction scores by increasing patients' ability to contact the podiatry clinic and receive a quick response. Significance of the Project With increasing healthcare staffing shortages and the number of patients requiring healthcare services due to the Silver Tsunami, referring to the number of Baby Boomers reaching 65 years of age and up (Booroosan, 2022), having efficient and effective communication in the clinical setting is vital. Improving healthcare staff and patient communication using an evidencebased framework can potentially increase satisfaction scores. Utilizing informatics teclmologies 5 has been proven to support health-promoting behaviors among clinicians (D' Antonio et al., 2022), and there is a growing interest in integrating healthcare employees in clinical settings to use health informatics-based strategies to help provide coordinated patient care (Ko11a et aL, 2021). By educating Veterans and clinical staff to utilize the personal health portal My HealtheVet, the V AMC can work towards improving patient outcomes and satisfaction. Review of the Literature Poor patient satisfaction scores can act as a catalyst for positive changes in healthcare. By gathering information from patient satisfaction surveys, healthcare providers can adjust their care to include patient preferences and best practices. Not all patient recommendations are best practices. This evidence-based literature review aims to explore communication technology in healthcare and investigate how educating patients and clinicians on using personal health applications, such as My Healthe Vet, can improve patient satisfaction scores. The PI COT question driving this literature review is: Can educating patients and staff members to utilize personal health messaging applications increase patient satisfaction scores within three months? A thorough literature analysis was used to explore evidence-based practice related to patient communication for this MSN Project. Framework Using a framework model in research can guide the design and conduct of studies, inform the theoretical and empirical thinking ofresearch teams, and aid the interpretation of findings (Moullin et al., 2020). The framework ofRosswurm and Larrabee's Model was used for this project because of its step-by-step model, which includes an area for change, showing the results and the ability to reassess the change through an ongoing loop of implementation reassessment 6 (Melnyk & Fineout-Overholt, 2019). Rosswurm and Larrabee's framework model is one of the first models for evidence-based practice that went beyond the step-by-step process and included planned change (Jurns, 2019). These are six steps in Rosswurm and Larrabee' s framework model and how they complement this project's topic: • Assessing the need for change in the practice setting (IvyPanda, 2022) Due to the decrease in patient satisfaction scores regarding call wait times and the ability to speak to clinical staff, there is a need for a change in clinic procedures (J. Jex, personal communication, July 18, 2023). The podiatry clinic at the VAMC has one phone line where patients call in to reach clinical staff, creating prolonged wait times. A literature review of improving patient time in primary care showed that systems leading to prolonged wait times are frustrating for patients, providers, clinical staff, and administration (Robinson et al., 2020). Robinson et al., 2020, continue to say that holding regular meetings to plan rapid improvement in low-satisfactory scoring areas can improve tl1e patient experience in a timely matter. • The researcher must connect the problem, interventions and outcomes (IvyPanda, 2022) The podiatry office cannot get a secondm·y phone system. Alternatively, the VAMC has a personal health application, My HealtheVet, which all Veterans can access to message clinical staff and receive responses quickly within the same day. Utilizing the clinic's RN Coordinator to make My HealtheVet instruction handouts and educate patients and employees on using the application can potentially increase patient satisfaction scores by 7 empowering patients with the lmowledge to use the My Healthe Vet resource and improve communication (Afriyie, 2020). • Research the best evidence (IvyPanda, 2022) Evidence-based practice studies show tlmt teclmology message applications, such as My Healthe Vet, can improve patient satisfaction scores by allowing patients to communicate directly with clinical staff (Campbell et at, 2021). Reseai-ch also shows how patient education handouts can improve patient outcomes (Bhattad & Pacifico, 2022). • Design the implementation and practice change (IvyPanda, 2022) The clinical RN Coordinator will print out education handouts for the Veterans and provide in-service for clinical staff members. Collaboratively, all staff can then educate patients on how to utilize the My HealtheVet messaging application. As messages come into the clinic messaging portal, the RN Coordinator will demonstrate to the employees how to access and manage the incoming messages. • Implement and estimate change in practice (IvyPanda, 2022) The podiatry clinical RN Coordinator will hold weekly in-services for staff to address staffing concerns about the patient handouts and educate the Veterans during scheduled visits. Changes will be made to the practice if areas of wealmess are identified. • Integrate and maintain the practice (IvyPanda, 2022) After three months, post-intervention patient satisfaction surveys will be compared to pre-intervention surveys, identifying if there was an improvement in patient satisfaction and a decrease in phone call volume and wait time. As the goal is met, the RN Coordinator and clinical staff will maintain the course of action with patient and employee education. 8 Strengths and Limitations Rosswurm and Larrabee' s model is based on academic and research literature associated with evidence-based practice, utilizing research, and maldng changes to theory (Melnyk & Fineout-Overholt, 2019). The strength of the Rosswurm and Larrabee Model framework is utilizing the organizational process. Outlining this project's plan with Rosswurm and Larrabee's internal feedback loop within the model clearly explains best practices by following evidencebased practice theory (Melnyk & Fineout-Overholt, 2019). Rosswurm and Larrabee' s framework model does have limitations. The model is based on the best literature to co1111ect to clinic practice. Limiting the value of this project's success in finding up-to-date research can be limiting. Results rely on the relationship between clinicians and patients utilizing My HealtheVet and how the patient understands and applies the information given (Jurns, 2019). Another limitation might be staff buy-in to eclucal<; during a busy clinic day. Analysis of Literature Conducting a literature review for this project followed the organized Rosswurm and Larrabee model and demonstrated the ability of the evidence presented to strengthen clinical practices. Medical advancements in healthcare technology are improving patient outcomes. Evidence-based practices have set the table for changing organizational input to maintain the best practices (Melnyk & Findout-Overholt, 2019). This literature review aimed to explore scholarly articles, credible research studies, and healthcare organization discussions to find ways to increase communication between the podiatry office and patients to improve patient satisfaction surveys. Research of articles within the past five years was examined and applied. 9 Search Strategies Examining and applying examples of best practices from literature posted within the last five years ensured that the current evidence-based practice was presented. The search engines used to find studies and discussions were Weber State University's Stewart Library's OneSearch, Google Scholar, and the use of the CINAHL search engine under the direction of the Department of Veterans Affairs Medical Center network. Only articles published between 2018 and 2023 were researched and used as references for this project for the requirement to keep practices current. Keywords and phrases included but were not limited to provider-patient communication, patient education, nursing education, My HealtheVet, personal health application, satisfaction scores, patient satisfaction surveys, healthcare handouts, podiatry, home health, and COVID-19 telehealth. Synthesis of the Literature The preferred outcome of this project is to improve patient satisfaction by increasing the ability of patients and clinical staff to communicate with each other. Three themes were established by reviewing the related articles. 1) The importance of patient healthcare provider communication. 2) Utilizing patient applications to improve patient satisfaction scores. 3) Using patient education materials about technology applications to improve health literacy. Importance of Patient Communication Comm1mication is the foundation of the nurse-patient relationship (Afriyie, 2020). It is essential for building trust and comfort in nursing. Effective communication is a fundamental yet complex nursing practice concept that influences clinical reasoning and decision-making (Afriyie, 2020). Communication promotes high-quality nursing care with positive patient outcomes, improving patient satisfaction. In a therapeutic communication style, sitting at eye level with the patient allows nurses to explain the care plan and address patient concerns while improving the patient's perception of the nurse's communication (El-Shami, 2023). Utilizing Patient Health Applications Improves Patient Satisfaction The eHealth and mHealth advances are changing how healthcare consumers and providers communicate, receive care, deliver care, and access health information (Chan, 2021). After utilizing eHealth applications in the clinical setting, Campbell (2021) found that 98.2% of patients liked the ability to send and receive text messages regarding their care, 95.5% said they felt more connected to their care team, and 91.9% of patients agreed that the text updates helped them avoid calling the office. Caregivers of patients appreciate using mHealth applications to implement new teclmology to assist them with their caregiving tasks (Kagwa et al., 2022). Patient Education Materials Can Improve Health Literacy To improve a patient's physical and psychosocial well-being, personalized patient education materials and verbal education by healthcare providers enhance patient care via shared decision-making and improve patient satisfaction (Bhattad & Pacifico, 2022). Additionally, printed step-by-step education helps patients better understand clinical care plans (Bhattad & Pacifico, 2022). Furthermore, the level of patient involvement aids in creating a more partnership-oriented model of care in which both parties contribute their lmowledge and experience on equal terms to achieve desired outcomes (Thimm et al., 2020). Summary of Literature Review Findings ancl Application to the Project Research shows that increased communication between patients and clinicians can have positive outcomes for the patient m1d improve patient satisfaction scores for the healthcare organization. Increased comn1tmication can come in the form of printed handout materials and quick messaging back and forth between provider and patient through a personal health 11 application. By following the organizing framework of the Rosswurm and Larrabee research model, this MSN Project was able to formulate and perform implementations of education materials and patient and employee education about My Healthe Vet, assess their cause and effect, and make changes in the plan if needed to obtain the goal outcome of increasing patient satisfaction scores while also decreasing clinic phone call wait times. Searching a1iicles with keywords that supported the project's PICOT question, such as patient communication, health applications, and satisfaction scores, helped identify best practice research. This MSN Project will use the concepts of information found in the literature review to utilize practical communication skills and produce evidence-based educational handouts for patients and healthcare employees explaining My HealtheVet, leading to increased health literacy and patient satisfaction. Project Plan and Implementation The Veterans Affairs Medical Center (VAMC) podiatry office has received multiple complaints from veterans about difficulty contacting clinical staff members, resulting in decreased patient satisfaction scores (R. Totten, personal commlmication, August 4, 2023). Veterans have stated they have had to wait over thirty minutes on hold to talk to a clinician; however, many times, after waiting on hold for so long, the call ends with a busy signal (M. Woods, personal communication, July 10, 2023). The VAMC has a patient health portal application called My HealtheVet. In this portal, veterans can find upcoming appointment information, see lab test results, a11d send and receive messages from clinicians. Unfortunately, many veterans have stated they do not know how to use the messaging portal application, and there is currently no step-by-step informational guide for the patients (M. Woods, personal commlmication, July 10, 2023). 12 As demonstrated in the literature review, improved communication can benefit the outpatient podiatry clinic staff and patient relationships. Better communication between clinicians and patients can increase the patient's understanding of medical information and satisfaction scores. Increased communication among the clinical staff members can be achieved by holding weekly meetings, which can also promote growth in teamwork and a healthy work environment. At the Veteran Affairs Medical Center (VAMC), Veterans and clinicians can utilize the eHealth messaging platform My HealtheVet to communicate back and forth in a timely and simplified manner. However, few VA.MC staff and Veterans utilize the platform because of the lack of My HealtheVet education. Educating clinicians and patients on how to use the eHealth messaging platform increases the ability of patients to communicate with their medical providers and can improve satisfaction outcomes. Plan and Implementation Process This MSN project aims to improve patient satisfaction scores by increasing veterans' and clinicians' communication skills by utilizing the text messaging portal within the My HealtheVet eHealth application within three months. A veteran-guided instruction pamphlet and education tutorials given by clinicians can improve patients' understanding of the eHealth application. A weekly outline is needed to ensure organization and guidance to meet the three-month goal. At the start of the first week, the podiatry RN Coordinator will obtain permission and access to My I-IealtheVet applications and patient satisfaction scores from the Nursing Administration Officer (AO). The RN Coordinator will create and print out step-by-step instruction pamphlets for the veterans on setting up and using their My I-IealtheVet messaging application to contact various clinics within the V AMC. With the help of the Chief podiatry attending, who has access to patient satisfaction survey results, the RN Coordinator will collect satisfaction scores for the 13 past three months, providing a beginning measurement to compare with satisfaction scores after the implementation process. During week two of the weekly clinicians' safety High-Reliability Organization HRO meeting, the RN Coordinator will educate staff members on the newly made step-by-step My HealtheVet instruction pamphlet on using the clinical messaging portal. Staff members will complete a pre-survey on how prepared they feel, giving veterans new com1mmication education. Educating staff members will ensure that the clinicians provide the con-ect information to the veterans. In weeks 3-4 of the implementation plan, clinicians begin to educate veterans with the provided instruction pamphlets on setting up and using the My HealtheVet eHealth application. The front desk staff can do this during check-in/check-out or at the end of a provider appointment by the RN Coordinator/LPN/Health Tech while helping the veteran with their shoes and socks in the podiatry patient room. Having multiple clinicians teaching veterans throughout the podiatry office visit will increase the chances of the veteran understanding how to utilize the eHealth application. During the weekly safety HRO meeting on week five of the implantation process, the RN Coordinator will ask staff members to take a survey if educating the veterans on utilizing My I-IealtheVet has improved clinician and patient communication and if the education pamphlet has been helpful and identify if a change in the process if needed. If additional education strategies are needed, the RN Coordinator will encourage staff to implement changes during weeks 6-9 veterans and conduct a staff education refresher course where the RN Coordinator will present a computer walkthrough tutorial on utilizing the My I-Iealthe Vet eHealth application. 14 As the three-month timeline approaches, the RN Coordinator will collect and interpret patient satisfaction survey scores from the past 12 weeks of implementation to see if there was an increase in veteran satisfaction in clinical communication. Clinicians will partake in a postsurvey on how prepared they feel to give veterans new commtmication education now that the three-month implementation process of introducing veteran education has finished. If surveys from Veterans and clinicians have improved, the RN Coordinator will continue to encourage the Veteran education process. However, if no improvement is noted, the RN Coordinator will revisit the week five process and ask for input from stakeholders on ideas of educational changes needed moving forward. Interdisciplinary Team Planning and implementing patient care processes takes teamwork with all the buy-in from clinicians involved. A statistically significant improvement in patient satisfaction scores is associated with team-based care (Will et al., 2019). Similarly, patient satisfaction scores are more outstanding with teams with more than two healthcare professionals and comprehensive team-based models of care that promote the most significant impact on quality, safety, and patient experience (Will et al., 2019). The healthcare stal<eholders needed to contribute to the success of this MSN project will include the podiatry RN Coordinator as the project leader who will build and introduce the My HealtheVet application educational pamphlets, educate clinicians, measure satisfaction scores and staff surveys, and oversee project implementation. The clinical LPN will monitor the implementation of veteran education with the materials provided by the Health Techs and the Medical Support Assistant (MSA), the front desk staff. Podiatry attendings and residents will 1, support veteran education by reiterating information given to patients by the LPN, Health Techs, 15 and the MSA. The Nmsing Administration Officer (AO) will assist the project leader by being a content expert for the RN Coordinator, giving clinicians access to informatics applications and support. Description and Development of Project Deliverables The RN Coordinator created four deliverables for this MSN project: two educational and two surveys. The first deliverable, an instructional handout, was created to be used as a tool to help veterans navigate the My HealtheVet eHealth application, which allows veterans to connnunicate with providers (see Appendix A). The My HealtheVet pamphlet shows a step-bystep guide on downloading and creating a login account. This pamphlet will be handed out dming clinical appointments. This deliverable will aid in decreasing barriers to utilizing this text messaging tool, which may lead to greater patient satisfaction (Cambell, 2021). Two surveys are needed to measure clinicians' understanding of the My Healthe Vet application and their comfort level in delivering the educational material to the veterans during their clinical visit. Before the RN Coordinator explains their project's plan and implementation process, they must use a pre-survey to get a baseline measurement of staff knowledge (see Appendix B). During staff meetings, the RN Coordinator will hold a training session for staff members about logging into and receiving the veteran's message on the clinical end of the My HealtheVet application. Using ideas from Chavez (2020), where the Veteran Advisor indicates the potential of using PowerPoint presentations as a powerful educational tool, the RN Coordinator created and presented to the staff members an educational PowerPoint, which will be presented during the second week and educational refresher week during five on the implementation process (see Appendix C). 16 The clinicians can revisit the My HealtheVet process during the RN Coordinator's educational refresher staff meeting throughout this MSN project implementation process. At this point, staff members will also take amid-implementation evaluation survey to voice their opinions about the project's progress and any changes they feel could be added to the veteran education process (see Appendix D). With the results of this survey, the RN Coordinator will have a record of how valuable the materials provided are. The Veterans Health Administration (VHA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), built the VA Survey of Healthcare Experiences of Patients (SHEP) (see Appendix F), which is given to every veteran during their inpatient discharge process and every 120 days for outpatient visits (VHA, 2023). At the end of the three-month timeline, clinicians will take the same pre-smvey (see Appendix B) to record a measmable difference in staffing knowledge and education comfortability before and after implementation. At the same time, the RN Coordinator will analyze the pre and post-intervention patient satisfaction scores. Timeline Implementing this MSN project follows a carefully outlined timeline to ensure organized progress and effective utilization of the eHealth application, My HealtheVet, among veterans and clinicians. This structured plan serves as a reference point for stakeholders involved, enabling easy identification of areas needing revision in case challenges are encountered dming the course of the project. During the first month, the RN Coordinator will obtain permission and access to My HealtheVet applications and analyze baseline patient satisfaction scores. Concurrently, a step-bystep instructional handout for veterans will be created to guide veterans in utilizing My 17 HealtheVet's messaging application. Additionally, clinician education will be provided through a PowerPoint presentation at a staff meeting. This will lay the grmmdwork for project implementation and introduce the MSN project. Throughout the second month, LPNs, Health Techs, and MSA will educate veterans during their clinical office visits on how to utilize My HealtheVet. Simultaneously, the RN Coordinator will maintain an active presence by empowering and encouraging clinicians at weekly staff meetings to monitor progress and gather feedback. The MSN project's timeline suggests a three-month period to create, implement, record, and evaluate the use of the eHealth application and measure veterans and clinicians satisfaction scores (see Appendix E). As the project progresses into the third and final phase, a critical emphasis is placed on refinement and final evaluation. This is accomplished through obtaining feedback from stakeholders, integrating adjustments into the process as necessary, and taking action to apply the changes in the educational process during interactions with veterans. Finally, the RN Coordinator will conclude the project by comparing the pre and post-surveys and analyzing baseline patient satisfaction scores to post-intervention scores. There is a need for proactive communication and collaboration throughout the project timeline to ensure smooth implementation and positive project outcomes. Staff engagement improves organizational outcomes and can promote culture, structural empowerment, and professional growth, leading to clinical excellence (George & Massey, 2020). Examples could include ongoing dialog, prompt attention to emerging challenges, and support to clinicians by actively participating in the clinical improvement project. Nursing leader visibility, two-way communication, and recognition strategies can lead to robust, meaningful, and sustainable staff engagement (George & Massey, 2020). 18 Project Evaluation Evaluation is the systematic process to determine a project's worth, merit, value, or significance (Wanzer, 2020). Measurable pre- and post-formative and summative methods are needed to evaluate this MSN project critically. Clinicians' baseline lmowledge of the My HealtheVet application will be assessed using pre-smvey testing (see Appendix B). Patient lmowledge will be evaluated by analyzing the patient survey scores (SHEP), focusing on satisfaction with communication between practitioner and patient before the implementation process. At the end of the three-month implementation process of this MSN project, employee summative evaluation will be measured by analyzing the results of the clinician midterm smvey (see Appendix D), which will be open for feedback and will measme clinicians' perceived knowledge growth up to this point during their participation in the project and the post-survey (see appendix B). These results will provide valuable data regarding clinician confidence in providing patient education on navigating the My I-IealtheVet application and utilizing it to communicate with patients effectively. Additionally, analyzing the differences in veterans' responses to the SHEP pre and post-project implementation will provide a summative evaluation of patients' satisfaction levels. Ethical Considerations This project's emphasis on Veterans' experiences encompasses effective communication, patient satisfaction, and preventing harm. Additionally, veterans may be considered a vulnerable population, mainly due to the increased risk of homelessness and mental health concerns such as PTSD and substance abuse. The VI-IA commits to health equity and the need for access to highquality care. Explaining the SHEP process to veterans addresses the ethical awareness of the 19 patient's comfort in sharing information. Clinicians will not !mow if or which veterans choose to participate in the SHEP unless they reveal their identity. As the RN Coordinator conducts staff training sessions, they will explain the importance of staff engagement in the MSN project but will highlight that since this will rnn as a pilot program, there is an opportunity for the clinician to opt out of the implementation process and evaluations. Discussion This MSN project's central focus is to address the tmderlying issue of low veteran satisfaction scores. Based on feedback from veterans, this issue can be primarily attributed to poor commtmication between patients and clinicians. This project proposes a solution to the issue through the implementation of staff education led by the RN Coordinator aimed at improving commtmication between veterans and staff through the utilization of the My Healthe Vet eHealth messaging application. Furthermore, future recommendations include the development of clinician training modules, the creation of patient pamphlets, and measurable goals to evaluate long-term effectiveness. Evidence-based Solutions for Dissemination Evidence-based practice (EBP) has been shown to prevent unsafe practices that lead to improving healthcare quality (Cardoso et al., 2021). However, research must be presented so those involved can comprehend, implement, and practice. As Cardoso et al., 2021, have shown, presenting EBP material can improve healthcare outcomes for those who implement the process. However, the presentation can rnalce all the difference in how the EBP knowledge is obtained. The essential methods for teaching EBP are research workshops and collaboration with clinical practices (Larsen et al., 2019). This MSN project applies those concepts by presenting the evidence in a poster format while fostering collaboration between podiatry veterans and 20 clinicians. This evidence-based practice approach can potentially increase the clinicians' EBP knowledge base, enhance patient engagement, and enhance the project's overall effectiveness in improving healthcare outcomes (Larsen et al., 2019). Significance to Advance Nursing Practice This MSN project can benefit the nmsing profession by opening the cormnunication window between patients and clinicians. It has been shown to increase the patient's lmderstanding of their diagnosis and commlmication satisfaction scores (El-Shami, 2023). As a nmse steps into a leadership role as RN Coordinator, this project demonstrates how leading clinicians through education can potentially advance nmsing practice. Additionally, the evolution of nursing from a small-scope profession to a field with many specialties results from improved nursing practice education (Flaubert et al., 2021). With effective communication and the application ofEBP education, nurses can develop the nursing practice to improve patient outcomes and meet the needs of an evolving healthcare system. Implications The prospective strengths of this MSN project showcase the increased effectiveness of communication between patients and clinicians and between clinical staff members, which can potentially improve patient outcomes. Providing nursing education opportunities among the stalceholders, such as pamphlets for patients and PowerPoint presentations for clinicians, may lead to advancing the nursing process. Limitations include reaching the right demographics. Chan (2021) identified that while technology is the future of healthcare, implementation challenges exist. Barriers such as lack of access to the required technology to utilize the My Healthe Vet tool may limit some veterans' benefits. Additionally, issues with internet access, a lack of technology literacy, or resistance to 21 new applications may decrease participation (Chan, 2021). To address these limitations, clinicians will evaluate and educate veterans during their clinical visits. Staff can refer veterans to voluntary services if a lack of resources is identified, such as limited or no access to required electronic devices. Voluntary services assess if the veteran qualifies for assistive equipment and can issue a tablet or other communicative device at no charge to the veteran. Recommendations With this MSN project focusing on improving veteran care within the VAMC, content experts suggested utilizing the VHA's Lean Yellow Belt program to increase the effectiveness of project implementation (M. Crookston, personal communication, January 8, 2024). Within the three-week course, VHA's Lean Yellow Belt program guides nurses who have a promising project they want to implement to improve veterans' healthcare outcomes within their unit (Department of Veterans Affairs, 2019). By utilizing the VHA program, this MSN project could become a new nursing process throughout the VAMC system. Conclusions Low patient satisfaction scores frequently act as a catalyst for positive changes in healthcare to improve patient outcomes. Increasing communication opporhmities between patients and clinicians can increase patients' understm1ding of their diagnosis and satisfaction within the communication areas (Cmnbell et al., 2021). The evidence-based literature review introduced the exploration of healthcare c01mnunication advancing with the benefit of technology and investigated how educating patients and clinicians on using personal health applications, such as My HealtheVet, can improve patient satisfaction scores. The frmnework of Rosswurm and Lm-rabee' s Model was used as a guide for this project, utilizing its step-by-step model, which includes an m·ea for change m1d shows the results and the ability to reassess the 22 change through an ongoing loop of implementation reassessment (Melnyk & Fineout-Overholt, 2019). Communication is more than sending and receiving messages, it is about creating, maintaining, and changing relationships and ourselves (Braithwaite, 2021). To have the potential for improved outcomes, there is a need for proactive communication and collaboration between all stakeholders throughout the project process. Staff engagement has been shown to improve organizational outcomes and promote culture, structural empowerment, and professional growth, leading to clinical excellence (George & Massey, 2020). Nurses have the ability to profoundly impact individuals' lives. 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Journal ofpatient-centered research and reviews, 6(2), 158-171. https://doi.org/1 0. l 7294/2330-0698.1695 27 Appendix A Veteran My HealtheVet Education Pamphlet infograph.venngage.com/pl/bM9GZSeP3ds 28 Appendix B Staff Pre/Post Survey Podiatry Clinician Pre/Post Veteran Education Survey This survey aims to measure the knowledge base of podiatry staff members on the My HealtheVet secure messaging portal before and after education implementation in three months. Circle answer using scale system 0-3: • 0 = no previous knowledge; no confidence • 1 = minimal knowledge; minimal confidence • 2 = somewhat knowledge; somewhat confident • 3 = expert knowledge; total confidence 1. Do you know what My HealtheVet is? 0 I 2 3 2. Do you know how veterans access My HealtheVet and what information they have access to? 0 I 2 3 3. Do you know how to access the Secure Messaging portal from CPRS? 0 1 2 3 4. Do you know how to address a secure message from a veteran and send a copy to CPRS and the podiatry provider? 0 I 2 3 5. How comfortable are you giving veterans My HealtheVet education? 0 1 2 5 29 Appendix C Staff My HealtheVet education PowerPoint MY HEALTHEVET SECURE MESSAGING TIMELINE INTRODUCTION CPRS MY HEALTHEVET PORTAL SECURE MESSAGING PORTAL CPRS NOTES • R,1ma1oCrRSaolo,<"'u,,v,fomn',elmrt THANK YOU 1,ltl>Ll""'""'"~'"'"''"''h"''''~'"'"lns on, I""''"' sol"'t"Sm'< m CPRS"frum 11~ '"'~'-"""l'f"'''•;,.y,,,mu',od;i""I'""'"'-"' wed ,WI' r<,,.m,., ,_111,1,,,,. o,, setua..a ME$8.-1<1EJa•~lnc'l•k8. • "'"1,.i,11 l<l,nur,"'"'""''"1,r_,,,,,"'"'"'"'"""'"'"'"" .. v.. .,.,.,,,,1,1,y1,:».i" QUESTIONS? J' Aam,• Chru1c,>«.,o,n8N, RN E:.tlo21 Pola1·ia.d,ri1~1i,ctt@va.gov 30 Appendix D Week 5 Staff Survey Podiatry Clinician Mid-Implementation Process Evaluation Survey This survey aims to measure the impressions of podiatry staff members of the current My HealtheVet veteran education process and if there are additional ideas or changes that are needed. Circle answer using scale system 1-3: • 1 = no change needed/no education needed • 3 = changes needed *If change is needed, please give situation example and improvement ideas • 3 = additional education is needed 1. Printed veteran My HealtheVet education pamphlet. 1 2 2. Staff My HealtheVet education PowerPoint. 1 2 3. Staff member lmowledge of My HealtheVet application use. 0 3 4. Do you !mow how to address a secure message from a veteran and send a copy to CPRS and the podiatry provider? 0 3 5. How comfortable are you giving veterans My HealtheVet education? Totally comfortable Somewhat comfortable Not comfortable *If not comfortable, please explain why below: 31 Appendix E Week 1 Week2 Week 3-4 1 Week 10-12 l Week 6-9 Weeks 32 AppendixF VA Survey of Healthcare Experiences of Patients (SHEP) VA Form 10-1465-5 https://omb.report/icr/201710-2900-010/doc/77871001