As the COVID-19 Pandemic took hold of the country last spring, the protocols — particularly in the first several months — were to stay inside. Gyms were closed. Many parks had limited access or no parking available. Finding ways to exercise regularly became a challenge. Additionally, as businesses closed or reduced hours, more and more time was spent at home and, for many, a sedentary lifestyle became the norm.
It didn’t take long for the jokes and memes to begin and soon the “COVID-15” became the term for 15 pounds of weight gain due to the pandemic. Helping people find ways to alter their lifestyle during COVID and develop or renew healthy habits became the centerpiece of then-DNP student Sybilla Myers’ quality improvement project.
Students in FNU’s DNP program must complete a quality improvement project. This project, which is generally conducted with their patient population at their place of work, involves one term dedicated to identifying the project, collecting data, and recruiting participants. After the term break, the students then begin implementing the project, tracking the data and results which are included in a final paper.
Like others in her class, Myers, DNP Class 33, APRN, FNP-C, had planned to do a completely different quality improvement project than the one she ended up doing. Myers was born in Germany and moved to the United States when she was three. Now an American citizen, she lives in Virginia but works in Washington, D.C., as an International Health Coordinator for a federal organization. She is also an adjunct professor of nursing at Stratford University and a mother of three children ranging in age from 9 to 15.
Myers had intended to do a quality improvement project to implement a case management system at the federal organization for which she works. The arrival of COVID, however, meant all of the organization’s volunteers were evacuated home and she would have no new medivacs to implement her project.
“I talked to my advisor, Dr. Chris Kennedy, who served as an incredible faculty mentor,” Myers said. “His recommendation was to do something that might be able to live past this project. Then I started thinking about it and decided on a virtual wellness project which could live past the pandemic and be implemented in primary care environments.”
Responding quickly to the pandemic and its impact on FNU’s DNP students, the FNU faculty had developed four quality improvement projects which could be conducted virtually. Since many clinics and organizations were closed, this offered a chance for the students to continue without delaying their academic progress.
“I didn’t want to take a hiatus,” Myers said. “My entire experience with FNU had been organized and thoughtful and I didn’t know what, but I knew something would fall into place that would allow me to continue on my DNP journey. I sat back and waited between term breaks. As expected, it didn’t take long for the FNU faculty to make an announcement that we would be given the option of implementing an IRB-approved virtual project..”
The project that drew her interest was a wellness project. The project involved ways for the participants to increase their physical activity, their hydration, and their mental well-being in ways that are attainable during the pandemic. To solicit the necessary volunteer participants, Myers took to social media. Once her group of approximately 30 participants was assembled, she created a closed group in which she released information and guidance about the project. She also met with each participant individually to work with them on their goals and overall progress. She provided tools and suggested resources, including apps for yoga, running, walking, hydration, and mental health. For some of her older participants who were less familiar with apps, Myers offered other ways to monitor their progress.
“My project was tailored to the individual needs of the participant,” Myers said. “Early on in the pandemic just going anywhere was difficult, so it was all about meeting their needs and learning how they could alter their exercise and lifestyle pattern to maintain wellness.”
Participants recorded their daily activity and progress on a Google form. The reporting was less about measurables such as weight loss and more about how they were feeling in each of the categories. A validated questionnaire was utilized at the beginning and end of the project to determine if there was an overall increase in wellness.
“They were doing so well on the apps, but when you asked them how they were feeling overall it was midline. It didn’t improve,” Myers said. “So, even though they were at their highest level of app use and goal attainment, you had to consider the outside force of being four months into social distancing and the pandemic. Even when people were exercising to their goal or higher, hydrating, eating well, using the mental health apps, they still were not feeling great.”
Despite the overall progress being hindered by the strain of the pandemic, Myers was encouraged by the overall results and her participants’ continued progress beyond the project.
“In following up with them after the project, they still continue to use the apps that they were implementing during my project to continue their wellness journey. I feel like it definitely helped them.”
Myers’ poster board for the project was presented at the Institute for Healthcare Improvement and her quality improvement Squire paper, Improving the Perception of Wellness in a Virtual Population During the COVID-19 Pandemic, has been accepted for publication in the Journal of Doctoral Nursing Practice Volume 14, Number 2. She also was able to finally implement her original case management plan within her place of work, completing, in a sense, two quality improvement projects instead of one.
“I feel like I’m the biggest cheerleader for FNU,” Myers said. “Many of my classmates and I were elated when they came up with the virtual project possibilities for us. The faculty went out of their way to be available to us and help guide us through our many questions. We were at a loss, but the DNP faculty were so positive and supportive. These virtual projects were hard, but they were supposed to be hard. Throughout this abrupt transition from on-the-ground to virtual implementation, I always felt completely supported by the FNU DNP faculty. I’m so grateful that I didn’t have to take a hiatus. This is a once in a 100-year pandemic and the silver lining for me was the opportunity to continue a rigorous DNP program on my original timeline.”