HPE 2001 _ Increasing _ HPV _ Vaccination _ Rates _ among _ Adolescent.pdf

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Section 1: Overview of the Evidence-Based Project

Introduction

Human papillomavirus (HPV) is one of the highest reported sexually transmitted

infections (STI) within the United States (Centers for Disease Control and Prevention

[CDC], 2012a). The rate of vaccine administration among adolescent males is much less

than among females. According to the CDC, 2012b, 20.8% of adolescent males (11 to 17

years of age) have received at least one dose of the HPV vaccine, and only 6.8% have

completed the entire HPV vaccine series. There are approximately 79 million Americans

cancer, and 5,600 will develop oropharyngeal cancer each year (CDC, 2014b). The

lifetime costs associated with treating chronic STIs, including HPV, is approximately $16

billion. Since HPV is one of the most commonly acquired STIs, it is one of the most

expensive to treat, due to the volume of new infections that are diagnosed each year

(CDC, 2013b). Many adolescents will be exposed to HPV within the first year of

becoming sexually active (Daley, 2011). As a result, the need to improve HPV

vaccinations among adolescent males is a public health issue that health care providers

must address during clinic appointments.

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This project was based on the needs of the community (Kettner, Moroney, &

Martin, 2013). Nurses are expected to understand the community in which they reside

and practice professional nursing. Understanding the community refers to the health

status as well as any potential threats to health and safety (American Nurses Association

[ANA], 2001). According to a nurse at a health care facility in a rural town in Texas,

primary health care providers have identified underutilization of the HPV vaccine as a

public health problem (H. Jeffreys, personal communication, September 8, 2013). One

potential threat to the health of the identified rural community is the spread of STIs.

Background

Researchers have identified over 100 different types of HPV (McCutcheon,

2009). Of these different types, approximately 30 are known to be transmitted sexually.

An individual may have an active infection with more than one type of HPV at the same

time. When compared to other STIs, HPV cannot be cultured. Diagnosis is often made

upon physical examination with most individuals being asymptomatic. Once the HPV

infection is present, there is no cure, and the focus of treatment is to control the number

of visible lesions, regardless of the anatomical site (McCutcheon, 2009).

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HPV prevention should include more than the vaccine. The male adolescent may

require education on the appropriate use of condoms. In addition, it is also important for

the adolescent to understand that HPV infections can spread to areas that condoms do not

protect, such as the pubic area (Jordan, 2008). It is equally important to teach parents of

male adolescents the importance of HPV and STI prevention (McCutcheon, 2009).

Vaccinating males against HPV can be effective not only for the male, but for

each sexual partner. Effective inoculation requires a series of three injections that should

be administered over a 6-month period. The effectiveness of the HPV vaccine is

years. Additionally, the vaccine should be administered to men between the ages of 22

and 26 years who are known to have sex with men or who are infected with HIV

(Campos-Outcalt, 2012). For the purposes of this project, the focus was on parents of

adolescent males between the ages of 11 and 17 years.

The CDC is the foremost authority on communicable diseases and the vaccines

that can prevent those diseases in the United States. There are no federal or state

regulations in the United States that mandate the HPV vaccine for all adolescents. Many

health care providers continue to present the HPV vaccine as an optional vaccination as

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compared to those vaccinations that are required. As a result, this leads to missed

opportunities for vaccination. Additionally, health care providers are reluctant to engage

in discussions regarding HPV and the vaccine, and parents become hesitant and reluctant

to accept the vaccine (Stokley, 2013).

A person should not be vaccinated in some extenuating circumstances. First,

anyone who has had a severe or life-threatening reaction to any component of the vaccine

should not be vaccinated. Second, pregnancy is a contraindication for vaccination. Last,

a person should not be vaccinated who is moderately or severely ill (CDC, 2014b).

vaccine to prevent genital wart infections in males. In October 2011, the ACIP

recommended that the vaccine be administered to adolescent males for the prevention of

the above-mentioned cancers known to be caused by HPV (CDC, n.d.). However, parents

must give consent for their adolescent sons to receive the vaccination.

My role in this scholarly project was the development of an HPV educational

toolkit for parents of adolescent males. The need for this project was identified through

the CDC’s (2013) press release that urged all health care providers to work with state and

local health providers to increase the utilization of the HPV vaccine. Health care

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providers at my practicum facility, as well as my mentor, were supportive of this

scholarly project and planned to implement the educational toolkit upon completion (H.

Jeffreys, personal communication, September 8, 2013). I developed an evidence-based

fact sheet to distribute to all parents of adolescent males in the clinic, referring them to

the facility’s website where the toolkit will be available, allowing parents to view the

information about HPV and the HPV vaccine before the next scheduled appointment.

Furthermore, this scholarly project supported the recommendation for primary prevention

in order to improve the health care outcomes of a community. Primary prevention

among adolescent males, ages 11 to 17 years, and parents had to consent for the

vaccination, the problem statement for this Doctor of Nursing Practice (DNP) project is:

There is a lack of understanding among parents of adolescent males regarding the

importance of being vaccinated against HPV.

The purpose of this scholarly project was to develop an educational toolkit for

parents of adolescent males regarding the value of the HPV vaccine. An educational

toolkit can take many different forms. A toolkit may be written and may be accessed by

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website. An educational toolkit is an intervention that is designed to provide patients and

families with the most current information and evidence-based resources in clinical

practice (Hopkins, DeCristofaro, & Elliott, 2010). The CDC urged health care providers

to work with state and local health departments to increase the utilization of the HPV

vaccine. It is imperative to teach parents of adolescent males the importance of receiving

this vaccine. The majority of the published literature emphasizes the importance of

immunizing adolescent females and to educate health care providers, but evidence-based

literature for parents is limited. There is a need to contribute to the current body of

on STI prevention (U.S. Department of Health & Human Services, 2010). This objective

was directly related to this scholarly project. The project was designed to educate parents

on the benefits of vaccinating their adolescent sons against HPV.

There are serious short-term and long-term consequences of not addressing the

issue of vaccinating adolescent males against the HPV virus, which may not be seen for

decades. The short-term consequences are most commonly associated with genital wart

outbreaks (Giuliano, Palefsky, & Goldstone, 2011). The most severe consequences are

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associated with long-term HPV infections. The long-term consequences of HPV

infection are different forms of cancer. Those cancers include oral cancer, pharyngeal

cancer, anal cancer, and penile cancer (CDC, n.d.). No studies have identified a specific

timeframe between exposure to HPV and the development of a particular malignancy. It

may be decades before the long-term consequences of HPV are discovered (Jordan,

2008).

The financial implications of treating STIs, including HPV, are direct and indirect

costs that can approach $16 billion (CDC, 2013b). The direct costs are associated with

The health care system in the United States is one of the most expensive and

costly in the world (Bodenheimer & Grumbach, 2009). Unfortunately, a decrease in the

cost of health care treatment is not foreseeable. The result of high costs may be a loss of

life for those who cannot afford health care treatment. Treating genital warts and various

forms of cancer is costly, much more than the cost of the vaccine itself. The average cost

of the quadrivalent vaccine is $130 to $140 per dose. Three doses of the vaccine are

required to complete the vaccine series. Parents need to speak with the health care

provider in order to determine if the HPV vaccine is covered by insurance. However, if

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the child is uninsured or underinsured, the federal Vaccines for Children (VFC) program

covers the HPV vaccine at no cost to the parents. The VFC program will cover children

up to the age of 19 years (Society of Obstetricians and Gynaecologists of Canada, 2013).

All health care providers have a responsibility to improve prevention efforts due

to rising health care costs (Ridenour & Trautman, 2009). Practicing preventative

medicine is essential during a time of health care uncertainty. Preventative medicine

begins with patient education. Professional nurses have a responsibility to provide

needed to develop an educational toolkit designed to educate parents of adolescent males,

ages 11 to 17 years, about the benefits of HPV vaccinations?

When creating a project that addresses issues related to sex and STIs, researchers

should be prepared to receive a wide variety of opinions and emotions. A discussion of

sex and STIs can be an emotionally charged topic for parents (Wilson, Dalberth, Koo, &

Gard, 2010). Emotional triggers may be parents not knowing how to talk to their

children about sex, being embarrassed to discuss sex, and family dysfunction regarding

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sex (Wilson et al., 2010). Organizations that support projects of this nature are primary

practices for women and pediatrics as well as health departments across the United

States. The target population (parents) should be aware of the purpose and goals of the

project. The purpose of this disclosure was to improve the long-term goal of the project,

which is the completion of the HPV vaccine series (Hodges & Videto, 2011).

In order for health care providers to promote health and wellness, they must

provide education about vaccines for adolescent patients and parents. As researchers

publish new research findings in peer reviewed journals, it is critical that the medical

long-term consequences of HPV (Jones & Cook, 2008). Additionally, information in the

toolkit can be modified to include the latest evidence-based literature as well meet the

cultural needs of the community (Paterson, Sock, LeBlanc, & Brewer, 2010). For this

reason, a toolkit for parents will allow health care providers to communicate the most

current evidence-based practice.

Educational toolkits can be utilized to disseminate evidence-based information

found in the literature. The information gained from a literature review can provide a

framework for the care of the adolescent male, in particular, vaccination against HPV that

I reviewed the abstracts of articles to determine the relevance and inclusion for

this literature review. I excluded articles for the review if they were conducted prior to

2009, if the study was completed outside the United States, if the article was published in

a language other than English, and if the articles were not specific to the male gender. I

also excluded mortality and morbidity reports, commentaries, and expert opinion pieces

from this review. Once I identified articles for inclusion, I carefully reviewed each

publication carefully and analyzed it for the study’s purpose, design, population sample,

findings, and limitations. Eight articles met the inclusion criteria.

average age of the participants was 20.8 years. Eighty-three percent reported having had

sexual intercourse at the time the survey. The average age of the participants at the onset

of sexual activity was 17 years. The average number of sexual partners was four. When

questioned about having been tested for STIs, 48% had been tested, and approximately

6% had tested positive for an STI during their lifetime. Majority of the participants

reported knowing about HPV (83%) and the HPV vaccine (73%). Less than one half of

the participants (41%) indicated that they intended to receive the vaccine. Heterosexual

men revealed that they had less intention of receiving the HPV vaccine. Men who

intended to receive the vaccine were also more likely to use condoms during sexual

intercourse. The findings showed a strong correlation between perceived knowledge and

actual HPV knowledge. Perceived knowledge was defined as a person’s belief system,

which serves as motivation for action, and actual knowledge was defined as a general

awareness to promote informed decision-making. A limitation of the study is that the

findings could not be generalized beyond the small sample size of 128 college males.

This study reinforced the fact that men should be educated on the HPV vaccine as well as

the disease itself.

identified that influenced the acceptance of the HPV vaccine among males. Influential

factors were perceived susceptibility of HPV, lack of knowledge regarding HPV and the

HPV vaccine, the vaccine not being recommended by a physician, vaccine availability,

cost, and safety and efficacy. The vast majority of patient education for the HPV vaccine

has focused on the prevention of cervical cancer. This systematic review of the literature

reinforced the need to improve patient education for HPV and the HPV vaccine for males

(Nandwani, 2010).

Parents’ and Sons’ Beliefs and Decisions Regarding HPV Vaccinations

Perkins et al. (2013) conducted a qualitative study to examine the attitudes of 120

low-income and minority parents of adolescent males (11 to 17 years of age) toward the

HPV vaccine. Participants for the study were of mixed ethnicity with 68 being African

American, 24 being Caucasian, and 28 being Latino. The mean age of the sons was 14

years, and the mean age of the parents was 43.5 years. Perkins et al. identified and

compared common themes among the ethnic groups that participated in the study.

Findings revealed that only 50% of the parents had heard of the HPV vaccine. If

and efficacy of the vaccine. Some parents were afraid that the vaccine would promote

promiscuity and unsafe sexual activity. Parents wished to see more information that was

specific to males. The limitations of the study were that the findings could not be

generalized beyond the small sample size of 120 parent participants, and the study was

conducted in a state that required all citizens to have insurance coverage, limiting the

impact of inadequate accessibility (Perkins et al., 2013).

Alexander et al. (2012) conducted a qualitative study that analyzed parents’ and

sons’ decision-making process regarding acceptance of the HPV vaccine. There were 23

parent-and-son dyads chosen as participants for the study. The parent group consisted of

17 females and six males. Participants of the study comprised mixed ethnicities (African

American, Hispanic, and Caucasian). The parents ranged in age from 31 to 53 years with

a mean age of 38.9 years. Over half of the parents (n = 12) identified as single parents

and less than half (n = 11) had at least a high school diploma. The son group consisted of

14 African Americans, five Hispanics, and two Caucasians. The average age of the sons

was 13 to 17 years with a mean age of 14 years. Alexander et al. collected data via

semistructured interviews. The interviews for the parents and the sons included topics on

sons wanted to maintain long-term health. There was a misconception on behalf of some

parents that the vaccine would protect children against other STIs. One limitation of the

study was that it only included sons between the ages of 13 and 17 years, when the

vaccine has been approved for males 9 to 26 years (Alexander et al., 2012).

Cates et al. (2012) triangulated data in order to determine what factors motivated

a sample of 29 African American parents to vaccinate their sons (11 to 12 years of age)

against HPV. African American parents (n = 29) were chosen because they are known to

be less aware of HPV and the HPV vaccine and are at a higher risk for STIs and HPV-

related cancers. Participants were recruited through churches and a middle school, which

the children attended, and through a university-based clinic. Cates et al. conducted five

focus groups. They used chi square tests to assess differences in parents’ gender, age,

race, age of sons, and the likelihood of vaccination. Participants expressed a low

awareness of HPV and the HPV vaccine. All parents agreed that their sons were at risk

for STIs. Overall, parents were confident about the vaccine preventing infection.

Identified barriers for vaccinating their sons included cost of the vaccine and the

perceived side effects, along with the lack of knowledge about the long-term efficiency of

knowledge relevant to fathers, urban participants, low socioeconomic status, and ethnic

minorities. Beliefs and attitudes of the HPV vaccine included religious convictions with

Christians more likely to vaccinate their sons when compared to those who do not

practice Christianity. Attitudes and beliefs varied among ethnic groups regarding the

vaccine. African Americans were more suspicious of the vaccine while Latina mothers

were more likely to vaccinate their sons against HPV when compared to other ethnicities.

Barriers to vaccination included fear that if vaccinations were administered before the age

of 12, promiscuity would be increased and that some parents felt that their sons would not

accept other forms of prophylaxis, such as condoms if vaccinated. Fathers were found to

be less likely to vaccinate sons when compared to mothers. Lastly, the cost of the

vaccine was the final barrier identified. Parents were more likely to vaccinate sons if the

vaccine was offered free of charge (Walhart, 2012).

Joseph et al. (2013) conducted a mixed methodology study to identify ethnic

differences regarding perceived benefits and barriers of the HPV vaccine. However,

quantitative data were not reported in this publication. Participants for this study

consisted of 89 males (18 to 22 years of age): 31 were African American, 26 were of

Americans voiced concerns regarding liver damage and insanity, and Haitian participants

were concerned about allergies and autism. Latinos were less likely to receive the

vaccine unless recommended by a physician rather than a physician assistant, nurse

practitioner, or nurse. Findings from this study suggested that cultural sensitivity should

be taken into consideration when discussing HPV vaccinations. Education initiatives can

promote awareness while dispelling myths. One limitation of the study was the small

number of racially/ethnic participants.

Reiter et al. (2013) conducted a longitudinal study to examine HPV vaccine

uptake and vaccine predictors among adolescent males. The national sample consisted of

327 parents and 228 sons (11 to 17 years of age) who participated with the parents.

Participants for this study were from 46 states as well as the District of Columbia and

completed a baseline survey and a follow-up survey 3 months after the baseline. Surveys

were administered online. The majority of the parents were less than 45 years of age

(56%), non-Hispanic (68%), married (80%), and resided in urban areas (84%).

Significant predictors for not vaccinating their sons against HPV were related to a lack of

Educational Toolkit Development and the Theory of Reasoned Action

The theoretical framework chosen to guide this DNP project was Ajzen and

Fishbein’s (1980) theory of reasoned action. The theory of reasoned action originated in

the field of social psychology in the late 1960s, is considered a predictor of human

behavior, and explains behavioral intentions, whether positive or negative, as compared

to social standards. Essentially, people make decisions based on the information that is

either available or provided (McEwen & Wills, 2011). This theory can be used in

multiple areas of professional nursing practice when developing interventions designed to

modify patient behaviors (Goldenberg & Laschinger, 1991). Applications of this theory

can be ideal for parents of adolescent males, who are at high risk for STIs (Roberto,

Krieger, Katz, Goei, & Jain, 2011). This theory states that an individual will engage in

certain behaviors based on the attitude of the person and a social norm. Social norms are

behaviors in response to socially desirable attitudes and beliefs based on the attitude of

the individual (Ortega, Huang, & Prado, 2012).

Experts argue that if this theory can be used in the patient population, then it can

also be used when explaining physician behavior, and in the case of this scholarly project,

parent behaviors (Roberto, Krieger, Katz, Goei, & Jain, 2011). The parental behavior in

scholarly project and can be predictive in influencing parents’ decision to vaccinate or

not vaccinate after viewing information from the educational toolkit (Goldenberg &

Laschinger, 1991).

The literature review resulted in a small number of articles (x = 8) that met the

inclusion criteria. I identified several common themes. Dominant themes were males’

knowledge of HPV and the HPV vaccine, and parents’ and sons’ beliefs and decisions

regarding HPV vaccinations. The review of the literature supports the need for an

educational toolkit to increase HPV vaccination rates among adolescent males. The

educational toolkit will address each theme identified in the literature review.

Addressing each theme will allow the parents of adolescent males to make an informed

decision regarding HPV vaccinations. The following chapter will discuss the project

approach, the target population, and the project evaluation plan.

Section 3: Approach

Introduction

The purpose of this DNP project was to develop an educational toolkit to educate

parents so that they can make an informed decision on vaccinating their adolescent sons

(11 to 17 years of age) against HPV. Since the project is developmental, implementation

will occur at a later time at the practicum facility’s discretion. This scholarly project was

designed to contribute to the current body of nursing knowledge about HPV. This

section of the project addressed the development of the educational toolkit, the target

Project Approach

this toolkit in order to capture those parents who have poor reading skills or parents who

have poor health literacy skills. Therefore, the educational toolkit consisted of two

separate parts. The first part of the toolkit was an evidence-based fact sheet (Appendix

A) that provides facts regarding HPV and the HPV vaccine. Additionally, the evidence-

based fact sheet will direct parents to the facility’s website to view the second part of the

toolkit (Appendix B) prior to the next scheduled clinic appointment.

The evidence-based fact sheet consists of four sections: factual information,

vaccine information, websites, and references. The first section (factual information)

Evidence-based fact sheet:

My Insurance?

I have provided the practicum mentor and the practicum facility with a version of

the toolkit that provides ease of editing when new information and evidence-based

practice becomes available. Additionally, a version of the educational toolkit will be

provided that will prevent website visitors from making any changes. The practicum

mentor will identify a registered nurse to monitor scholarly journals for new information

and evidence-based practice. This nurse will be responsible for ensuring the educational

toolkit is updated as new information becomes available (H. Jeffreys, personal

communication, August 5, 2014).

Discussion of Findings in Context of Literature

fact sheet and the educational toolkit provide parents with the necessary information that

will aid in making an informed decision. The educational toolkit is an excellent platform

to disseminate information and current evidence-based practice to parents and patients.

The toolkit allows parents to work through the information at their pace with or without

their children and can be referenced multiple times (Lobban et al., 2011). Lastly, the

toolkit provides an opportunity for active participation in the plan of care (Paterson,

Sock, LeBlanc, & Brewer, 2010).

Krawczyk et al. (2013) examined males’ knowledge regarding HPV and the HPV

vaccine. There is a need to provide the same level of HPV and HPV vaccine education to

males as there is for females in order to dispel any myths and misconceptions (Krawczyk

et al., 2013). Numerous barriers have been identified regarding the acceptance of the

HPV vaccine by males. Identified barriers were perceived susceptibility to HPV, lack of

knowledge regarding HPV and the HPV vaccine, the vaccine not being recommended by

a physician, vaccine availability, cost, and safety and efficacy. The vast majority of

patient education for the HPV vaccine has focused on the prevention of cervical cancer,

local health departments to improve HPV vaccination rates. As a result, many states have

labeled the HPV vaccine as a priority. However, there is not an educational toolkit that

specifically addressed the adolescent male population (CDC, 2014a). This scholarly

project addresses that specific need.

Addressing the public health issue of poor HPV vaccination rates among

adolescent males will decrease the short-term and long-term consequences of HPV

infection. The vaccine will protect each male as well as each sexual partner encountered

(CDC, 2014a). Since HPV is one of the most common STIs, it is one of the most

expensive to treat (CDC, 2013b). In turn, it is expected there will be fewer burdens

placed on the health care system by decreasing the number of genital wart outbreaks and

preventing the various cancers known to be caused by HPV. The educational toolkit has

reinforced the cost-effectiveness of the vaccine as compared to years of genital wart

outbreak treatments and cancer treatments.

Professional nurses must be willing to set aside any biases in order to provide

open and honest education to all patients. Regardless of gender, the expectation of nurses

related illnesses will continue to rise as well. Interventions, such the evidence-based fact

sheet and the educational toolkit, are an attempt to address this growing public health

issue.

The review of literature yielded eight articles that met the inclusion criteria for

this scholarly project. Articles for the specific literature review were excluded if they

were conducted prior to 2009, if the study was completed outside the United States, if the

article was published in a language other than English, and if the articles were not

specific to the male gender. Additional nursing research is needed on this public health

issue. Additionally, this scholarly project promotes future research on educational

toolkits and technology since smart phones and tablets are prominent in society.

A press release issued by the CDC urging health care providers to work with state

and local health departments prompted the development of the evidence-based fact sheet

and the educational toolkit. The public health issue of poor HPV vaccination rates

among adolescent males is not isolated to any particular geographic area, but rather

nationwide (CDC, 2013a). Addressing parents of adolescent males as the target

of adolescent males. Parents can be more active participants in their child’s plan of care.

In addition to general information, the toolkit directs parents and patient to helpful

websites that offer support reassurance. An educational toolkit on a website can offer

health care providers and nurses the opportunity to develop their practice by seeking out

new information (through literature searches and seminars) to add to the toolkit.

The strengths of the HPV evidence-based fact sheet and the educational toolkit

are the ease of reading and understanding. Both components were written at a sixth-

grade level. An educational toolkit is an intervention that is designed to provide patients

and families with the most current information and evidence-based resources in clinical

practice (Hopkins, DeCristofaro, & Elliott, 2010). Each component was provided to the

practicum facility in two different formats (one which is editable and one which is not

editable). The editable format allows the health care provider to update the toolkit as new

information becomes available. The noneditable version is ready to be sent to the

informational technologist for upload to the facility’s website.

One limitation of this project is the fact that this toolkit is specific to parents of

practicum facility. Additionally, if the practicum facility chooses to broaden its scope of

inclusion for the educational toolkit, it is easily modifiable and offers other male age

groups the same information and level of care.

The journey of working toward a doctoral degree has been very exciting and some

of the best years of my life. Although exhausting at times, the achievement is one that

few nurses complete. A high school teacher told me that I would amount to nothing.

Instead of using those words to foster hatred and discontent, I used them as motivation. I

was intimidated when I enrolled in Walden’s DNP program. I did not feel I was smart

enough to complete this degree. Two years later, I am working on my scholarly project.

This program has allowed me to grow personally and professionally. I have been pushed

to my personal limits at times, and I have been successful in each endeavor.

Professionally, I have gain confidence and competence through the practicum

experiences.

As a scholar, I have learned to rely on current research. I did not fully appreciate

scholarly literature before enrolling in this program. Through weekly discussions, I have

profession. The lettering I have earned in this program allows me the opportunity to

grow through scholarship. Professional growth and scholarship are expectations of the

DNP-prepared nurse, and I am ready to face those challenges.

It is an honor to practice professional nursing. I have become increasing aware of

this honor throughout the course of the DNP program. I am more confident and

competent in my practice. Confidence and competence are skills that I gained through

my practicum experiences, my clinical practice of nursing, and the scholarly literature.

The progression in this terminal degree program has earned the respect of many

colleagues. I am becoming a scholarly peer to those who currently practice with a

terminal degree, which I find to be a humbling experience. However humbling, there is a

higher expectation of scholarship and responsibility to the profession of nursing. The

development of an educational toolkit, which addresses difficult topics such as HPV and

the HPV vaccine, is something I am very proud to accomplish. The educational toolkit

for parents of adolescent males is a new concept that enhances nursing practice and offers

opportunities for additional research.

practicum mentor, I was able to schedule my practicum experiences. The literature, the

practicum experiences, and the previous course work guided the development of an

educational toolkit.

The DNP scholarly project process is overwhelming and time-consuming.

However, I have learned more than I ever thought was possible. I learned a great deal of

patience during project development. My stress levels increased once I submitted the

project for review since each committee member had 2 weeks to review the project and

provide feedback. I learned to use the feedback as constructive criticism since each

response from the committee members was intended to improve my writing and to ensure

I am producing a scholarly project. The experience of the DNP scholarly project will

guide my future research and my future project developments.

The development of the DNP scholarly project has increased my personal and

professional growth and development. I have gained confidence and competence in this

program that will guide my career for the rest of my life. I have learned to prioritize

activities in order to meet goals and deadlines. I will use the skills I learned in this

of individuals who are infected with HPV continue to grow each year. Scholarly

literature lacks research and interventions directly related to vaccinating adolescent males

against HPV. Currently, there are no educational toolkits designed for adolescent males.

This gap in knowledge has prompted the development of an educational toolkit for

parents of adolescent males in order to improve HPV vaccination rates. I designed an

educational toolkit to be used in the practicum facility, and it can be modified for use in

other facilities across the nation. The following section will discuss project

dissemination, the project summary, and the program evaluation report.

Introduction

Doctoral education reinforces the importance of scholarship. The DNP is no

exception. The AACN has established eight essentials for the DNP-prepared nurse that

outlines the expectations of the practice scholar. The DNP Essential III outlines clinical

scholarship and its integration into professional practice (AACN, 2006). The final

scholarly product was an educational toolkit for parents of adolescent males. I developed

the toolkit in response to a press release issued by the CDC, which indicated the HPV

necessary information that will allow for an informed decision regarding the HPV

vaccine.

Dissemination of evidence-based practice is essential to the practice of

professional nursing. All current policies, guidelines, and protocols are driven by

evidence-based practice (AACN, 2006). Dissemination of research and scholarly

projects can take many different forms. The most common forms include, but are not

limited to, manuscript publication, poster presentations, professional conference

presentations, and dissemination through independent nurse consultants. A research