Date of Award

Summer 8-12-2022

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Bethany Rolfe-Witham, DNP, FNP-BC

Faculty Reader

Bomin Shim, PhD, RN

Executive Summary

Executive Summary

Background and Significance: The many stressors and risks for injury involved in a firefighter’s role are inherent, and become more prevalent as years in service increase (Negm et al., 2017). Firefighters (FF) in the United States are required to undergo an annual physical and wellness visit with a healthcare provider, as well as screenings and diagnostic tests to assess for potential illnesses and disorders. However, literature shows that screenings for certain types of cancers (Printz, 2020) and mental health issues (Martin et al., 2017) are generally underperformed, whereas other diagnostics tend to be utilized in many cases where they are unnecessary. These scenarios can lead to missed diagnoses and medical repercussions for the patient, as well as inadvertently misspent resources and funds.

Problem and Purpose Statements: When performing FF annual wellness visits, the partnering clinic’s four family nurse practitioners (FNP) faced barriers in gaining ready access to updated clinical recommendations for screenings and diagnostic tests, as the reference they rely on (The Technical Committee on Fire Service Occupational Safety and Health, 2017) is updated with a new edition just once every three to six years. Updates to this reference are published intermittently, but can only be accessed after subscribing, then logging into the publishing organization’s portal, and searching for the updates by topic. The purpose of this project was to assess the clinic’s existing clinical processes for FF annual wellness visits, to review scholarly literature regarding evidence-based care during these visits, and to develop and implement a supplemental clinical toolkit for use in conjunction with the established reference.

Methods: The primary investigator (PI) performed a scholarly literature review, and developed a supplementary clinical toolkit for use by the partnering clinic’s four FNPs, to support their decision-making with updated recommendations regarding ordering of exam elements during FF annual physicals. The four FNPs were invited to view a remote presentation of the project via Zoom, review the supplementary clinical toolkit, and to participate in a voluntary and anonymous survey to evaluate the implementation. The survey, hosted by, consisted of five Likert-style questions, assessing the FNP’s confidence level in using the NFPA reference alone, versus using the additional supplemental resource toolkit. Additional questions assessed the FNP’s experience of workflow, updated recommendations, and likelihood they would utilize the clinical toolkit.

Results/Outcomes: Three of the four FNPs participated in the survey, and responses varied. Two respondents appeared to agree on some points, with the third respondent indicating a very different perspective. Two out of three respondents reported feeling very confident in the current process alone, and low confidence in the added value of the new supplementary clinical toolkit. On the other hand, the third respondent reported very low confidence in the use of the current reference alone, and high confidence in the new toolkit providing valuable up-to-date information, to ensure FNPs have ready access to most current recommendations. This same respondent reported that they are very likely to utilize the toolkit in the future, whereas the other two respondents responded that they were neither likely nor unlikely to use it. The frequency of workflow interruptions due to difficulty accessing updated recommendations, and the frequency of discovering clinical updates contradicting the current reference was reported as less than once per month by two FNPs, and once per month by one FNP. Therefore, evaluation showed that project goals were partially met.

Sustainability: The toolkit was presented to the clinic in electronic form, so that ongoing customizations, revisions and updates can be easily maintained by clinic staff. Future projects might include evaluation of the toolkit’s usefulness after a period of one year or more, redesign of the toolkit based on clinic need, integration with the electronic health record, etc. There is opportunity for toolkit dissemination to additional clinics providing FF annual wellness visits, to encourage use of supplementary resources.

Implications: The clinical toolkit has the potential to significantly improve FNP access to up-to-date recommendations, and thereby ensure appropriate care and improved wellness outcomes, as well as increased provider confidence in ordering exam elements. The success of this project proves the feasibility of design and implementation of this type of clinical tool, and paves the way for broader use of such supplemental clinical resources by other clinics providing FF annual visits, and perhaps even by the NFPA organization itself.


Martin, C. A., Tran, J. K., & Buser, S. J. (2017). Correlates of Suicidality in Firefighter/EMS Personnel, 208, 177–183.

Negm, A., MacDermid, J., Sinden, K., D'Amico, R., Lomotan, M., & MacIntyre, N. J. (2017). Prevalence and distribution of musculoskeletal disorders in firefighters are influenced by age and length of service. Journal of Military, Veteran and Family Health, 3(2), 33–41.

Printz, C. (2020). New research finds lung cancer screening guidelines are insufficient for firefighters. Cancer, 126(4), 692–693.

The Technical Committee on Fire Service Occupational Safety and Health. (2017). NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments (2018th ed.). Retrieved from

FMoran.DigitalPoster2.2022.pptx (473 kB)
Digital Poster for Project Presentation