Browsing by Author "Addison, Kara Marie"

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Rural nurses' perceptions of disruptive behavior and clinical outcomes : a replication-extension study
(Montana State University - Bozeman, College of Nursing, 2012) Addison, Kara Marie; Chairperson, Graduate Committee: Susan Luparell
Disruptive behavior in the healthcare setting is considered a major threat to patient safety, patient outcomes, patient satisfaction, and interdisciplinary relationships. The Institution of Medicine estimated that over 44,000 to 98,000 people die related to medical errors (2000). The Joint Commission suggests that disruptive behavior is one of the leading causes of adverse events in the healthcare setting (2008). The purpose of this study was to evaluate Montana nurses perceptions of disruptive behavior and its impacts on interdisciplinary relationships, patient safety, and patient outcomes while working in rural hospitals. This study was a replication-extension study based on Rosenstein & O'Daniel's research in 2008. Rosenstein's survey was used to assess perceptions of disruptive behavior in the healthcare environment. This survey was sent out to 120 rural nurses in Montana. Fifty-nine participants completed the survey resulting in a 49% response rate. One hundred percent of nurses indicated that disruptive behavior could have a potential negative effect on patient outcomes. Over 45% of nurses indicated that they were personally aware of an adverse event that occurred from disruptive behavior and 82.2% of nurses indicated this event could have been prevented. Nurse indicated that both nurse and physician disruptive behavior was prevalent in the rural healthcare setting. Also, participants indicated that disruptive behavior could be linked to increased stress, frustration, loss of concentration, reduced team collaboration, frustration, reduced information transfer, reduced communication, and impaired RN/MD relationships. Results from this survey demonstrated that disruptive behavior can lead to adverse events, compromises in patient safety and quality, and finally decrease overall interdisciplinary relationships. These findings have important implications for patient safety and effective interdisciplinary relationships and support the development of effective policy implementation to address and mange such behavior.
Safety improvement in biologic therapy for patients with moderate to severe plaque psoriasis: a pilot project and quantitative analysis
(Montana State University - Bozeman, College of Nursing, 2016) Addison, Kara Marie; Chairperson, Graduate Committee: Jennifer Sofie
Biologic Response Modifier (BRM) medications are indicated for moderate to severe psoriasis and demonstrate high efficacy for disease reduction. Although BRM medications are considered the most effective therapy in the treatment of moderate to severe plaque psoriasis, their side effect profile can be severe. Using BRMs may increase the risk of infections, demyelinating disease, and malignancy (Reich, Burden, Eaton, & Hawkins, 2012). With such established risks, baseline assessments and monitoring have been recommended. However, no standardized guidelines exist for the monitoring of BRM medications (Hanson, Gannon, Khamo, Sodhi, Orr, & Stubbings, 2013). Therefore, the objective of this scholarly project was to implement a BRM monitoring protocol into the Electronic Medical Record (EMR) of a Montana dermatology clinic to improve provider monitoring compliance and therefore improve psoriasis patient outcomes, safety, and education. Monitoring criteria were developed based on recommendations from the University of Illinois Medical Center Clinical Care Guidelines and the American Academy of Dermatologists Biologic Monitoring guidelines. A BRM Electronic Medical Record (EMR) template was then created to utilize such guidelines to improve clinical compliance and patient safety. Seven main criteria were measured for completion including laboratory studies, physical assessment, patient education, follow up, psoriasis severity scale, immunizations, and vital signs. Side effects experienced and patient comorbidities were also recorded. Completion rates of the protocol were analyzed using before and after comparisons, the paired t-test, and McNemar's test. Before the intervention was implemented, 54% of charts had completion of all seven categories and after the intervention 98% of charts were completed, illustrating a 44% improvement in provider compliance and monitoring. The paired t-test illustrated an average difference of 0.43 with a standard error of .029. The McNemar's test established a positive association between implementation of the BRM protocol and improvement in provider compliance. 40% of patients experienced co-morbidities associated with psoriasis and 25% of patients experienced side effects related to BRM therapy. These project findings demonstrated the efficacy of a BRM monitoring template for improving provider-monitoring compliance and improving patient safety through early identification of comorbidities and side effects.