Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Implementing advance directive screening and education in the primary care setting(Montana State University - Bozeman, College of Nursing, 2021) Nordlund, Sarah Lou; Chairperson, Graduate Committee: Yoshiko Yamashita Colclough and Polly Petersen (co-chair)Advance care planning is a topic that has become increasing important due to medical technology advancement and the growing population of elderly Americans. Although advance care planning has been proven to positively impact patient satisfaction and quality of care, education and advance directive formulation does not occur as often as it should. The primary aim of this project was to increase the number of completed advance directives in patient medical records by 10% at a small rural Critical Access Hospital. The intervention implemented was screening patients age 65 and older for the presence of an advance directive during the clinic intake process. Patients that reported having a completed advance directive were asked to provide the site a copy and patients that reported not having an advance directive were provided an educational packet. A total of 5 patients presented to the clinic during the 6-week data collection period that were age 65 and older. Of these patients, 40% (n=2) reported having a completed advance directive, and both returned a copy. There were 40% (n=2) that reported not having a completed advance directive and did not return a completed copy. One patient did not get screened by mistake. The site is considering adjusting the screening process to be the responsibility of the clinician instead of the receptionist. A social media post was created on the site's Facebook page requesting individuals that had a completed advance directive to provide the facility a copy resulting in three additional individuals (n=3) bringing in completed directives. The goal to increase completed advance directives in patient medical records was met. A secondary aim of this project was to have facility clinicians complete an advance care planning education course from the education platform Relias, promoting their comfort to have the conversation with the patients. Facility clinicians have not yet completed the education, but the course was added to the facility's annual requirements. Currently 16 out of 36 of the non-clinician employees have completed this education course. The interventions adopted for this DNP QI project brought awareness to important topic of advance care planning and increased advance directive formulation.Item The value of telemedicine in rural healthcare and associated financial obligation(Montana State University - Bozeman, College of Nursing, 2018) Nordlund, Sarah Lou; Chairperson, Graduate Committee: Polly PetersenThe purpose of this project was to raise awareness of the vital impact emergency room telemedicine has on rural residents and health care and the financial challenges facilities face to maintain these services following implementation. Limited knowledge is available to determine how rural critical access hospitals are able to financially sustain emergency room telemedicine long term. The study completed found that more than half of the Critical Access Hospitals utilize telemedicine in their emergency rooms. Funding emergency room telemedicine projects is an area of concern at many of these hospitals. As health care continues to advance with the use of technology, health care facilities are in need of more research in this area to develop policy that could potentially improve sustainability and increased reimbursement to offset the cost.