Theses and Dissertations at Montana State University (MSU)
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Item Implementation of a nurse-driven algorithm for safety companion usage: a pilot study(Montana State University - Bozeman, College of Nursing, 2019) Phillips, Kahrin Lillian; Chairperson, Graduate Committee: Jennifer Sofie and Susan Luparell (co-chair)Safety companions, also known as sitters, are commonly placed in a 1:1 setting with patients in hospital settings to maintain their safety. These patients include (a) those that are suicidal, confused, delirious, or violent; (b) those with psychiatric issues; (c) those with behaviors that interfere with their medical treatment; and (d) those experiencing behavioral problems associated with substance abuse. However, several problems exist with the use of safety companions, such as cost, inconsistent evidence supporting their effectiveness, and lack of evidence-based guidelines for their use. The primary aim of this pilot study was to assist staff RNs on a 39-bed inpatient hospital unit in using more discernment in the use and management of safety companions. Based on the needs of key stakeholders at the pilot site and a thorough review of the literature, a nurse-driven, evidence-based algorithm for safety companion usage was developed and implemented over four months to meet this aim. In addition, the project investigated the issues surrounding safety companion use and compared these issues to those experienced at the pilot site. Five online surveys targeting different groups of stakeholders were used pre- and post-implementation of the algorithm to assess their perceptions of the algorithm and its effect on the management of safety companion usage. The success of the algorithm was determined by the level of nursing satisfaction with the algorithm and whether it was helpful to assess their patients for a safety companion. The primary aim of the project was successfully met, with all participating team leaders finding the algorithm to be 'somewhat' to 'very effective' in helping staff RNs in being more discerning with the use and management of safety companions. Most of the unit's participating team leaders (87.5%) were satisfied with the algorithm, and all of the participating staff nurses found the algorithm to be 'somewhat helpful' or 'very helpful.' Implications for improvement included room for additional education and training for safety companions, improved staffing and support when using the algorithm, and issues surrounding patient safety.Item Family environmental risk factors for adolescent substance use: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2019) Walker, John Caleb; Chairperson, Graduate Committee: Tracy HellemSubstance use continues to be an ongoing problem throughout the United States and worldwide. In terms of substance use initiation, adolescence is characterized as an especially vulnerable developmental time period. There are many potential influences that can affect an adolescent's risk for initiating substance using behaviors. One particularly influential factor is the family environment the adolescent is exposed to on a daily basis. The purpose of this project was to summarize the evidence on the topic of adolescent substance use risk factors within the immediate family environment. Following an integrative review guideline, three library databases were searched utilizing a set of key search terms in order to obtain all relevant studies related to this topic. Each relevant research article found in the literature search that met the inclusion and exclusion criteria was included in the review process. Research findings were extracted from these research studies, organized into common categories, and integrative summaries were presented. The results of the review were categorized and presented based on commonly identified influential factors that were examined in the primary studies. As a result of this review, it was concluded that many significantly influential immediate family environment risk and protective factors have been identified in the literature. The significance of these findings and the potential implications for practice, prevention, and research, are discussed.Item Beliefs and use of evidence-based practice by nurses: a needs assessment at a hospital in south central Montana(Montana State University - Bozeman, College of Nursing, 2018) Gipe, Leigh Ellen; Chairperson, Graduate Committee: Stacy StellflugNurses consistent use of evidence-based practice (EBP) will improve healthcare quality, improve patient outcomes, and decrease healthcare costs. Nurses constitute the largest group of healthcare providers and are in direct contact with patients, thus have an opportunity to make the largest impact using EBP. Despite EBP being accepted as the best method of providing care, many nurses may not be fully implementing it in daily clinical practice. The purpose of this project was to investigate nurses' beliefs about the readiness for and organizational culture for evidence-based practice, attitudes and beliefs about evidence-based practice, and nurses' implementation of evidence-based-practice at this organization. This was done by asking the following questions: What are nurses' current individual beliefs and attitudes about EBP at this organization? What are nurses' current levels of self-reported implementation of EBP at this organization? What are nurses' perceptions of organizational and cultural readiness for EBP at this organization? This project used a cross-sectional, descriptive design. A 75-question survey was sent via email in a SurveyMonkey to a convenience sample of 485 nurses. Nurses were asked demographic and professional characteristic questions, three open-end questions about EBP and to respond to three surveys: (1) The Organizational Culture & Readiness for System-Wide Integration of Evidence-Based Practice scale (2) The Evidence-Based Practice Beliefs scale (3) the Evidence-Based Practice Implementation scale. The findings were that nurses had positive attitudes and beliefs about evidence-based practice but reported low levels of implementation behaviors. Nurses report that they need more time, education and training, and resources to increase implementation of evidence-based practice. Interventions recommended to increase EBP implementation include encouraging more nurses to participate in the clinical ladder program, using mentors to assist and encourage use of EBP, and to provide more training and education opportunities for nurses.Item An assessment of nurse confidence, perception of individual impact, and view of professional responsibility to influence policy(Montana State University - Bozeman, College of Nursing, 2019) Chovanak, Lori Anne; Chairperson, Graduate Committee: Laura LarssonProfessional governing organizations call all registered nurses to engage in political advocacy to improve the delivery of care as well as to promote positive change in the health care system. Little is known about the confidence of nurses towards engaging this mandate as well as their attitudes regarding the impact on patient care. This project outlined the impact of educational content in a nurse's confidence level to engage political advocacy, perception of ability to impact health policy, and perception on professional responsibility to engage political advocacy. It includes a literature review on nurse views regarding their ability to address practice and health care issues, explore what inspires nurses to engage in professional advocacy, research nurse' attitudes regarding how political action affects them professionally, and a review of existing research regarding the impact of education on an individual nurse's confidence. Two state nursing associations developed continuing education activities which they provide regularly to nurses with content aimed specifically at increasing participation in political advocacy. The content of these events included information regarding historical political efforts that have advanced the nursing profession, updates of current issues, instruction on legislative process engagement and strategies for success, and information on resources and support that are available for engagement in political advocacy. Participants at these state events were surveyed before and after the educational event to learn if nurses' knowledge, confidence, perceptions, and disposition towards engaging political advocacy increased with receipt of educational content on the topic. The dependent samples t-test demonstrated significant difference (t(47) = -7.99, p < .001 ) between the scores before (M = 80.2, sd = 14.67) and after the intervention (M = 89.9, sd = 14.82) supporting the hypothesis that participant scores would positively change on engaging political advocacy.Item An assessment of surgical oncology patient education(Montana State University - Bozeman, College of Nursing, 2018) Bartholomew, Cody Sue; Chairperson, Graduate Committee: Susan RaphCancer patients are faced with tremendous amounts of information during a very vulnerable time, challenging the medical community to provide patients and families with up to date, relevant, evidence-based information to make informed decisions that promote positive health outcomes. Lack of standardized pre-operative patient educational efforts for adult surgical oncology patients has the potential to negatively impact system efficiency, patient outcomes, patient satisfaction and trust in their healthcare team. When patients possess understanding of their care process, their role in recovery, and trust in the healthcare team increases (Reiter, 2014). The aim of the project was to assess the current structure and process of surgical oncology patient education within one integrated health system in the northwest United States using the Donabedian framework for healthcare quality (Donabedian, 1980). A non-experimental descriptive exploratory survey was used for data collection. Project findings include identification of systematic structure and processes of surgical oncology education due in part to the complexity of the health system structure and lack of standardization across care settings. Documentation of education provided is varied by location and provider type with an absence of formal pre-operative or post-operative education plan within the system. Information collected will be used for future quality improvement projects and interventions to improve surgical oncology patient education across the continuum one of the integrated health system.Item Human trafficking: what is the role of the healthcare professional?(Montana State University - Bozeman, College of Nursing, 2018) Jennings, Melissa Rae; Chairperson, Graduate Committee: Alice RunningThe idea of this professional project originated after a learning-needs assessment was performed by the education department on the Labor and Delivery/Mother Newborn unit at a healthcare facility in Montana. Information obtained from the learning-needs assessment indicated that the staff wanted more information on human trafficking in the healthcare setting. A literature review was completed regarding human trafficking in the healthcare setting and the evidence showed that healthcare professionals are not adequately trained in identification of a human-trafficking victim, rescuing a victim, or resource utilization for suspected victims. An educational presentation was developed and learning objectives were identified. The goal of the project was to increase staff awareness regarding human-trafficking victims, increase confidence in the ability to identify a trafficked victim, and provide staff with resources in the event that they encounter a human-trafficking victim. A pretest to assess knowledge of the topic was given immediately prior to the presentation and a posttest was given immediately after the presentation to assess attainment of learning objectives. Results showed an increased awareness of this topic post presentation and staff felt more confident in identifying a human-trafficking victim. Staff were given resources to utilize at the end of the presentation to assist them in identifying potential victims and use for referral purposes on their unit. Although this was one area to increase awareness of the problem of human trafficking, there continues to be a need for protocol development for healthcare providers, collaboration amongst law enforcement, service providers, and private organizations and increased research regarding this topic.Item Chemotherapy education: standardizing education and improving knowledge retention through multimedia platform(Montana State University - Bozeman, College of Nursing, 2019) Norby, Sydney Lauren; Chairperson, Graduate Committee: Susan RaphPatients with a new diagnosis of cancer undergoing chemotherapy treatment receive an overwhelming amount of information at the start of their journey. At a northcentral Montana healthcare agency, it was observed that patients were not retaining the chemotherapy education provided to them, which can negatively impact their timeliness of recognizing and reporting symptoms. The purpose of this project was to determine best practice, standardize the chemotherapy delivery process, and implement multimedia into chemotherapy education delivery in hopes of improving knowledge retention. A chemotherapy education checklist was developed to standardize the information delivered to patients during their chemotherapy education. Prior to their education, patients were asked to answer a seven-question pretest. Before their first day of treatment, patients followed a link to watch the Chemotherapy Basics video created by the Cleveland Clinic. On their first day of treatment, patients answered the same seven-question post-test and their scores were analyzed. Patients showed improvement in their post-test scores after the education intervention. The results of this project suggest that the addition of multimedia to the chemotherapy education process coupled with a standardized education checklist improves knowledge retention of patients.Item Delivering prenatal breastfeeding education to a vulnerable population in rural Montana(Montana State University - Bozeman, College of Nursing, 2019) Young, Cindy Rae; Chairperson, Graduate Committee: Julie Ruff; Helen Melland (co-chair)The educational project aimed to document the efficacy of delivering prenatal breastfeeding education on exclusive breastfeeding (EBF) rates of mothers identified as vulnerable in a rural western Montana community. A convenience sample was utilized to implement the pilot project that included three educational sessions, taught by certified lactation counselors scheduled to coincide with routine prenatal appointment. A control group (CG) was established from a two-month sample of mothers delivering at the implementation site one year before implementation. The education was expected to enhance breastfeeding intentions as evidenced by the scores on the Infant Feeding Intentions (IFI) Scale, thus leading to higher rates of EBF in the participant group (PG) versus a control group. The PG mothers had slightly higher rates of EBF at both hospital discharge (PG 62% vs. CG 59%) and 7-10 days after birth (PG 57% vs. CG 53%), which failed to show statistically significant differences. One statistically significant difference was noted in the higher rates of EBF at 7-10 after birth for PG first-time mothers versus CG first-time mothers (73% vs. 0%, p < .001, 95% CL), indicating prenatal breastfeeding education may have made a more significant impact with first-time mothers. However, the efficacy of delivering prenatal breastfeeding education to impact EBF rates in this vulnerable population can neither be supported nor refuted based on the project results. A review of medical records showed that over 90% of the participant mothers attempted to breastfeed in the hospital (control 76%) and 75% of participant mothers who were not EBF while in the hospital were still giving their infant their breast milk versus 33% of the CG mothers. Seventy-five percent of the PG and CG mothers who were not EBF at 7-10 days were offering breast milk with formula supplementation. Due to acknowledged limitations in design, measurement and data collection, it is not possible to credit the statistically significant results mentioned above to the educational project. This project did provide useful information to guide future project modifications in implementation design and significant suggestions for further study.Item Standardizing documention of schedule II prescription in a primary care clinic(Montana State University - Bozeman, College of Nursing, 2019) Taylor, Lindsey Beth; Chairperson, Graduate Committee: Wade G. HillStandardization of processes and documentation in healthcare has continually been linked to quality of care. Implementation of new electronic health records (EHR), inadequate training, and lack of processes in place can all effect nursing documentation. The purpose of this project is to standardize documentation of charting the destruction of schedule II prescriptions in an Internal Medicine Clinic. Prior to the implementation of this project there was no standardized workflow for how or where to document the destruction of schedule II prescriptions. Lack of standardization and protocol contributed to prolonged time to complete refills, increased risk of duplicates, increased risk of harm to patients, and high nurse utilization. A pre and post-test was utilized to evaluate the nurse practice on documenting the destruction of controlled prescriptions. The pre-intervention results demonstrated inconsistent documentation which included: documenting in a communication encounter, documenting in the medication tab, a mixture of both documenting in the communication encounter and medication tab, or just not documenting. A standardized workflow was developed, presented to nursing staff, and competency assessment completed. The post-test demonstrated 100% compliance in documentation and made locating the documentation in the chart faster and easier reducing nurse workload.Item Bridging the gap of care for chronic pain patients(Montana State University - Bozeman, College of Nursing, 2019) Lantz, Stormy Paige; Chairperson, Graduate Committee: Polly PetersenAim: Examine the need for multidisciplinary pain management support for primary care providers at a provider based ambulatory care setting in western Montana. Background: Although chronic pain ailments make up a significant portion of primary care provider visits, many providers do not feel equipped to manage nonmalignant chronic pain and often fear legal consequences of opioid prescribing. With gaps in pain specialist availability, provider comfort, and geographical and financial challenges, Telemedicine may help alleviate provider stress through the delivery of emotional support and structured case discussion and consultation, assisting providers with communication strategies, mental health referrals, and difficult decision-making surrounding opioid prescribing Method: Twenty six primary care providers received an electronic questionnaire to assess their pain management needs and views regarding the training, challenges, expectations, and impact of implementing Telehealth at their current organization. Results: Five out of twenty six providers participated in the project. Eighty percent (80% 'n=4') of providers said they would use Telehealth for pain management if it was available to them, identifying interprofessional collaborative practice, initial evaluation and treatment plan recommendation, ongoing treatments, and education as the most useful telehealth applications. Conclusion: Chronic pain management is a problem for primary care providers. Future research on small, rural organizations using telehealth to meet their patients' pain management needs and additional needs assessments are needed to gain insight into providers engagement levels prior to moving forward with implementation of a Telehealth program at this organization to ensure a successful implementation.