Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
Browse
6 results
Search Results
Item Programming despair: post-9/11 American television show mirroring a too-familiar dark reality(Montana State University - Bozeman, College of Letters & Science, 2024) Holthaus, Nicholas Edwin; Chairperson, Graduate Committee: Daniel FloryThis work is an analysis of the phenomenon of wildly popular television shows airing since the 9/11 attacks, many of which appear to critique United States foreign and domestic policies and the morally and economically deprived environments those policies have created, all of which have led to correlative, disturbing psychological changes in US citizens. Television is a textual site, and, especially since 9/11, an indicator of national mood, temperament and consumption trends. "TV" is an increasingly important vehicle through which to examine how producers engage with consumers, as they sometimes "mirror," sometimes create, and occasionally criticize systemic ideologies and beliefs. Since 9/11 the qualitative content of shows has changed drastically, which poses new challenges for consuming viewers. Many of these shows reify the old critics' warnings, but some obliterate them with these new writers' critical examinations of cultural, economic and political problems we increasingly face. I look at what some show producers are telling us now that they've achieved that supposed "American Dream," that is, working toward and achieving some economic independence. They show a maturity in their earnest messages that the old dichotomies of "good guys and bad guys," are no longer believable. These shows in varying degrees to the discomfort and to the pleasure of a more discriminating and disenfranchised US public show this. I propose an approach to discern which shows are enlightening in many ways and those which only serve to obediently "take up consumers' time with meaningless entertainment" as pre-9/11 scholars had bemoaned. Not all TV shows are created arguably equal anymore, at least in regards to the agendas of the producers; some humanistic writers and producers have daringly scrutinized many institutional social governors and throttles inherent in the machinery of control over the public. Yet, no matter how enlightening some of these new visual vehicles are, some are not, and simply drain time. And with "bingewatching" also come new health problems. It is up to the individual reader/viewer to recognize the difference and to choose what benefits one's self, from how to choose their "leisure" time to becoming more active in eliminating the sources of their anxiety, alienation and dis-ease. This work hopefully offers a new way of looking at the changes we've encountered, especially those presented televisually the past twenty + years. Just as the creators of some of these new shows have heeded the old scholars' criticisms, so too is a need for new scholarship on television so that both can co-evolve, in the hopes that there grows enough consensus in how to pinpoint and then resolve the financial problems we've inherited.Item Implementation of the patient health questionnaire- 2 & 9 adolescent modified [PHQ-2 & 9 A] in a pediatric clinical setting: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Mock, Devin Michael; Chairperson, Graduate Committee: Julie Ruff; This is a manuscript style paper that includes co-authored chapters.In Montana, the importance of pediatric depression screening within the pediatric primary care setting cannot be overstated, mainly due to the state's high prevalence of pediatric depression and unique rural challenges. Pediatric primary care is often the first line of defense in identifying and addressing mental health issues in children and adolescents. In such a vast and predominantly rural state, primary care providers play a crucial role in early detection and intervention, overcoming barriers such as limited access to specialized mental health services and cultural stigmas. Effective screening and early intervention strategies immediately benefit the child's mental health and contribute to long-term positive academic and social development outcomes. Integrating mental health services into primary care is essential for improving healthcare outcomes. The American Academy of Pediatrics' current guideline recommends that all children 12 years and older receive annual depression screening using a validated and reliable tool such as the Patient Health Questionnaire- 2 & 9 Adolescent Modified [PHQ-2 & 9 A]. Unfortunately, at an urban Montana pediatric primary care clinic, the number of pediatric patients receiving appropriate screening is below sub-optimal. A Plan, Do, Study, Act cycle was implemented throughout the clinic to increase pediatric depression screening rates through education, reminder-based systems, and standardized hand-off reports.Item Implementing standardized depression screening for adults in a rural setting: a quality initiative(Montana State University - Bozeman, College of Nursing, 2024) Downing, Kjersti Lee; Chairperson, Graduate Committee: Stacy Stellflug; This is a manuscript style paper that includes co-authored chapters.Background: Major depressive disorder (MDD) imposes a significant burden, affecting 15-17% of the population. Early detection and intervention are crucial to mitigate adverse health outcomes associated with untreated depression. Clinical guidelines recommend regularly screening patients for depression within the primary care setting. The Patient Health Questionnaire (PHQ) is a widely recognized and validated tool used for depression screening. Local Problem: A rural clinic in Eastern Montana elected to implement a standardized process for administering PHQ-2 and PHQ-9 assessments to their adult primary care population. Methods: The Iowa Model guided the implementation process over eight weeks. Intervention: Nursing staff administered a PHQ-2 to eligible adult patients during primary care appointments. A PHQ-2 score of > or = 3 triggered the nursing staff to administer the PHQ-9. Positive PHQ-9 scores (> or = 5) prompted provider notification and subsequent evaluation for depression. Patients diagnosed with depression or other mental health concerns received appropriate interventions and treatments based on clinical expertise. Data was collected and deidentified before entry into a spreadsheet for further analysis. Results: Nursing staff administered a PHQ-2 to 71.8% (n=326) of eligible patients over the eight weeks. Of those screened, 46 had a positive PHQ-2 result, and 30 had a positive PHQ-9 result. Providers evaluated 100% of patients with a positive PHQ-9, and all were determined to have varying severities of depression. Conclusion: The findings supported the efficacy of the PHQ in identifying depression within a primary care setting. Moreover, these measures promise to enhance mental health care delivery and outcomes in the rural primary care setting.Item Measurement based care for improving clinical depression and attention-deficit/hyperactivity disorders(Montana State University - Bozeman, College of Nursing, 2024) Blouin, Patrick Daniel; Chairperson, Graduate Committee: Alice RunningBackground: Measurement based care is an evidence-based approach proven to enhance diagnosis and treatment of psychiatric disorders. This patient-centered strategy involves the routine use of clinically validated, self-report rating scales to quantify clinical outcomes over time and guide decision-making. Extensive research indicates that measurement based care improves the quality of psychiatric care and patient outcomes. Local Problem: Prior to implementation of the Doctor of Nursing Practice project, measurement based care for adults diagnosed with clinical depression and/or attention-deficit/hyperactivity disorders had not been implemented at a mental health clinic located in southwest Montana. Methods: Hence, the purpose of the Doctor of Nursing Practice project was to implement the Beck Depression Inventory II and the Adult ADHD Self-Report Scale for adult patients, treated in-person at the clinic, diagnosed with clinical depression and/or attention/deficit-hyperactivity disorder. Interventions: After approval by the Montana State University Institutional Review Board, qualifying patients were administered the appropriate self-report rating scale via iPad at the beginning of each clinical encounter. Immediately after patients completed the self-report rating scale, the clinician reviewed their scores and used this data to augment decision-making. Results: The results of the 11-week project revealed improved follow-up scores, suggesting that data collected from clinically validated, self-report rating scales may have enhanced earlier detection rates of deterioration and enhanced clinician responsiveness to subtle changes in morbidity. Conclusion: In summation, the Doctor of Nursing project underscores the importance of measurement based care for improving patient outcomes related to clinical depression and/or attention/deficit-hyperactivity disorders and provides valuable insights for future quality improvement initiatives.Item Improving depression screening and follow-up in primary care settings(Montana State University - Bozeman, College of Nursing, 2023) Houghtelling, Jeanette Renee; Chairperson, Graduate Committee: Margaret HammerslaBackground: Depression is a serious problem globally and locally. It not only impacts work productivity and the costs of healthcare, but it also directly reduces quality of life and increases the burden of chronic illness. In addition, depression increases the risk of death by suicide. Depression is thought to be one of the most treatable of mental health disorders, yet it remains underdiagnosed and undertreated. The primary care setting provides the ideal location to identify individuals with depression and to initiate treatment. Objective: The objective of this quality improvement initiative was to meet or exceed the target rate of depression screening and follow-up in a federally qualified health center in northwest Montana. Method: Following a review of relevant literature, an extensive organizational assessment was conducted. A clinical practice guideline was written which recommended a standardized workflow and written standard operating procedure. Measures to educate and engage staff were employed. Staff feedback was solicited through an online survey. The clinical practice recommendation was appraised by the organization's quality team using the AGREE II appraisal tool. Results: Staff expressed support of change as evidenced by verbal responses to manager and anonymous online survey. The quality team approved the practice recommendations for implementation which was initiated on March 1, 2023. Preliminary data indicate that screening and follow-up rates have improved. Conclusion/Implications: It is feasible to improve depression screening and follow-up in primary care settings by studying the current state thoroughly and implementing key facilitators.Item Lessons learned: evaluating the implementation of a yoga-cognitive behavioral therapy group(Montana State University - Bozeman, College of Nursing, 2020) Hamilton, Karlee Renee; Chairperson, Graduate Committee: Tracy HellemThere is a significant need for those with depression and anxiety to have complementary treatment options to help treat the multifaceted symptoms of these illnesses. Evaluating programs for the complementary treatment of depression and anxiety is essential for organizations to measure the outcomes of their programs and to offer quality comprehensive care to clients. This project evaluated the outcomes of a yoga-Cognitive Behavioral Therapy group started at a community mental health center in Montana using the CDC's Guide to Effective Evaluation as a guideline. The yoga-CBT group did not show any positive results in either BDI or GAD-7 scores, and a discussion of limitations of this program was had with stakeholders. Despite the number of limitations, lessons were learned about effective implementation of programs at the community mental health center.