Theses and Dissertations at Montana State University (MSU)
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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.Item Exercise as treatment for depression, dissemination of evidence-based practice to providers(Montana State University - Bozeman, College of Nursing, 2019) Dean, Amber Jewel; Chairperson, Graduate Committee: Tracy HellemStatement of the problem: Depression is the leading cause of disability worldwide with low remission rates. Exercise has been used as an evidence-based treatment option with positive results. This project assessed the usefulness of a pocket card to disseminate evidence-based research to medication providers while collecting additional information. Methods: 93 medication providers were identified in northwestern Montana counties at 14 outpatient clinics to disburse an informational packet to, including the pocket card. A letter directed providers to take an initial survey and a follow up survey. Results: The majority of participants (86%) found the pocket card to be a useful way in receiving information regarding exercise as treatment for depression. Conclusion: The pocket card was a useful way to disseminate evidence for exercise as treatment for depression to medication providers.Item Implementation of an evidence-based protocol to improve depression identification in primary care(Montana State University - Bozeman, College of Nursing, 2017) Blixt, Melissa Noel; Chairperson, Graduate Committee: Julie PullenThis research project addressed a practice gap in the identification of patients experiencing depression in primary care. Depression is a significant cause of morbidity and mortality worldwide, including one million suicide deaths annually. One rural Western state has a depression rate more than three times the national rate, and the highest rate of suicide in the U.S., nearly double the national rate. The setting of interest was a primary care clinic in this state, and the following research question was asked: among adult patients, does the routine administration of the Patient Health Questionnaire-2 (PHQ-2) during wellness visits improve depression identification as compared to routine care? The project sample was gathered between May 2 and July 25, 2016, and consisted of 33 patients meeting the inclusion criteria gathered from a total patient panel of 1,479. Patients were screened for depression with the PHQ-2 during their wellness visits. Two new cases of depression were identified in the study group, compared to none in the control group. A randomization test, based on 5,000 trials, was done to assess statistical significance. The rate of new diagnosis with the depression screening tool was observed to be 0.062 with an associated 95% confidence interval of between 0 and 15.6%. Associated p-value was 0.243. Although 6.2% was not a statistically meaningful difference, this project holds clinical relevance. By implementing routine depression screenings, discussion of depression was found to be initiated more often, and patients' perceived barriers to seeking help for depression were addressed.Item Evaluation of the Nurses Assistance Program in Montana(Montana State University - Bozeman, College of Nursing, 1994) Pawlyshyn, William John; Chairperson, Graduate Committee: Kathleen ChafeyItem Concept analysis : hopelessness(Montana State University - Bozeman, College of Nursing, 1996) VanDaveer, Karen Lynn; Chairperson, Graduate Committee: Therese SullivanItem A study of post partum mood changes as reflected by response to the Nowlis mood scale(Montana State University - Bozeman, College of Professional Schools, 1972) Yuhas, Frances Beckman; Chairperson, Graduate Committee: Merlyn Jean Maurer Willett