Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Certification of reprocessing standardization: preventing endoscopy associated infections(Montana State University - Bozeman, College of Nursing, 2023) Ranck, Aaron Thomas; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Between 2012-2015, 25 outbreaks were linked to contaminated duodenoscopes worldwide due to human error or negligence during reprocessing. A standardized education and training reprocessing program is necessary to address nationally increasing Endoscopy Associated Infections (EAIs). Problem: A Montana endoscopy unit committed to adopting national standards. An unmet objective was the certification of endoscopy reprocessing (CER) requirement. This pilot project sted in developing a mandatory CER protocol to optimize infection control. Methods: A Plan-Do-Study-Act (PDSA) quality improvement method was employed, with pre- and post-intervention design to evaluate infection incidence and risk. This involved patient chart review and duodenoscope reprocessing log review. An aggregate comparison was made between a CER participant and eight non-CER technicians. To inform future program development, a survey was conducted to collect data on CER participant motivation, preparation, and perception of recommended educational materials. Intervention: A pilot study involving a single participant attempting to obtain nationally recognized CER was conducted. The facility manager shared the facility's intention of mandatory certification and via endoscope technician meeting, including incentives. Created certification-benefit video presentation and exam preparation materials were provided one month before the exam. Results: Zero infections occurred during pre- and post-intervention. Pre-intervention, the average infection risk scores per endoscope reprocessing were 12.2 relative light units (RLUs) for the unit and 11.1 RLUs for the CER participant. Post-intervention phase, these numbers were 15.7 RLUs by non-CER technicians and 2.8 RLUs by the CER participant. Conclusion: This study highlights the effectiveness of mandatory CER in reducing the risk of patient infections. Maintaining infection prevention and control in endoscopy procedures requires ongoing education, training, and motivation. Informing employees of the benefits of standardization may improve motivation.Item Improving advance directive conversations in a primary care clinic: a quality improvement intervention(Montana State University - Bozeman, College of Nursing, 2022) Hong, Mikyong; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: Leading American health organizations have emphasized the necessity of promoting end-of-life conversations in health care settings. Yet the rates of these conversations remain woefully low across all settings, including primary care. Advance directives (AD) are documents that relay the degree of medical care desired by a patient. Thus, ADs are a practical and appropriate approach that can be used by primary care providers for initiating end-of-life conversations with their patients. Purpose and Methods: The purpose of this DNP project was to increase the rates of advance directive (AD) conversations between providers and their patients in a primary care setting. The project used provider training instruments that were developed within a scientific framework. These instruments included: 1) a tutorial on the appropriate use of AD related CPT codes, 2) a documentation guide for advance care planning, 3) a conversation guide for discussing ADs with patients, and 4) education on the use of the (AD) form. These instruments were delivered over eight weekly video tutorials and in-person question and answer sessions. Results: The rates of end-of-life conversation at the clinic, as reflected in advance care planning (ACP) documentation and scanned AD forms in EMRs, increased from 12% of patients to 35%. The project also improved patient care and generated revenue for the organization through the utilization of Current Procedural Terminology (CPT) codes related to advanced directive conversations.Item Optimization of advanced practice clinician billing: the first key step to creating an APC-specific onboarding within a healthcare organization(Montana State University - Bozeman, College of Nursing, 2021) Overstreet, Jordan Marie; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughAdvanced practice clinicians (APCs) have proven to be a cost-effective solution to meet the demands of increasing needs for providing high-quality healthcare, these clinicians continue to report difficulty transitioning into their role. Organizations that employ APC-specific onboarding programs have resulted in improved role transition with reports of increased provider confidence, increased interdisciplinary collaboration, and improved provider competencies. One healthcare organization sought to develop and implement an APC-specific onboarding program. Problem: A healthcare organization was lacking an APC onboarding program to support and provide professional development for APCs. A needs assessment of 90 APCs in the organization resulted in over 30% of responses, reporting feeling less than confident in the skills to independently select billing codes for patient encounters. Also, 60% of respondents were interested in education for the optimization of billing practices. Methods: After collaborating with organizational stakeholders, it was determined a comprehensive educational intervention would be created. A video series of 15 educational modules was created and disseminated to all APCs along with a post-interventional survey. Results: 7 of the 90 APCs responded to the post-interventional survey resulting in positive, but inconclusive data. Due to slowed billing resulting from the pandemic, billing data was unavailable for analysis during the timeline for the project. Of the survey responses, 57% reported the intervention was useful for providers of all experience levels and 43% reported it was most beneficial for newly licensed or hired providers. Conclusions: While the project cannot state the intervention resulted in the optimization of APC billing practices, a comprehensive educational program was created and disseminated with positive responses from APCs participating in the survey. More work needs to be done to determine the effects of the education on billing practices. However, positive survey feedback indicates the intervention would be a feasible, beneficial first step and contributed to the development of a comprehensive onboarding program for all APCs within a healthcare organization.Item Cardiac services nurse residency(Montana State University - Bozeman, College of Nursing, 2016) Kennedy-Collins, Kamera Machel; Chairperson, Graduate Committee: Alice RunningThis professional project was born out of a specific need within the cardiac services department at Kalispell Regional Medical Center. In order to describe, and best determine the exact needs of the cardiac services department, a clinical microsystem assessment was completed for the department focusing on the 'five P's' of the assessment process; Purpose, Patients, Processes, Professionals, Patterns. Information obtained from the microsystem assessment highlighted the need for additional staffing. Factors such as retirement, department growth, and turnover have left the department chronically short staffed. Chronic short staffing has resulted in long work hours and routine overtime. Attempts at hiring experienced nurses have not been successful enough to meet the department demand. Evidence would support nursing residency programs as one solution to staffing shortages. Therefore, a literature review was completed regarding the design and success of nurse residency programs. Given the issues of persistent short staffing, and the subsequent increased work load for staff, a proposal for the development of a unit specific nurse residency program was made. This professional project proposes a 16 week unit specific nurse residency program designed to be integrated into the existing organizational program. The programs includes components of preceptorship, mentoring, and didactics. The goal of the proposed nurse residency program would be to provide education, professional support, and mentoring to new graduate nurses interested in cardiac care in order to satisfy long term staffing needs within the department.Item Factors that present challenges to healthcare staff during EMR implementation : an integrative review of literature(Montana State University - Bozeman, College of Nursing, 2013) Howland, Amy Lynn; Chairperson, Graduate Committee: Susan LuparellOver twenty years ago, the Institute of Medicine began urging the medical community to embrace the conversion from paper-based charting to electronic medical records (EMR) (National Assembly on School Based Health Care [NASBHC], n.d.). However, it has only been in recent years following the offering of financial incentives by the Department of Health and Human Services that hospitals and doctors' offices have begun the transition in documentation to an EMR (Haupt, 2011). As of the year 2009, it was reported that only 11.9% of US hospitals were using either a basic or comprehensive EMR, and only 2% of hospitals were using an EMR robust enough to comply with the federal government's "meaningful use" criteria (Jha DesRoches, Kralovec, & Joshi, 2010). One reason that so few healthcare organizations have completed the transition to an EMR system of documentation is due to the tedious implementation process and the challenges that arise during this process. The purpose of this integrative review of literature is to explore the factors that present challenges to healthcare staff during EMR implementation in healthcare organizations. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the located literature. A total of 26 articles met the predetermined inclusion criteria. The results indicated that the factors that present challenges can be organized into two themes: personal/professional factors and organizational factors. Personal/professional factors include adequate time, inadequate computer skills, workflow disruption, user friendliness, negative impact on patient-provider relationship, security, and poor understanding of the EMR benefits. Organizational factors include cost, inadequate EMR standardization, information technology issues, and issues with implementation. After determining these factors that present challenges to healthcare staff during EMR implementation through careful literature review, the reviewer concluded that a standardized plan for successful EMR implementation in all healthcare settings including remedies for these challenges should be formulated. This standardized plan would offer healthcare organizations the best chance for smooth EMR implementation into practice for the staff, patients, and organization as a whole.Item Knowledge of late-life depression among staff in long-term care facilities(Montana State University - Bozeman, College of Nursing, 2005) Pullen, Julie Marie; Chairperson, Graduate Committee: Vonna BranamIn summary, the graying of America is anticipated to dramatically increase the incidence and prevalence of depression in this country. This is due, in part, to the burgeoning aging population of baby-boomers. Baby-boomers are predicted to experience depression at higher rates than prior generations. More beds in long-term care facilities will be required to meet the demands of increased numbers of elders who will need nursing care at some point during their older years. Many of these patients will be admitted for depression, and many others will be depressed upon their relocation to the residential setting. Long-term care staff will need satisfactory knowledge of late-life depression in order to accurately assess and treat their elder patients. Therefore, the purpose of this study is to assess knowledge of depression among staff in long-term care facilities.Item The effect of an educational intervention on facility staff knowledge regarding pressure ulcer care(Montana State University - Bozeman, College of Nursing, 2010) Forseth, Cynthia Dawn; Chairperson, Graduate Committee: Karen ZulkowskiThree million pressure ulcers occur in the United States in a year. Pressure ulcers are painful, stressful, and costly to treat and may be preventable. In a frontier facility, staff education about new techniques for preventing and treating pressure ulcers is often problematic. In the rural area, there are fewer opportunities, less money, less time for training and education of staff as well as high staff turnover. These obstacles to nursing staff's ability to maintain competency can lead to less than optimal care. The simple act of reading an article or attending a lecture can increase pressure ulcer knowledge. The purpose of this study was to examine nursing staff knowledge before and after an educational intervention in a frontier critical access/nursing home facility. Knowledge scores did increase but because of the small sample, size statistical significance was not obtained although the knowledge score increased. Increased educational opportunities can improve pressure ulcer knowledge in a rural facility.