Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Use of a protocol to improve exam standardization and clinical support for SANE practitioners in Montana(Montana State University - Bozeman, College of Nursing, 2024) McKinney, Elizabeth Anne; Chairperson, Graduate Committee: Carrie W. Miller; This is a manuscript style paper that includes co-authored chapters.Statement of Problem: Sexual assault is a common occurrence throughout the United States with significant side effects. Reporting shows that one in every six women, one out of thirty- three men, one in nine girls, and one in 20 boys are victims of sexual assault. These rates are greater among Native Americans, incarcerated individuals, military members, and those who identify as LGBTQ+IA. Side effects are many and include physical, psychological, and financial repercussions. Research suggests that sexual assault nurse examiners (SANEs) improve not only the judicial outcomes but improve patient's sense of well-being and reduce secondary traumatization. A needs survey administered to a Southeast Montana hospital SANE program indicated provider confusion when training to do the SANE exam due to a lack of standardization among how providers completed the exam. Methods: A needs survey administered to a Southeast Montana hospital SANE program indicated provider confusion when training to do the SANE exam due to a lack of standardization among how providers completed the exam. Using recommendations provided by the National SANE Protocol, a quality improvement plan was created to evaluate the implementation of an adult/adolescent exam protocol, and a flowchart based on the protocol. Participants completed a pre-and post-survey to determine whether the protocol improved exam standardization, exam clarity, staff awareness of exam policy and procedures, quality of exam, confidence in practice, and clinical support of SANEs. Results: Survey respondents were primarily novice and advanced beginners to the SANE role. Prior to the intervention They had low confidence, low levels of clarity surrounding exam requirements, and a poor sense of clinical support. They report collecting high quality evidence and completing exams in line with policies and procedures. Following the intervention all survey elements increased in level agreement whether there was high agreement pre - intervention. Conclusion: The availability of standardized clinical tools increases confidence, clarity, and support among SANE providers, which we theorize will improve retention of SANEs and evidence quality.Item Improving communication and patient outcomes with SBAR at a skilled nursing facility: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Westphal, Mackenzie Sue; Chairperson, Graduate Committee: Margaret HammerslaBackground: Improving patient outcomes depends on high-quality communication among healthcare providers. The aim of this project is to improve communication between geriatric providers and a skilled nursing facility during after-hour phone calls. Local Problem: Geriatric providers expressed concerns about inadequate communication during after-hours phone calls from a Medicare-Medicaid-certified skilled nursing facility. Methods: This quality improvement project utilized the Plan-Do-Study-Act method to create sustainable change. Communication was quantified by establishing 11 key elements of SBAR created based on the Agency for Healthcare Quality and Research TeamSTEPPS curriculum and provider preferences. A needs assessment was conducted to determine baseline data and identify gaps in communication. Phone audits and surveys were used to collect data. Interventions: The Agency for Healthcare Quality and Research's TeamSTEPPS curriculum provided the foundation to create a facility specific SBAR training for staff. The inperson training included a presentation, sample SBAR reports, and resources to reference. Results: The SBAR training at the skilled nursing facility resulted in 10% increase in average SBAR components reported to providers. There was an increase in SBAR elements reported in the Situation, Assessment, and Recommendation categories. There was not a significant change in provider satisfaction, staff satisfaction, or staff confidence. Several residents were unnecessarily transferred to the hospital and received interventions that could have been performed at the facility. Conclusions: SBAR can improve communication between geriatric providers and nursing staff during after-hour calls. Improving communication in skilled nursing facilities is vital to quality patient outcomes and reducing preventable hospitalizations.Item Medication reconciliation in ambulatory surgery to prevent adverse drug events(Montana State University - Bozeman, College of Nursing, 2021) Marion, Kirsten Ayres; Chairperson, Graduate Committee: Amanda H. LucasAdverse drug events (ADEs) cause a significant burden to the healthcare system. Medication reconciliation (MR) is a well-documented method to reduce ADEs in a variety of healthcare settings. The purpose of this project was to determine best practice for performing MRs, implement best practice into practice, and evaluate outcomes based on successful completion of MRs. This project was implemented at an ambulatory surgery center (ASC) in southwestern Montana with a focus on adult orthopedic patients. Four PDSA cycles were completed over a 6-week period to improve the MR process. Improvement of the MR process was deemed necessary to meet evidence-based MR guidelines for patient safety and to meet accreditation standards. The definition of a complete MR was based on current literature and state and national accreditation guidelines. Over the 6-week process, MR completion rates increased from 0% at implementation to 52% at project completion. Continuation of improvement utilizing the processes implemented in this project is recommended.Item Evaluation of interdisciplinary patient care conferences for the complex patient population in a rural state(Montana State University - Bozeman, College of Nursing, 2021) Posada, Britt Kristen; Chairperson, Graduate Committee: Wade G. HillPrimary care practice in the 21st century requires innovative and visionary transformation. With the prevalence of chronic diseases continuing to increase, the management of diseases and patients has to change in order to make an impact on outcomes and healthcare costs. As needs for primary care expand, the population ages and patient complexity increases, collaborative care is vital in providing optimum patient care. In 2018, the United States healthcare costs were $3.6 trillion, averaging $11,000 per person and are projected to increase to $6.2 trillion by year 2028. With care that is often fragmented between large hospital systems and community resources, rural states have shown that coordinated care teams have had a dramatic impact on healthcare costs. Monthly de-identified interdisciplinary patient care conferences were evaluated using the Collaborative Case Conference form. In the spring of 2021 an electronic survey was delivered to 18 historical participants of the interdisciplinary patient care conferences via email with goals of obtaining formative and summative evaluations. Formative evaluation found that 100% of participants responded Very Good-Excellent in usefulness of discussions as well as collaborative nature. The summative evaluation revealed that 93.34% of participants Agreed-Strongly Agreed that, as a result of the care conferences, they had a clearer sense of other health professionals roles. All participants reported that they Agreed-Strongly Agreed that there was greater value in interprofessional collaboration after participating in the conferences. Limitations of the evaluation included technology, recall bias, poor survey choices, and low scalability of project. In conclusion, the evaluation of the interdisciplinary patient care conferences for complex patients in a rural state was an overall success. Unfortunately, the program is no longer ongoing as it was halted after funding ended, making sustainability one challenge of convening statewide care conferences of this type. On a positive note, after the initiative was finished individual organizations did implement similar localized care conferences within their settings.Item Outcome measurement in direct primary care(Montana State University - Bozeman, College of Nursing, 2021) Davis, Lindsey Michelle; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughThe cost of healthcare in the United States compared to the quality of outcomes achieved is disproportionately high. Limitations in access to primary care result in poorer population health, increase in frequency and severity of exacerbations of chronic conditions, higher numbers of emergency room visits, surgical interventions and specialty consultations which increase healthcare expense. A novel model of primary care delivery, Direct Primary Care (DPC), claims anecdotal improvement in cost, access, satisfaction, and clinical outcomes but the results have not been validated in the literature. This project aimed to gain insight to the degree of improvement in access and care outcomes achieved at a direct primary care clinic in Montana. A valid and reliable, patient-reported outcome measure (the Person-Centered Primary Care Measure) was implemented to identify the extent to which this DPC clinic achieved improvements in these areas. The results of this project indicated that efforts in DPC have the capacity to advance population health, improve clinical outcomes and reduce cost through increased access to care. Further evaluation is recommended including repetition of this project in other geographic locales. Others wishing to continue the work may desire to include demographic information such as age, gender and length of practice membership.Item Assessment of an educational binder for newly diagnosed oncology patients(Montana State University - Bozeman, College of Nursing, 2020) Woloszyn, Sarah Christine; Chairperson, Graduate Committee: Angela JukkalaNewly diagnosed oncology patients have many complex educational needs. These needs can be affected by stress, age, health literacy, and culture/ethnicity. It is important to take these factors into account when developing and evaluating patient health information. It is imperative that oncology patients are provided with quality health information to ensure that they are able to participate in shared decision making, thereby improving their outcomes. A new patient binder has been developed for patients seeking cancer care at the Benefis Sletten Cancer Institute. It is important that this educational tool be evaluated for readability, understandability, and actionability. The Patient Education Material Assessment Tool and the Flesch Reading Ease formula are two proven methods to evaluate patient health information. These tools will be used to evaluate the newly developed patient binder at the Sletten Cancer Institute. The results of the evaluation will be shared with the developers of the educational tool and leadership team. The continual evaluation of patient health information materials is essential to ensure that patients are receiving information that will meet their needs. The Clinical Nurse Leader can play an important role by acting as an educator, patient advocate, team leader, and expert clinician to ensure patients are receiving high quality patient health information.Item Assessing the readability of educational material for the urology patient with benign prostatic hyperplasia(Montana State University - Bozeman, College of Nursing, 2020) Cramer, Haily Lynn; Chairperson, Graduate Committee: Angela JukkalaEducation for the Bozeman Health Urology patient is not standardized and at the recommended AMA reading level. Patient education is outdated, either verbal or written, and differs between providers. A microsystem assessment, patient survey, and staff survey have presented the need to assess patient education and education readability. Results have presented the average urology patient is male with a diagnosis of benign prostatic hyperplasia (BPH). This assessment concluded patient education needs to be standardized and tailored specifically to this population to increase patient satisfaction and improve clinical processes. Using Up-to-Date and assessment readability tools, patient education can be created based on evidence-based information.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 The role of the doctorate prepared nurse practitioner in medical surge policy development and revision(Montana State University - Bozeman, College of Nursing, 2020) Dunshee, Chelsea Jean; Chairperson, Graduate Committee: Casey ColeDisasters and mass casualty events pose significant challenges to healthcare facilities. It is imperative as an organization to have a medical surge policy in place should a sudden influx in patients occur. Proper policy planning is required to ensure the policy in place works sufficiently to meet the healthcare organization's needs. The purpose of this project was to define the role of the Doctorate prepared Nurse Practitioner (DNP) in the medical surge policy development and revision process. This was accomplished by leading a quality and performance improvement project workgroup after performing a review of current literature and a Root Cause Analysis of a recent mass casualty patient surge incident at the organization. The results show that the role of the DNP as it relates to medical surge policy revision are to: (a) analyze policy processes and lead development and implementation of policies, (b) influence policy making process through participation on committees and educating policymakers on nursing processes, policy, and patient outcomes, and (c) act as a change agent and stakeholder. All recommendations made to improve the medical surge policy by the DNP student were accepted and utilized in the acting organizational EOP.Item Empathy assessment in doctor of nursing practice curriculum(Montana State University - Bozeman, College of Nursing, 2019) Hardwick, Kimberly M.; Chairperson, Graduate Committee: Susan RaphNursing is a caring profession requiring empathetic care for positive patient outcomes. The doctor of nursing practice (DNP) degree has recently become the standard of educational preparation for advanced prepared registered nurses (APRNs). It is unknown how DNP programs currently incorporate empathy as a therapeutic communication skill imperative for today's APRNs. Limited literature exists related to affective learning activities within the DNP curriculum, and even less research exists regarding empathy. The purpose of this scholarly project was to perform a baseline assessment of an existing DNP curriculum for empathetic learning activities and to establish an understanding of DNP student and nurse faculty perceptions related to the importance of empathy as a skill set for APRNs. Kristen Swanson's Theory of Caring was utilized to provide a robust framework for curriculum assessment. The measurement of DNP student and nurse faculty perceptions regarding empathy was accomplished through the use of student-developed online surveys. Course materials, including Master Resource Outlines, were evaluated for affective learning content as defined by Bloom's Taxonomy of Educational Objectives and Graber et al. (2012) well as current literature recommendations. Limited affective learning activities existed in the evaluated DNP curriculum, paralleling the lack of literature related to empathy in DNP curriculum. Both DNP students and nurse faculty place value on the development of empathy as an essential skill set for APRNs. Additional research is needed regarding empathy development in DNP curriculum to obtain a more complete understanding of this essential attribute of a DNP-prepared-APRN. In addition, valid and reliable curriculum survey tools are needed to perform comprehensive, evidence-based curriculum assessments.