Theses and Dissertations at Montana State University (MSU)
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Item Improving survivorship care at a community cancer center: a program evaluation(Montana State University - Bozeman, College of Nursing, 2020) Bowen, Melissa Raelene; Chairperson, Graduate Committee: Jennifer SofieSurvivorship care is an opportunity to prepare cancer survivors for living a life impacted by cancer. The physical, psychological, and spiritual effects of cancer goes beyond the days or hours patients have spent receiving treatment. Over a decade ago, the Institute of Medicine created the survivorship care plan (SCP) as a solution for improving care for cancer survivors. The Commission on Cancer (CoC) since adopted the SCP as an accreditation standard which requires SCP delivery to at least 50% of eligible survivors. However, the implementation of SCPs has been challenging as the evidence supporting its use is mixed. There is minimal evidence to support SCPs positively impact patient outcomes, yet, patients report higher satisfaction with survivorship knowledge, find the SCP helpful, and recommend its use. As a result, organizations are confronted with meeting a CoC standard that is difficult to implement and has discordant evidence to support its use. The purpose of this project was to provide a program evaluation for a CoC accredited community cancer center that is committed to improving survivorship care for adult oncology patients. Three objectives were assessed; percentage of SCP delivery completions, evaluation of the SCP and visit with a pre and post survey, and assessment of survivors ongoing needs with a Cancer Impairment Screening Tool. A small case study was also conducted. Between February 1st and July 31st fifty-seven SCP visits were completed, however, only 36 survivorship visits met eligibility criteria making the completion rate 35.6%. The pre and post survey revealed patients had an increase in; knowledge of the SCP visit purpose, available resources, familiarity with treatment side effects, and importance of the visit. There were no reports of unmet needs on the post survey. Survivors most common treatment concerns were numbness in extremities, muscle weakness, fatigue, physical limitations, and sleep difficulties. In conclusion patients find value in the SCP and visit and its use should not be abandoned. It is well understood that survivorship care can be complex. Advancing survivorship care from the sole provision of the SCP to a more individualized process may better address the specific needs of individual cancer survivors.Item An evaluation tool to measure pregnancy outcomes and quality improvement interventions at Northern Cheyenne Service Unit(Montana State University - Bozeman, College of Nursing, 2020) Tallbull, Cheyenne Rose; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughQuality Improvement projects are not always evaluated for their effectiveness after they are implemented. This professional project was to address this shortcoming by developing an evaluation strategy on the Healthy Mother Healthy Tribe (HMHT) project which aims at improving pregnancy outcomes for Northern Cheyenne women and their babies. The Montana State Birth Certificate Data indicate that the percentage of Montana Native American Women entering prenatal care after the first trimester was 56.4% compared to Montana Caucasian Women at 24.2%. While early and regular prenatal care are crucial to have healthier babies, numerous difficulties to access prenatal care and the impact of illicit drug use during pregnancy increased the number of precipitous deliveries at the emergency room in the Northern Cheyenne Service Unit (NCSU). The NCSU was chosen as a pilot test site to overcome these barriers; the HMHT project started. Posavac's program evaluation theory, in particular examining the processes of the intervention and how the intermediate outcomes lead to the desired outcome, was used to guide this project. After process-mapping prenatal care and developing a gap analysis, the NCSU implemented the following interventions: policy update, practice changes in drug screening and drug testing, updating electronic prenatal records, education and contracting for a prenatal case manager. Then, two types of evaluation processes were compared in this project. One was a conventional, practical strategy which was used for the Joint Commission's Evidence of Standards Compliance Report as an accreditation survey follow-up. Another was theoretically developed, based on a logic model, for this project to measure the effectiveness and improve evaluation consistency. In comparison, the conventional strategy was action oriented to ensure that compliance is sustainable for going forward. On the other hand, the developed logic model showed relationships and had a focus on measurable outcomes. Unfortunately, implementation of the logic model was not possible due to a change of the work site and time limitation. The effectiveness of the HMHT interventions would be important information in order to optimize resources for the organization and determine sustainability of the project.Item Implementation of an evidence-based policy and educational program on caring for neonates withdrawing from opioids: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Olson, Amy JoAnn; Chairperson, Graduate Committee: Stacy StellflugThe opioid use among pregnant women has increased, which has led to a rise in the rate of Neonatal Abstinence Syndrome (NAS). Infants with NAS are delivered at rural and urban locations throughout the country and require specialized treatment. The rural community access hospitals (CAH) often lack the resources (policy development and education updates) to prepare health care team members for safe care of infants that present with NAS. The purpose of this project was to improve team member confidence when providing care for neonates suspected of substance withdrawal at a CAH in Montana by: (a) developing and implementing a policy on care and treatment of a drug dependent newborn; (b) educating the team providing care to these neonates on the use of NAS scoring tools; and (c) evaluating the education and improved confidence levels of the health care team. A pretest/posttest design was used to evaluate change in nursing knowledge on NAS/scoring tools. The results suggest implementation of a NAS educational program including education regarding the implementation of a corresponding evidence-based policy, has a statistically significant effect on provider and nurse knowledge and confidence about NAS. Specifically, the results suggest NAS education improved provider/nurse knowledge and confidence in caring for neonates affected by NAS.Item Promoting advance care planning education and advance directive completion in the community setting(Montana State University - Bozeman, College of Nursing, 2019) Smith, Mary Elizabeth; Chairperson, Graduate Committee: M. Jean Shreffler-Grant; Dale Mayer (co-chair)The United States population is aging due, in part, to western medicine's ability to prevent, treat, and cure disease which has allowed the prolongation of life. End-of-life care has become more invasive and, despite the continued focus on patient autonomy, rates of advance directive (AD) completion remain low. Increased knowledge may increase the community dwelling adult population's ability to plan for end-of-life, have end-of-life conversations, complete ADs, and increase individual's autonomy at end-of-life. Purpose: The purpose of this project was to educate community-dwelling adults about the purpose and importance of ADs, encourage conversation about end-of-life planning, encourage completion of ADs in community-dwelling adults of all ages and in doing so, promote personal autonomy. Method: A sample of N=16 community-dwelling adults participated in an educational intervention that contained information on end-of-life planning with a focus on ADs. Pre- and post-intervention surveys were used to gather demographic information, assess AD knowledge and examine participant views on importance of understanding health information and autonomy. Descriptive statistics, qualitative description, and paired-sample t test was used to analyze the data. Outcome: The sample consisted of 16 community-dwelling adults between ages 30 and 84-years old. The five questions assessing AD knowledge Pre- and Post-intervention were scored as correct or incorrect for each participant and total correct responses were computed into a mean score. The results of the paired sample t-test indicates that there was a significant difference between scores for pre-intervention survey (M= 63.75, SD = 22.84) and post-intervention survey (M= 90.0, SD= 10.9, t(4)=3.015, p=.039). Conclusion: The project results indicate that this intervention was effective in increasing AD knowledge, although, the impact on actual AD completion rates was not assessed. Further research is needed to identify successful methods of increasing ACP and AD knowledge in the community-dwelling adult population and also to identify the impact of such programs on actual AD completion.Item Providing primary health care to rural homeless populations : a resource manual for rural nurse practitioners(Montana State University - Bozeman, College of Nursing, 1997) McNerney, Sarah Jane; Chairperson, Graduate Committee: Doris HensonItem An experimental study on the concept of continuity of care in the maternity cycle : the postpartal period(Montana State University - Bozeman, College of Professional Schools, 1973) Wilson, Karen Hauf; Chairperson, Graduate Committee: Laura WalkerItem A study of physician's expectations of nurses for health teaching and guiding parents and children(Montana State University - Bozeman, College of Professional Schools, 1969) Fleming, Nancy LysingerItem An experiment in a nurse operated cold clinic at Montana State University(Montana State University - Bozeman, College of Professional Schools, 1968) Hodis, Ruth AschenbrennerItem Development of an employer-sponsored health and wellness program(Montana State University - Bozeman, College of Nursing, 2016) Manion, Brenna Christine; Chairperson, Graduate Committee: Teresa Seright; Deanna Babb (co-chair)Obesity is affecting Americans at a higher rate and cost than ever before. This disparity does not evade those who work in hospitals or health professions, as the nursing profession is routinely statistically ranked in the top ten most obese occupations in the United States. Obesity, and its co-morbidities, such as depression, Type 2 diabetes, heart disease, sleep apnea, and chronic joint pain, are associated with higher rates of injury, absenteeism, and poor job performance. The purpose of this project was to analyze the current overall health status of the employees at a community hospital in Western Montana and to use this statistical information to develop a health and wellness program tailored to the identified deficiencies and problem areas. A total of 403 employees, 32% of the total population, participated in voluntary free health screenings. Results of the screenings indicated that 32.3% (n=130) of staff were overweight (BMI 25-29.9), and 25.6% (n=103) were obese (BMI >30). Additionally, 77.4% (n=312) of the screened population reported exercising less than five days per week, while 13.4% (n=54) reported not exercising at all. In regards to daily caloric intake, 63.3% (n=255) of employees are at increased risk for health issues related to poor food choices, while 28% (n=113) are at very high risk. Furthermore, when analyzing mental health, 31.3% (n=126) of employees indicated high levels of stress at work, 20.1% (n=81) indicated they are experiencing two or more major life events that were causing stress, and 16.4% (n=66) reported having a depressed mood, or feeling down, unhappy, and hopeless. These findings demonstrated that this setting is in need of overall health improvement. Through this project, a multifaceted health and wellness program was established to target the identified risk areas, as well as promote overall wellbeing at no cost to the employee. The conclusion of this project is that through the identification of problem areas and creation of the associated interventions, a health conscious work environment that promotes average BMI, healthy eating, balanced mental health, and physical activity provides multiple incentives and benefits to both the individual and the employer (CDC, 2014).Item Nursing faculty's knowledge on health impacts due to climate change(Montana State University - Bozeman, College of Nursing, 2014) Streich, Jenny Luella; Chairperson, Graduate Committee: Wade G. HillMore than 150 thousand excess deaths occurred in 2000 from disease and injury related to climate change (Frumkin et. al, 2008). With the increase in climate temperature, the sea level is rising causing flooding, displacing people from their homes and damaging the water supply causing water-borne illnesses. Warm temperatures are extending the length of transmission seasons for vector-borne illnesses, and variable precipitation is causing damage to food crops affecting the source of nutrition (WHO, 2008). Nurses are often on the front lines of managing illness and injury related to climate change, but, it is unknown to what extent they are prepared to do so. Because basic nursing competencies are achieved in nursing schools, focus on preparation of nursing faculty to prepare nursing students in competencies related to climate change is logical. The purpose of this study is to evaluate professor's knowledge of health impacts due to climate change. In total, 103 nursing faculty were selected from the single university to participate in a survey designed to obtain a general baseline of faculty knowledge regarding health effects associated with climate change. Results: The most recognized health impact related to climate change reported by respondents was flooding-related displacement of residents. They viewed flooding as already increased (n=32, 84%) and expected flooding to continue increasing into the future . Other recognized health impacts due to climate change that respondents believe have already increased and will increase in the next 20 years included air quality related illnesses (already increased 83%, will increase 80%) and disruption of health care services during extreme weather events (already increased 70% will increase 68%) Discussion: In general, when comparing present-day health impacts to those that may occur 20 years from now, faculty believed the incidence of each health impact will increase and very few responses reported the health impacts not increasing over the next 20 years.
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