Theses and Dissertations at Montana State University (MSU)
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Item Addressing access barriers for geriatric Montanans: a CNL approach(Montana State University - Bozeman, College of Nursing, 2022) Martini, Melissa Lynne; Chairperson, Graduate Committee: Denise RiveraRural residents experience risk factors that contribute to health disparities and lower life expectancy (CDC, 2017; Skoufalos et al., 2017). Rurality and the associated social settings of rural communities have direct relation to difficulty in accessing healthcare which is further complicated by distance and weather-related issues common to Montana. The overarching purpose of this review is to determine if the health of elderly rural Montanans is improved with the creation and use of a mobile care clinic in the community to serve these individuals. This quality improvement project will be conducted using survey's via convenience sampling of elderly members in a rural community in Montana.Item Implementing INACSL standardized simulation to improve NCLEX scores(Montana State University - Bozeman, College of Nursing, 2022) Poole, Joseph David; Chairperson, Graduate Committee: Denise RiveraThe current nursing shortage further worsens every time a new nurse fails the National Council Licensure Examination (NCLEX-RN) exam. Simulation education presents a possible solution to better prepare nursing students for licensure and professional practice. This project aims to demonstrate how nursing schools can improve NCLEX-RN first attempt pass rates by adhering to INACSL simulation standards and improving clinical judgment. Seminal research by the National Council of State Boards of Nursing (NCSBN) found no statistical difference when nursing schools substituted 50% of bedside clinical time with simulation experiences. The International Nursing Association of Clinical and Simulation Learning (INACSL) created standards of simulation which were adhered to for the previous study. While no specific causal research proves INACSL standards-based simulation training improves NCLEX-RN pass rates, adjacent literature demonstrates simulation learning engages students and improves clinical judgment. The first methodology step in this project proposal establishes a foundation of understanding amongst all nursing education faculty regarding the nine INACSL standards for simulation by conducting a brief webinar. Further training focuses on a tiered approach for educators, explicitly teaching clinical, skills, and simulation. This next tier of faculty would attend a one-day Gateway Debriefing Workshop which briefly trains enhanced simulation debriefing skills. The highest level of simulation-specific instructors will complete a five-day Healthcare Simulation Essentials Course that provides intensive training in simulation theory and debriefing skills for simulation educators. The Debriefing Assessment for Simulation in Healthcare (DASH) tools facilitate the evaluation of project influenced changes and enhance debriefing excellence by utilizing the DASH rater tool. The results of this project proposal are pending execution. Outcomes expected include increased DASH rater evaluations of simulation faculty and improved NCLEX-RN first attempt pass rates up to 100%. Conclusions derived from investigations of this project proposal support INACSL simulation standards adherence enhances simulation outcomes and leads to improved NCLEX-RN first attempt pass rates.Item Educating psychiatric nurses in cognitive behavioral therapy for adolescent patients: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Thralls, Claire Eileen; Chairperson, Graduate Committee: Tracy HellemIt is estimated that 20% of adolescents have a diagnosable mental health disorder. However, there is a deficit of providers that are available to treat this population. This gap in care can potentially be mitigated by increasing mental health caregivers' education on therapeutic interventions. Cognitive behavioral therapy (CBT) is considered to be the gold standard of care for the population of adolescent mental health patients. This project set out to educate nurses working on an inpatient adolescent unit on topics of evidence-based CBT and adolescent group therapy. Nurses interacted in a 3-hour educational intervention that reviewed topics of CBT, group therapy with adolescents, and the Creating Opportunity for Empowerment (COPE) program. Additionally, the nurses participated in a role-playing group therapy session to practice implementing CBT interventions to adolescent patient populations. This intervention was utilized to determine the feasibility and effectiveness in educating psychiatric nursing staff on CBT concepts with regard to group therapy for adolescent populations. After participation in the intervention, nursing staff reported benefits and satisfaction with the CBT and group therapy intervention, increased understanding of CBT concepts and interventions, and enhanced preparation for working with adolescent psychiatric patients. It is hoped that this project will guide adolescent-mental-health caregivers in seeking additional education in CBT practices to enhance their education in evidence-based interventions.Item Undergraduate nursing students' learning needs and attitudes about trauma and trauma-informed care(Montana State University - Bozeman, College of Nursing, 2021) Mangus, Katalyn Kelsey; Chairperson, Graduate Committee: Stacy StellflugTrauma is a very prominent and pervasive problem that causes numerous and harmful effects on the physical and mental health of those affected. Trauma-informed care (TIC) is a care framework that encourages healthcare workers to acknowledge trauma and care for patients in a way that takes past traumas into account. The practice of trauma-informed care leads to better healthcare experiences, better health outcomes, better trauma recovery, and more health compliance in trauma survivors. Unfortunately, many healthcare workers, including nurses, recognize the significance of trauma but feel unprepared to provide trauma-informed care to patients. The doctor of nursing practice project presented here sought to assess the current level of TIC education for undergraduate maternal-child nursing students at Montana State University College of Nursing. A secondary aim of this project was to provide guidance and recommendations to maternal-child nursing faculty for revisions to current curriculum. In order to achieve this aim, nursing students were recruited to participate in a survey that evaluated participants' attitudes about trauma, trauma-informed care, and which aspects of trauma-informed care they felt most strong and most weak in. The data were analyzed to evaluate undergraduate nursing students' current preparedness for providing trauma-informed care in their future nursing practice. The findings indicated that participants did feel somewhat confident in their understanding that trauma is impactful on women and that trauma-informed care can be beneficial. The participants also understood that working with trauma-affected patients can emotionally impact or re-traumatize a healthcare worker. Participants reported a lack of confidence in their ability to recognize trauma, recognize trauma-affected patients, and provide appropriate TIC to these patients. These data were used to guide the creation of a trauma-informed care education resource for nursing educators to utilize for teaching future nursing students about trauma-informed care. Ideally, this resource will encourage and facilitate the implementation of basic TIC education for nursing students, which will help future Montana State University nursing cohorts become more knowledgeable and confident in trauma-informed care as they prepare to join the nursing workforce.Item Clinical nursing education in a time of Covid-19: a comparison of virtual and in-person simulation debriefing methods(Montana State University - Bozeman, College of Nursing, 2021) Kirk, Meghan Anne; Chairperson, Graduate Committee: Jennifer SofieA global COVID-19 pandemic was declared in March, 2020, causing educators and students around the world to pivot toward virtual education when in-person education methods became impossible to safely deliver. This posed unique challenges within nursing education and other disciplines, which historically required experiential or hands-on training. Barriers and disadvantages to traditional in-person clinical nursing education methods such as: limited clinical site availability, competition between schools for clinical sites, cost, increased risk potential, increased patient acuity, decreased average length of hospital stay, and faculty shortages led to exploration of clinical education through in-person and virtual simulation methods predating the COVID-19 pandemic. One of the essential elements of simulation is debriefing, which describes an interactive and reflective discussion of simulation events, which aids in assimilation of new knowledge and ability to apply what is learned in future clinical experiences. The project lead explored and compared 3rd-year nursing student experiences with face-to-face simulation debriefing and virtual debriefing methods. Debriefing Assessment for Simulation in Healthcare survey scores for a small convenience sample of students (n=17) for each debriefing method were collected before and after the COVID-19 mediated educational shift. Qualitative responses were solicited only in the virtual debriefing survey, when students were asked to identify their preference for either face-to-face or virtual debriefing as well as any benefits or challenges associated with each method. Descriptive statistics along with a one-group two-tailed repeated measures Student's T-test was completed for analysis in The Statistical Package for the Social Sciences. T-test results of student scores for each debriefing element were all statistically insignificant at a 95% confidence interval, aside from Element #5 which describes instructor identification of success or failure modes. Student ratings for debriefing quality and subsequent T-test findings suggest that student experience with virtual and face-to-face methods is equal, except with regard to instructor feedback, but are limited due to diminished statistical power. However, qualitative results indicate students uniformly expressed a preference for traditional debriefing methods over virtual simulation debriefing. Virtual simulation debriefing, while not as familiar or easy in terms of communication, appears to be an effective alternative to traditional, face-to-face debriefing.Item The use of sexual assault nurse examiners in the emergency department(Montana State University - Bozeman, College of Nursing, 2021) Gassman, Gina Rashelle; Chairperson, Graduate Committee: Casey ColeThe statistics are staggering for SA victims. Rape is the fastest growing and most under reported crime. The significance of the problem resides in a lack of trained SANE within the emergency department (ED). The strong evidence presented is multifaceted and the literature supports the importance for a full time (FT) SANE program. For this QI project, the aim was to measure how many SA cases came in the ED between November 18, 2020 and December 31, 2020. Patients 14 years and older who presented to the ED during this time period were included in the data collection. A specific tool for the local hospital was created to track whether each SANE case was completed by a SANE or non-SANE, and whether they were pulled from the ED floor or they were on-call for SA exams. This data was successfully collected and one out of three, or 33% of SA cases were completed by a non-SANE, and one out of three cases required pulling a nurse from the ED floor. The end goal of the quality improvement (QI) project is to implement a policy change within the ED to create a functional SANE Program as part of the ED. The current model at the local hospital does not provide the gold standard of care for victims of SA in the community. The outcomes of the QI project along with the strong literature support the need to have a SANE completing all SA exams. The data collected during this QI project will be presented to stakeholders at the local hospital Summer 2021.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 Supporting immunization clinic nurses in framing the conversation: recommending HPV vaccination for 11-12-year-old adolescents to increase HPV immunization rates(Montana State University - Bozeman, College of Nursing, 2019) McLoughlin, Kelli Elizabeth; Chairperson, Graduate Committee: Jennifer SofieDespite the widespread availability of a safe and effective vaccine to prevent cancers caused by high-risk strains of human papillomavirus (HPV), vaccination rates in the United States remain low. Rates in Flathead County, Montana, have historically been even lower, below Healthy People 2020's goal of 80% series completion, and below state HPV immunization rates. Existing literature supports a strong recommendation for HPV vaccination (HPVV) from a health care professional (HCP) as the single most influential factor in vaccination behavior (Chuang et al., 2017; Gilkey et al., 2016; Sturm et al., 2017). The aim of this project was to educate and empower the nurses within the Flathead City-County Health Department's (FCCHD) Immunization Clinic in how to make strong, clear, and consistent recommendations for HPVV with the overall goal of increasing HPVV series initiation and completion rates for 11-12-year-olds. Staff were surveyed to assess baseline HPV knowledge and perceived barriers to HPVV. A series of communication interventions based on specific language from the Centers for Disease Control and Prevention's (CDC) 'You are the Key to HPV Cancer Prevention' campaign was used to train HCPs in more frequently and confidently recommending HPVV to parents and patients. Interventions were instituted during the Immunization Clinic's scheduled nurses' meeting by a change agent (DNP student), over the course of six months. A post-survey was administered upon project completion. A resource binder for the HCPs was developed which included handouts for HPVV hesitant parents, infographics for the clinic and patient rooms, succinct information on how to recommend HPVV, upcoming continuing education credits involving recommending HPVV, appointment reminder cards for parents/adolescents, and the clinic's HPVV policies. Lippitt's Phases of Change Theory served as the framework for this project. Efficacy was assessed by comparison of pre- and post-survey results, the actual number of HPV vaccines administered during the intervention period, and rates of HPVV series initiation and completion in 11-12-year-olds pre- and post-intervention. The communication intervention increased the comfort and confidence of HCPs as well as HPVV initiation and completion rates. An intervention such as this can help increase the uptake of HPVV and in turn, protect adolescents from HPV-associated cancers.Item Nurse-initiated protocols in the emergency department(Montana State University - Bozeman, College of Nursing, 2019) Morse, Jennifer Ashley; Chairperson, Graduate Committee: Casey ColeEmergency departments are overcrowded. Overcrowding has resulted in resources being stretched beyond their capacity, leading to decreased patient satisfaction, increased numbers of patients leaving without being seen, and exorbitant wait times. The purpose of this project was to implement nurse-initiated protocol order sets for specific chief complaint in an attempt to decrease length of stay in a local emergency department (ED) and improve flow. Additionally, protocol order sets would allow nurses to more rapidly and legally initiate medical interventions for patients with specific chief complaints. Three chief complaints were identified as common reasons why people seek emergency care: abdominal pain, chest pain, and ankle trauma. Protocols were created to allow nurses to initiate interventions prior to a physician seeing the patient. Retrospective chart audits were done prior to the intervention. Thirty charts with a chief complaint of abdominal pain were reviewed post implementation of nurse-initiated protocols. In the audit, nurse order mean times for abdominal pain were registration-to-order time 28.3 minutes (SD=25.5 minutes), registration-to-result time 79.4 minutes (SD=28.4 minutes), and registration-to-disposition time 221.4 minutes (SD=68.2 minutes). Results of the nurse-initiated protocol study showed a decrease in registration-to-order time of 15.7 minutes and a decrease in registration-to-results time of 20.7 minutes. There was an increase in time for registration-to-disposition of 33.5 minutes. Although overall length of stay was not decreased in the study, there was a decrease in registration-to-order times and registration-to-result times. The reduction in time to initiation of patient care suggests there is a potential for future implementation and evaluation of nurse-initiated protocols.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.