Theses and Dissertations at Montana State University (MSU)
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Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.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 Policy development: practice improvement, blind sweep fetal fibronectin collection(Montana State University - Bozeman, College of Nursing, 2019) Liedtka-Holmquist, Diana Elizabeth; Chairperson, Graduate Committee: Julie RuffRecognizing preterm labor can help guide the management of care of the mother and fetus between the obstetrician and registered nurse. A simple test called the rapid fetal fibronectin (fFN) can detect proteins that are indicators of preterm delivery. A trained registered nurse can perform this simple test, in which a swab is placed in the posterior fornix of the vagina. The March of Dimes has created a pathway for standardized preterm labor assessment developing a Preterm Labor Assessment Tool (PLAT) for hospitals to aid in the reduction preterm labor and deliveries. A positive fFN test allows for antenatal steroids and preparation for optimal neonatal care, whereas a negative fFN test allows for less intervention, avoidance of unnecessary medical treatment and hospitalization, and the provision of reassurance to both obstetrician and patient. The purpose of this project was to develop an evidence based policy that would guide and support practice improvements for the blind sweep fFN collection method. This evidence based protocol will allow trained registered nurses to perform a blind sweep fFN test without an obstetrician or residents' supervision. By performing the fFN tests on patients who present with preterm labor signs and symptoms, obstetricians will be able to recognize preterm labor assessment and initiate early treatment.Item Addressing preventive oral health for pregnant women, childbearing age females & children age zero to six in primary care(Montana State University - Bozeman, College of Nursing, 2017) Johnson, Abrianna Lee; Chairperson, Graduate Committee: Elizabeth S. KinionMost oral health disease is preventable despite the availability of effective prevention and treatment (Nathe, 2016). Oral health conditions are becoming a silent epidemic and during pregnancy the risk increases for oral disease (Qualis Health, 2015; Vamos, Walsh, Thompson, Daley, Detman, & DeBate, 2015). About 40% of pregnant women have a varying form of periodontal disease (Lieff et al., 2004). The social impact on school-age children substantially affects their academics, as more than 51 million school hours are lost each year due to dental related illnesses (U.S. Department of Health and Human Services, 2003). The purpose of this project was to educate providers, nurses, and patients in a primary care clinic on the importance of oral health care and to create simple referral process for at risk patients. The author gave a pretest on oral health best practice to seven primary care nurses. After the pretest, the author gave an oral health education seminar. The nurses took a posttest based on content from the educational seminar. Patients who met the inclusion criteria were given oral health surveys to determine oral health status and need for referral to a dentist. Six of the seven nurses completed the seminar and testing showing a higher post-seminar test score. The V-statistic of 21 showed a p-value of 0.0178 suggesting strong evidence the nurses' scores tended to be higher after the seminar. Of the nineteen adults surveyed regarding their oral health status, 62% showed good oral health behaviors. Of the eleven pediatric patients surveyed regarding their oral health status, 75% answered positive oral health behaviors. The literature supported the value of oral health education in primary care. Awareness was created in the clinic with the use of posters and educational packets given to all participating patients. There is a great need for preventive oral health education to primary care providers, pregnant women, childbearing age females, and parents of children. Current research on the value of preventive oral health education and dental care is needed in primary care.Item Unwed pregnant women and locus of control : a descriptive study(Montana State University - Bozeman, College of Nursing, 1981) Smith, Marilee DaughnItem Social support and pregnancy outcome(Montana State University - Bozeman, College of Nursing, 1988) Newman, Helen Colleen StephensItem Investigation of the relationships of maternal pre-gravid weight and weight gain to birth weight and condition of the infant at birth(Montana State University - Bozeman, College of Nursing, 1974) Moehling, Lanette HaasItem Dietary intake of pregnant farmworkers : patterns among migrant workers in Montana(Montana State University - Bozeman, College of Nursing, 2001) Stearns, Candace KayeItem Perceived social support and self-esteem in pregnant adolescents choosing to parent(Montana State University - Bozeman, College of Nursing, 1994) Scofield, Nada Derry