Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
Browse
5 results
Search Results
Item Implement ACE screening tool in a psychiatric outpatient clinic: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Herron, Michelle Marie; Chairperson, Graduate Committee: Susan LuparellAdverse childhood experiences (ACEs) can decrease some of the identified leading causes of death in adults. These leading causes of death include heart disease, cancer, respiratory diseases, diabetes, and suicide. Adverse childhood experiences cause toxic stress, and the long-term effects of which follow people their entire lives. Screening of ACEs can identify ACEs early and allow for early prevention, referrals for additional services and supports to reduce long term health effects. Despite recommendations, psychiatric providers do not consistently screen for ACEs, ultimately missing opportunities to prevent ACEs with early intervention in childhood for those with higher risk or occurrence of ACEs. This quality improvement project took place a pediatric psychiatric outpatient clinic. This project focused on incorporating recommendations from studies completed by Centers for Disease Control and Prevention and Kaiser Permanente focusing on identifying high ACE scores and offering preventative supports. Lewin's three step change theory was used to guide this quality improvement project. The project was conducted for six weeks, collecting data on an excel spreadsheet identifying patients with high ACE scores for psychiatric providers. At the end of the quality improvement project, minimal data was able to be collected due to the barriers of the pandemic. The quality improvement project sought to identify patients with high ACE scores in order to offer additional preventative interventions, supports and referrals to decrease long term health issues. ACEs are a critical public health issue due to the profound negative and lasting effects on the health and wellness of a child later in life. Psychiatric pediatric outpatient clinics are settings in which ACEs can be identified and implementing interventions and supports can help children build resilience and decrease the effects of the adverse experiences and improve patient outcomes.Item Turning straw into gold, ACE screening for adult agricultural workers in primary care: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Conner, Jeanne Randale; Co-chairs, Graduate Committee: Yoshiko Yamashita Colclough and Susan LuparellHistory of adverse childhood experiences (ACEs) is common among adults and associated with nine of the ten leading causes of death in the United States. ACEs screening, coupled with patient education and support from behavioral health promotes resilience and healing from trauma. ACEs screening was not a routine component of the annual assessment visit at the primary care clinic, a federally qualified health center serving agricultural workers and their families. The purpose of this project was to implement ACEs screening as a routine part of the annual assessment visit for adult agricultural workers, coupled with education and, for patients at increased risk, prompt referral to behavioral health. Prior to implementation, training was provided to clinical staff to prepare them for ACEs screening. During the ten-week data collection period, 75% of annual assessment visits included ACEs screening with documentation in the patient's medical history. 17% of the patients screened were determined to be at increased risk due to ACEs, and 57% of patients referred to behavioral health secondary to ACEs screening completed a visit with a behavioral health provider within two weeks of screening. Recommendations to increase ACEs screening and behavioral health referrals in this primary care clinic include adding ACEs screening to the organization's At-a-Glance Checklist for chart preparation, adding ACE score documentation to peer review chart audit, and identifying ACE-specific diagnoses to list in the medical history to facilitate data extraction and meaningful use for population health.Item Trauma screening in chronic disease management: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Vaughan, David James; Chairperson, Graduate Committee: Sandra Benavides-Vaello and M. Jean Shreffler-Grant (co-chair)More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.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 Introducing trauma-informed care in an acute inpatient psychiatric unit: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Thompson, Evan Robert; Chairperson, Graduate Committee: Julie RuffTraumatic experiences are common in society and are associated with an increased risk of development of adverse physical and psychological outcomes extending throughout the lifespan. Individuals accessing mental health services, such as inpatient hospitalization, are likely to have experienced interpersonal trauma at some point during their lives. Mental health professionals are well suited to provide supportive and effective trauma-informed care (TIC) to patients with trauma histories. TIC seeks to actively resist patient re-traumatization and caregiver secondary traumatic stress. An evidenced-based trauma-informed care training was presented to mental health professionals working on a psychiatric inpatient unit. The project involved a single group pre-post test design with a 1-month follow-up assessment. Staff attitudes towards trauma-informed care were evaluated by a psychometrically validated tool (ARTIC-35). Sums of the items on the ARTIC?35 for each participant were divided by the number of items, means and standard deviations for aggregate average scores for each time point were obtained, and percent change for participant average scores between time points were calculated. Additionally, participants were asked to share if they had incorporated trauma-informed care into their work with patients and if they experienced any barriers to implementing TIC since the training. Immediately following the training, ARTIC-35 scores increased on average by 11%, demonstrating that attitudes related to trauma-informed care improved as a result of the training. One month following the training, all six participants maintained their score on the ARTIC-35, representing a 12% increase from pre-training scores and 0.61% from immediately following training. Further, all participants indicated at the 1-month follow-up assessment that they changed their practice to incorporate trauma-informed care into their work with patients. A 1-hour TIC in-service training demonstrated the ability to improve psychiatric healthcare professional's attitudes toward trauma-informed care. Healthcare organizations serving patients with traumatic histories should consider TIC training for all personnel.