Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item An improved approach to screening of eating disorder risk in a pediatric psychiatric care facility(Montana State University - Bozeman, College of Nursing, 2022) Smith, Christopher Scott; Chairperson, Graduate Committee: Molly SecorEating disorders (EDs) have emerged as a prominent but underrecognized problem in the pediatric population from lack of screening. Reviewed were multiple screening tool options for risk of EDs to utilize in the admission assessment at a pediatric psychiatric care facility, resulting in the use of the Sick-Control-One-Fat-Food (SCOFF) questionnaire. Additionally, screening on admission was moved from nursing staff to that of the project's population--the medical group of nurse practitioners (NPs) who facilitated referrals based on results. The goals of this quality improvement project included a 100% screening rate for all patients aged 6 to 18 years admitted to the facility and a subsequent 100% referral rate for all positive screenings to psychiatry and the registered dietitian. These changes were implemented at the facility over eight weeks with weekly data collection and analysis comparing weekly census reports to SCOFF screened admissions and positive screenings to the number of referrals made. Every two weeks in the implementation, Plan-Do-Study-Act (PDSA) cycles were used in meetings with the medical group NPs to address and overcome barriers in implementation. The results showed overall improved screening rates, but the goals of 100% screening and 100% referral rates were not met. An average of 88% screening rate and 85% referral rate for positive screenings were achieved. Findings of this study inform future practice to utilize a risk for EDs screening tool that is valid, reliable, brief, and easy to score implemented in similar populations. Additionally, more time should be allowed in implementation--at least 12-weeks to allow for more data collection and PDSA cycle completions.Item Improved suicide risk assessment screening in a youth treatment facility: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Sell, Carly Ruth; Chairperson, Graduate Committee: Tracy HellemResearch suggests that youth receiving mental health treatment are at increased risk for suicidal ideation or suicide attempts. Thus, youth admitted to a psychiatric treatment facility must receive appropriate suicide risk assessments. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a well-researched, evidence-based, tool which has been endorsed by multiple agencies, including The Joint Commission, as an effective instrument to screen for suicide risk in youth populations. This quality improvement project aimed to improve the overall safety of patients admitted to the designated clinical site by implementing a standardized suicide assessment screening process using the C-SSRS as the identified screening tool. The Model for Improvement was the framework chosen for this quality improvement project. The clinical site selected was a licensed therapeutic group home and school specializing in relational-based trauma-informed care, treating children and adolescents aged 5 to 15 years. Five licensed therapists and one registered nurse received formal training to administer the two identified versions of the C-SSRS. Data pertaining to completion rates for assessments and interventions implemented per protocol were collected over three PDSA cycles. 100% (n=19) of baseline and admission assessments were completed and documented in the EHR within 24 hours of assessment completion. Additionally, 100% (n=19) of the patients assessed completed a safety plan as part of the organization's identified suicide risk-reduction interventions. During the data collection period, no patients presented with possible suicidal ideation, and no patients screened in the "high-risk" category. Therefore, no data were collected related to these objectives. This quality improvement project aimed to improve the overall safety of patients admitted to the designated clinical site. Despite several limitations, all patients received baseline suicide assessments and completed a safety plan. The long-term hopes for this process change include improving the ability of clinicians to accurately assess suicide risk and intervene appropriately, leading to fewer patients presenting with suicidal behaviors and overall improvements to patient safety.Item Improving depression screening and follow-up in primary care settings(Montana State University - Bozeman, College of Nursing, 2023) Houghtelling, Jeanette Renee; Chairperson, Graduate Committee: Margaret HammerslaBackground: Depression is a serious problem globally and locally. It not only impacts work productivity and the costs of healthcare, but it also directly reduces quality of life and increases the burden of chronic illness. In addition, depression increases the risk of death by suicide. Depression is thought to be one of the most treatable of mental health disorders, yet it remains underdiagnosed and undertreated. The primary care setting provides the ideal location to identify individuals with depression and to initiate treatment. Objective: The objective of this quality improvement initiative was to meet or exceed the target rate of depression screening and follow-up in a federally qualified health center in northwest Montana. Method: Following a review of relevant literature, an extensive organizational assessment was conducted. A clinical practice guideline was written which recommended a standardized workflow and written standard operating procedure. Measures to educate and engage staff were employed. Staff feedback was solicited through an online survey. The clinical practice recommendation was appraised by the organization's quality team using the AGREE II appraisal tool. Results: Staff expressed support of change as evidenced by verbal responses to manager and anonymous online survey. The quality team approved the practice recommendations for implementation which was initiated on March 1, 2023. Preliminary data indicate that screening and follow-up rates have improved. Conclusion/Implications: It is feasible to improve depression screening and follow-up in primary care settings by studying the current state thoroughly and implementing key facilitators.Item Implementing signs of suicide program and Columbia-Suicide Severity Rating Scale in a school-based setting: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Kellam, Mariah Swank; Chairperson, Graduate Committee: Molly SecorIn Montana, the youth suicide rate is more than double the national rate. Signs of Suicide (SOS) is one prevention program that is utilized within the school-based setting to educate middle and high school students. In a rural Montana school, the Brief Screen for Adolescent Depression (BSAD) is administered in conjunction with the SOS program to screen for depression; however, no focused suicide risk screening protocol exists. A Plan, Do, Study, Act cycle was implemented throughout 6 weeks to screen middle and high school students for depression, introduce subsequent suicide risk screening, and refer to mental health professionals as indicated. The school counselor (SC) performed SOS/BSAD, then subsequently collected Columbia-Suicide Severity Rating Scale (C-SSRS) scores, made referrals, and followed up as necessary. All data were de-identified and entered into an excel document before analysis and dissemination by the DNP-S. One hundred percent of high school and middle school students (n=144) participated in the SOS program and completed a BSAD. Of 20 identified as high-risk for depression, 11 completed the C-SSRS. Of those 11, three were identified as at-risk for suicide. All three students had completed referrals with a mental health professional. Follow-up C-SSRS indicated an ultimate reduction in suicide risk. The project effectively identified students at risk for depression and subsequently evaluated suicide risk and closely tracked completed referrals. Future research should evaluate long-term changes in C-SSRS scores over time post follow-up with mental health professionals.Item Implementing peer conducted mental health and wellness checks in rural law enforcement: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Feltz, Cheyenne Jae; Chairperson, Graduate Committee: Molly SecorBackground and purpose: Law enforcement officers in the United States are at a significantly increased risk of suicide and mental health challenges, accompanied with increased perceptions of stigma that limits mental health resource utilization. These trends are even more prominent among rural law enforcement officers compared to their urban counterparts. The purpose of this quality improvement project was to assist a rural law enforcement detachment in decreasing mental health stigma through implementation of peer conducted mental health and wellness check-ins. Methods: Baseline and progressive trends of stigma were assessed through the Attitudes About Mental Illness and its Treatment Scale (AMIS) following implementation of peer conducted proactive mental health support check-ins in the detachment. Intervention: This project utilized peer support law enforcement members to facilitate scheduled check-in's and discuss predetermined mental health topics while facilitating access of additional resources and education that could improve health outcomes. Results: A small rural law enforcement detachment conducted peer facilitated mental health and wellness checks with its full team of six team members. Evaluation of the AMIS assessments and personal feedback indicated that these meetings decreased reports of stigma and increased open discussion of mental health issues. Conclusion: Conclusive support for this intervention cannot be ascertained due to the small sample size and short duration of evaluation. However, this initiative indicates a framework for initiating similar processes in other areas and reveals a promising acceptance and trend of utilization and support by involved law enforcement members.Item Screening for perinatal mood and anxiety disorders during well-child appointments: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Buscher, Jennifer; Chairperson, Graduate Committee: Christina BorstPerinatal mood and anxiety disorders (PMADs) are prevalent among birthing individuals. Conversely, PMAD screening rates are insufficient to support assessment, making PMADs the most underdiagnosed obstetrical complication in the United States. This quality improvement project aimed to improve PMAD screening and referral rates within one pediatric clinic. Prior to implementation, the pediatric clinic was screening with the PHQ-2 at 2-month well child checks. The purpose of this initiative was to update the clinic's screening process to align with current clinical practice guidelines as outlined by the American Academy of Pediatrics. The Edinburgh Postnatal Depression Scale (EPDS) was provided to birthing individuals at each 2-week, 2- month, 4-month, and 6-month well-child check appointment. Individuals who screened positive were provided with follow-up support. Over six weeks 152 birthing individuals were present for 2-week, 2-mo, 4-mo, and 6-mo well-child check appointments. Among these women, 129 (85%) were screened with the EPDS. Among those individuals, 14 (11%) had a positive score. Among the positive scores, 8 (57%) were addressed for follow-up recommendations. When following clinical practice guidelines, more birthing individuals were screened for PMADs and referred for follow-up support as compared to the previous screening intervention used by the pediatric clinic which was misaligned with clinical practice guidelines. This quality improvement project effectively increased PMAD screening rates and amplified awareness of the topic. Additional PDSA cycles are recommended to bolster adequate follow-up among individuals scoring positive.Item Implementation of an evidence-based protocol to improve early suicide risk identification in psychiatric practice(Montana State University - Bozeman, College of Nursing, 2023) Bashaw, Racheal Ann; Chairperson, Graduate Committee: Christina BorstAmong the top nine leading causes of death for individuals aged 10-64 is suicide, and it's the primary cause of preventable death. Currently, only one-third of healthcare providers routinely screen for suicide risk, even though this screening is recommended by entities such as The Joint Commission. The objectives of this project were to identify ways to increase suicide risk identification in the prevention of suicide through the utilization of a standardized suicide screening using the Ask suicide-screening Questions (ASQ) reflexing to the Brief Suicide Safety Assessment (BSSA), and to mitigate barriers to the implementation of suicide screening protocols in a rural Montana psychiatric practice. This project was accomplished using pre- and post-education surveys and three 2-week PDSA cycles, which evaluated selected aggregate data evaluated against SMART goals. During this project, the facility screened 93% of 86 patients that presented to the practice; 15 patients refused to screen and six were not provided the screening tool. Of the patients screened, 41.3% were positive using the ASQ, with one patient scoring at the threshold for further evaluation with the BSSA. In this sample, none needed further intervention beyond this setting. The project successfully identified the evidence-based tools and processes fitting this practice, provided efficient and convenient implementation steps, gained stakeholder buy-in and support, and facilitated rapid PDSA cycling to identify and mitigate barriers to screening. Per the providers report, additional secondary assessments improved patient care through standardization and consistency, and provided a conversation structure regarding suicide risk. Limitations, including practice size, rurality, and practice specialty, did not indicate a correlation between suicide screening and early risk identification.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 Family environmental risk factors for adolescent substance use: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2019) Walker, John Caleb; Chairperson, Graduate Committee: Tracy HellemSubstance use continues to be an ongoing problem throughout the United States and worldwide. In terms of substance use initiation, adolescence is characterized as an especially vulnerable developmental time period. There are many potential influences that can affect an adolescent's risk for initiating substance using behaviors. One particularly influential factor is the family environment the adolescent is exposed to on a daily basis. The purpose of this project was to summarize the evidence on the topic of adolescent substance use risk factors within the immediate family environment. Following an integrative review guideline, three library databases were searched utilizing a set of key search terms in order to obtain all relevant studies related to this topic. Each relevant research article found in the literature search that met the inclusion and exclusion criteria was included in the review process. Research findings were extracted from these research studies, organized into common categories, and integrative summaries were presented. The results of the review were categorized and presented based on commonly identified influential factors that were examined in the primary studies. As a result of this review, it was concluded that many significantly influential immediate family environment risk and protective factors have been identified in the literature. The significance of these findings and the potential implications for practice, prevention, and research, are discussed.Item The progression from acute to chronic low back pain: a systematic review of risk factors and practice recommendations(Montana State University - Bozeman, College of Nursing, 2018) Sheehan, Willow Anne; Chairperson, Graduate Committee: Jennifer SofieAcute low back pain (LBP) is common and can lead to chronic LBP. Chronic LBP carries the risk of significant financial burden and reduced quality of life. If low back pain persists beyond six weeks, the likelihood of recovery is limited. Therefore, it would be beneficial to identify those acute LBP patients most at risk of progressing to chronic LBP early in the disease process. This project seeks to identify acute LBP risk factors (RFs) that are most predictive of chronic LBP in primary care populations. A systematic review of literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Article review resulted in the inclusion of 13 studies with 3,641 subjects, evaluating 104 RFs. Data extraction and analysis based on the review protocol resulted in clinical practice and future research recommendations. Coping by catastrophizing and the patient's perspective of risk of chronicity are the most well-supported RFs identified and can be safely assessed in clinical practice for the purpose of recognizing those acute LBP patients most at risk of chronicity and in need of early intervention. An additional 82 RFs are discussed for their value in future research and potential implications for future clinical practice.