Theses and Dissertations at Montana State University (MSU)
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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 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 Presentation of a comprehensive community suicide prevention program: improvements for young adult males ages 18-34 years old(Montana State University - Bozeman, College of Nursing, 2019) Bagley, Jamie Lynn; Chairperson, Graduate Committee: Maria WinesSuicide continues to be a worldwide phenomenon causing more than 44,000 deaths nationally (American Foundation for Suicide Prevention [AFSP], 2015) and 800,000 deaths globally (World Health Organization [WHO], 2017). Although any population can be affected by suicide, certain populations are at a higher risk of being impacted. Completed suicides by the male population have been rapidly accelerating both nationally and within the state of Montana. Over the last 40 years Montana has been in the top five states for the highest suicide rates in the nation (Montana Department of Public Health and Human Services [MTDPHHS], 2016b), and as of January 2018, Montana ranked first in the nation for highest suicide death rate (Centers for Disease Control and Prevention [CDC], 2018). Male youth suicide is rising and is now the second leading cause of death between males ages 15-34 years old (CDC, 2015). Butte-Silver Bow County, located in Montana, is no exception, and is one of four counties in Montana with the highest suicide rates of 20.6/100,000 compared to Montana's suicide rate of 16.4/100,000 (MTDPHHS, 2016a). Twelve percent of males in Butte-Silver Bow County report 'fair' or 'poor' mental health (Sisters of Charity of Leavenworth [SLC], 2015). There is significant need for mental health support services for this age group. The lack of evidenced-based suicide prevention interventions/programs for males, particularly male youth, is alarming. The goal of this proposed community implementation program is to provide Butte-Silver Bow County and future communities with evidence-based interventions to decrease male youth suicides. An exhaustive literature search was conducted, and evidence-based suicide prevention programs were evaluated. As a result, evidenced-based components from Problem Solving Therapy (PST), and The Collaborative Assessment and Management of Suicidality (CAMS) were combined to form one comprehensive suicide prevention intervention program.Item Concept analysis : hopelessness(Montana State University - Bozeman, College of Nursing, 1996) VanDaveer, Karen Lynn; Chairperson, Graduate Committee: Therese SullivanItem Decreasing suicide among veterans(Montana State University - Bozeman, College of Nursing, 2014) Perry, Livia Csonka Marta; Chairperson, Graduate Committee: Polly PetersenEstimates are showing that approximately 22 veterans commit suicide per day. Those at highest risk for suicide are married, white males between the ages of 50-59 with a high school education or higher, located in specific western, central and eastern states. Research has shown that 45% of those who completed suicide have seen their PCPs in the month preceding their death, and 67% of those who attempt suicide receive medical attention as a result. Although PCPs may be in a strategic position to assess for suicide risk within the veteran population, research has shown that suicide screening is underutilized in the Primary Care Setting. A possible cause for this may be the inadequate training of practitioners in the area of suicide screening. Research has demonstrated that educating PCPs in this area resulted in an increase in suicide screening in their practice settings. To meet this educational gap, a podcast was created for the purpose of educating PCPs on the topic of veteran suicidality and suicide screening. To test the effectiveness of the podcast, Montana State University graduate students from the College of Nursing were invited to participate in listening to the podcast. Each participant completed a corresponding pre and posttest. Test results show an average increase of 21% in correct answers when comparing pre and posttest results, indicating that the podcast effectively served to convey intended information to participants.Item Practice implications for addressing Native American youth suicide : an integrative review(Montana State University - Bozeman, College of Nursing, 2013) Erickson, Janet Leigh; Chairperson, Graduate Committee: Patricia A. HolkupAmerican Indian/Alaska Natives experience the highest rate of suicide compared to all ethnic groups in the United States, and the youth of this minority population account for 40 percent these suicides. The aim of this integrative literature review was to provide information and direction to health care professionals, including nurses, who deliver care to the AI/AN youth across Indian Country. An integrative review, including a comprehensive computer-assisted search of three separate databases, and a subsequent review of the reference lists of selected articles was completed. Forty-one articles met the inclusion/ exclusion criteria. The findings, recommendations and practice implications were documented in a chart (Appendix C) and then organized according to the biological systems theory model (Appendix D), which allowed for illustration of the multi-layered risk unique to Native youth, the importance of considering the social context in which Native youth suicide occurs, and assisted in identifying practice implications specific to Native American youth. The risk factors ranged from individual and family "day-to-day realities," to factors that were a part of the adolescent's environment but not necessarily a direct influence, to cultural, economic and political issues, and historical events that remain active as factors affecting the lives of Native youth. The results of this integrative literature review provided the evidence for the need to develop a collaborative approach that is culturally anchored in the world of the Native youth. The need for increased research related to addressing the Native American youth suicide crisis is described as imperative with suggestions to focus on studying current culturally appropriate, holistic care in attempts to determine its effectiveness.