Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
Browse
8 results
Search Results
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 access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Patera, Caitlyn Ashley; Chairperson, Graduate Committee: Margaret HammerslaCaregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.Item Improving screening of eating disorders in rural community adolescents(Montana State University - Bozeman, College of Nursing, 2021) Smelser, Ryann Lyn; Chairperson, Graduate Committee: Susan LuparellEating disorders are the least likely to be screened for in adolescents aged 12 to 21 years. In many rural communities the only screening done is during a school physical questionnaire in which the child is asked if they are happy with their weight. Many clinicians are not comfortable investigating these concerns and are unsure what resources are available. A rural clinic was observed to have no formal screening tool in place for eating disorders among adolescents aged 12 to 21 years. This project sought to improve screening in the stated age group within the clinic setting. The SCOFF screening tool, consisting of five questions, was administered to adolescents during any clinic visit to any of three providers in the facility. Nursing staff offered the SCOFF tool during intake of the patients and prior to seeing the clinician. Out of 67 patients who were seen in an 8-week period, 19 were offered the SCOFF screening, equating to an overall 28.4% increase in screening. Plan-Do-Study-Act (PDSA) evaluations were done at 4-week intervals with the intention to further improve the number of screenings. This did improve screenings periodically throughout the project showing improvement in some weeks as high as 100%.Item Implementation of standardized trauma and resiliency screening in a youth therapeutic residential setting: a quality-improvement project(Montana State University - Bozeman, College of Nursing, 2021) Bugni, Katherine Tabije; Chairperson, Graduate Committee: Sandra Benavides-VaelloThe purpose of this DNP project was to establish standardized trauma and resiliency screening for patients within the youth therapeutic residential setting. A lack of standardized screening and documentation of trauma exposure and resiliency factors was identified internally by the organization. The establishment of routine screening for traumatic experiences provides valuable data, which will inform and be incorporated into the patient's treatment plan. Additionally, routine screening of the patient's resiliency measures complements the trauma information that was collected. This information is important as resiliency plays a critical role in countering the downward trajectory that is set by a child's experience of trauma. Resilience can act as a safeguard from the negative outcomes that are linked with experiencing early trauma. The major objectives for this project were (1) for staff to implement trauma screening and (2) resiliency screening with youth in a therapeutic setting. Not only does the trauma score provide key information about the patient, but it can also guide treatment and serves to establish a baseline for the continued tracking of trauma and resiliency experiences. Additionally, continued data tracking beyond discharge is a requirement of the recent Family First Prevention Services Act of 2018. This project's aim was for participants to utilize the organization's electronic health record to collect and house the screening data. At a later date, the information can be utilized for advocacy of funding, vitals tracking, and for future quality-improvement processes. The results include that staff obtained screenings for 100% of the organization's residential population, with screenings for trauma (ACEs) and resiliency (CYRM-R), incorporating the new process into routine practice within the short PDSA cycle. The results of staff success in incorporating the new screening process for trauma and resiliency with youth residents during weekly routine visits indicate that this practice change is not only achievable, but can be applied during already established weekly visit time between existing trained staff and the patients within the two communities' residential therapeutic group homes.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 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.Item The lived experience of social support in adolescent diabetes patients(Montana State University - Bozeman, College of Nursing, 2012) Scott, Daen Eve; Chairperson, Graduate Committee: Charlene WintersAdolescence is a time of change in many aspects of a person's life, and this time is further complicated by the presence of a chronic illness such as diabetes. Further, the metabolic control exhibited by teens is generally worse than at other points in life, with as many as 30-50% being characterized as out of control Despite extensive research on the interaction between the social milieu and diabetes control, results have been inconclusive or contradictory. The purpose of this study was to explore how adolescents ages 12-18 experience social support from friends and peers. A convenience sample of adolescent patients from three clinics in a small city in south central Montana were interviewed regarding friendships, use of insulin delivery devices, social networking, and the impact of diabetes on social interaction and daily life. An inductive analysis approach revealed nine themes: full disclosure, taking care of myself, getting help, making it a part of life, people who know are important, sharing information as positive, adults as negative reactors, age differences make a difference and heavy issues early in life. Technology, such as insulin pumps and online social networking, was found to have a major positive impact in participants' social functioning and control. Peer relationships with other teens with diabetes were found to be important and different from friendships with non-diabetics. Negative reactions and social impacts were found to be much more prominent from adults than from same age peers. Implications include the need for further investigation of how technology might benefit teens with chronic conditions, the potential for positive impact from peer connection and mentoring programs, and the importance of clinicians' awareness of patients' social functioning as it impacts care behaviors and general well being.