Theses and Dissertations at Montana State University (MSU)
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Item Improving eating disorder identification in a psychiatric outpatient clinic using the SCOFF+ binge eating question screening tool: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Rollins, Jordyn Faye; Chairperson, Graduate Committee: Carrie W. Miller; This is a manuscript style paper that includes co-authored chapters.Eating disorders are a set of diagnoses that significantly impact the world, families, and individuals. Anorexia nervosa, one type of eating disorder, has the highest mortality rate of the psychiatric diseases, second to opioid use disorder. They are also significant contributors to suicide. Currently, minimal proactive screening of eating disorders is occurring despite the severe medical and psychiatric complications that are associated with eating disorders. The Doctor of Nursing Practice quality-improvement project aimed to implement the SCOFF+BED screening tool during all initial evaluation appointments at an outpatient psychiatric practice. The project was implemented for seven weeks, from January 22, 2023, to March 15, 2023, with participation from eight psychiatric mental health nurse practitioners and their scheduled patients. The following procedures took place: (1) A pre-survey assessing provider confidence was given; (2) Stakeholders were educated on the most recent eating disorder practice guidelines; (3) Providers administered the SCOFF+BED during all initial psychiatric evaluations; (4) Providers further assessed, treated, and referred patients with positive scores based on their discretion; (5) A post-survey assessing provider confidence was given. Findings were consistent with the overall prevalence of eating disorders in the United States. Individual eating disorder prevalence was only consistent with the national averages for binge eating disorder. Additionally, following the educational presentation for providers, post-survey results were increased when compared to pre-survey results; however, they did not meet the aim of the study.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 A quality-improvement initiative: implementation of a screening process for eating disorders in outpatient psychiatry(Montana State University - Bozeman, College of Nursing, 2022) Potts, Alexandra Mae; Chairperson, Graduate Committee: Amanda H. LucasEating disorders (EDs) are one of the most life-threatening and disabling mental health conditions and have a significant prevalence in men and women of all ages worldwide. Despite their severity and improved treatment outcomes with early identification, EDs are not frequently disclosed by patients or proactively screened for by many medical providers. ED screening is an effective, safe, quick, and cost-effective way to assess for the presence of EDs, allowing for further medical provider evaluation. An outpatient psychiatric setting is an optimal place to screen for EDs due to the concurrence of these with other mental health conditions treated in this setting. The Doctor of Nursing Practice (DNP) quality-improvement (QI) project aimed to implement within the outpatient psychiatric clinic setting an ED screening process using the Eating Disorder Examination-Questionnaire Short (EDE-QS), focused on enhancing nursing processes with nurse mentoring and psychiatric mental health nurse practitioner (PMHNP) assessment. A 6-week implementation period took place between January 3, 2022, and February 11, 2022, including a participating PMHNP and their scheduled patients. The following procedures took place: (1) Stakeholders were educated on the DNP process and purpose by the DNP student; (2) The clinic front desk staff gave each patient an EDE-QS screener at check-in to be completed with other screening tools already utilized by the provider; (3) The patient brought these completed screeners back to the registered nurse (RN) upon nursing intake; (4) The RN scored the EDE-QS screeners, and positive screeners, scores of 15 or greater, were given to the PMHNP by the RN at patient hand-off; and (5) The PMHNP had the opportunity to further assess for EDs during the visit and manage the ED, if present, at the PMHNP's discretion, either by managing in the outpatient psychiatric clinic or by referring to an ED treatment center. Findings paralleled literature that described the EDE-QS as an effective screening tool for EDs and suggested that mentoring and education of nurses, along with pre-implementation process development, can standardize workflow and the integration of new screening processes into practice.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 From East to West : An exploratory cross cultural comparison of night eating syndrome and related eating pathology in Mainland China and the USA(Montana State University - Bozeman, College of Letters & Science, 2008) Cooper, Barbara Ellen; Chairperson, Graduate Committee: Wesley LynchThe current study investigates the prevalence rate of Night Eating Syndrome (NES) in mainland China. Although some research has investigated the prevalence and characteristics of anorexia nervosa and bulimia nervosa in China, virtually no research has been carried out on NES in the indigenous Chinese population. Thus, the primary goal of the current study was to examine NES prevalence and characteristics in China and to compare these prevalence rates and characteristics to published prevalence rates for the USA and also to a sample of college students in the USA. NES has also been linked to various other characteristics of eating pathology so the current study examined these facets as they have received inadequate attention in mainland China. Participants completed survey packets that contained the following measures: Night Eating Questionnaire (NEQ), Night Eating History and Inventory (NEHI), Eating and Attitudes Test-26 (EAT-26), Eating Disorder Inventory-2 (EDI-2), and the Food Frequency Questionnaire (FFQ). NES prevalence in the Chinese sample was found to be greater than rates for the US and for other countries. However, the NEQ may not be a valid measure for NES screening in the Chinese population. Seven of the 21 participants scoring above the NEQ cut-off, indicating likely cases of clinically diagnosable NES, also met the criteria for anorexia nervosa and one met the criteria for bulimia nervosa. Prevalence of other eating pathological symptomatology in the Chinese sample, such as anorexia nervosa, was also higher than reported rates for American Caucasians. With adjusted body mass index (BMI) norms for China, prevalence of obesity in the Chinese sample was much lower than the rates reported for Americans even though the Chinese participants overall reported consuming foods at a much greater frequency per week.Item Problematic eating and weight control behaviors among Native Americans : a meta-analytic review(Montana State University - Bozeman, College of Letters & Science, 2006) Maertens, Julie Ann; Chairperson, Graduate Committee: Wesley LynchA ubiquitous clinical stereotype has conventionally associated eating pathology with White, upper-class girls and women. However, recent studies suggest that problem eating behavior and use of unhealthy weight control techniques span many ethnic and socioeconomic groups. High rates of obesity and non-insulin-dependent diabetes suggest that unhealthy eating behaviors may be a particularly serious problem among Native American youth and adults. This meta-analytic review of studies reporting the prevalence of specific eating practices among Native American participants reveals that on average, 18% of Native Americans report engaging in pathologic eating and weight control behaviors. Additionally, nearly half of Native Americans report body dissatisfaction, while 10% report chronic dieting, despite normal body mass index. Finally, compared to their White counterparts, Native Americans are significantly more likely to report body dissatisfaction, pathologic weight control methods, as well as binge eating. Study limitations and future considerations are discussed.