Theses and Dissertations at Montana State University (MSU)
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Item Translating prenatal oral health guidelines into obstetric practice, a practice change project(Montana State University - Bozeman, College of Nursing, 2017) Martin, Terryn Lynn; Chairperson, Graduate Committee: Elizabeth S. KinionEarly childhood caries (ECC) is prevalent and burdensome to a child's quality of life and development, albeit preventable. ECC prevention strategies implemented in the prenatal period are well supported by evidence to reduce ECC incidence and dictated in numerous prenatal oral health guidelines. However, obstetric (OB) providers do not often practice this evidence. The purpose of this project was to assess, plan, implement, and evaluate the introduction of prenatal oral health practices, that coincide with current prenatal oral health guidelines, to OB providers at one OB clinic. To do so, current prenatal oral health guidelines were evaluated and coalesced to form of a prenatal oral health protocol (POHP). Two OB provider and medical assistant (MA) pairs implemented the POHP over a 90-day implementation period in one OB clinic. Lewin's Change Theory guided the practice change process. To determine if, by implementing the POHP, the prenatal oral health practices of participating OB providers were significantly improved, before and after patient's charts were reviewed and data measuring provision of oral health practices were compared using a permutation test. It was also planned to measure dental attendance. A written survey was given to participating OB providers and MAs at the end of the project to gain their perspective on the practice change process and likelihood of sustainability. The results show that significantly more patients had documentation of prenatal oral health education (p<.0002, 95% CI 0.476-0.857), oral screening questions (p<.0002, 95% CI 0.857-1), and an oral screening exam (p<.0002, 95% CI 0.619-0.952) after the POHP was implemented than before. A dental referral was not made, thus it is unknown how many patients, in receiving a dental referral, would have attended the dentist at some point during pregnancy. Four out of 17 patients, correctly screened, should have received a dental referral based on the POHP, but did not. The survey showed favorable views of the practice change process and likelihood of sustainability. In conclusion, prenatal oral health practices can be incorporated into the practice of OB providers using a POHP, an appropriate implementation period, and a practice change process guided by Lewin's Change Theory.Item Information calendar for pregnant teenagers(Montana State University - Bozeman, College of Nursing, 2000) Anderson, Amy Heather; Chairperson, Graduate Committee: Lea AcordItem The role of the advanced practice nurse in facilitating home care for the preterm labor patient(Montana State University - Bozeman, College of Nursing, 1996) Smigaj, Denise Adelle; Chairperson, Graduate Committee: Jennifer HensleyItem An exploratory study of the effect of prenatal classes on the amounts of concerns expressed by primipara patients(Montana State University - Bozeman, College of Professional Schools, 1971) Vojnovich, Margaret Houston; Chairperson, Graduate Committee: Merlyn Jean Maurer WillettItem Social support and pregnancy outcome(Montana State University - Bozeman, College of Nursing, 1988) Newman, Helen Colleen StephensItem Barriers to accessing prenatal care in low income rural women(Montana State University - Bozeman, College of Nursing, 2012) Burk, Laci Ann; Chairperson, Graduate Committee: M. Jean Shreffler-GrantBarriers exist to accessing prenatal care for low income women throughout the United States, such as scheduling appointments, finding childcare, and paying for prenatal care. Women who reside in rural areas experience barriers to accessing prenatal care unique to their geographical locations. Barriers to accessing prenatal care have been associated with less than optimal health outcomes for both women and infants. The purpose of this study was to explore the barriers to accessing prenatal care that are specific to low income rural women. A qualitative approach was used by conducting telephone interviews using open ended questions with low income women from one rural county in Montana. A sample of 6 women was recruited from the Women, Infants, and Children (WIC) nutritional supplement program in a rural county. Patterns were identified from the interview responses and categorized into themes that allowed for identifying common barriers. The results from this study revealed that low income rural women reported an overall lack of providers who offered prenatal care in their area. Difficulty with scheduling transportation to and from appointments was reported in half of the women, as well as distance to the nearest hospital for 2 of the women. These same 2 women also reported that if a complication arose during pregnancy or if a woman were to have a high risk pregnancy, distance to the nearest hospital or provider would be a barrier. There was difficulty recruiting a larger sample population, therefore the sample size of 6 women was a major limiting factor of this study. Implications for practice included a need for recruitment of providers in rural areas, and the potential use of nurse practitioners for providing high-quality, low cost prenatal care for low income rural women. The implementation of group prenatal care in rural locations and investing in rural communities were also implications for future practice. Lastly, the results from this study may help with future practice and research to help focus on the needs of this unique population for gaining improved access to prenatal care.Item A survey of perceived social support among pregnant women in the intermountain region(Montana State University - Bozeman, College of Nursing, 2004) Roth, Carol Ann; Chairperson, Graduate Committee: Fredericka GiljeSocial support influences health and well-being. Research findings show that social support positively influences pregnancy outcomes. The purpose of this descriptive study was to describe and explore perceived social support of pregnant women and determine if social support is associated with degrees of rurality, i.e., urban, rural and remote rural. The sample was comprised of 60 pregnant women in their second and third trimester who resided in the Intermountain region. Perceived social support self-report surveys (PRQ85- Part 2) were distributed and completed by women at two urban clinics and one hospital located in Montana. Perceived social support scores were calculated for each participant, with a possible range from 25-175; higher scores indicated greater perceived social support. The mean perceived social support score for the sample was 152.9. Scores were highest among those who were married, Caucasian, had a higher level of education, had a higher annual income, and who indicated their primary source of support as spouse. Scores were also highest for those in their third trimester with complications of the current pregnancy. Scores were lowest for those who indicated living in a remote rural setting and highest for those from a rural setting. When stratified by degrees of rurality, findings reflected those of the entire sample except the remote rural group, which had lower scores with a higher annual income and were in their third trimester. Possible explanations for these findings are supported by Cohen's stress buffering model of social support and rural nursing theory. These results may help nurses and other healthcare providers offer a more holistic approach to meeting unique health care needs of pregnant women in rural communities. Of significance here is recognizing social support as important to health care during pregnancy, a specific period of time when health promotion and prevention are of critical importance.Item Prenatal interventions that improve Native American pregnancy outcomes and reduce infant mortality : an integrative review(Montana State University - Bozeman, College of Nursing, 2012) Bloom, Jeanne Kathryn; Chairperson, Graduate Committee: Sandra KuntzNative mothers are at increased risk for negative pregnancy outcomes and within the first year of life, Native babies have substantially higher infant mortality rates than their White counterparts. The primary aim of this study was to identify a broad range of interventions/perspectives that positively affect pregnancy outcomes and reduce infant mortality in Indigenous communities. An integrative review using four databases was conducted. Thirty-four articles met the inclusion/exclusion criteria. The findings and recommendations of each article were documented in a chart (Appendix C) that gave rise to the development of a socioecological framework for pregnancy outcomes in Native women (Appendix D). Individual factors that influence pregnancy outcomes included behaviors/lifestyles, mental health, tobacco use, educational attainment, maternal age, prenatal care, breastfeeding, immunizations, family planning, and socioeconomics/WIC enrollment. Interpersonal factors included significant other, family support, peer support, and traditional beliefs. Community factors included: community health clinics, prenatal services, SIDS education, infant care education, home visits, smoking cessation & prevention programs, injury rates/environmental safety, tribal commitment to mothers and infants, and integration of traditional and western medicine. Public policy factors included WIC, safe water and sanitation, IHS funding, and systems to monitor Native health. In total, the synthesis of the findings from the literature appears to influence pregnancy outcomes. For Native American pregnancy outcomes to improve and infant mortality rates decline, interventions will need to target all levels of the socioecological framework: individual, interpersonal, community, and public policy. In addition, Maslow's Hierarchy of Needs must be considered.