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 Implementing metabolic monitoring in second-generation antipsychotic use: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Stone, Amanda Marie; Chairperson, Graduate Committee: Lindsey Davis; This is a manuscript style paper that includes co-authored chapters.Background: Roughly one in five adults in the United States live with a psychiatric disorder, including major depressive disorder, bipolar disorder, and schizophrenia. Despite their effectiveness in treating psychiatric disorders, second-generation antipsychotics (SGAs) are associated with an increased rate of metabolic side effects (MSEs). To reduce the impact of MSEs and the potential development of metabolic syndrome, individuals on SGA need routine metabolic screening. Local problem: At an outpatient mental health clinic, 21% of the patients were prescribed SGAs; however, the clinic lacked a standardized protocol to assess MSEs. This project aimed to increase the completion rate of metabolic monitoring and improve patient health outcomes in patients diagnosed with a psychiatric disorder. Methods: A multifaceted approach was created for providers to increase adherence to metabolic screening in SGA use. Interventions: Three interventions were initiated: an electronic health record macro was created to promote consistent provider documentation, a standardized metabolic monitoring process, and educational in-services performed to encourage screening adherence. Results: The project aims were achieved with the clinic maintaining an 80% blood pressure (BP) completion rate. Documentation of body mass index (BMI) increased by 72%. Appropriate lab monitoring improved from an 8.5% rate during the preintervention phase to a rate of 33% postintervention. There were no changes in provider perceptions and practices regarding metabolic monitoring in SGA use. Conclusion: The project effectively increased the rate of metabolic monitoring in individuals prescribed an SGA.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 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 Educating psychiatric nurses in cognitive behavioral therapy for adolescent patients: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Thralls, Claire Eileen; Chairperson, Graduate Committee: Tracy HellemIt is estimated that 20% of adolescents have a diagnosable mental health disorder. However, there is a deficit of providers that are available to treat this population. This gap in care can potentially be mitigated by increasing mental health caregivers' education on therapeutic interventions. Cognitive behavioral therapy (CBT) is considered to be the gold standard of care for the population of adolescent mental health patients. This project set out to educate nurses working on an inpatient adolescent unit on topics of evidence-based CBT and adolescent group therapy. Nurses interacted in a 3-hour educational intervention that reviewed topics of CBT, group therapy with adolescents, and the Creating Opportunity for Empowerment (COPE) program. Additionally, the nurses participated in a role-playing group therapy session to practice implementing CBT interventions to adolescent patient populations. This intervention was utilized to determine the feasibility and effectiveness in educating psychiatric nursing staff on CBT concepts with regard to group therapy for adolescent populations. After participation in the intervention, nursing staff reported benefits and satisfaction with the CBT and group therapy intervention, increased understanding of CBT concepts and interventions, and enhanced preparation for working with adolescent psychiatric patients. It is hoped that this project will guide adolescent-mental-health caregivers in seeking additional education in CBT practices to enhance their education in evidence-based interventions.Item Evaluating provider opinion of telepsychiatry(Montana State University - Bozeman, College of Nursing, 2021) Brannen, Hilary Jane; Chairperson, Graduate Committee: Tracy HellemTelepsychiatry, or two-way video conferencing for psychiatric purposes, has been around for the last 60 years. However, full implementation of its usage has stalled. Research has shown that clinical outcomes and patient satisfaction are equivalent to or superior when utilizing telepsychiatry, but provider satisfaction is lower. The aim of this project was to initially survey medication providers of psychiatric services at a statewide community mental health center in Montana to determine barriers that may exist to implementation and then provide education to determine whether that would impact their overall opinion of the modality. However, during the time between initial survey and follow-up survey, the COVID-19 global pandemic occurred and forced all providers to utilize telepsychiatry exclusively to continue providing care. This driving force of change allowed for the providers to increase their overall opinion of the feasibility, benefit, and confidence and belief in the modality. Continued challenges were noted but an overall increase of knowledge about telepsychiatry was also found. These findings are encouraging for increasing utilization of telepsychiatry by providers to provide access to mental health services in more rural and underserved communities.Item Benzodiazepine prescription evaluation on inpatient psychiatry(Montana State University - Bozeman, College of Nursing, 2018) Loven, Jill Marie; Chairperson, Graduate Committee: Maria WinesSince the Food and Drug Administration announced on August 31, 2016 it was requiring boxed warnings regarding the risk of respiratory depression and death when benzodiazepines are combined with opioid, facilities face growing scrutiny of benzodiazepine utilization. Benzodiazepines are an effective treatment for acute anxiety and often administered to patients who require inpatient psychiatric treatment. Medication Utilization Evaluation (MUE) is a multidisciplinary quality improvement method that can evaluate safety and utilization of medications in a facility. This MUE pilot project identified 261 records of patients prescribed benzodiazepines in a facility from January 1, 2017-March 31, 2017. Results showed that 75% of the sample received appropriate orders for benzodiazepine. Potential factors to predict inappropriate orders were depression and alcohol withdrawal. More information is needed pertaining to the actual utilization of benzodiazepines on the inpatient unit.Item Effectiveness of telepsychiatry : an integrative literature review(Montana State University - Bozeman, College of Nursing, 2011) Rudolf, Jeri Nagel; Chairperson, Graduate Committee: Kathleen SchachmanThe aim of this integrative literature review was to evaluate the state of the science to determine if telepsychiatry, though the use of videoconferencing, was as effective as a face-to-face method of service delivery for the treatment of psychiatric-mental health disorders. Geographical isolation, lack of access to mental health care, a shortage of mental health prescribers, and stigma contribute significantly to mental health disparities. Access to mental health care has proven to be a significant barrier for many people including those living in rural areas, the incarcerated, military personnel, the homeless, the elderly, or individuals with health related issues affecting their mobility (Anthony, Mertz Nagel, & Goss, 2010). Telepsychiatry in health care is an emerging technology that offers the potential to reduce these service disparities. This literature review was organized and presented according to the methodology recommendations of Whittemore and Knafl (2005). Components of the research paper included are a presentation of the problem, literature review, a description of data analysis methods, presentation of findings, and discussion and summary. Seventeen primary research articles were evaluated comparing clinical outcomes using telepsychiatry to a more traditional, face-to-face method of intervention. Telepsychiatry in health care has been proven to reduce mental health disparities for the rural and underserved populations by increasing access to mental health care, but research regarding the effectiveness of this technology has been limited. Demonstrated effectiveness of telepsychiatry must be established if the goal of widespread implementation is to be realized.