Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Developing a nurse-led Medicare annual wellness visit program for the outpatient setting(Montana State University - Bozeman, College of Nursing, 2021) Wahrer, Sarah Rahal; Chairperson, Graduate Committee: Angela JukkalaChronic disease causes preventable deaths each year. The financial cost of preventable diseases continues to grow. Many evidenced-based screenings and recommendations provide ways to stop or decrease the effects of chronic diseases. The number of preventive care screenings individuals received increases when a wellness visit is provided. Yet, less than a quarter of eligible Medicare beneficiaries receive their free annual wellness visit. Low participation rates in the annual wellness visit leads to missed preventive services, increased chronic disease, and increased cost. Medical providers continue to have mixed opinions regarding the importance of the visit, leading to decreased buy-in and patient education about the visit. A nurse-led annual wellness visit program, created in an outpatient primary care setting, aims to increase awareness about the visit and increase the number of patients receiving preventive care. A multi-professional committee formed to implement and continue the program. One registered nurse was trained and piloted the program by seeing patients one day per week for their annual wellness visit and recruiting patients for the visit on another half-day. The number of people receiving the annual wellness visit will be tracked to analyze the impact of nurses recruiting and conducting the visit at an outpatient clinic. Previous programs have shown an increase in participation in the annual wellness visit and an increase in preventive services being performed.Item Trauma screening in chronic disease management: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Vaughan, David James; Chairperson, Graduate Committee: Sandra Benavides-Vaello and M. Jean Shreffler-Grant (co-chair)More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.Item Complementary and alternative medicine use in children with chronic health conditions(Montana State University - Bozeman, College of Nursing, 2003) Glover, Laurie BernhardtItem Women, spirituality, and chronic illness(Montana State University - Bozeman, College of Nursing, 2004) Hampton, Jenaneta Sue; Chairperson, Graduate Committee: Clarann WeinertPeople with chronic health conditions can experience life changing limitations which often require the help of family or other outside resources to manage the condition. Rural dwellers are at increased risk for chronic health conditions. Social support and spirituality have both been shown to be important contributors to adjustment, health, management, and, nursing care of chronically ill people. The purpose of this study was to explore expressions of spirituality in rural women with chronic illness, and investigate the relationship between spirituality and social support. This study was a secondary data analysis, in which data already collected through a larger research project were examined using qualitative and quantitative techniques. The secondary analysis was conducted with data collected from the Women to Women study at Montana State University-Bozeman, a study which provided computer-based support to women with chronic illness who lived in rural Montana. Asynchronous, computer-based communications of thirteen women were examined. A content analysis of data previously identified as having spiritual content by the research team was undertaken. Analysis of Personal Resource Questionnaire (PRQ) scores, was also performed. Six categories emerged from the content analysis, which were prayer, faith, verse, finding meaning, transcendence, and family. The women used spirituality to support each other and they shared and relied on their faith to deal with trying times. They prayed for each other, shared bible verses, hymns, and poems all in an effort to deal with illness and daily life. The degree of social support was examined and there was no statistical difference in PRQ scores from the beginning to the end of the computer intervention phase. The communications of the women who had particularly high or low scores were further explored relative to their group interactions. Results of this study were consistent with findings in previous literature that identified a link between spirituality and social support, yet the relationship between the two remains unclear. Nursing implications include clarifying the role of spirituality in chronic illness and the continued research into the relationship between spirituality and social support.