Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
Browse
10 results
Search Results
Item An evaluation tool to measure pregnancy outcomes and quality improvement interventions at Northern Cheyenne Service Unit(Montana State University - Bozeman, College of Nursing, 2020) Tallbull, Cheyenne Rose; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughQuality Improvement projects are not always evaluated for their effectiveness after they are implemented. This professional project was to address this shortcoming by developing an evaluation strategy on the Healthy Mother Healthy Tribe (HMHT) project which aims at improving pregnancy outcomes for Northern Cheyenne women and their babies. The Montana State Birth Certificate Data indicate that the percentage of Montana Native American Women entering prenatal care after the first trimester was 56.4% compared to Montana Caucasian Women at 24.2%. While early and regular prenatal care are crucial to have healthier babies, numerous difficulties to access prenatal care and the impact of illicit drug use during pregnancy increased the number of precipitous deliveries at the emergency room in the Northern Cheyenne Service Unit (NCSU). The NCSU was chosen as a pilot test site to overcome these barriers; the HMHT project started. Posavac's program evaluation theory, in particular examining the processes of the intervention and how the intermediate outcomes lead to the desired outcome, was used to guide this project. After process-mapping prenatal care and developing a gap analysis, the NCSU implemented the following interventions: policy update, practice changes in drug screening and drug testing, updating electronic prenatal records, education and contracting for a prenatal case manager. Then, two types of evaluation processes were compared in this project. One was a conventional, practical strategy which was used for the Joint Commission's Evidence of Standards Compliance Report as an accreditation survey follow-up. Another was theoretically developed, based on a logic model, for this project to measure the effectiveness and improve evaluation consistency. In comparison, the conventional strategy was action oriented to ensure that compliance is sustainable for going forward. On the other hand, the developed logic model showed relationships and had a focus on measurable outcomes. Unfortunately, implementation of the logic model was not possible due to a change of the work site and time limitation. The effectiveness of the HMHT interventions would be important information in order to optimize resources for the organization and determine sustainability of the project.Item The effect of drug-free school zone laws on teen drug use(Montana State University - Bozeman, College of Agriculture, 2019) Wert, Eric Daniel; Chairperson, Graduate Committee: Mark AndersonOne often stated goal of drug policy in the United States is keeping drugs and drug related violence away from children. Drug-free school zone laws, which impose harsher penalties on those caught on drug related offenses near schools, are perhaps the most ubiquitous policies with this specific aim in mind. While some form of drug-free zone is currently enforced in all 50 states, several have made reforms to their laws in the last 10 years. Using data from the Youth Risk Behavior Survey, I estimate the relationship between weakening drug-free school zone laws and teen drug use. I find little evidence to suggest these reforms have led to increases in teen drug use.Item Interventions for the prevention of opiate use disorder in patients with high adverse childhood experience scores in northern New Mexico: a qualitative project(Montana State University - Bozeman, College of Nursing, 2019) Clawson, Kendra Sweeney; Chairperson, Graduate Committee: Maria WinesAdverse childhood experiences (ACEs) are known to be associated with chronic disease, various disorders, and social-emotional challenges (Anda et al., 2008). Furthermore, illicit drug use has been indicated to be associated with ACE scores, in a dose-dependent relationship (Centers for Disease Control and Prevention, 2016a). This DNP project explored the experience of patients with opiate use disorder (OUD) in northern New Mexico, who had ACE scores of four or greater. The purpose of the project was to identify, via structured interviews, interventions the participants felt may have been significant in preventing their OUD. The project sought to specifically examine interventions as they relate to ACEs. The project gave a voice to those who have the lived experience of both ACEs and OUD, to synthesize strategies to address ACEs, and conceivably build resilience. In analyzing the participant responses, the most prominent themes identified were intentional communication, understanding the home environment, creating a safe space for the pediatric patient, referring to counseling, and providing increased education regarding opiates and mental health respectively. These approaches were compared to similar interventions in the literature, to synthesize recommendations to inform the practice of primary care providers, school nurses, and counselors who interact with children with high ACE scores in the northern New Mexico region (Felitti et al., 1998).Item Identification of barriers and facilitators to the implementation of an opioid-alternative protocol to treat patients with migraine in the emergency department(Montana State University - Bozeman, College of Nursing, 2018) Carlson, Jennifer Angelique; Chairperson, Graduate Committee: Alice RunningThe Centers for Disease Control and Prevention list prescription medication (opioid) overdoses as the leading cause of death because of injury in the United States. This overwhelming statistic has led to what is now being considered an opioid epidemic and a national crisis. Provider opioid-prescribing practices have been recognized as one of the key components contributing to our nation's opioid epidemic. Hospital emergency departments (EDs) have been identified as one possible area for focused intervention. Even though ED providers write a small percentage of the total opioid prescriptions, many opioid-addicted patients have linked their first exposure to opioids with visits to the ED. To prevent a future generation of opioid-addicted individuals, literature reviews have shown education as well as the consistent use of pain management guidelines and protocols could help improve provider opioid-prescribing practices. Protocols for non-opioid pain management have the potential for great impact on the care patients receive in the ED as well as reducing opioid use and misuse in our country. For purposes of this quality improvement project, an opioid-alternative protocol for managing migraine was evaluated for use in a Pacific Northwest Hospital (PNWH) ED. This project utilized a constant comparison technique to evaluate the effectiveness of an educational intervention by evaluating results of surveys provided before and after the educational intervention. The intervention was based on a thorough review of the literature and current evidence-based migraine and opioid prescribing guidelines. The intended outcome of this project was threefold. The student investigator wanted to determine whether education could improve opioid knowledge among providers (MDs, NPs, PAs) and nursing staff at a PNWH ED; reduce perceived barriers toward implementation of opioid alternative protocols in the ED; and facilitate the implementation of an opioid-alternative protocol for migraine in the emergency department, thus improving provider opioid-prescribing practices. Survey comparisons showed how nursing and provider knowledge regarding the opioid epidemic and commonly used opioid-alternatives for managing migraine pain was improved, many perceived barriers toward the implementation of opioid-alternative protocols in the ED were reduced, and support for the implementation of an opioid-alternative protocol to treat patients with migraine in the ED was achieved as a result of this project.Item Improving quality through the development of a benzodiazapine sparing protocol for treating alcohol withdrawal in a community correctional setting(Montana State University - Bozeman, College of Nursing, 2018) Hill, Wade G.; Chairperson, Graduate Committee: Maria WinesAlcohol detoxification within community correctional environments poses significant challenges to local jurisdictions that are called to manage rising rates of incarceration among citizens with complex health needs including multiple comorbidities and mental illness and substance abuse. Traditional methods for intervening during detoxification have relied upon benzodiazepine tapers to reduce chances of the most serious consequences of alcohol withdrawal syndrome (AWS) but these medications have been increasingly attributed to poor outcomes such as increased risks of delirium, medication interactions, and risk of diversion among others. This project describes an evidence-based benzodiazepine sparing protocol that can be used to avoid use of this class of medications as well as an associated education intervention for detention officers and healthcare staff in one community correctional institution designed to improve knowledge of monitoring and treatment for inmates suffering from AWS. In total, 28 staff participated in the training and results suggest excellent overall quality and accomplishment of objectives at a high level. Implications for advanced practice nursing are discussed as well as directions for future dissemination efforts for BZ-sparing treatment.Item A review of literature of the history, legal and illegal aspects and methods of treatment of drug abuse(Montana State University - Bozeman, 1972) Funk, Paul EdwardItem Personality variables of drug users at a land grant university(Montana State University - Bozeman, 1971) Tanberg, Lesley MonroeItem A counselor's guide to drugs(Montana State University - Bozeman, 1970) Day, George LambertItem A descriptive analysis of selected intrapersonal characteristics of drug abusers(Montana State University - Bozeman, College of Education, Health & Human Development, 1973) Funk, Paul EdwardItem Drug education for rural middle school students in a resilience format(Montana State University - Bozeman, College of Nursing, 2006) Granger, Jamie Sue; Chairperson, Graduate Committee: Barbara Derwinski-RobinsonMontana has the nation's youngest average age for first use of alcohol and marijuana. Montana also ranks among the top five states in the highest rates of alcohol use among youth. In one Montana county, 31% of eighth grade students report having had five or more drinks in a 30-day period, 14% were current cigarette smokers, and 12% smoked marijuana. The principal of a rural Montana middle school, in this same county, requested a drug education program for his sixth, seventh, and eighth grade students. The goal of the program was resilience education. Resilience education allows for the development of decision-making abilities in adolescents. This gives them the skills and knowledge necessary to make informed decisions. Education was provided about alcohol, tobacco, marijuana, and methamphetamine through written materials, interactive classes, and an audio-visual presentation. Information was also given about peer use statistics, influences that promote drug use, and the harms associated with drug use. Drug resistance skills were introduced through the use of role-play scenarios and small group interaction in the classroom setting. A pretest and posttest, created by the project writer, were given to twenty-eight students. The pretest mean score was 57.39% and the posttest mean score was 80.64%. This is statistically significant at the .01 level. Eight student's posttest answers were more responsive on the short answer essay question than were their pretest answers, 16 students gave comparable pretest and posttest answers, and four gave more responsive pretest answers. Resilience drug education, combining factual drug information, consequences of drug use, and social skills training, has been found to be the most effective educational method in reducing drug use behavior. Further research of methods providing effective resilience education should be continued.