Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Improving depression screening and follow-up in primary care settings(Montana State University - Bozeman, College of Nursing, 2023) Houghtelling, Jeanette Renee; Chairperson, Graduate Committee: Margaret HammerslaBackground: Depression is a serious problem globally and locally. It not only impacts work productivity and the costs of healthcare, but it also directly reduces quality of life and increases the burden of chronic illness. In addition, depression increases the risk of death by suicide. Depression is thought to be one of the most treatable of mental health disorders, yet it remains underdiagnosed and undertreated. The primary care setting provides the ideal location to identify individuals with depression and to initiate treatment. Objective: The objective of this quality improvement initiative was to meet or exceed the target rate of depression screening and follow-up in a federally qualified health center in northwest Montana. Method: Following a review of relevant literature, an extensive organizational assessment was conducted. A clinical practice guideline was written which recommended a standardized workflow and written standard operating procedure. Measures to educate and engage staff were employed. Staff feedback was solicited through an online survey. The clinical practice recommendation was appraised by the organization's quality team using the AGREE II appraisal tool. Results: Staff expressed support of change as evidenced by verbal responses to manager and anonymous online survey. The quality team approved the practice recommendations for implementation which was initiated on March 1, 2023. Preliminary data indicate that screening and follow-up rates have improved. Conclusion/Implications: It is feasible to improve depression screening and follow-up in primary care settings by studying the current state thoroughly and implementing key facilitators.Item Exploring the impact of a values-based reward system on engagement and perceptions of office culture in higher education(Montana State University - Bozeman, College of Education, Health & Human Development, 2020) Gresswell, Candice Marie; Chairperson, Graduate Committee: Sweeney WindchiefEmployee engagement and satisfaction may be telling indicators of employee health that can have rippling effects on the employee, university, and the student who interacts with the employee every day. Research has demonstrated a positive correlation between administrative styles and retention in the context of engagement, climate and culture (Farrell, 2009). Across industries and disciplines, employees who are engaged are more productive, creative, solve more problems, and more easily adapt to change (Craig & DeSimone, 2011; Flade, 2006; Holbeche & Matthews, 2012). Contrast to this research, in the higher education setting, employee engagement is measuring at an all-time low (Wasilowski, 2016). The purpose of this transformative, sequential, mixed-methods study is to examine how formalizing an engagement incentive program for higher education administrative staff in the Division of Student Success at a regionally accredited, land-grant institution impacts employee-reported engagement as measured by the Gallup Q12. The researcher collected qualitative data to help explain the quantitative Gallup Q12 survey scores to give individuals in leadership roles concrete information on how employees interpret Gallup Q12 and which, if any, actions they can take to improve employee engagement in their offices in the context of climate and culture. Wilcoxon Signed Rank test indicated significant change in the overall engagement score for the Division of Student Success (z = 2.79, p = .002), indicating the formalization of an engagement program does have a statistically significant effect on engagement as measured by the Gallup Q12. Major themes that emerged from the engaged offices in relation to climate were Relatedness and Care for the Student Experience. Major themes that emerged from the disengaged offices included Frustration, Stress, Turnover, Exclusivity, Not Being Able to Demonstrate Expertise or Improve Processes, Customer Service Focus, and Problem-Solving.Item Montana criminal justice personnel attitudes toward the mentally retarded offender(Montana State University - Bozeman, 1987) Christensen, Marsha Ann; Chairperson, Graduate Committee: Richard L. HainesItem What is good and what is right : an investigation of the outcomes of a comprehensive ethics program in municipal government(Montana State University - Bozeman, College of Education, Health & Human Development, 2014) Webb, Elizabeth Johnston; Chairperson, Graduate Committee: Marilyn Lockhart.To build public trust in government through ethical management of citizen resources, leaders of agencies should be intentional in their adoption of a Comprehensive Ethics Program (CEP) and in measuring the impact the program has on the ethical climate, observations of misconduct and reporting of misconduct. The purpose of this study was to investigate the outcomes of a CEP within a municipal government, five years after implementation. This was a mixed methods study where an electronic survey first measured perceptions of ethical climate followed by interviews with ethics administrators and anonymous employees. After five years, the municipal employees rated their environment as somewhat ethical through two measures; an overall ethics score (an average of 35 items from an ethical climate assessment), and a single item rating of the ethical climate by employees. Both measures can be used as a benchmark of organizational ethics health. Observations of misconduct were low in comparison to national statistics and reporting of misconduct was low in comparison to national statistics. Binary logistic regression was conducted on the overall ethics score and observations of misconduct and was statistically significant in distinguishing between employees who observe misconduct from those who do not. One ethics factor, ethical leadership, was also statistically significant in distinguishing between employees who observe misconduct and those who do not. Ethics factors that were not reliable predictors of observations of misconduct included the code of ethics, ethics resources, independent ethics commission, ethical decision-making, and informal ethical norms. Employees also rated the most effective components of the ethics program. Role modeling by peers, role modeling by supervisors, talking about ethics on the job, annual ethics training, the code of ethics, and the ethics handbook were rated as the most effective components. Six interviews with employees deepened the understanding of the quantitative data. Key themes of leadership and concerns about reporting and retaliation emerged through the interviews. CEP outcomes identified in the interviews included enhanced awareness and talking about ethics, seeking advice for ethical dilemmas, cross-departmental conversations, ethics code revisions, ethics resources for employees, and learning from training examples and interactive discussions.