Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Certification of reprocessing standardization: preventing endoscopy associated infections(Montana State University - Bozeman, College of Nursing, 2023) Ranck, Aaron Thomas; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Between 2012-2015, 25 outbreaks were linked to contaminated duodenoscopes worldwide due to human error or negligence during reprocessing. A standardized education and training reprocessing program is necessary to address nationally increasing Endoscopy Associated Infections (EAIs). Problem: A Montana endoscopy unit committed to adopting national standards. An unmet objective was the certification of endoscopy reprocessing (CER) requirement. This pilot project sted in developing a mandatory CER protocol to optimize infection control. Methods: A Plan-Do-Study-Act (PDSA) quality improvement method was employed, with pre- and post-intervention design to evaluate infection incidence and risk. This involved patient chart review and duodenoscope reprocessing log review. An aggregate comparison was made between a CER participant and eight non-CER technicians. To inform future program development, a survey was conducted to collect data on CER participant motivation, preparation, and perception of recommended educational materials. Intervention: A pilot study involving a single participant attempting to obtain nationally recognized CER was conducted. The facility manager shared the facility's intention of mandatory certification and via endoscope technician meeting, including incentives. Created certification-benefit video presentation and exam preparation materials were provided one month before the exam. Results: Zero infections occurred during pre- and post-intervention. Pre-intervention, the average infection risk scores per endoscope reprocessing were 12.2 relative light units (RLUs) for the unit and 11.1 RLUs for the CER participant. Post-intervention phase, these numbers were 15.7 RLUs by non-CER technicians and 2.8 RLUs by the CER participant. Conclusion: This study highlights the effectiveness of mandatory CER in reducing the risk of patient infections. Maintaining infection prevention and control in endoscopy procedures requires ongoing education, training, and motivation. Informing employees of the benefits of standardization may improve motivation.Item Improving advance directive conversations in a primary care clinic: a quality improvement intervention(Montana State University - Bozeman, College of Nursing, 2022) Hong, Mikyong; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: Leading American health organizations have emphasized the necessity of promoting end-of-life conversations in health care settings. Yet the rates of these conversations remain woefully low across all settings, including primary care. Advance directives (AD) are documents that relay the degree of medical care desired by a patient. Thus, ADs are a practical and appropriate approach that can be used by primary care providers for initiating end-of-life conversations with their patients. Purpose and Methods: The purpose of this DNP project was to increase the rates of advance directive (AD) conversations between providers and their patients in a primary care setting. The project used provider training instruments that were developed within a scientific framework. These instruments included: 1) a tutorial on the appropriate use of AD related CPT codes, 2) a documentation guide for advance care planning, 3) a conversation guide for discussing ADs with patients, and 4) education on the use of the (AD) form. These instruments were delivered over eight weekly video tutorials and in-person question and answer sessions. Results: The rates of end-of-life conversation at the clinic, as reflected in advance care planning (ACP) documentation and scanned AD forms in EMRs, increased from 12% of patients to 35%. The project also improved patient care and generated revenue for the organization through the utilization of Current Procedural Terminology (CPT) codes related to advanced directive conversations.Item Optimization of advanced practice clinician billing: the first key step to creating an APC-specific onboarding within a healthcare organization(Montana State University - Bozeman, College of Nursing, 2021) Overstreet, Jordan Marie; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughAdvanced practice clinicians (APCs) have proven to be a cost-effective solution to meet the demands of increasing needs for providing high-quality healthcare, these clinicians continue to report difficulty transitioning into their role. Organizations that employ APC-specific onboarding programs have resulted in improved role transition with reports of increased provider confidence, increased interdisciplinary collaboration, and improved provider competencies. One healthcare organization sought to develop and implement an APC-specific onboarding program. Problem: A healthcare organization was lacking an APC onboarding program to support and provide professional development for APCs. A needs assessment of 90 APCs in the organization resulted in over 30% of responses, reporting feeling less than confident in the skills to independently select billing codes for patient encounters. Also, 60% of respondents were interested in education for the optimization of billing practices. Methods: After collaborating with organizational stakeholders, it was determined a comprehensive educational intervention would be created. A video series of 15 educational modules was created and disseminated to all APCs along with a post-interventional survey. Results: 7 of the 90 APCs responded to the post-interventional survey resulting in positive, but inconclusive data. Due to slowed billing resulting from the pandemic, billing data was unavailable for analysis during the timeline for the project. Of the survey responses, 57% reported the intervention was useful for providers of all experience levels and 43% reported it was most beneficial for newly licensed or hired providers. Conclusions: While the project cannot state the intervention resulted in the optimization of APC billing practices, a comprehensive educational program was created and disseminated with positive responses from APCs participating in the survey. More work needs to be done to determine the effects of the education on billing practices. However, positive survey feedback indicates the intervention would be a feasible, beneficial first step and contributed to the development of a comprehensive onboarding program for all APCs within a healthcare organization.Item Atlas - Academic Technology Literacy ASsessment: a technology literacy modified delphi method study(Montana State University - Bozeman, College of Education, Health & Human Development, 2018) Luft, Stephen James; Chairperson, Graduate Committee: Carrie B. Myers; Nick Lux (co-chair)How technology literate are you? Today, the world and associated technologies are far more complicated than the simple wheel, requiring a technologically literate society and workforce. Despite the widespread agreement about the critical nature of technology literacy and the role it plays in the success for college students, there exists no mechanism for helping students align their technology skills to the skills needed to be successful in college classes. The purpose of this modified Delphi method study was to identify exemplary technology literacy definitions from current technology literacy definitions, develop a basic academic technology literacy rubric and identify steps needed to implement the Academic Technology Literacy ASsessment (ATLAS) rubric system at the program, department, college and university level. The reduction of 25 technology literacy definitions to 10 technology literacy definition signified a certain level of them being exemplary. All the 10 technology literacy definitions had common threads of problem-solving, communication, responsibility and lifelong. Some of the definitions equated these as the demands of learning in the 21st century. Ten technology experts in higher education were asked how they would align academic technology literacy skills with skill levels. These alignments would be used to create an Academic Technology Literacy ASsessment (ATLAS) rubric. This was accomplished using a modified Delphi method study methodology. Over the course of three rounds, the SME participants aligned 93 out of 131 academic technology literacy skills with skill levels. The integration of the ATLAS was favorable at varying levels at all four areas. The greatest take-away from the responses was that participants observed that they did not see the black and white, digital native and digital immigrant separation of technology literacy. These perceived digital natives were in many cases as technology illiterate as the perceived digital immigrants This study provides students, faculty, and institutions with an understanding of technology literacy definitions, a tangible ATLAS rubric system that will provide those that feel overwhelmed with technology to identify where they are weak. Administrators will be able to identify actual steps on how to institutionalize the ATLAS rubric at the course, department, college and university level.Item Cardiac services nurse residency(Montana State University - Bozeman, College of Nursing, 2016) Kennedy-Collins, Kamera Machel; Chairperson, Graduate Committee: Alice RunningThis professional project was born out of a specific need within the cardiac services department at Kalispell Regional Medical Center. In order to describe, and best determine the exact needs of the cardiac services department, a clinical microsystem assessment was completed for the department focusing on the 'five P's' of the assessment process; Purpose, Patients, Processes, Professionals, Patterns. Information obtained from the microsystem assessment highlighted the need for additional staffing. Factors such as retirement, department growth, and turnover have left the department chronically short staffed. Chronic short staffing has resulted in long work hours and routine overtime. Attempts at hiring experienced nurses have not been successful enough to meet the department demand. Evidence would support nursing residency programs as one solution to staffing shortages. Therefore, a literature review was completed regarding the design and success of nurse residency programs. Given the issues of persistent short staffing, and the subsequent increased work load for staff, a proposal for the development of a unit specific nurse residency program was made. This professional project proposes a 16 week unit specific nurse residency program designed to be integrated into the existing organizational program. The programs includes components of preceptorship, mentoring, and didactics. The goal of the proposed nurse residency program would be to provide education, professional support, and mentoring to new graduate nurses interested in cardiac care in order to satisfy long term staffing needs within the department.Item Medical privacy, confidentiality, and privilege and their relationship to the instruction of medical office technology curricula(Montana State University - Bozeman, College of Business, 1997) Haugen, Roberta Rae; Chairperson, Graduate Committee: Norman L. MillikinThe details of our personal lives are our property and no one else's business. Those professionals who train medical office workers need to teach the medical law and ethics to those who will deal with these personal details of our lives. The instructors of medical office technology indicate that the right to medical privacy and all that it encompasses are very essential in the instruction of this curricula. Yet, they are not as familiar as they should be with the laws, and they are not covering medical law and ethics thoroughly in all curricula. Medical law and ethics should be taught as a separate core class in all medical office technology curricula, regardless of the length of training involved. Health care providers, their employees, and their agents have a legal duty to adopt security safeguards for the information they acquire and maintain--physical care of the recorded information, and care that employees are not verbally sharing the recorded information publicly. Verbal leakage of medical information may be the most dangerous due to how quickly information travels through the grapevine and the tremendous distortion of the information that occurs.Item Attitudes of Montana vocational educators toward a fifth-year teacher preparation program(Montana State University - Bozeman, 1984) Welch, Thomas Mark; Chairperson, Graduate Committee: C. Van ShelhamerItem CETA in Montana : success or failure?(Montana State University - Bozeman, 1981) Nwosu, IkechukwuItem Survey of the 1980-82 secretarial students of Medicine Hat College with implications for curriculum improvement(Montana State University - Bozeman, 1984) Middleton, Marla KarenItem The status of in-service training programs offered by business and industry to secretarial/clerical personnel(Montana State University - Bozeman, 1981) McFarland, Janie Hammer