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 sleep opportunities in hospitalized postpartum mothers(Montana State University - Bozeman, College of Nursing, 2022) Cantwell, Lindsay Rose; Chairperson, Graduate Committee: Christina BorstSleep deprivation and the fatigue experienced by new mothers remain well-accepted facts of life after the birth of a newborn. In the past, most new mothers utilized hospital nurseries to aid them in caring for their infants after birth; but recent paradigm practice changes in hospitals emphasize rooming-in, breastfeeding, and strongly discourage separation of the mother/newborn couplet. In Baby-Friendly accredited hospitals, postpartum mothers are encouraged to prioritize their infant's needs often above their own, contributing to significant maternal sleep deprivation and fatigue. This quality-improvement project aimed to increase sleep/rest opportunities for mothers through the implementation of coordinated quiet times on a postpartum unit in a Baby-Friendly hospital in the northwestern area of the United States. The Knowledge to Action framework guided this project. Staff received education about the importance of postpartum sleep and the quiet-time practice change. The implementation took place over 4 weeks. Chart reviews were completed, and the mothers who received quiet times were tracked. Practice outcomes included 51% of postpartum moms having a quiet time during week 1; week 2, 64%; week 3, 57%; and week 4, 62%. The quality-improvement project successfully increased sleep/rest opportunities for mothers through quiet times. Prior to the project, there was no standardized effort on the unit to promote maternal sleep or rest. An increase of over 50% during all practice weeks was accomplished. Additionally, there was no significant increase in infants utilizing the nursery, making this intervention viable in the Baby-Friendly hospital setting.Item Perceptions of the nurse practitioner in the hosptial setting(Montana State University - Bozeman, College of Nursing, 2020) Cunningham, Marji Rae; Chairperson, Graduate Committee: Polly PetersenThe practice of nurse practitioners (NPs) has evolved over the last 60 years. This evolution has taken the NP from practicing mainly in a family-practice setting into various other settings such as the hospital environment. The knowledge and associated role of the NP is often confusing for healthcare professionals. The purpose of this project was to gain insight from Medical Doctors (MDs) and Doctors of Osteopathy (DOs) regarding their perception of NP scope of practice, educational background, and appropriate utilization in the hospitalist's position. A Likert-scale questionnaire was deployed to MD and DO providers from two different facility types in central and eastern Montana using a snowball sampling method. The two facility types were hospitals that currently utilize NPs in their inpatient settings and hospitals that do not utilize NPs in their inpatient settings in Montana. A total of 51 questionnaires were sent out with a response rate of 47%. Along with demographic data, the questionnaire included three umbrella themes: MDs'/DOs' perceptions regarding the NPs' educational background, NPs' scope of practice, and the utilization of NPs in a hospital setting. The results from the questionnaire suggest that MDs/DOs do not understand the differing roles or educational processes of the APRN, specifically the Family Nurse Practitioner (FNP) versus the Acute Care Nurse Practitioner (ACNP). The results also showed strong support by MDs/DOs for the NP to work in a hospital setting, especially in urban areas. These findings support the need for changes in organizational hiring and regulatory policy consistent with independent state APRN practice regulations and the LACE Consensus Model. Enhancing hiring practices can lead to increased educational opportunities for MDs/DOs regarding the various APRN roles, afford an organization the opportunity to hire an APRN that is appropriately licensed to work in a hospital setting, and provide clarity between the FNP and ACNP roles.Item Beliefs and use of evidence-based practice by nurses: a needs assessment at a hospital in south central Montana(Montana State University - Bozeman, College of Nursing, 2018) Gipe, Leigh Ellen; Chairperson, Graduate Committee: Stacy StellflugNurses consistent use of evidence-based practice (EBP) will improve healthcare quality, improve patient outcomes, and decrease healthcare costs. Nurses constitute the largest group of healthcare providers and are in direct contact with patients, thus have an opportunity to make the largest impact using EBP. Despite EBP being accepted as the best method of providing care, many nurses may not be fully implementing it in daily clinical practice. The purpose of this project was to investigate nurses' beliefs about the readiness for and organizational culture for evidence-based practice, attitudes and beliefs about evidence-based practice, and nurses' implementation of evidence-based-practice at this organization. This was done by asking the following questions: What are nurses' current individual beliefs and attitudes about EBP at this organization? What are nurses' current levels of self-reported implementation of EBP at this organization? What are nurses' perceptions of organizational and cultural readiness for EBP at this organization? This project used a cross-sectional, descriptive design. A 75-question survey was sent via email in a SurveyMonkey to a convenience sample of 485 nurses. Nurses were asked demographic and professional characteristic questions, three open-end questions about EBP and to respond to three surveys: (1) The Organizational Culture & Readiness for System-Wide Integration of Evidence-Based Practice scale (2) The Evidence-Based Practice Beliefs scale (3) the Evidence-Based Practice Implementation scale. The findings were that nurses had positive attitudes and beliefs about evidence-based practice but reported low levels of implementation behaviors. Nurses report that they need more time, education and training, and resources to increase implementation of evidence-based practice. Interventions recommended to increase EBP implementation include encouraging more nurses to participate in the clinical ladder program, using mentors to assist and encourage use of EBP, and to provide more training and education opportunities for nurses.Item The role of the doctorate prepared nurse practitioner in medical surge policy development and revision(Montana State University - Bozeman, College of Nursing, 2020) Dunshee, Chelsea Jean; Chairperson, Graduate Committee: Casey ColeDisasters and mass casualty events pose significant challenges to healthcare facilities. It is imperative as an organization to have a medical surge policy in place should a sudden influx in patients occur. Proper policy planning is required to ensure the policy in place works sufficiently to meet the healthcare organization's needs. The purpose of this project was to define the role of the Doctorate prepared Nurse Practitioner (DNP) in the medical surge policy development and revision process. This was accomplished by leading a quality and performance improvement project workgroup after performing a review of current literature and a Root Cause Analysis of a recent mass casualty patient surge incident at the organization. The results show that the role of the DNP as it relates to medical surge policy revision are to: (a) analyze policy processes and lead development and implementation of policies, (b) influence policy making process through participation on committees and educating policymakers on nursing processes, policy, and patient outcomes, and (c) act as a change agent and stakeholder. All recommendations made to improve the medical surge policy by the DNP student were accepted and utilized in the acting organizational EOP.Item Pain assessment tools for the nonverbal critical care adult: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2019) Creek, Tami Julianne; Chairperson, Graduate Committee: Susan RaphPatients in critical care often lack the ability to report the presence of pain due to conditions such as altered levels of consciousness, sedation, and endotracheal tubes. Untreated or poorly managed pain may lead to adverse psychological sequelae, a longer duration of mechanical ventilation, and an increased risk of infection. Several behavioral pain assessment tools are available to clinicians to improve their ability to detect the presence of pain. A large intensive care unit in the Northwest lacks a pain instrument for the assessment of pain in adult, non-verbal patients. An integrative review of the literature was performed from the years 2012-2017 to identify evidence-based pain instruments available for use in this population. Nine instruments were identified representing ten behavioral pain assessment tools. The Joanna Briggs Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework was utilized to determine the best instrument for implementation into a general intensive care unit. Based on the FAME criteria, the Critical Care Pain Observation (CPOT) is recommended for implementation for non-verbal patients in a general critical care unit.Item Outcomes of a quality improvement project: integrating sepsis bundles in the rural emergency department(Montana State University - Bozeman, College of Nursing, 2019) Popp, Kierston Christian; Chairperson, Graduate Committee: Casey ColeBACKGROUND: Rural hospitals have a poor adherence to the Surviving Sepsis Campaign guidelines, which includes door-to-antibiotic administration times under 60 minutes leading to a higher risk of mortality (Mohr et al., 2018). The aim of this project was to improve door-to-antibiotic times through the implementation of a sepsis bundle, which would place all necessary orders together. The project was set in a rural emergency department in southwestern Montana. Participants included provider staff at the facility including family nurse practitioners, physician assistants, and medical doctors. METHODS: The FADE (focus, analyze, develop, execute, and evaluate) method of quality improvement was used for this project. Baseline assessment included a review of patient medical records who met sepsis criteria from January-June 2017. Antibiotic administration times were reviewed using data collection from the patient charts. A literature review was conducted to identify appropriate sepsis bundle implementation interventions. INTERVENTIONS: Sepsis bundles were introduced to the provider staff through education and meetings to aid in identifying the need for sepsis bundles in the emergency department. Baseline times were also presented to the staff to provide evidence that the current practices were not meeting goals. A sepsis bundle was chosen by the medical director and the Doctor of Nursing Practice (DNP) student that fit best with the resources available in the emergency department. RESULTS: Three months after the implementation of sepsis bundles, a chart review was performed on all patients that met sepsis criteria. Again, door-to-antibiotic administration times was reviewed. Door-to-antibiotic administration times improved by 40.5 minutes, which is a 22 percent improvement. CONCLUSION: The use of sepsis bundles in the care of the septic patient improved door-to-antibiotic administration times. Although improvement in the quality improvement measures was noted, additional work is needed to achieve Surviving Sepsis Campaign's goal of door-to-antibiotic times of under 60 minutes.Item Design of a primary care advanced practice nursing fellowship(Montana State University - Bozeman, College of Nursing, 2019) Weber, Anna Katherine; Chairperson, Graduate Committee: Jennifer SofieNew graduate nurse practitioners (NPs) can find the transition between student and independent practitioner to be difficult. Residency and fellowship programs are becoming a popular option to help support NPs with this transition. The Institute of Medicine has called for support through residency and fellowship programs. These programs have shown positive outcomes including increased job satisfaction, retention, positive patient outcomes, and increased interprofessional collaboration. A hospital located in the northwestern United States is struggling with NP satisfaction and retention. Purpose: A graduate scholarly project was initiated to design a fellowship for NPs in the primary care setting in response to this problem. Methods: The American Nurses Credentialing Center Standards, National Nurse Practitioner Residency and Fellowship Training Consortium Standards, a current program at the Carolinas HealthCare System, and the National Organization of Nurse Practitioner Faculties Competency areas was used as a foundation to the design. Guidance used was Benner's Novice to Expert Theory. Results: A twelve-month program was designed that includes didactic learning sessions, primary care clinical experience, specialty area clinical experience, interprofessional teamwork, and structured evaluation. Intended outcomes of the project for the sponsoring organization are 1) retention of NPs for twelve months after completion of the program and 2) increased employee satisfaction. The graduate nursing student concluded that more input from current programs and increased participation from the sponsoring organization would have made this project more successful. Further research into the best practice for evaluation tools for personnel and participants in these types of programs would also strengthen the design. Foundation based on current accreditation standards helps to strengthen this design.Item Alarm management on an inpatient surgical unit(Montana State University - Bozeman, College of Nursing, 2016) Whiteley, Rhyana Rose; Chairperson, Graduate Committee: Elizabeth S. KinionAlarm fatigue is a rapidly growing problem in hospitals across the nation, contributing to missed care opportunities and patient safety events. The purpose of the improvement project was to refine the use of audible alarms on an inpatient surgical unit by decreasing the frequency of false and non-actionable alarms, in turn decreasing clinician alarm fatigue and, ultimately, improving patient safety. The biggest culprit of false alarms we found on this type of unit that is of particular concern is the pulse oximetry alarm. Evidence from the literature indicated that capnography was superior to pulse oximetry in the detection of respiratory depression. Although capnography monitoring equipment was available, the current policy on monitoring patients post-operatively at the community hospital in Montana required the use of pulse oximetry and did not include the use of capnography. After determining that there was a gap in practice, an evidence-based practice project was implemented to include the use of capnography for monitoring patients post-operatively. By ensuring that audible alarms are specific to the patient condition, decreasing the frequency of false and non-actionable alarms, alarm fatigue should be lessened. Two policies were put in place that included the use of capnography, one directed at the monitoring of patients using patient-controlled analgesia and one directed at the monitoring of all high-risk patients receiving opioid analgesia. Education of staff regarding the practice change was multi-faceted and included both in-person and online education of the policy changes and both the cognitive and psychomotor aspects on the use of capnography. Additionally, competency validation was assessed in both the cognitive and psychomotor domains. Full assessment of the results of the practice change will take place in 2017.Item The views of a group of adolescents concerning their hospital experiences in one Montana community(Montana State College, Division of Professional Schools, 1963) Donohue, Susan; Chairperson, Graduate Committee: Eleanore L. ModeThe primary purposes of this study were to determine the views of a selected group of adolescents towards their hospital experiences and obtain information from this group concerning their illnesses or injuries. The study was based on a survey conducted by interviewing a selected sample of adolescents between the ages of twelve and seventeen years. The majority of the adolescents indicated that they did not mind being hospitalized and viewed their hospitalization experiences as 'an experience.' The statistical analysis of the data revealed significant results in the answers to the majority of the questions asked but that there was no significant difference among the responses of the boys and girls.Item A study of the common task requirements of the head nurse position in one Montana hospital(Montana State University - Bozeman, 1965) Cic, Mary Vianney, Sister; Chairperson, Graduate Committee: Laura Walker
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