Theses and Dissertations at Montana State University (MSU)
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Item Store and forward wound teleconsultation in rural home health: a practice improvement project(Montana State University - Bozeman, College of Nursing, 2019) Roche, Rebecca Lynn; Chairperson, Graduate Committee: Susan RaphWound prevalence is increasing due to the aging demographics of the population and a rise in chronic diseases. Home health organizations face many challenges managing the rural home health patient with wounds as this population consumes a high number of resources and lacks access to wound experts. Store-and-forward (SAF) wound teleconsultation allows the home health patient to receive treatment recommendations from a wound expert using photographs taken by the home health nurse. The purpose of this practice improvement project was to explore patient, nurse, wound expert, and primary care provider satisfaction and perceived benefits of wound photography and SAF wound consultation in rural adult home health patients with wounds. Rozzano Locsin's Technological Competency as Caring in Nursing theory provided the guiding framework for this project. A standardized wound photography protocol utilizing the NE1 Tool was developed and implemented in a home health department as an adjunct to the weekly written assessment. One month later, three adult patients were recruited to a 12-week SAF wound consultation pilot using AthenaText application on mobile devices. Following the project period, a quantitative survey assessment of satisfaction and perceived benefits was conducted using three group-specific surveys. Seventeen participants completed the survey: (1) wound expert, (2) patients, (5) providers and (9) nurses. All groups reported moderately high satisfaction with photography and 100% indicated agreement that photographs should be a standard component of care. Additional perceived benefits were noted in communication and identifying wound changes. All participant groups were highly satisfied with SAF wound consultation. Patients and the wound expert rated SAF wound consultation the highest citing benefits of reduced travel and promotion of rapid changes in treatment. Patients reported SAF consultation was equivalent to clinic care; however, comments suggest home-based wound care is superior to clinic-care in cases of severe immobility and difficult to reach wounds. This project demonstrated high satisfaction and multidisciplinary benefits related to wound photography and SAF wound consultation in the rural home health population. Standardized wound photography and SAF consultation is a cost-efficient, feasible, and essential component of wound management that improves access to wound expertise in the rural home health setting.Item Emergency telehealth use in Montana(Montana State University - Bozeman, College of Nursing, 2016) Beck, Kristen Staley; Chairperson, Graduate Committee: Charlene WintersOver 75% of Montana's population resides in rural or frontier areas which often lack access to high quality emergency care services and/or specialty expertise found at larger hospitals. Specifically, rural emergency patients have disproportionately higher morbidity and mortality than their urban counterparts due to increased distance to hospitals, lack of specialty resources, and decreased encounters with such patients. Emergency telehealth has come to the forefront in delivering high quality emergency care for rural patients. Because other rural states have successfully implemented emergency telehealth, it is pertinent to know how Montana is utilizing this technology. The purpose of this project was to document the use of emergency telehealth in Montana and to identify perceived barriers to implementation and sustainability of emergency telehealth. A 26 question survey regarding telehealth use and its associated barriers was emailed to all hospitals within the state. Results indicated that Montana is in line with national use standards as 88% of respondents reported using at least one telehealth service. Emergency telehealth is the second most utilized service after in-house education in Montana's critical access hospitals with a large projected growth in other critical care areas such as stroke, intensive care unit, and burns. Top perceived barriers to implementation and sustainability of telehealth services were lack of specialist availability and provider buy-in. Furthermore, the most concerning regulatory barrier to telehealth use was government reimbursement. Such findings warrant further investigation and state-specific initiatives to promote emergency telehealth use and continued success. Because of the critical benefits of this technology and the high demand for services, it is evident that continued development and access to emergency telehealth services is imperative for rural Montanans.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 SIERRA : an octree-based spatial data system for neural data(Montana State University - Bozeman, College of Engineering, 1998) Glassy, LouisItem Health care providers perspectives on social media in professional practice(Montana State University - Bozeman, College of Nursing, 2013) Dixon, LaNora Bellamy; Chairperson, Graduate Committee: Laura LarssonCommunication technology evolution including social media (SMT) is creating challenges and opportunities in health care delivery, the impact of which is not fully understood in the health care arena. While consumer utilization studies are ongoing, a paucity of published literature exists to study health care provider's perceptions of the significance of these changes. The purpose of this research was to quantify health care provider's familiarity, utilization of SMT, and perceptions of benefits and barriers to use in professional practice. This was a non-experimental descriptive phenomenological study. The study population (n=310) included health care providers (M.D., D..O., ND, NP, PA) employed with a regional, Western health care system. This study was conducted using a concurrent, mixed-methods approach. A validated survey, developed using Pender's Health Promotion Model, was distributed to the target population by the organization's Nursing Research Council (NRC). Response rate was 20% with an age range of 27-70 years. Gender included females (50.8%) and males (49.2%). Tenure in practice included < 5 years (16.9%), 5-10 years (15.3%), 10-20 years (30.5%), and 20 + years (37.3%). Respondents were primarily M.Ds (62.7%), followed by D.O. (1.7%), N.D. (1.7%), NPs (16.9%), and PAs (16.9%). Familiarity with the term "social media" was 95% with personal account ownership (62.7%). Utilization of SMT in practice varied by application with 78.7% indicating no current use followed by health education (13.1%), practice promotion (6.6%), scheduling and appointment reminders by text (4.9%), interactive patient communities (4.9%), and patient self-management tools (1.6%). Smartphone utilization was 98.3% with 69.5% accessing health care applications. Sixty one percent perceived benefit of SMT in improving patient care, but 53% disagreed or strongly disagreed with benefit for clinical decision-making. Predominant barriers to SMT in practice included: uncertainty of legal implications, time commitment to monitor, and patient/provider confidentiality concerns. Power-users were younger, were 4 times more likely to utilize smartphones to access health care related applications, 3.4 times more interested in SMT benefits, and 3.5 times more likely to anticipate future SMT use in practice. SMT may be most useful as a complement to traditional delivery modalities.Item Electronic medical record implementation in nursing practice : a literature review of the factors of success(Montana State University - Bozeman, College of Nursing, 2009) Steiner, Bridget Anne; Chairperson, Graduate Committee: Christina SieloffThis is a review of the current literature to discern what factors need to be present in an electronic medical record (EMR) implementation in order for it to be successful for nurses. An extensive literature search was performed by using databases CINAHL, MEDLINE, and Health Reference Center for primary sources of research that specifically addressed EMR implementation and nursing. A coding scheme was developed and applied to each article for analysis. It was found that fit of the EMR with nurse functions, education, and positive nurse attitude were the three most common factors associated with successful EMR implementation for nurses. Lack of computer system quality, lack of fit of the EMR with nurse functions, and time requirements of its use were most commonly associated with lack of success.