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 follow up for postpartum women at a rural critical access hospital: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Crane, Alicia Lynn; Chairperson, Graduate Committee: Stacy Stellflug; This is a manuscript style paper that includes co-authored chapters.Background: Approximately 800 U.S. women die annually from pregnancy-related complications according to Croke (2019) and at least 60% of these deaths are considered preventable. Critical access hospitals and rural healthcare facilities are under-resourced causing healthcare disparities for rural populations. Closing the gap by initiating contact with postpartum women will help ensure postpartum appointments are made and patients do not slip through the cracks. In April 2018, The American College of Obstetrics and Gynecology (ACOG) recommended 12 weeks of support with the first postpartum evaluation within the first 3 weeks after delivery in-person or by phone with a comprehensive visit scheduled no later than 12 weeks (Lopez-Gonzalez & Kopparapu, 2022). Local Problem: The United States has a maternal death rate higher than any other developed country. Montana has the 6th highest rate of maternal deaths in the U.S. (Glover, 2021). In critical access hospitals obstetric outcomes are worse than those at high-volume hospitals and rural populations have a 9% greater probability of severe maternal morbidity and mortality (Woo & Glover, 2021). Methods: This quality improvement project will follow the Iowa model of evidence-based practice to promote excellence in healthcare. Intervention: Two follow-up calls after discharge from delivery, one at 72 hours and one at 7 days post-discharge. Results: The 72-hour call was completed 100% of the time, with all three women receiving the initial call. The seven-day call was completed 66% of the time, with only two women receiving the second call. Follow-up appointments were in place for each participant by the second discharge call, meeting the goal of 100%. Conclusions: The results of this project aligned with the literature with improved patient and provider satisfaction, early identification of patient needs for follow-up, and the use of phone calls provided an ideal alternative to increase accessibility and improve maternal outcomes with the advantages of flexibility, individualized care, and privacy.Item Implementing birth trauma screening at the post-partum appointment: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Milam, Kelsey Rene; Chairperson, Graduate Committee: Margaret HammerslaBirthing individuals perceive their birth experience as a traumatic experience in 30-45% of births. This can lead to negative consequences such as increased maternal stress, fears of subsequent pregnancies, and impaired infant bonding. Post-Partum Post Traumatic Stress Disorder (PP-PTSD) after childbirth is a significant clinical problem, as 4-9% of birthing individuals develop it. In order to prevent and reduce the negative impacts of traumatic births, perinatal providers can implement birth trauma screening into their assessments of perinatal mood disorders, increasing the identification and implementation of treatment. An Ob/Gyn clinic in Southwestern Montana sought to improve the identification of birth trauma in their population, as they relied on the patient to self-report concerns and post-traumatic symptoms. The Iowa Model of Evidence-Based Practice informed the implementation of birth trauma screening at the 2-week post-partum appointments over a 3-week period. At the 2-week post-partum appointment, birth trauma screening was implemented by the RN using the first two questions of the City Birth Trauma Scale (CBTS). If the patient screened positive, they were given a counseling referral and supportive education from the RN. The electronic health record (EHR) was modified for documentation. 37 patients attended a 2-week post-partum appointment. 37.84% received birth trauma screening. Of the patients screened, 100% received correct documentation of screening in the EHR. 14.29% screened positive for birth trauma. 100% of positive screens received an offer for a counseling referral and 50% attended that appointment. This project was effective at increasing the screening rate of birth trauma in birthing individuals and provided increased access to counseling and education on this topic to every patient screened, regardless of the result. By including involvement of Ob/Gyn providers, nursing staff and mental health clinicians in the development of this project, allowed for an increased knowledge base of this clinical issue, leading to increased commitment for the early identification of birth trauma for this organization.Item Screening for perinatal mood and anxiety disorders during well-child appointments: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Buscher, Jennifer; Chairperson, Graduate Committee: Christina BorstPerinatal mood and anxiety disorders (PMADs) are prevalent among birthing individuals. Conversely, PMAD screening rates are insufficient to support assessment, making PMADs the most underdiagnosed obstetrical complication in the United States. This quality improvement project aimed to improve PMAD screening and referral rates within one pediatric clinic. Prior to implementation, the pediatric clinic was screening with the PHQ-2 at 2-month well child checks. The purpose of this initiative was to update the clinic's screening process to align with current clinical practice guidelines as outlined by the American Academy of Pediatrics. The Edinburgh Postnatal Depression Scale (EPDS) was provided to birthing individuals at each 2-week, 2- month, 4-month, and 6-month well-child check appointment. Individuals who screened positive were provided with follow-up support. Over six weeks 152 birthing individuals were present for 2-week, 2-mo, 4-mo, and 6-mo well-child check appointments. Among these women, 129 (85%) were screened with the EPDS. Among those individuals, 14 (11%) had a positive score. Among the positive scores, 8 (57%) were addressed for follow-up recommendations. When following clinical practice guidelines, more birthing individuals were screened for PMADs and referred for follow-up support as compared to the previous screening intervention used by the pediatric clinic which was misaligned with clinical practice guidelines. This quality improvement project effectively increased PMAD screening rates and amplified awareness of the topic. Additional PDSA cycles are recommended to bolster adequate follow-up among individuals scoring positive.Item Standardizing lactation education for home visiting staff to improve breastfeeding duration rates(Montana State University - Bozeman, College of Nursing, 2020) Reed, Samantha Alicia; Chairperson, Graduate Committee: Angela JukkalaBreastfeeding has been shown to improve short-and long-term health outcomes to both mother and child. Health departments are in a unique role to provide community level support in breastfeeding. Gallatin-City County Health Department provides breastfeeding support through multiple programs within the community, including maternal child health home visiting. Based on a recent survey, results showed that half of home visitors did not feel confident in educating prenatal clients on breastfeeding. In addition to this, home visitors did not feel they were providing the same education on breastfeeding. Stemming from this, the need for a standardized lactation curriculum was researched. Ready, Set, Baby is an evidence-based standardized curriculum that increases a mother's knowledge of breastfeeding benefits and practices. This scholarly project examines home visiting staff education on Ready, Set, Baby curriculum, improved breastfeeding education with home visiting families, and improved breastfeeding duration rates.Item Penetrating the undercurrent(Montana State University - Bozeman, College of Arts & Architecture, 1991) Harvey, Katie McLeodImmediately visible is raw swirling paint and vigorous markmaking depicting images which resemble nests, whirlwinds, spirals and vortexes. The images I use represent personal symbols and interact, sometimes with long sweeping amorphous shapes and spherical masses. My color is intuitive and often muted. My art alludes to a darkened inner-world space. Although dark, this place is not still. Images spin and collide. Energy is wound in coils of paint and surface markings. A visible struggle occurs when combining these images, which exude such different energy and directional forces. This provides an ambivalent and turbulent relation to space. These images appear to want to break out of the limitations of the surface and framework.Item Locus of control in abusive/neglective mothers and abused/neglected children(Montana State University - Bozeman, College of Nursing, 1979) Jones, Susan Ann