Theses and Dissertations at Montana State University (MSU)
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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 The role of hemoglobin A1c testing in undiagnosed diabetes and myocardial infarction in emergency and intensive care settings(Montana State University - Bozeman, College of Nursing, 2018) Nicola, Marcus; Chairperson, Graduate Committee: Teresa SerightStatement of the Problem: The disease of diabetes is insidious. Its complications can be devastating and, if left untreated, often leads to early mortality. With the effects of diabetes being so extensive within body systems, complications like myocardial infarction are all too common. To complicate the matter further, a large portion of the population of diabetics is undiagnosed. Having no knowledge of this disease process allows the disease to progress unfettered for an indeterminate amount of time. If diabetic status is unknown, an increased risk of mortality from MI exists. Systematic Hgb A1C testing for myocardial infarction patients may provide prognostic data for undiagnosed diabetics and increase our ability, as providers, to develop treatment plans to address the increased risk of mortality posed to these individuals. Methods: All MI patients admitted to ED and ICU charts were screened for hemoglobin A1C testing and diabetic care planning as evidenced in their discharge summary. Results: This project found that testing with Hgb A1C only occurred in 40% of MI patients. Of those tested, 8% were found to be new diabetics. This project also found that 16.3% of the patients tested were pre-diabetic and that this was only noted in 1.8% of these patients' discharge summaries. Conclusions: Currently, Hgb A1C testing is underutilized in MI patients. Identification of new diabetics in this population allows providers to address this diagnosis in a manner that can prevent the complications all too common to diabetics with heart disease.Item The perceived and actual diabetes knowledge of registered nurses in Montana's critical access hospitals(Montana State University - Bozeman, College of Nursing, 2003) Reichelt, Connie SueItem The effect of earplugs on perceived sleep quality of acute care patients(Montana State University - Bozeman, College of Nursing, 2008) Martin, Kristy Ann; Chairperson, Graduate Committee: Susan LuparellThe purpose of this study was to evaluate the use of earplugs to improve perceived sleep quality in hospitalized patients. Sleep disruption is a common problem for hospitalized patients and has been shown to lead to physical and emotional complications. A variety of factors such as pain, illness, stress, worry, noise, lights and patient care activities contribute to disturbed sleep. Studies on sound in hospitals have shown that levels exceed recommendations by the Environmental Protection Agency. Limited research has shown that earplugs are a cost-effective, nonpharmacologic intervention with clinical usefulness to improve sleep quality. The study design was a quasi-experimental pilot study using a pre-test and post-test with the participants serving as their own control. Participants were recruited from a telemetry unit at St. Vincent Healthcare in Billings, Montana. The Verran and Snyder-Halpern Sleep Scales were selected to measure sleep quality. Ten participants were able to complete the two nights of study. The proposed hypothesis was supported for the sleep characteristic, soundness of sleep, with an improvement greater than 15 mm on the night with the ear plugs. Subjective findings identified positive comments with only one participant unable to tolerate the earplugs. The improvement in sleep was clinically significant for these participants. Hospitals should consider creating a sleep promotion policy and re-evaluating their night care practices. Earplugs could be included as an option for patients, and patients experiencing sleep difficulties should be encouraged to try earplugs. Further research is needed with a variety of populations and a large sample size. Research should also be done on nurses' knowledge and beliefs regarding sleep and sleep interventions. This information could provide useful information on areas where additional education is needed.