Theses and Dissertations at Montana State University (MSU)
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Item Development and implementation of a new referral process and dot phrase technology for a rural medication therapy management program to improve patient safety(Montana State University - Bozeman, College of Nursing, 2023) Scott, Jonathan Muir; Chairperson, Graduate Committee: Margaret HammerslaNo medication or procedure will cure dementia, and most patients will experience behavioral and psychiatric symptoms as the disease progresses. Medications to treat the symptoms of dementia are complex. Medication therapy management is a patient-centered collaborative agreement between provider and pharmacist that has shown positive outcomes in reducing adverse drug reactions. In January 2021, an outpatient clinic in Southwest Montana implemented the Rural Access to a Psychiatric Pharmacist for Seniors (RAPPS), an MTM pilot program to address the complex medication-related problems of elderly dementia. During the RAPPS process, an internal review identified two major concerns: (1) clinical information being communicated from provider to pharmacist needs to be more consistent and (2) the current system lacks a clearly defined referral process. This ongoing process improvement project used four Plan-Do-Study-Act cycles to develop, implement, and evaluate the dot phrase. A dot phrase is a section of text to be inserted into an electronic health record progress note. The dot phrase's utilization was analyzed at three different timepoints over the project's 6-week implantation period. A five-question visual analog scale provider-satisfaction survey was developed to be conducted at the fourth PDSA cycle. Preliminary data collected from the electronic health record from November 2022 to December 2022 found that 45% of providers' notes at the time of referral did not document a psychiatric diagnosis, and 81% of the notes did not confirm or deny outside psychiatric management. The primary, secondary, and tertiary SMART goals were not met. The QI project encountered many unforeseen problems throughout this study. The preliminary data collected in this project demonstrated that documentation deficits are occurring between providers and the clinical pharmacist. As more and more of our medical information becomes digital, health professionals will require additional training to become proficient in using these systems. IT systems are complex and challenging, so future quality improvement projects should have a dedicated IT specialist on their team. For collaborative agreement programs to succeed, clear communication between all stakeholders must be championed. Future research should examine technologies that encourage interprofessional communication within electronic referral systems.Item Concurrent validity of dementia screening tools(Montana State University - Bozeman, College of Nursing, 2003) Benton, Don JamesItem Supporting caregivers through education on dementia(Montana State University - Bozeman, College of Nursing, 2011) Smith, Kammiell Marie; Chairperson, Graduate Committee: Elizabeth S. KinionDementia, a degenerative condition, is a progressive and debilitating disease evidenced by a decline in cognitive function affecting memory, communication, motor activity, and judgment. It is difficult for caregivers to cope with substantial changes in behavior, personality, and communication associated with this illness. Consequently, as the population ages the incidence of dementia will increase. It draws particular importance to the family caregiver role in maintaining the activities of daily care and managing unpredictable, progressive changes of the disease. Caregivers of persons with dementia take on a role that has considerable responsibility. Family caregivers also experience an added sense of duty that often leads to caregiver stress and burden. The purpose of this project was to develop an educational program. The program included a comprehensive literature review, input gathered from two assistive living homes and one senior center, and a one-hour educational presentation. The one hour educational presentation was presented at two assisted living homes and one senior center. Careful consideration was given to the aspects of stress and burden on family care givers of individuals with dementia. Psychosocial interventions, caregiver self-care, community resources, and interventions to assist with activities of daily living were also discussed. Content for the educational presentation addressed the following topics: signs and symptoms of dementia; interventions to assist with communication, behavioral and environmental management; and community resources to help with caregiver burden. Of the eight key lessons learned, two lessons are important to note. First, it is imperative to assess the emotional needs of the caregiver prior to the program development. Second, caregivers require an individualized approach to dealing with individuals with dementia. Important roles for Family Psychiatric Mental Health Nurse Practitioners (FPMHNP) are to provide anticipatory guidance to family caregivers about managing the changes in behavior, personality, and communication associated with dementia. They should also develop individualized, appropriately tailored, psychosocial interventions for the management of dementia. The FPMHNP is instrumental in assisting family caregivers with self-care management and providing information on community resources.Item Alternative therapies for individuals with Dementia(Montana State University - Bozeman, College of Nursing, 2008) Fahlquist, Jeannie Marlene; Chairperson, Graduate Committee: Nadine ParkerDementia is a chronic insidious disease that destroys the individual's cognitive, emotional and mental abilities. Ultimately, the individual is unable to appropriately verbalize basic wants and needs; therefore, behavioral symptoms become the way of communicating. Behavioral symptoms vary greatly from passivity to hostility and aggression. Unfortunately, due to the difficult task of caring for these individuals many families must place their loved ones in a long-term care facility for direct supervision. Long-term care facilities often use chemical restraints in order to treat the behavioral problems. Thus, with the use of pharmacologic restraints quality of care is diminished. This professional paper will discuss three alternative therapies that, through research studies, have been found to provide optimal quality of care for the individual with dementia. The three therapies that will be examined are Music Therapy, Snoezelen Therapy and Validation Therapy. These alternative therapies will be taught to staff in two nursing homes and one assisted living facility in a western community in Montana. The use of educational brochures and a multi sensory table will be used for the three in-services. There will be a telephone follow-up six months after the in-service to determine if any of the alternative therapies were used. The telephone follow-up revealed that there was a high degree of turnover with staff as well as administration. The results of the study established the need for ongoing in-services for alternative therapies due to the high turnover rate.