Theses and Dissertations at Montana State University (MSU)
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Item Transportation of ST-segment elevated myocardial infarctions in rural Montana to percutaneous coronary intervention capable medical centers and achievement of goal treatment times(Montana State University - Bozeman, College of Nursing, 2019) Bothman, Nicole M.; Chairperson, Graduate Committee: Casey ColeBackground: Rapid reperfusion via primary percutaneous coronary intervention or thrombolytic therapy is critical to limit death and disability associated with ST-elevated myocardial infarction. However, the majority of Montanans reside in rural areas and require time consuming interfacility transportation for specialized cardiac care. Purpose: The aim of this scholarly project is to analyze the treatment and transfer process of adult patients experiencing a ST-elevated myocardial infarction with initial presentation to a rural medical facility requiring interfacility transfer for specialized cardiac care to generate quality improvement recommendations for changes in the care and transfer process to decrease door-to-needle, door-to-door, and door-to-balloon times among this patient population. Sample: Subjects were adults (18 years of age and older) diagnosed with a ST-elevated myocardial infarction at a rural medical facility and transferred to the nearest STEMI receiving medical facility for specialized cardiac services. Subjects transferred for primary PCI and post thrombolytic therapy were included in this project (n = 8). Methods: Retrospective data analysis of deidentified quality metric data was utilized to examine if treatment benchmarks set forth by the American Heart Association were met during the data collection period of January 2018 through September 2018. A voluntary survey was implemented at the rural medical facility to provide supplementary and clarifying information related to the treatment and coordination of transportation of ST-elevated myocardial infarction cases from February 2018 through August 2018 (n=3). Conclusions: Of the eight cases reviewed in this project, none met all of the applicable quality metric benchmarks; all eight met the door-to-ECG benchmark, one met the door-to-needle benchmark, none met door-to-door or door-to-balloon benchmarks. Providers in rural areas can provide quality care with positive clinical outcomes among ST-elevated myocardial infarction patients though adherence to treatment guidelines and working as a collaborative team with transporting agencies to facilitate rapid interfacility transportation (American Heart Association, 2015; National Clinical Guideline Centre, 2013).Item An integrative review of utilizing mutual goal setting with the elective coronary artery bypass graft patient to improve postoperative physiotherapy adherence(Montana State University - Bozeman, College of Nursing, 2018) Funderburk, Courtney Lee; Chairperson, Graduate Committee: Charlene WintersThe purpose of this integrative literature review was to determine if mutual goal setting improved postoperative adherence to physiotherapy in adult patients undergoing elective coronary artery bypass graft (CABG) surgery. The integrative review was conducted using the methodology outlined by Whittemore and Knafl (2005). Literature was gathered by searching databases with key search terms related to physiotherapy adherence and goal setting. A review of abstracts and full-text using inclusion and exclusion criteria was conducted to determine which reports to include in the review. There no reports or studies that discussed the effects of mutual goal setting on physiotherapy adherence in the adult elective CABG patient. Reports and studies that looked at the effects of mutual goal setting in patients with heart disease and patients in cardiac rehabilitation programs were analyzed. The results from those reports and studies were extrapolated and applied to the adult elective CABG patient on the basis that the groups share similar levels of anxiety and depression, which evidence has shown affects adherence to physiotherapy. The results were analyzed based on outcome measurement of adherence (objectively measured levels of adherence or subjectively reported by participants' perception of how adherent they were). Results were inconclusive, but most of the studies suggest that goal setting, used alone or in conjunction with other motivational techniques, can improve adherence to physiotherapy in heart disease patients.Item Prenatal breastfeeding education toolkit for baby-friendly hospitals(Montana State University - Bozeman, College of Nursing, 2017) Olivo, Elizabeth Ann; Chairperson, Graduate Committee: Maria WinesStudies suggest that approximately half of women do not meet their breastfeeding goal. The objectives of this study were to implement a prenatal breastfeeding education toolkit, assess prenatal breastfeeding goals, gauge breastfeeding goal attainment at 10 weeks postpartum, and evaluate patient variables that may impact goal attainment. The educational information was compiled into a toolkit and divided into three sections, one for each trimester. After completing at least one trimester of education, patients were then asked to fill out a survey on their breastfeeding goals. They were contacted by phone at approximately 10 weeks postpartum to assess how their breastfeeding was progressing and if they were still on track to meeting their goals. A total of 20 participants were included in data analysis. The reported goal duration of the whole cohort ranged from 16 weeks to two years with an average of approximately 50 weeks. The majority (75%) reported that they planned to breastfeed exclusively. At 10 weeks postpartum, 65% of subjects were on track to or had met their goal breastfeeding duration. Subsequently, 35% reported early cessation of breastfeeding prior to reaching their goal. Of the 15 participants who planned to breastfeed exclusively, only about half (53%) were still exclusively breastfeeding at the time of follow-up. Patients who planned to supplement with formula from an early stage were more than twice as likely (60%) to have early cessation of breastfeeding compared to those who planned to breastfeed exclusively (27%). The results of this study suggest that most women would like to breastfeed exclusively and for longer periods of time. Unfortunately, many continue to fall short of their goals. Planning to breastfeed exclusively appears to increase the mother's chance of reaching her goals at ten weeks postpartum. The literature has shown that prenatal education has a positive impact on breastfeeding rates. Unfortunately, due to time constraints, this study was unable to evaluate the impact of the entire prenatal breastfeeding education toolkit on breastfeeding goal attainment.