Theses and Dissertations at Montana State University (MSU)
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Item Increasing patient support for chronic heart failure self-management through structured telephone support: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Pursell, Melissa Zoe; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Chronic heart failure (CHF) affects an estimated 6.2 million Americans and is the leading cause of hospitalization in adults older than 65 in the U.S. and has the highest 30- day readmission rate among all surgical and medical conditions. Experts suggest nearly 25% of these readmissions are preventable. Problem: A clinic in northwest Montana has a higher than the national CHF readmission rate. The clinic follows current guidelines for post-hospitalization follow-up. Evidence shows supplementing usual care with structured telephone support (STS) is an effective method for decreasing readmission rates. Methods: All CHF patients of the clinic are called within three days of hospital discharge to be enrolled into the STS program. The Care Coordinator calls the CHF patients twice weekly using the STS template to provide support for CHF self-management. The content of each biweekly call is documented using the STS template. Results: No patients were enrolled in the STS program during the eight-week QI implementation period. Two CHF patients were discharged but were not enrolled into the program for various reasons. Discussion: Inconclusive results related to insufficient data does not inherently mean this project provides no value. Recommendations were derived from the results of this QI project that may be useful for future STS QI projects. This project revealed that not all recently discharged CHF patients are good candidates for STS and the importance of developing candidate inclusion criteria.Item Getting fixed : perceptions of rural and urban patients who have experienced total knee or hip replacement surgery and their discharge planners in a Montana hospital(Montana State University - Bozeman, College of Nursing, 1991) McIntosh, Allison MarieItem What are the attitudes of nurses employed by small, rural hospitals toward discharge planning?(Montana State University - Bozeman, College of Nursing, 1983) Sorenson, Dianna Lee SpiesItem Home care follow-up for people with heart failure(Montana State University - Bozeman, College of Nursing, 2011) Sisk, Carol Kittrell; Chairperson, Graduate Committee: Elizabeth S. KinionHeart failure (HF) is a major health problem in the United States and is one whose prevalence is steadily on the rise. For people over the age of 65 years it is the most common reason for hospital admission and many of these people have to be readmitted to the hospital because of HF exacerbations. Follow-up care by professional nurses in the immediate time period after hospital discharge to home is limited despite suggestions from research studies that it may be helpful in decreasing the occurrence of exacerbations from HF, and thus decrease rehospitalizations. This project was developed with the support of a local physician with the purpose of investigating the needs of HF patients after they had been discharged from the hospital. Part one of the project involved a literature review centered on the topic of home care follow-up for this population. Part two of the project was the collection of data obtained during home visits by the author with the participants. The third part of the project included the compilation of results. Of the five participants taking part in this project the two with the least amount or no supportive care had unanswered questions and voiced some lack of confidence in their ability to take care of their needs. The other three participants were comfortable that their needs would be met by the supportive care providers who were involved with their care. The findings from this project would suggest that patients with HF may not have their needs totally met by the time they are discharged from the hospital. Each patient will have individual variation in their needs. A post hospitalization phone call or home visit from a professional nurse may provide an opportunity for clarification of symptom management.Item Satisfaction determinants : parents with children admitted to an adult inpatient surgical unit(Montana State University - Bozeman, College of Nursing, 2006) Dosier, Sharla June; Chairperson, Graduate Committee: Karen ZulkowskiWith the recent movement in healthcare to view the patient as a consumer, it has been recognized that patient satisfaction is an essential measurement of high quality healthcare. For populations of patients that have difficulty speaking for themselves, such as pediatrics, assessing the parent guardian satisfaction becomes essential. Rural areas face unique challenges with pediatric care including long distances from home to a healthcare facility and lack of specialized care. The causal model is used for the theoretical framework, which states that there are two factors that directly influence patient satisfaction. These are process quality and clinical quality. Demographic factors are also included because there is conflicting information of the correlation between demographics and satisfaction. There is little known about the factors that contribute to high levels of satisfaction in the pediatric population. The purpose of this study is to understand what factors play the greatest role in directly influence satisfaction of parents whose children are hospitalized. Specifically, the relationship between overall satisfaction and parent demographics, process quality and clinical quality were explored. The study is a descriptive correlational study with a non-random, convenience sample of parents whose children are admitted to adult in-patient surgical unit during an eight week period of time. The parents filled out a Pediatric Family Satisfaction Questionnaire (PFSQ) at the time of discharge. The total sample size was 13 with a 77% response rate. Overall, the satisfaction scores were very high. Correlations could not be established due to the lack of variability in certain factors. The study did reveal trends that are consistent with findings of previous studies. These trends include the reluctance to be critical of healthcare, higher satisfaction scores with lower levels of education and higher satisfaction with process quality.