Theses and Dissertations at Montana State University (MSU)
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Item Perceptions of the nurse practitioner in the hosptial setting(Montana State University - Bozeman, College of Nursing, 2020) Cunningham, Marji Rae; Chairperson, Graduate Committee: Polly PetersenThe practice of nurse practitioners (NPs) has evolved over the last 60 years. This evolution has taken the NP from practicing mainly in a family-practice setting into various other settings such as the hospital environment. The knowledge and associated role of the NP is often confusing for healthcare professionals. The purpose of this project was to gain insight from Medical Doctors (MDs) and Doctors of Osteopathy (DOs) regarding their perception of NP scope of practice, educational background, and appropriate utilization in the hospitalist's position. A Likert-scale questionnaire was deployed to MD and DO providers from two different facility types in central and eastern Montana using a snowball sampling method. The two facility types were hospitals that currently utilize NPs in their inpatient settings and hospitals that do not utilize NPs in their inpatient settings in Montana. A total of 51 questionnaires were sent out with a response rate of 47%. Along with demographic data, the questionnaire included three umbrella themes: MDs'/DOs' perceptions regarding the NPs' educational background, NPs' scope of practice, and the utilization of NPs in a hospital setting. The results from the questionnaire suggest that MDs/DOs do not understand the differing roles or educational processes of the APRN, specifically the Family Nurse Practitioner (FNP) versus the Acute Care Nurse Practitioner (ACNP). The results also showed strong support by MDs/DOs for the NP to work in a hospital setting, especially in urban areas. These findings support the need for changes in organizational hiring and regulatory policy consistent with independent state APRN practice regulations and the LACE Consensus Model. Enhancing hiring practices can lead to increased educational opportunities for MDs/DOs regarding the various APRN roles, afford an organization the opportunity to hire an APRN that is appropriately licensed to work in a hospital setting, and provide clarity between the FNP and ACNP roles.Item Translating prenatal oral health guidelines into obstetric practice, a practice change project(Montana State University - Bozeman, College of Nursing, 2017) Martin, Terryn Lynn; Chairperson, Graduate Committee: Elizabeth S. KinionEarly childhood caries (ECC) is prevalent and burdensome to a child's quality of life and development, albeit preventable. ECC prevention strategies implemented in the prenatal period are well supported by evidence to reduce ECC incidence and dictated in numerous prenatal oral health guidelines. However, obstetric (OB) providers do not often practice this evidence. The purpose of this project was to assess, plan, implement, and evaluate the introduction of prenatal oral health practices, that coincide with current prenatal oral health guidelines, to OB providers at one OB clinic. To do so, current prenatal oral health guidelines were evaluated and coalesced to form of a prenatal oral health protocol (POHP). Two OB provider and medical assistant (MA) pairs implemented the POHP over a 90-day implementation period in one OB clinic. Lewin's Change Theory guided the practice change process. To determine if, by implementing the POHP, the prenatal oral health practices of participating OB providers were significantly improved, before and after patient's charts were reviewed and data measuring provision of oral health practices were compared using a permutation test. It was also planned to measure dental attendance. A written survey was given to participating OB providers and MAs at the end of the project to gain their perspective on the practice change process and likelihood of sustainability. The results show that significantly more patients had documentation of prenatal oral health education (p<.0002, 95% CI 0.476-0.857), oral screening questions (p<.0002, 95% CI 0.857-1), and an oral screening exam (p<.0002, 95% CI 0.619-0.952) after the POHP was implemented than before. A dental referral was not made, thus it is unknown how many patients, in receiving a dental referral, would have attended the dentist at some point during pregnancy. Four out of 17 patients, correctly screened, should have received a dental referral based on the POHP, but did not. The survey showed favorable views of the practice change process and likelihood of sustainability. In conclusion, prenatal oral health practices can be incorporated into the practice of OB providers using a POHP, an appropriate implementation period, and a practice change process guided by Lewin's Change Theory.Item Complementary and allopathic approaches to health care : otitis media as exemplar(Montana State University - Bozeman, College of Nursing, 1996) Turnbull, Teresa S.; Chairperson, Graduate Committee: Doris HensonItem Health care providers perspectives on social media in professional practice(Montana State University - Bozeman, College of Nursing, 2013) Dixon, LaNora Bellamy; Chairperson, Graduate Committee: Laura LarssonCommunication technology evolution including social media (SMT) is creating challenges and opportunities in health care delivery, the impact of which is not fully understood in the health care arena. While consumer utilization studies are ongoing, a paucity of published literature exists to study health care provider's perceptions of the significance of these changes. The purpose of this research was to quantify health care provider's familiarity, utilization of SMT, and perceptions of benefits and barriers to use in professional practice. This was a non-experimental descriptive phenomenological study. The study population (n=310) included health care providers (M.D., D..O., ND, NP, PA) employed with a regional, Western health care system. This study was conducted using a concurrent, mixed-methods approach. A validated survey, developed using Pender's Health Promotion Model, was distributed to the target population by the organization's Nursing Research Council (NRC). Response rate was 20% with an age range of 27-70 years. Gender included females (50.8%) and males (49.2%). Tenure in practice included < 5 years (16.9%), 5-10 years (15.3%), 10-20 years (30.5%), and 20 + years (37.3%). Respondents were primarily M.Ds (62.7%), followed by D.O. (1.7%), N.D. (1.7%), NPs (16.9%), and PAs (16.9%). Familiarity with the term "social media" was 95% with personal account ownership (62.7%). Utilization of SMT in practice varied by application with 78.7% indicating no current use followed by health education (13.1%), practice promotion (6.6%), scheduling and appointment reminders by text (4.9%), interactive patient communities (4.9%), and patient self-management tools (1.6%). Smartphone utilization was 98.3% with 69.5% accessing health care applications. Sixty one percent perceived benefit of SMT in improving patient care, but 53% disagreed or strongly disagreed with benefit for clinical decision-making. Predominant barriers to SMT in practice included: uncertainty of legal implications, time commitment to monitor, and patient/provider confidentiality concerns. Power-users were younger, were 4 times more likely to utilize smartphones to access health care related applications, 3.4 times more interested in SMT benefits, and 3.5 times more likely to anticipate future SMT use in practice. SMT may be most useful as a complement to traditional delivery modalities.Item Cultural considerations at the end of life : communication of helathcare providers with Native American patients(Montana State University - Bozeman, College of Nursing, 2012) Hunsucker, Heidi Lynn; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughThe purpose of this project was to provide information to non-Native-American healthcare providers to help enhance their communication with Native-American patients at the end of life. The end of life can be a distressing time for patients, families, and healthcare providers alike. Cultural differences which may exist among these groups can make the transition even more difficult. Communication may be hindered due to misunderstandings or unclear expectations. This project was an extension of a study focusing on an Indian reservation in north central Montana which identified several areas to focus on for improving end-of-life care including educating the patients and families about palliative care options, helping healthcare providers become more culturally sensitive, and creating a culturally appropriate and sensitive end-of-life program. A pamphlet was developed based on the findings of a literature review and information from a cultural expert to help healthcare providers identify and address communication issues at the end of life. The pamphlet addressed communication issues between non-Native-American healthcare providers and Native-American patients. Madeleine Leininger's Theory of Culture Care Diversity and Universality was used to guide the project, and a modified Delphi method was used to help create a culturally appropriate pamphlet for non-Native-American healthcare providers. By understanding their own cultural influences and taking the time to understand and respect the cultural influences of their patients, healthcare providers can provide quality end-of-life care. Communication at the end of life can be enhanced by recognizing that culture may confound understandings and expectations, and addressing that factor can help remove barriers from quality care. This pamphlet will serve as a device to help prepare APNs for the barriers they may encounter when working with patients from not only the individual tribe in north central Montana, but also to make them aware of the fact that cultural barriers exist among different cultures. Perhaps making APNs aware of the cultural differences will open the way for increasing research about different cultures in the future. APNs should enter into every patient encounter with the knowledge that there are things they can learn from their patient to better provide effective care.