Theses and Dissertations at Montana State University (MSU)
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Item Pain management of buprenorphine patients in the perioperative setting(Montana State University - Bozeman, College of Nursing, 2024) Hildner, Kate Ella; Chairperson, Graduate Committee: Julie Ruff; This is a manuscript style paper that includes co-authored chapters.Background: Buprenorphine is an FDA-approved medication for the treatment of opioid use disorder and a useful tool in helping patients recover from opioid addiction. Due to the mechanism of action of buprenorphine on opioid receptors, treatment of acute pain in the perioperative setting can be challenging. Local problem: At the facility site, buprenorphine patients who present for surgery have a longer average length of stay in the post-anesthesia care unit (PACU). Nurses also expressed a need for further education and increased proficiency in caring for buprenorphine patients. Methods: The purpose of this project was to increase staff communication, provide specific education to staff about buprenorphine, and decrease the length of stay for buprenorphine patients in the PACU. Interventions: This project involved the implementation of three interventions. The first intervention involved adding chart documentation of buprenorphine status, allowing for notification to the operating room and PACU staff. The second intervention was the initiation of improved communication between the preoperative department and the PACU. The third intervention was an educational presentation and reference sheet that was provided to the PACU staff. Results: After implementation, 80% of buprenorphine patients had a note in their chart alerting the OR and PACU staff of their buprenorphine status, however direct communication between departments only occurred for 20% of patients. 100% of PACU staff nurses reported increased proficiency in caring for buprenorphine patients after education implementation. Conclusion: The QI project resulted in increased staff proficiency and interdepartmental communication, indicating improved care for buprenorphine patients in the perioperative setting.Item Quality improvement project: reducing operating room turnover time for robotic surgery(Montana State University - Bozeman, College of Nursing, 2024) Stier, Shelby Anne; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Background: Institutional goals for the Operating Room (OR) aim to decrease time between surgical cases to support surgical demand while improving revenue and profit. Turnover time (TOT), defined as the time between one patient exiting surgery to the time the next patient enters the room for surgery, is considered non-productive, thus a standard target for efficiency. Local Problem: Following TOT delays, surgeon time constraints, and staffing frustration, a Level III trauma center aimed to improve affordability and access within their OR. Methods: This quality improvement project implemented evidence-based practices, to create a sustainable decrease in TOT. This project utilized the Plan-Do-Study-Act method to engage stakeholders, implement best practices, and evaluate outcomes. Interventions: The project implemented role differentiation, parallel processing, and an assigned robot facilitator to achieve a 28-minute TOT. To accomplish this goal, we anticipated the primary nurse would retrieve the patient in the perioperative department 12 minutes after their return from PACU. Results: Prior to implementing the QI project, the OR's TOT averaged 34 minutes. Implementation of the evidence-based interventions resulted in an average TOT of 28 minutes. Conclusion: Results indicated the implementation of a secondary nurse with defined roles, along with adequate turnover assistance yielded an improvement in TOT. Staffing is a major contributor to implementing these changes and requires a motivated team to achieve positive outcomes.Item Optimizing preoperative nutrition using enhanced recovery from surgery (ERAS) guidelines to improve clinical outcomes for patients undergoing total joint replacement(Montana State University - Bozeman, College of Nursing, 2022) Deshner-Miller, Kertrina Rae; Chairperson, Graduate Committee: Denise RiveraSurgical site infection (SSI) following total joint arthroplasty (TJA) is one of the most frequently encountered hospital-acquired conditions. Consequently, as the largest population of people in the United States known as the 'baby boomers' continue to age, the need for TJA to treat arthritis is projected to grow exponentially as is the incidence of SSI. Evidence-based enhanced recovery after surgery (ERAS) guidelines have been shown to decrease the prevalence of postoperative complications, hospital length of stay, improve the patient's return to normal function, and quality of life. ERAS guidelines recommend screening for risk of malnutrition with referral to a registered dietician and consumption of a preoperative oral carbohydrate (POC) the night before and the day of surgery. Current research does not directly link the use of POC to decreased occurrence of SSI. It is hypothesized that implementing nutritional screening and POC will be associated with a decreased occurrence of postoperative SSI. The primary goal of this project is to build a consistent preoperative nutritional optimization program utilizing ERAS guidelines in the pre-anesthesia clinic (PAC) for patients aged 50-70 and scheduled for elective TJA.Item Promoting opioid stewardship in an orthopedic ambulatory surgery center: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Stromberg, Sara Elyse; Chairperson, Graduate Committee: Margaret HammerslaOverprescribing opioids poses a substantial risk to patients and communities as it may result in patients continuing to use or in-excess pills that can become diverted to others. Postoperative prescribing guidelines address the national epidemic at the local level by reducing the availability of opioids for nonmedical use. This project sought to align the postoperative discharge opioid prescribing practices of a small orthopedic ambulatory surgery center (ASC) in southwestern Montana with best practices. The evidence-based postoperative prescribing guidelines were pilot tested with a targeted surgical procedure over four weeks. Patients meeting inclusion criteria were prescribed an opioid pill quantity within the recommended amount was inconsistent, with the most adherence reaching 25%. Mechanisms within the electronic health record (EHR) system are recommended to improve adherence.Item Medication reconciliation in ambulatory surgery to prevent adverse drug events(Montana State University - Bozeman, College of Nursing, 2021) Marion, Kirsten Ayres; Chairperson, Graduate Committee: Amanda H. LucasAdverse drug events (ADEs) cause a significant burden to the healthcare system. Medication reconciliation (MR) is a well-documented method to reduce ADEs in a variety of healthcare settings. The purpose of this project was to determine best practice for performing MRs, implement best practice into practice, and evaluate outcomes based on successful completion of MRs. This project was implemented at an ambulatory surgery center (ASC) in southwestern Montana with a focus on adult orthopedic patients. Four PDSA cycles were completed over a 6-week period to improve the MR process. Improvement of the MR process was deemed necessary to meet evidence-based MR guidelines for patient safety and to meet accreditation standards. The definition of a complete MR was based on current literature and state and national accreditation guidelines. Over the 6-week process, MR completion rates increased from 0% at implementation to 52% at project completion. Continuation of improvement utilizing the processes implemented in this project is recommended.Item An assessment of surgical oncology patient education(Montana State University - Bozeman, College of Nursing, 2018) Bartholomew, Cody Sue; Chairperson, Graduate Committee: Susan RaphCancer patients are faced with tremendous amounts of information during a very vulnerable time, challenging the medical community to provide patients and families with up to date, relevant, evidence-based information to make informed decisions that promote positive health outcomes. Lack of standardized pre-operative patient educational efforts for adult surgical oncology patients has the potential to negatively impact system efficiency, patient outcomes, patient satisfaction and trust in their healthcare team. When patients possess understanding of their care process, their role in recovery, and trust in the healthcare team increases (Reiter, 2014). The aim of the project was to assess the current structure and process of surgical oncology patient education within one integrated health system in the northwest United States using the Donabedian framework for healthcare quality (Donabedian, 1980). A non-experimental descriptive exploratory survey was used for data collection. Project findings include identification of systematic structure and processes of surgical oncology education due in part to the complexity of the health system structure and lack of standardization across care settings. Documentation of education provided is varied by location and provider type with an absence of formal pre-operative or post-operative education plan within the system. Information collected will be used for future quality improvement projects and interventions to improve surgical oncology patient education across the continuum one of the integrated health system.Item Is music an effective intervention for improving sleep quality among adult postoperative open-heart patients: a feasibility project(Montana State University - Bozeman, College of Nursing, 2019) Olds, Jenna Leann; Chairperson, Graduate Committee: Alice RunningSleep deprivation is a common disorder known to impair the immune system and healing. Noise, pain, anxiety, and illness in general contribute to sleep deprivation. Patients admitted to the hospital setting are at heightened risk for complications related to decreased quality of sleep. Pharmacological interventions such as opioids and sleep aids are frequently administered to combat this issue. Integrative therapies are often overlooked as a way to increase quality sleep while hospitalized. One of the safest and easiest alternative interventions to employ is music. The purpose of this pilot feasibility project was to determine whether implementing music at the bedside during hours of sleep in the acute coronary-care setting addressed quality of sleep for postoperative open-heart patients. While statistical significance was not met in this project, promising results were found.Item An integrative process: acupressure to prevent and treat postoperative nausea and vomiting in patients undergoing abdominal surgery(Montana State University - Bozeman, College of Nursing, 2017) Seed Kinsler, Shoshannah; Chairperson, Graduate Committee: Alice RunningProblem Statement: Postoperative nausea and vomiting (PONV) continues to be problematic for surgical patients despite use of new-generation antiemetics. Purpose: This project was designed to bridge a knowledge gap for nursing staff by providing education on the implementation of acupressure at P6, assisting them in implementing this intervention, and analyzing the results. Methods: A survey of surgical nurses revealed an interest and lack of knowledge in acupressure implementation. Education for nurses was provided on the use of acupressure at P6 to prevent PONV. The implementation of acupressure by nursing staff was then assessed with a pilot study using a non-blinded, randomized controlled design. Jean Watson's Human Caring Theory and the Integrative Healthcare principles served as theoretical foundations for this project. Surgical patients undergoing abdominal surgery at risk for PONV were randomized to either the acupressure treatment group (acupressure and routine antiemetics) or control group (routine antiemetics only). Nausea and vomiting were rated using the PONV intensity scale and a Verbal-Rating scale. Nurse and patient attitudes toward holistic health and complementary and alternative healthcare were assessed, as well as patient perceptions of nurses' level of caring using the Caring Factor Scale. Analysis: Statistical analysis included Welch's two-sample t-test, Wilcoxson's Rank Sum Test, repeated measures ANOVA, and descriptive statistics. Results: Participants who received acupressure experienced less PONV, but this was not statistically significant. Those who received acupressure required more antiemetic medications, which marginally increased their healthcare cost. Participants who received acupressure had a significant improvement in CAM attitudes, but there were no differences in how patients perceived the level of care from nursing staff between groups. Significance: The results of this study provide evidence for the feasibility of nurse-implemented acupressure for PONV, and clinically significant data to promote use of acupressure at P6 to prevent and treat PONV. Future qualitative research regarding patient and nurse experiences with acupressure would add to the already extensive quantitative data available.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 Identification of anxiety manifestations of preschool tonsillectomy children and their mothers(Montana State University - Bozeman, College of Professional Schools, 1970) Sikonia, Carol Ann Merrett; Chairperson, Graduate Committee: Phyllis Hillard