Theses and Dissertations at Montana State University (MSU)
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Item An evaluation tool to measure pregnancy outcomes and quality improvement interventions at Northern Cheyenne Service Unit(Montana State University - Bozeman, College of Nursing, 2020) Tallbull, Cheyenne Rose; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughQuality Improvement projects are not always evaluated for their effectiveness after they are implemented. This professional project was to address this shortcoming by developing an evaluation strategy on the Healthy Mother Healthy Tribe (HMHT) project which aims at improving pregnancy outcomes for Northern Cheyenne women and their babies. The Montana State Birth Certificate Data indicate that the percentage of Montana Native American Women entering prenatal care after the first trimester was 56.4% compared to Montana Caucasian Women at 24.2%. While early and regular prenatal care are crucial to have healthier babies, numerous difficulties to access prenatal care and the impact of illicit drug use during pregnancy increased the number of precipitous deliveries at the emergency room in the Northern Cheyenne Service Unit (NCSU). The NCSU was chosen as a pilot test site to overcome these barriers; the HMHT project started. Posavac's program evaluation theory, in particular examining the processes of the intervention and how the intermediate outcomes lead to the desired outcome, was used to guide this project. After process-mapping prenatal care and developing a gap analysis, the NCSU implemented the following interventions: policy update, practice changes in drug screening and drug testing, updating electronic prenatal records, education and contracting for a prenatal case manager. Then, two types of evaluation processes were compared in this project. One was a conventional, practical strategy which was used for the Joint Commission's Evidence of Standards Compliance Report as an accreditation survey follow-up. Another was theoretically developed, based on a logic model, for this project to measure the effectiveness and improve evaluation consistency. In comparison, the conventional strategy was action oriented to ensure that compliance is sustainable for going forward. On the other hand, the developed logic model showed relationships and had a focus on measurable outcomes. Unfortunately, implementation of the logic model was not possible due to a change of the work site and time limitation. The effectiveness of the HMHT interventions would be important information in order to optimize resources for the organization and determine sustainability of the project.Item Implementation of an evidence-based policy and educational program on caring for neonates withdrawing from opioids: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Olson, Amy JoAnn; Chairperson, Graduate Committee: Stacy StellflugThe opioid use among pregnant women has increased, which has led to a rise in the rate of Neonatal Abstinence Syndrome (NAS). Infants with NAS are delivered at rural and urban locations throughout the country and require specialized treatment. The rural community access hospitals (CAH) often lack the resources (policy development and education updates) to prepare health care team members for safe care of infants that present with NAS. The purpose of this project was to improve team member confidence when providing care for neonates suspected of substance withdrawal at a CAH in Montana by: (a) developing and implementing a policy on care and treatment of a drug dependent newborn; (b) educating the team providing care to these neonates on the use of NAS scoring tools; and (c) evaluating the education and improved confidence levels of the health care team. A pretest/posttest design was used to evaluate change in nursing knowledge on NAS/scoring tools. The results suggest implementation of a NAS educational program including education regarding the implementation of a corresponding evidence-based policy, has a statistically significant effect on provider and nurse knowledge and confidence about NAS. Specifically, the results suggest NAS education improved provider/nurse knowledge and confidence in caring for neonates affected by NAS.Item Delivering prenatal breastfeeding education to a vulnerable population in rural Montana(Montana State University - Bozeman, College of Nursing, 2019) Young, Cindy Rae; Chairperson, Graduate Committee: Julie Ruff; Helen Melland (co-chair)The educational project aimed to document the efficacy of delivering prenatal breastfeeding education on exclusive breastfeeding (EBF) rates of mothers identified as vulnerable in a rural western Montana community. A convenience sample was utilized to implement the pilot project that included three educational sessions, taught by certified lactation counselors scheduled to coincide with routine prenatal appointment. A control group (CG) was established from a two-month sample of mothers delivering at the implementation site one year before implementation. The education was expected to enhance breastfeeding intentions as evidenced by the scores on the Infant Feeding Intentions (IFI) Scale, thus leading to higher rates of EBF in the participant group (PG) versus a control group. The PG mothers had slightly higher rates of EBF at both hospital discharge (PG 62% vs. CG 59%) and 7-10 days after birth (PG 57% vs. CG 53%), which failed to show statistically significant differences. One statistically significant difference was noted in the higher rates of EBF at 7-10 after birth for PG first-time mothers versus CG first-time mothers (73% vs. 0%, p < .001, 95% CL), indicating prenatal breastfeeding education may have made a more significant impact with first-time mothers. However, the efficacy of delivering prenatal breastfeeding education to impact EBF rates in this vulnerable population can neither be supported nor refuted based on the project results. A review of medical records showed that over 90% of the participant mothers attempted to breastfeed in the hospital (control 76%) and 75% of participant mothers who were not EBF while in the hospital were still giving their infant their breast milk versus 33% of the CG mothers. Seventy-five percent of the PG and CG mothers who were not EBF at 7-10 days were offering breast milk with formula supplementation. Due to acknowledged limitations in design, measurement and data collection, it is not possible to credit the statistically significant results mentioned above to the educational project. This project did provide useful information to guide future project modifications in implementation design and significant suggestions for further study.Item Addressing preventive oral health for pregnant women, childbearing age females & children age zero to six in primary care(Montana State University - Bozeman, College of Nursing, 2017) Johnson, Abrianna Lee; Chairperson, Graduate Committee: Elizabeth S. KinionMost oral health disease is preventable despite the availability of effective prevention and treatment (Nathe, 2016). Oral health conditions are becoming a silent epidemic and during pregnancy the risk increases for oral disease (Qualis Health, 2015; Vamos, Walsh, Thompson, Daley, Detman, & DeBate, 2015). About 40% of pregnant women have a varying form of periodontal disease (Lieff et al., 2004). The social impact on school-age children substantially affects their academics, as more than 51 million school hours are lost each year due to dental related illnesses (U.S. Department of Health and Human Services, 2003). The purpose of this project was to educate providers, nurses, and patients in a primary care clinic on the importance of oral health care and to create simple referral process for at risk patients. The author gave a pretest on oral health best practice to seven primary care nurses. After the pretest, the author gave an oral health education seminar. The nurses took a posttest based on content from the educational seminar. Patients who met the inclusion criteria were given oral health surveys to determine oral health status and need for referral to a dentist. Six of the seven nurses completed the seminar and testing showing a higher post-seminar test score. The V-statistic of 21 showed a p-value of 0.0178 suggesting strong evidence the nurses' scores tended to be higher after the seminar. Of the nineteen adults surveyed regarding their oral health status, 62% showed good oral health behaviors. Of the eleven pediatric patients surveyed regarding their oral health status, 75% answered positive oral health behaviors. The literature supported the value of oral health education in primary care. Awareness was created in the clinic with the use of posters and educational packets given to all participating patients. There is a great need for preventive oral health education to primary care providers, pregnant women, childbearing age females, and parents of children. Current research on the value of preventive oral health education and dental care is needed in primary care.Item Community assessment of cancer screening services for women in Cascade County and perceptions of American Indian women regarding those services(Montana State University - Bozeman, College of Nursing, 2001) Rowell, Nancy Jo; Chairperson, Graduate Committee: Therese SullivanItem Prescribing habits for hormone replacement therapy in Montana practitioners(Montana State University - Bozeman, College of Nursing, 2004) Nasser, Sherri Lynn; Chairperson, Graduate Committee: Karen ZulkowskiThis study sought to examine the change in prescribing habits for hormone replacement therapy (HRT) in Montana practitioners since the publication of the Women’s Health Initiative (WHI). STUDY DESIGN: A random sample of 160 Montana physicians, nurse practitioners, and physician assistants in the field of women’s health were selected to receive a survey examining the effects of the WHI on their current and past prescribing habits. RESULTS: 53% of the sample returned the survey. Ninety-seven percent of the respondents were familiar with the WHI results, with 88% reporting that the results had a significant impact on their prescribing. Ninety-eight percent reported using HRT for menopausal symptoms, and only 4% currently use HRT for cardiovascular protection. This compares with 57% of respondents using HRT for cardiovascular protection prior to the WHI results. Ninety-four percent of the respondents report using other modalities for treating hot flashes and 96% use other modalities for osteoporosis treatment and prevention. Currently, most of the respondents are recommending that women use HRT for 1-5 years or for not set time. The results showed . that the WHI had the most impact on those in practice greater than 10 years. Finally, there were very few differences in results when the data was analyzed based on specialty area, gender, or professional designation. CONCLUSIONS: This study demonstrated that the Women’s Health Initiative results had a significant impact on participating Montana practitioners. It also showed that the providers in Montana are following national trends for HRT use and have quickly responded to new evidence in the women’s health arena.Item Toxic exposures from personal care products in women of childbearing age(Montana State University - Bozeman, College of Nursing, 2013) Lieser, Amy Elizabeth; Chairperson, Graduate Committee: Wade G. HillA review of current literature suggests an association between the use of personal care products and adverse health outcomes. Significant levels of phthalates, parabens and lead have been detected in many cosmetics. Almost all humans tested have some level of phthalate, paraben and lead body burden. These three chemicals represent a few of the many chemicals prevalent in cosmetics. Human and animal studies link these chemicals with several negative health consequences including endocrine disrupting effects. A review of epidemiology reveals an increasing trend in the prevalence of associated health consequences. In the United States, the cosmetic industry is independently responsible for the safety of cosmetic products. The Federal government has regulatory oversight through the FDA, but does not have authority to test product safety. The Toxic Substance Control Act from 1976 and the Food, Drug and the Cosmetics Act of 1938 represent the most current legislation addressing regulatory standards for personal care products. Nurses advocate for legislation that protects public safety and intervene where public exposures to environmental health hazards are identified.Item Prenatal interventions that improve Native American pregnancy outcomes and reduce infant mortality : an integrative review(Montana State University - Bozeman, College of Nursing, 2012) Bloom, Jeanne Kathryn; Chairperson, Graduate Committee: Sandra KuntzNative mothers are at increased risk for negative pregnancy outcomes and within the first year of life, Native babies have substantially higher infant mortality rates than their White counterparts. The primary aim of this study was to identify a broad range of interventions/perspectives that positively affect pregnancy outcomes and reduce infant mortality in Indigenous communities. An integrative review using four databases was conducted. Thirty-four articles met the inclusion/exclusion criteria. The findings and recommendations of each article were documented in a chart (Appendix C) that gave rise to the development of a socioecological framework for pregnancy outcomes in Native women (Appendix D). Individual factors that influence pregnancy outcomes included behaviors/lifestyles, mental health, tobacco use, educational attainment, maternal age, prenatal care, breastfeeding, immunizations, family planning, and socioeconomics/WIC enrollment. Interpersonal factors included significant other, family support, peer support, and traditional beliefs. Community factors included: community health clinics, prenatal services, SIDS education, infant care education, home visits, smoking cessation & prevention programs, injury rates/environmental safety, tribal commitment to mothers and infants, and integration of traditional and western medicine. Public policy factors included WIC, safe water and sanitation, IHS funding, and systems to monitor Native health. In total, the synthesis of the findings from the literature appears to influence pregnancy outcomes. For Native American pregnancy outcomes to improve and infant mortality rates decline, interventions will need to target all levels of the socioecological framework: individual, interpersonal, community, and public policy. In addition, Maslow's Hierarchy of Needs must be considered.Item Cultural perceptions of American Indian women in Southcentral Montana regarding pre-diabetic education(Montana State University - Bozeman, College of Nursing, 2008) Hartford, Lori Ann; Chairperson, Graduate Committee: Christina SieloffTreatment of prediabetes includes education which provides the prediabetic person with information to help them make lifestyle modification choices regarding their nutrition, exercise and weight control; in order that they control their illness and delay or prevent the development of diabetes. American Indians have a high incidence of both prediabetes and diabetes as a group compared to other ethnic groups in the U.S. There is a lack of data in the literature about what American Indians from the Crow Tribe in Montana consider to be cultural information that they feel should be included in education for pre-diabetics. This qualitative ethno-nursing study was conducted through one-on-one interviews with six American Indian women of the Crow Tribe over a period of months to determine what they defined as culturally important for the health care provider to know when teaching about prediabetes. The data from these interviews were then analyzed using qualitative software by Ethnograph ®, and four primary themes were found. These themes were: extended family and elders, spirituality and traditions, culturally specific foods and activities and a feeling of inevitability of developing diabetes. As cultural competency is an area that is included in all schools of nursing and some schools of medicine, it is important that health care providers have an awareness of cultural specific health information. All the informants in this study reported that they felt more respected when their health care provider brought up the topic of how their culture affects their health habits, as well as how important to them it is that the health care provider be open to learning about the specifics of their culture.