Theses and Dissertations at Montana State University (MSU)
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Item De-escalation training for pyschiatric/mental health nurse practitioner students(Montana State University - Bozeman, College of Nursing, 2020) Hatfield, Carly Jordan; Chairperson, Graduate Committee: Dale MayerWorkplace violence towards nurses is occurring at alarming rates throughout Montana and the United States. Verbal de-escalation is recommended for the prevention and management of aggressive patients in health care settings. However, de-escalation training is not required to be provided in nursing education programs. The purpose of this project was to develop, implement, and evaluate simulation-based verbal de-escalation training for psychiatric/mental health graduate nursing students on the prevention and management of aggressive patient behavior. The de-escalation training included an education module and simulated scenario using a simulated patient behaving as an agitated psychiatric patient. Confidence levels before and after the training were measured with the Confidence in Coping with Patient Aggression (CCWPA) scale and de-escalation techniques were assess with the English Modified De-escalating Aggressive Behavior scale (EMDABS). Strengths and weakness of the de-escalation techniques used in the simulation were identified and discussed. Overall scores on the CCWPA increased after the training. All participants received EMDABS scores representing acceptable de-escalation techniques. Identified strengths include use of a calm demeanor and maintaining a safe distance. Weakness include use of emotional suppression, limited use of inference, and lack of confidence. De-escalation training can positively affect nurses' confidence levels for coping with patient aggression. Use of a simulated patient scenario can provide a high-fidelity mental health experience that is effective for practicing de-escalation techniques. Participants reported that they felt the training was beneficial to their education and recommended that de-escalation training with a simulated patient be required in all nursing education.Item An educational program to increase staff knowledge and skills in the therapeutic management of violent behaviors by patients(Montana State University - Bozeman, College of Nursing, 2016) Combs, Eleanor Stacey; Chairperson, Graduate Committee: Christina SieloffWork place violence (WPV) is an unfortunate fact of life for health care workers and has evolved into a serious health hazard among both in the United States, and worldwide. Health care workers, facilities, and patients themselves often suffer negative consequences, both physically and mentally, by experiencing or witnessing WPV. An educational intervention, consisting of a pre-test, PowerPoint R presentation, and a post-test, was conducted to increase health care workers' knowledge regarding the therapeutic management of WPV. The intervention group (N=18) consisted of a variety of the direct care employees of an adult inpatient psychiatric facility in a rural/frontier western state. The educational intervention and tests were based on the Centers for Disease Control, Workplace Violence Prevention for Nurses Program (Centers for Disease Control [CDC], 2014). Topics covered in the intervention included: definition of violence, types of violence, workplace violence consequences, and risk factors for violence, prevention strategies for health care workers, and intervention strategies. The goal was to compare the pre-test and post-test mean scores, in an effort to see if the educational intervention could significantly increase the participants' overall knowledge of WPV. Test data was analyzed using a dependent sample t-test of mean scores, as the same group completed both the pre-test and the post-test. Results indicated that the educational intervention significantly increased WPV knowledge of the participants. Future research would benefit from using a larger sample size and by conducting a long term project to identify if there was a correlation between the evidence-based WPV education and the overall reduced incidents and/or injuries related to WPV. Continued research is important as an effective system needs to be implemented to safely manage potentially dangerous situations while protecting health care workers.Item Horizontal violence in nursing : policy implications(Montana State University - Bozeman, College of Nursing, 2015) Price, Brandom Jones; Chairperson, Graduate Committee: Sandra KuntzThe problem of horizontal violence (HV) in nursing remains a prevalent problem despite recommendations of zero tolerance from national organizations such as the American Nursing Association and the Joint Commission. Horizontal violence is defined as "hostile, aggressive, and harmful behavior by a nurse or group of nurses toward a coworker or group of nurses via attitudes, actions, words and/or behaviors" (Thobaben, 2007, p. 82). A study conducted in 2003 and repeated in 2013 by the Institute of Safe Medication Practices (ISMP) found a persistent culture of HV tolerance and indifference in healthcare settings. Horizontal violence is closely related to retention of both seasoned and new graduate nurses, a serious concern in the current and looming nursing shortage. This project investigated possible policy implications related to horizontal violence in nursing by increasing an understanding of the supportive role of hospital policies. Procedures for this project included (a) a review of current HV literature, (b) a request for policies on HV, workplace violence, harassment, bullying and/or codes of conduct/ethics from 10 hospitals (both critical access and non-critical access) in Montana, and (c) analysis of the policies using an evidence-based grid. Out of the ten hospitals of various sizes contacted, there was a 50% response/participation rate. Of the five hospitals that responded, none had policies specific to horizontal violence. Three hospitals had workplace violence policies and two hospitals had no policies on HV or any related key words. Findings indicate a clear need for further study with a larger hospital sample and an improved policy retrieval process to better understand the presence or absence HV healthcare policies. Use of the evidence-based grid developed for this project could serve as a useful tool for hospitals interested in creating a policy directly related to HV in nursing and a mechanism for consciously developing and enforcing cultures of respect in the workplace.Item An integrative literature review : the relationship between healthy work environment and nursing-sensitive patient outcomes(Montana State University - Bozeman, College of Nursing, 2012) England, Jessica Brooke; Chairperson, Graduate Committee: Christina SieloffThe impact of the nursing work environment on patient safety has received national attention, and has led to efforts to reduce morbidity and mortality in the health care environment (American Hospital Association, 2004). According to the American Association of Critical-Care Nurses, (2005) there is mounting evidence that unhealthy work environments contribute to medical errors, ineffective care delivery, and stress among health care professionals. There are few studies that examine a healthy work environment and the effect on patient outcomes. The purpose of this integrative literature review was to analyze the research that has been completed on healthy work environments and the effect they have on nursing-sensitive patient outcomes. An extensive literature search was performed using the following databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-Line (MEDLINE), The Agency for Health care Research and Quality Patient Safety Network (AHRQ PSN), and The Robert Wood Johnson Foundation publications on-line database. The studies were evaluated using the following strategies: overall quality, data reduction, and identification of patterns, themes, variations and relationships. They were then further analyzed and synthesized using; data display, data comparison, conclusion drawing and verification. Twelve studies met the inclusion criteria and were compiled, organized by theme and analyzed based on similarities and differences. The data was examined, discrepancies and gaps in literature were discussed and conclusions were drawn based on the patterns found in the literature. The majority (n= 9; 75%) of the articles that met inclusion criteria suggested that a healthy work environment effects nursing sensitive patient outcomes by showing a decrease in the number of negative outcomes. However researchers used multiple healthy work environment factors and different patient outcomes in each study making it difficult to compare results. The findings of this research suggests the need for better identification of a healthy work environment, the use of consistent nursing-sensitive patient outcomes by researchers, and suggests the importance of a healthy work environment on all aspects of patient care. Findings strengthen the principle that the work environment at the unit level mediates the effects of nursing interventions.