Theses and Dissertations at Montana State University (MSU)
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Item An assessment of health literacy in independent rural older adults(Montana State University - Bozeman, College of Nursing, 2019) Schubert, Tiffani Paulette; Chairperson, Graduate Committee: M. Jean Shreffler-GrantAdequate health literacy can increase an older adult's ability to manage treatment options, promotes informed decisions concerning self-care, and can play an important part in improving public health while decreasing healthcare costs. The purpose of this project was to assess general health literacy and complementary and alternative medicine (CAM) health literacy in independent older rural adults, explore their use of CAM and over the counter (OTC) medications and their sources of information regarding these therapies, and determine if health literacy and CAM health literacy levels changed based on prior experience with the questionnaire used in this project. Two questionnaires were administered to 30 rural independent older adults approximately 4 weeks apart. Descriptive statistics, paired samples t tests, and correlations were utilized for analysis. To measure general health literacy, three measures were used: Newest Vital Sign (NVS), a single question, and PEPPI. It was found that participants in this project had confidence in their ability to communicate with their provider, had average to above average general health literacy, and on average, were moderately health literate about CAM. Participants were less likely to have used CAM in the last five years than previous research and they frequently referred to their provider for information regarding CAM therapies. The majority of the participants had used OTC medicines in the last year, and mainly received their information regarding OTC medicines from their healthcare provider. There was no change in the participants' scores on the instruments used in this project with repeated exposure to the questionnaires. The results of the Health Information-Seeking Instrument allowed for the exploration of participants' tendency to seek health information. The results suggested that those participants who had a higher average income were more likely to seek health information than those with a lower annual income. This study has implications that are important to patient care. Determining the health literacy of the patient is of utmost importance in order to provide quality care to older adults. As a provider, it is important to understand a patient's health literacy level and to monitor this level over time.Item Impact of complementary relaxation therapy education for palliative care nurses(Montana State University - Bozeman, College of Nursing, 2018) McKinley, Whitney Barnekoff; Chairperson, Graduate Committee: Alice RunningBackground: CAM interventions can improve symptom management in end of life care. Nursing knowledge and routine integration of CAM in the impatient setting is lacking in palliative care. Education regarding CAM therapies for health providers could help ameliorate this problem. Purpose: The purpose of this project was to enhance nursing knowledge and comfort with relaxation therapy, and to evaluate of how this knowledge enhancement could impact palliative care patient outcomes. Setting/participants: Setting was an inpatient Oncology unit. This project had two populations; registered nurses (n=13) with primary employment on the oncology unit and palliative care patients (n= 20) with end stage pulmonary disease or pulmonary malignancy. Methods: This quasi-experimental pilot project utilizing before and after comparisons of nursing education and patient symptoms. Three phases were implemented. Phase one included a CAM Health Beliefs Questionnaire distributed to nursing staff. This was followed by an educational intervention for nursing staff regarding relaxation therapy that included instructions on the use of the Emwave Heartmath Biofeedback technology. An instrument (Relaxation Therapy Competency), intended to measure change in nursing knowledge, was developed and utilized in a pre-test/post?test format. Once competence was established, nurses implemented the relaxation therapy for palliative pulmonary patients. Subjective and objective measures were gathered before and after relaxation therapy was initiated on enrolled participants. Data collected included inpatient implementation utilizing Emwave Heartmath Biofeedback technology, pain, anxiety and breathlessness ratings (utilizing Likert scales), and vital sign measurements. Results: Knowledge was improved by an average of 35% for nursing participants through enhancing knowledge with an education session. A reduction in breathlessness, pain, and anxiety resulted for nearly all patient participants utilizing a singular biofeedback session. Physiological coherence achieved through relaxation therapy integration was expressed through significant improvement in blood pressure, respiratory rate, heart rate, and pulse oximetry for the patient population as a whole. Conclusion: The results of this pilot project show that symptom management can be improved for palliative care patients. Nursing knowledge regarding relaxation therapies was greatly improved, and nursing attitudes were positive overall. This safe, effective therapy has the potential to impact palliative care patients' symptom management and their end of life care.Item Medicinal use of herbs : an introductory guide for health care practitioners(Montana State University - Bozeman, College of Nursing, 1999) Hughes, Laine Dean; Chairperson, Graduate Committee: Catherine CaniparoliItem 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 Evaluation of MSU CAM health literacy scale with older adults(Montana State University - Bozeman, College of Nursing, 2015) Gregory, Kelly Marie; Chairperson, Graduate Committee: M. Jean Shreffler-GrantThe lack of health literacy is a critical problem in the United States. The use of complementary and alternative medicine (CAM) has become more prevalent and adds to the complexity of consumer health literacy. The Montana State University (MSU) CAM Health Literacy Scale is a new instrument developed to measure literacy specific to CAM therapies. The purpose of this study was to conduct further psychometric evaluation of the MSU CAM Health Literacy Scale with a rural older adult population. The specific aims were to (a) continue the assessment of the concurrent validity and reliability of the MSU CAM Health Literacy Scale and, (b) identify CAM use among older rural participants. A cross-sectional correlational design with quantitative methods was used to address the purpose and aims. Fifty two rural adults 50 years or older participated. Each participant completed a study packet which included the MSU CAM Health Literacy Scale and three general health literacy measures. The packet also included a short set of demographics and CAM use questions. Concurrent validity was assessed by examining correlations between the MSU CAM Health Literacy Scale and the health literacy measures. Internal consistency reliability was assessed using Cronbach's alpha. The analysis revealed significant correlations between the MSU Scale and the Newest Vital Sign (r=.465, p=<.001) and the S-TOFHLA (r=.293, p=<.035). The correlation between the MSU Scale and the Single Item Health Literacy Measure was not significant. The Cronbach's alpha for the Newest Vital Sign was .804, the MSU Scale was .667, and the S-TOFHLA was .915. Over one-half (N=31, 59.6%) of the respondents acknowledged using CAM therapies. This study contributes to the evidence that the MSU CAM Health Literacy Scale may be a reliable and valid tool to assess CAM Health Literacy. Ongoing assessment of the MSU CAM Health Literacy Scale is needed with a larger and more diverse sample to strengthen the evidence of validity and reliability. All providers need to include a CAM and CAM health literacy assessment with clients in their comprehensive healthcare approach to better understand and prevent health disparities.Item Integrative healthcare : facilitators to successful integration of complementary health approaches and conventional healthcare(Montana State University - Bozeman, College of Nursing, 2015) LaRue Bagley, Sheri; Chairperson, Graduate Committee: M. Jean Shreffler-GrantIntegrative healthcare (IH) is a relatively new area of specialization in the U.S. healthcare system. The existence of IH is widely attributed to popular demand for the range of therapies known collectively as Complementary Health Approaches (CHA) or Complementary and Alternative Medicine (CAM). In the U.S., alternative, complementary, and integrative healing movements have become a significant part of popular and healthcare cultures, yet there has not been a focus on what is driving integration of CHA and conventional healthcare. The purpose of this thesis was to identify factors that facilitate successful integration of CHA and conventional healthcare practices. To address this purpose, an answer to the following research question was sought: What are the principal driving forces that support the development and maintenance of Integrative Healthcare? Interviews with a convenience sample of eight allopathic providers were conducted to gain knowledge about their use of CHA, IH, or referral for these healthcare therapies. Participants were selected based on their current or potential involvement with CHA and/or IH. Roger's theory of the progressive stages used in adopting change was employed to guide the study. Qualitative analysis was conducted to identify major concepts and subconcepts. Based on the participants' responses, four key concepts and 4 subconcepts emerged. The major concept of perceived benefits was further narrowed to include clinical outcomes and financial outcomes. Other key concepts included growth of CHA and IH, and facilitators to utilization of CHA and IH. The fourth key concept was satisfaction which included the subconcepts of provider and patient satisfaction. All participants reported improved clinical outcomes, positive impact on the financial health of clinics/facilities, and enhanced provider and patient satisfaction through utilizing or referring for IH or CHA. Given the growth of IH, it is paramount that providers meet the demand for IH in a competent manner by educating themselves and developing alliances with reputable and knowledgeable CHA practitioners. Models of care delivery for IH need to be developed and tested. Finally, additional large scale studies are needed to validate the findings of this study and identify other facilitators that impact integration of CHA and allopathic healthcare.Item Complementary and alternative medicine use in children with chronic health conditions(Montana State University - Bozeman, College of Nursing, 2003) Glover, Laurie BernhardtItem Nurses' perceptions of the use of complementary and alternative medicine for pain management(Montana State University - Bozeman, College of Nursing, 2014) Esper, Sunshine Meralee; Chairperson, Graduate Committee: M. Jean Shreffler-GrantUse of complementary and alternative medical therapies (CAM) by adults for pain management is common practice. More hospitals and clinics are incorporating CAM into treatment plans. Nurses are key team members in planning and implementing care. Perceptions can influence care that is given. It is important to understand nurses' perceptions CAM use for pain management, their comfort level for recommending and initiating CAM therapies, and educational needs regarding CAM. Some studies have been conducted regarding nurses' perceptions of CAM, but not particularly CAM used for pain management. A descriptive qualitative approach was employed using a convenience, cross-sectional sample of 10 nurses who work at a northwest Montana medical center. Data were collected during semi-structured interviews. Imogene King's Theory of Goal Attainment provided a theoretical framework for the study. Results indicated nurses were optimistic about CAM and supported incorporating CAM into patients' pain management treatment plans. Nurses were generally comfortable recommending some kinds of CAM, but some desired the direction of a physician for certain types of CAM. Nurses seemed unsure of their role and responsibility regarding incorporating CAM into treatment plans. Themes that emerged were that nurses thought CAM could be useful for decreasing or even eliminating narcotic use, nurses felt there was a lack of resources and guidance regarding recommending CAM therapies to patients, and although they thought they had a good understanding about CAM, they would like more education about CAM. There are several implications for future research. Including; replicating the study in other geographic areas, exploring how increased education and available resources impact nurses comfort levels about discussing and incorporating CAM, understanding the relationship between CAM and narcotic use, and more research focusing on physicians' perceptions of CAM use for pain management. This research impacts the advanced practice registered nurse (APRN) practice in many ways. The expanded role of the APRN requires a focus on education and advocacy. The APRN could conduct professional educational offerings for medical professionals. Patients and nurses will look to the APRN for guidance. It is important for the APRN to be knowledgeable about CAM use and CAM resources.Item An assessment of health literacy about complementary and alternative medicine in adult residents of Flathead County, Montana(Montana State University - Bozeman, College of Nursing, 2007) O'Neill, Jennifer Lynn; Chairperson, Graduate Committee: Jean Shreffler-GrantThe purpose of this study was to explore health literacy about complementary and alternative medicine (CAM) in adult residents of Flathead County, Montana. The combination of documented low health literacy levels in U.S. and the proliferating use of CAM throughout the country create the potential for poor healthcare outcomes. Previous research indicates that due to lack of access to healthcare, rural residents often utilize CAM. Quantitative research methods and Margaret Newman's Health as an Expanding Consciousness provided the underlying framework for this study. A systematic sampling of 92 residents of Flathead County participated in the study. The data were collected by use of a mail survey which included a ten item CAM health literacy quiz and was analyzed using the SPSS 15 version statistical software program. The results indicated that almost half of the participants used CAM providers and more than half used self directed CAM. Musculoskeletal pain was the most frequently reported health problem for utilizing CAM.Item Use of complementary and alternative medicine among rural Montanans(Montana State University - Bozeman, College of Nursing, 2004) Beebe, Michele Morgen; Chairperson, Graduate Committee: Vonna BranamComplementary and alternative medicine (CAM), an assortment of varying health care practices that exist outside the definition or accepted practices of conventional medicine, is increasing. Little is known about CAM use among rural Montanans. Health care providers need this information to better manage patient-care situations such as CAM-drug interactions or skewed laboratory results which may result from CAM use.The selected method was the qualitative approach. A convenience sample was selected, and after informed consent was obtained, interviews with the subjects were audio taped and transcribed. Coding of data in the transcripts revealed concepts and themes regarding the subject's CAM use. After each interview, field notes were written to record salient points. The committee chair reviewed selected interviews which facilitated triangulation of data and enhancement of credibility.Data were analyzed for major themes that emerged which where, Using CAM: Pros, Cons and Influences, CAM Providers: Pros and Cons, Validating CAM Use, and Managing Health Issues and Enhancing Control with CAM. The themes showed how the sample was similar to the literature describing national CAM use, but also allowed glimpses into how the rural Montana sample was different from studies of national CAM use.Results are not generalizable due to sample size. However, the results do offer a glimpse into the use of CAM in rural Montana. Further research on CAM use among Montana populations, including minorities and varying socioeconomic groups, is needed.