Theses and Dissertations at Montana State University (MSU)
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Item Optimizing virtually-based communication among tribal primary care facility team members to improve patient care(Montana State University - Bozeman, College of Nursing, 2023) Meeks, Sarah Ann Skuhetka; Chairperson, Graduate Committee: Elizabeth A. JohnsonBackground: Effective communication among healthcare providers is linked to patient safety and improved patient outcomes but requires leadership accountability, team engagement, and organizational structure. Improving communication exchange at a tribal primary care facility among staff during group meetings may positively impact patient care and outcomes for American Indian and Alaska Native people who already experience disproportionate chronic health issues. Objective: The aim of this Doctor of Nursing Practice (DNP)/quality improvement project is to improve effective communication among tribal healthcare staff during weekly staff meetings by incorporating TeamSTEPPS framework in the form of structured technology platform etiquette, using targeted agendas, and utilizing leadership follow-up and feedback to enhance the care provided. Methods: Descriptive statistics and qualitative findings were used. Five weekly meetings that included a blend of multidiscipline and multicultural staff were observed for baseline assessment of perceived satisfaction among health care providers and review of the frequency of interruptions with non-agenda items, etiquette interruptions, and the number of missed opportunities for leadership to provide timely follow-up/feedback. The literature review was conducted to identify evidence-based or informed communication interventions. Intervention: Based on the literature review, Team Strategies and Tools to Enhance Performance and Patient Safety was used to guide the intervention. The three interventions included improved structure through agenda sharing, enhanced expectations in the form of chat/emoji use for discussion to discourage interruption, and enhanced leadership through well-planned follow-up. Results: Outcomes included improved communication exchange regarding an increased number of staff who participated in agenda sharing, a decrease in frequency of "hi-jacked" agenda items, an increase in frequency of staff who used chat/emoji features, and a decrease in frequency of interruptions. The frequency of missed opportunities for leadership to follow-up with staff on agenda items increased. Improvement in communication elements was observed in all but follow-up and resolution. Conclusions: The insights gained from this quality improvement project may further the understanding of optimizing communication in the tribal healthcare setting. Further studies related to how tribal culture influences the exchange of communication are needed in order to continue improving upon healthcare team communication in an effort to improve patient health outcomes.Item Interdepartmental transitions of care: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Crass, Kami Magdalene; Chairperson, Graduate Committee: Margaret HammerslaBackground: Lack of standardization and communication failures during interdepartmental transitions of care frequently contribute toward sentinel events and medical errors. Local Problem: At a hospital in Montana, lack of standardization and communication failures during interdepartmental handoffs resulted in potential and actual patient safety events. The purpose of this project was to implement a standardized interdepartmental handoff process utilizing a newly developed tool to improve patient safety and nursing staff satisfaction during intradepartmental handoffs. Methods: Incident reports and nurse satisfaction surveys pertaining to interdepartmental patient transfers from the Cardiac Cath Lab to the Intensive Care Unit (ICU) were reviewed pre-and post-implementation of the standardized handoff tool. Intervention: A standardized process utilizing a customized, paper IPASS (Illness severity, Patient summary, Action items, Situation monitoring/Contingency planning, and Synthesis) mnemonic tool was developed and implemented during this project. Results: No handoff incidents were reported and nurse satisfaction pertaining to handoff report between the Cardiac Cath Lab and ICU nurses improved after implementing the IPASS tool. Suboptimal tool usage rates indicate future improvements are required. Conclusions: This project implemented a customized, standardized, handwritten Cardiac Cath Lab-to-ICU handoff tool. Although reported patient safety events declined and nursing satisfaction improved, suboptimal tool use indicates the need for embedding the tool into the electronic medical record.Item Use of Information Dispensing in the Emergency Department to Improve Patient Satisfaction and Reduce Leave-Without-Treatment Rates: A Quality Improvement Project(Montana State University - Bozeman, College of Nursing, 2024-05) McIntosh, Delaney M.Ineffective communication between healthcare professionals and patients results in decreased patient perceptions regarding the quality of care received and contributes to reduced patient satisfaction, negative patient care outcomes, and decreased compliance with treatment recommendations. A microsystem assessment completed within a rural region trauma transfer facility identified a need for improved communication between clinicians and patients to improve patient satisfaction. Information dispensing is a form of intentional knowledge sharing between healthcare professionals and patients used to proactively engage patients and improve patient satisfaction. Review of the literature identified contributing factors to patients who sought care in the emergency department (ED) and reported low patient satisfaction or left-without-treatment (LWOT) such as inadequate communication, unmet expectations, and negative patient-clinician interactions. The literature supported the use of a patient-information-leaflet (PIL) in the ED as a sustainable and cost-effective method to communicate commonly sought information requested by patients to improve patient satisfaction and reduce LWOT rates.Item Addressing Communication Challenges Related to Nursing Unit Design(Montana State University - Bozeman, College of Nursing, 2024-05) Thorson, Hannah L.When nurses transition from a centralized nursing unit to a decentralized nursing unit, significant workflow changes can occur. A literature review identified four significant themes related to the transition to a decentralized unit. These themes are challenges with collaboration and teamwork, decreased nurse work efficiency, improvement to patient outcomes, and the importance of nurses’ role in departmental design. Additionally, literature related to the efficacy of electronic communication systems for bedside nursing staff was reviewed. The aim of this scholarly project is to propose a quality improvement intervention to increase nurse usage of clinical phones in an intermediate care unit (IMCU) to help with communication challenges caused by the transition to a decentralized nursing unit. By improving communication through use of the phones, nurses will be able to deliver care more efficiently and enhance communication with other members of the multidisciplinary care team. This quality improvement project falls within the scope of the Clinical Nurse Leader, and has the potential to improve job satisfaction for nurses, as well as provide a safer care environment for patients.Item Improving communication and patient outcomes with SBAR at a skilled nursing facility: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Westphal, Mackenzie Sue; Chairperson, Graduate Committee: Margaret HammerslaBackground: Improving patient outcomes depends on high-quality communication among healthcare providers. The aim of this project is to improve communication between geriatric providers and a skilled nursing facility during after-hour phone calls. Local Problem: Geriatric providers expressed concerns about inadequate communication during after-hours phone calls from a Medicare-Medicaid-certified skilled nursing facility. Methods: This quality improvement project utilized the Plan-Do-Study-Act method to create sustainable change. Communication was quantified by establishing 11 key elements of SBAR created based on the Agency for Healthcare Quality and Research TeamSTEPPS curriculum and provider preferences. A needs assessment was conducted to determine baseline data and identify gaps in communication. Phone audits and surveys were used to collect data. Interventions: The Agency for Healthcare Quality and Research's TeamSTEPPS curriculum provided the foundation to create a facility specific SBAR training for staff. The inperson training included a presentation, sample SBAR reports, and resources to reference. Results: The SBAR training at the skilled nursing facility resulted in 10% increase in average SBAR components reported to providers. There was an increase in SBAR elements reported in the Situation, Assessment, and Recommendation categories. There was not a significant change in provider satisfaction, staff satisfaction, or staff confidence. Several residents were unnecessarily transferred to the hospital and received interventions that could have been performed at the facility. Conclusions: SBAR can improve communication between geriatric providers and nursing staff during after-hour calls. Improving communication in skilled nursing facilities is vital to quality patient outcomes and reducing preventable hospitalizations.Item Navigating in the synthetic void: a hardboiled investigation(Montana State University - Bozeman, College of Arts & Architecture, 2022) Pomarico, Thomas John; Chairperson, Graduate Committee: Rollin BeamishSociety is in the midst of a rapid and drastic shift of ontological perception. Technological advancements in connectivity have altered the rhythm and scale of life due to media saturation, social media, and surveillance. The success of these viral technologies has many obvious benefits; however, they also harbor malicious tendencies when left unchecked. Prescience visions of dystopia by authors George Orwell, Aldous Huxley and David Foster Wallace, once seemingly outlandish, have now become apparent. Shosana Zuboff's 'The Age of Surveillance Capitalism' published in 2018 would have read as science fiction 25 years ago. As a temporary panacea to the pace of technological engagement, I offer the creative process as a way to alter duration. Using 1940s and 1950s film noir as a metaphor for the environment and challenges of the modern artist. Through this examination a code of conduct emerges to navigate the disruptive pitfalls of media addiction. Construction of the art object involves a multistep conceptual and physical practice guiding behavior away from excessive technological encroachment. My research paper aims to elucidate this process and its potential benefits to an outside observer.Item Tobacco cessation program utilization(Montana State University - Bozeman, College of Nursing, 2022) Rishavy, Airica Linne; Chairperson, Graduate Committee: Molly SecorPurpose: Every year in the United States, tobacco use kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. In Montana, 440 million dollars a year are spent on illnesses directly related to tobacco use and 1,600 adults die from smoking-related illnesses. The American Lung Association Freedom from Smoking Program (FFSP) is an evidence-based, gold-standard tobacco cessation program in place at a medical facility in Helena, Montana but is not being utilized due to a cumbersome referral process and lack of provider knowledge about this program. The aim of this quality improvement (QI) project is to increase providers' knowledge about the FFSP and create a streamlined electronic medical record (EMR) referral process to increase the utilization of the FFSP. Methods: A new referral process in the existing EMR was created and information about the FFSP and the new ordering process was disseminated to all relevant providers. Results: The number of results to the FFSP was tallied each week for five weeks. At the end of five weeks, there were 21 referrals, up from zero before the start of this QI project. Twenty-one referrals are only 8% out of the average 240 smokers seen at this medical facility per month. Implications: Referrals to the FFSP will occur if providers have knowledge and buy-in about the importance of the program and access to an easy-to-use referral system in the existing EMR.Item Humans and howls: wolves and the future of animal communication(Montana State University - Bozeman, College of Letters & Science, 2021) Narotzky, Emma May; Chairperson, Graduate Committee: Mark FiegeWolf howls have seldom been subjected to studies focusing on their semantic content, especially in wild populations where the context is natural but the availability of contextual clues for researchers is limited. The meaning of wolf howls as interpreted by humans depends on the human's position in ecological, cultural, and scientific context. I describe human interpretations of wolf howling from the perspective of amateur observers, historians, and biologists; the historical context of wolf howl research within ethology and questions about semantics in animal communication research; and the possibility of semantic differences in wolf howls from different contexts recorded in the wild. Wolf howls were recorded in Yellowstone National Park in 2017 and howls from territorial borders were compared with howls from territory interiors. Howls from the two groups were not discriminable. There may be no structural differences containing semantic information about territorial content, or the location relative to a border may not be a useful proxy for territorial message. Questions about intended meaning as opposed to observed function in animal communication are difficult to answer and often collide with humans' desire to be unique in their communication systems. Questions about wolves run into political and cultural baggage arising from humans' and wolves' history as ecological competitors. As semantic research in animal communication develops, wolves may become a coveted subject species because of their social living, strong individual/personal characters, and group coordination. These studies and their results will always be filtered through a thick barrier of human biases and reflections--possibly more so than any other non-primate in the world--but information about wolf communication can be disentangled from human culture in both scientific and vernacular accounts with enough historical information about the sources of the humans' biases. Future research on this topic will require simultaneous approaches from different angles, including ethological, historical, neurological, perceptual, and socioecological.Item Evaluation of interdisciplinary patient care conferences for the complex patient population in a rural state(Montana State University - Bozeman, College of Nursing, 2021) Posada, Britt Kristen; Chairperson, Graduate Committee: Wade G. HillPrimary care practice in the 21st century requires innovative and visionary transformation. With the prevalence of chronic diseases continuing to increase, the management of diseases and patients has to change in order to make an impact on outcomes and healthcare costs. As needs for primary care expand, the population ages and patient complexity increases, collaborative care is vital in providing optimum patient care. In 2018, the United States healthcare costs were $3.6 trillion, averaging $11,000 per person and are projected to increase to $6.2 trillion by year 2028. With care that is often fragmented between large hospital systems and community resources, rural states have shown that coordinated care teams have had a dramatic impact on healthcare costs. Monthly de-identified interdisciplinary patient care conferences were evaluated using the Collaborative Case Conference form. In the spring of 2021 an electronic survey was delivered to 18 historical participants of the interdisciplinary patient care conferences via email with goals of obtaining formative and summative evaluations. Formative evaluation found that 100% of participants responded Very Good-Excellent in usefulness of discussions as well as collaborative nature. The summative evaluation revealed that 93.34% of participants Agreed-Strongly Agreed that, as a result of the care conferences, they had a clearer sense of other health professionals roles. All participants reported that they Agreed-Strongly Agreed that there was greater value in interprofessional collaboration after participating in the conferences. Limitations of the evaluation included technology, recall bias, poor survey choices, and low scalability of project. In conclusion, the evaluation of the interdisciplinary patient care conferences for complex patients in a rural state was an overall success. Unfortunately, the program is no longer ongoing as it was halted after funding ended, making sustainability one challenge of convening statewide care conferences of this type. On a positive note, after the initiative was finished individual organizations did implement similar localized care conferences within their settings.Item Improving well water contaminant awareness among Big Horn County healthcare professionals through community engagement(Montana State University - Bozeman, College of Nursing, 2020) Schott, Raelene Ursula; Chairperson, Graduate Committee: Sandra Benavides-VaelloBighorn County, Montana sits in the Little Bighorn River Valley in the south-central part of the state. The Crow Reservation, a Northern Plains Indian Reservation, encompasses 2.3 million acres in the Little Bighorn River Valley; the majority of the reservation is in Bighorn County. Over 8,000 tribal members live on the reservation, many of whom reside near rivers and streams. Due in part to the rurality of the area, up to 60 percent of the people living on the reservation have home wells as their primary water source. A variety of contaminants has been discovered in well water in Bighorn County, including manganese, uranium, nitrate, and arsenic. Manganese has been shown to cause cognitive delays in children with minimal exposure, along with neurological effects in children and adults alike, known as 'manganism', signified by extrapyramidal dysfunction. Uranium exposure causes kidney damage, increases the risk for various types of cancer, and can have reproductive and developmental effects on women. With minimal exposure, arsenic can cause neurological effects, hypertension, peripheral vascular disease, cardiovascular disease, respiratory disease, diabetes mellitus, and malignancies - including skin cancer. Arsenic toxicity includes links to cancer, cardiovascular disease, immune dysfunction, diabetes, and altered neurodevelopment. There are clear public health implications to providing an educational intervention regarding the contaminants to the healthcare providers in Hardin, MT, a community in Big Horn County, in order for them to provide evidence-based information to their patients. This pre/post-quasi-experimental project was designed to evaluate the knowledge gained by healthcare providers in Hardin following a short PowerPoint presentation with voiceover that provided educational information about the common contaminants and their health effects. There were seven healthcare providers who participated in the project. Results of the survey showed an overall improvement in their knowledge about the contaminants, as well as their comfort speaking to patients about these contaminants. These results indicated that the educational intervention provided by the author was successful in meeting the goals of this scholarly project.