Theses and Dissertations at Montana State University (MSU)
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Item SBAR in long-term care: a quality improvement initiative(Montana State University - Bozeman, College of Nursing, 2024) van Houte, Alyshia Grace; Chairperson, Graduate Committee: Jamie M. Besel; This is a manuscript style paper that includes co-authored chapters.Background: The Situation-Background-Assessment-Recommendation (SBAR) tool was adapted by hospitals from the United States Navy in the late 1990s to improve communication during critical situations. SBAR is regularly used in the hospital setting, but its applicability to long-term care is often underutilized. Local Problem: At a 135-bed long-term care facility, there is no institutionally endorsed standard of communication between nurses and providers. Providers receive instant-messaging style communications from nursing staff that often lack structure and pertinent clinical information. An incomplete clinical picture increases the need for clarification, causing delays to patient care. Communication barriers serve as a source of frustration for nurses and providers. Methods: An interdisciplinary approach was used to develop an educational template that was incorporated into the facility's nursing orientation material. Attendance at staff huddles and face-to-face discussions with floor nurses provided education and introduced SBAR as the standard for nurse-provider communication. The Jefferson Scale of Attitudes Towards Nurse and Physician Collaboration (JSAPNC) measured staff satisfaction regarding interdisciplinary collaboration. SBAR utilization was monitored through regular audits of patient progress notes. Results: No statistically significant change was found in JSAPNC scores pre- and post-intervention; post-intervention rates did not meet the long-term goal of 75% utilization of SBAR for nurse-provider communication. Conclusion: Introductory and regularly interval education fosters high-fidelity use of SBAR, but the impact of SBAR utilization on nurse and provider satisfaction with interdisciplinary communication was indeterminate and requires further study.Item Increasing awareness and referral of diabetes prevention program in the hospital setting(Montana State University - Bozeman, College of Nursing, 2022) Tsao, Huei-Ling; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: Type 2 diabetes is a great burden on the US health care system. The increase in prevalence makes the prevention of diabetes an urgent public health priority. The Diabetes Prevention Program (DPP), an intensified lifestyle modification program established by the CDC, has the capacity to reduce overall diabetes risk by 58% in people considered high risk for the disease. However, despite its encouraging results in diabetes prevention, the DPP continues to be underutilized. Purpose and Methods: The overall goal of this DNP scholarly project, conducted in a hospital setting, was to increase provider awareness of the DPP and increase referrals to the program. Three key methods were used to carry out the project. First, an educational presentation about the DPP was disseminated to providers to increase their awareness and knowledge of the program. The second involved embedding a referral pathway from a local hospital (project site) to the local DPP. The third was to build a clinical-community linkage (CCL) among the local hospital, the local DPP, and primary care providers (PCP). The goal of the latter was to enhance care coordination and increase PCP awareness of the DPP. Results: The results demonstrated that educational presentations did increase the providers' awareness and knowledge of DPP. During the implementation period, there were 35 DPP-eligible patients. Yet, the majority of these patients were missed due to a lack of time from the volunteer staff. The referral rate did not meet the project's goal. However, most of the patients approached refused to enroll in the DPP due to lack of awareness of their high diabetes risk. Nonetheless, the implications of this project were valuable for the local hospital as it highlighted the need to better address this national public health issue.Item Discussing end-of-life care in the emergency department : to attempt resuscitation or allow a natural death(Montana State University - Bozeman, College of Nursing, 2014) Kelly, Catherine Grace; Chairperson, Graduate Committee: Dale MayerPatients on a known dying trajectory quite frequently present to the emergency department (ED), unprepared for some of the common and inevitable crises related to their disease process, and most of them have not prepared an advance directive. Near end-of-life (EOL) patients who present to the ED with an emergent need for symptom management may instead be faced with an incongruent treatment plan focused on lifesaving interventions. Time constraints, lack of prior patient-provider relationship, vague and misleading terminology, and patient misconceptions about attempted resuscitation interfere with discussions about EOL care preferences in the ED. Questions sometimes posed by ED providers such as "If your heart stops beating, do you want us to try and start it again?" or "If you stop breathing, do you want us to put in a breathing tube?" or the more loaded question "Do you want us to do everything?" are problematic because patients are offered no tangible alternatives; in essence, the choice they are presented with is between doing everything and doing nothing. Realistically, who will choose nothing? There is a growing movement toward using more precise language to discuss attempted resuscitation and allowing natural death. The purpose of this project was to explore the language used during patient-provider conversations about attempted resuscitation versus allowing natural death. A case study was used to interview emergency department physicians, nurse practitioners, and physician assistants. Twelve topics emerged during the interviews regarding how providers discuss attempted resuscitation versus allowing a natural death. The interviews revealed areas where patient-provider communication may be improved, and highlighted the need to replace ambiguous language with more frank and detailed discussions of EOL care options. ED providers need to become more comfortable discussing EOL care, and give patients and families the full benefit of making informed decisions in line with their goals of care.