Theses and Dissertations at Montana State University (MSU)
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Item Effectiveness of trauma nurse practitioner-led patient-centered discharge plan: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Stricker, Lisa Genevieve; Chairperson, Graduate Committee: Alice RunningTrauma Nurse Practitioners (TNPs) in Trauma Centers have been shown to expand the multidisciplinary team approach in caring for that patient population. TNPs create opportunities for increased patient throughput, decreased length of hospital stay, increased staff support for TNP collaboration, and the development of a comprehensive, detailed, patient-centered discharge plan. To evaluate peer-reviewed evidence-based articles assessing the impact of TNPs in developing a patient-focused, detailed discharge plan, a review of current literature (2007-2022) was completed by searching CINAHL, Google Scholar, PubMed, and Web of Science using mesh terms "trauma nurse practitioner," "trauma," "staff satisfaction," "throughput times," and "patient-centered plan of care." Thirty-nine articles were found and, of those, 28 are included in this review. Evidence supports the TNP's role in developing patient-focused discharge plans leading to increases in communication, increased focus on planning for unmet needs, efficiency in rounding, and decreases in length of stay. These changes result in increased satisfaction from physicians and nursing staff related to the TNP-centered role in discharge plan development. TNPs can be a valuable addition to trauma services as they coordinate the development of a comprehensive, individualized plan of care for patients throughout the hospital stay, allowing for a successful transition of care.Item Exploring and clarifying the role of the nurse on the specialty palliative care team(Montana State University - Bozeman, College of Nursing, 2022) Crape, Brooklyn Taylor; Chairperson, Graduate Committee: Denise RiveraPalliative care interdisciplinary teams seek to relieve the pain, stress, and suffering associated with terminal illness. The medical specialty is relatively new, and rapidly developing to attempt to meet the needs of an estimated 6 million Americans coping with a serious illness. Problem: Unfortunately, there is a severe shortage of palliative care professionals, and burnout and dissatisfaction with organizational practices threatens to exacerbate this shortage. Thoughtful use of each interdisciplinary team member's skills is necessary to meet the needs of patients while preserving team satisfaction. Nursing is considered a core role on palliative care interdisciplinary teams, and available evidence suggests nurses positively impact care team satisfaction and the quality of care. However, the palliative care nurse role is under-researched and often misunderstood. The variability of the role across the continuum of care contributes to role misunderstanding. Depending on the setting palliative care nurses may serve as symptom managers, care coordinators, providers of emotional care, team leaders, and/or contributors to quality improvement. This variation requires teams to clarify the role expectations of their palliative care nurses at the microsystem level. Purpose: This quality improvement project aims to create microsystem-specific, evidence-based guidelines for the practice of palliative care nurses on a palliative care interdisciplinary team in western Montana with the goal of increasing care team satisfaction and retention. Methods: A Plan-Do-Study-Act method will be used to guide the project. A committee lead by a clinical nurse leader will facilitate active, interdisciplinary participation in the improvement process. Prior to intervention the interdisciplinary team will complete a Strengths-Weaknesses-Opportunities and-Threats analysis. The nurses will also record their daily activities for one week and complete a role clarity survey. The outcomes of staff satisfaction and improved retention will be assessed with a yearly survey, self-reports at monthly meetings, and repeated role clarity surveys. Recommendations: Since the healthcare environment is ever-changing the quality improvement process should be continuous, and the microsystem specific palliative care nurse guidelines that are created should be considered living documents.Item Implementation and evaluation of a simulation-based team training program within an unstable pediatrics course utilizing the TeamSTEPPS® 2.0 framework(Montana State University - Bozeman, College of Nursing, 2018) Butterly, Kathryn Margaret; Chairperson, Graduate Committee: Jennifer SofieAccording to the Agency for Healthcare Research and Quality (AHRQ), ineffective communication and teamwork are two leading causes of medical errors in the United States. The Institute of Medicine (IOM) recommended that healthcare facilities employ measures to improve patient care and safety including teamwork training. Poor communication and lack of teamwork have been found to be the common denominator in up to 70% of serious or fatal medical errors. The Joint Commission and the IOM recognized that successful teamwork is critical for positive patient outcomes. TeamSTEPPS® 2.0 is an evidenced-based approach to developing and supporting teamwork in the healthcare setting with a focus on communication, mutual support, situational monitoring, leadership, and team structure. A simulation-based team training event, guided by the TeamSTEPPS® 2.0 framework, was added to an unstable pediatrics course at a rural Montana community hospital. The purpose of this scholarly project was to implement a simulation-based team training (SBTT) component as part of a comprehensive interdisciplinary unstable pediatrics course. Evaluation of the team training included teamwork attitudes, teamwork perceptions, team performance, and participant satisfaction. Twenty employees of a community hospital participated in the unstable pediatrics course. Total teamwork attitudes in all five sub-constructs improved (p=0.0001). Teamwork perceptions improved in communication, leadership, mutual support, and situational monitoring after the training. Participants agreed or strongly agreed when rating satisfaction with the learning modality of SBTT. Observed team performance improved after the SBTT. The results indicate favorable outcomes for use of the TeamSTEPPS framework with SBTT.Item A microsystem assessment : communication - the foundation for patient satisfaction(Montana State University - Bozeman, College of Nursing, 2015) Schlepp, Kathryn Michelle; Chairperson, Graduate Committee: Polly PetersenThe intent of this project was to focus on improving communication between total joint patients and care team with the aim to improve patient satisfaction. Communication between patient and care team is a large factor that can shape a patients care experience. A tool to improve communication between patients and their care team was implemented to address expected outcomes and improve patient satisfaction. This tool was a question prompting sheet that was used during the post-operative, inpatient period to help address patient specific questions and concerns, increase and improve communication with the care team and create a higher level of patient satisfaction. The tool created additional opportunities for direct patient communication related to their specific questions and concerns which created the ability to address the individual patient concerns.