Theses and Dissertations at Montana State University (MSU)
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/732
Browse
7 results
Search Results
Item Increasing patient support for chronic heart failure self-management through structured telephone support: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Pursell, Melissa Zoe; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Chronic heart failure (CHF) affects an estimated 6.2 million Americans and is the leading cause of hospitalization in adults older than 65 in the U.S. and has the highest 30- day readmission rate among all surgical and medical conditions. Experts suggest nearly 25% of these readmissions are preventable. Problem: A clinic in northwest Montana has a higher than the national CHF readmission rate. The clinic follows current guidelines for post-hospitalization follow-up. Evidence shows supplementing usual care with structured telephone support (STS) is an effective method for decreasing readmission rates. Methods: All CHF patients of the clinic are called within three days of hospital discharge to be enrolled into the STS program. The Care Coordinator calls the CHF patients twice weekly using the STS template to provide support for CHF self-management. The content of each biweekly call is documented using the STS template. Results: No patients were enrolled in the STS program during the eight-week QI implementation period. Two CHF patients were discharged but were not enrolled into the program for various reasons. Discussion: Inconclusive results related to insufficient data does not inherently mean this project provides no value. Recommendations were derived from the results of this QI project that may be useful for future STS QI projects. This project revealed that not all recently discharged CHF patients are good candidates for STS and the importance of developing candidate inclusion criteria.Item Nurse willingness to implement iPad-based education in the care of heart-failure patients(Montana State University - Bozeman, College of Nursing, 2018) Phillips, Margaret Lynn; Chairperson, Graduate Committee: Jennifer SofieThe aim of this Doctorate of Nursing Practice (DNP) scholarly project was to investigate nurse willingness to accept the use of technology for implementation of standardized heart-failure self-care education in an acute-care setting. Integrating iPads into the usual acute-care workflow presents challenges for nurses. A pre-implementation and post-implementation questionnaire, based on the Davis model (1989) of perceived usefulness and perceived ease of use of technology, were created to evaluate nurse willingness to adopt the technology. Both questionnaires include a section for comments. Nurse participants attended a competency skills day prior to implementation of iPad-based patient education. Participants completed the pre- questionnaire, reviewed a demonstration of iPad use, viewed an Agency for Healthcare Research teach-back video, and completed a nurse competency checklist. The checklist included a nurse demonstration of the use of the iPad-based education and verbal acknowledgement of how to use the teach-back method. The post- questionnaire was completed six months after implementation of the iPad-based patient education. Data from the pre- and post- questionnaires were evaluated and the nurse-written comments reviewed for the final analysis. Overall, nurses had high levels of perceived usefulness and perceived ease of use with implementation of iPads for heart-failure self-care education, and the iPads will continue to be utilized in the acute-care setting.Item Cost-effective strategies to minimize heart failure readmission rates(Montana State University - Bozeman, College of Nursing, 2018) Herring, Russel Ryan; Chairperson, Graduate Committee: M. Jean Shreffler-GrantThe purpose of this project was to identify and analyze the potential costs and benefits associated with the inclusion of a certified heart-failure nurse responsible for inpatient education and outpatient follow-up services for heart-failure patients. Admission and avoidable readmission data for a representative, Eastern Montana, inpatient healthcare facility were obtained and analyzed as the standard care model, and then compared against a care model utilizing a specialist heart-failure nurse responsible for inpatient education and outpatient, post-discharge follow-up care. A five-year pro forma was constructed, presenting a five-year cost versus savings forecast, in which a positive savings trend was estimated over the course of a five-year period.Item The accuracy of heart failure beliefs in rural Montana and Wyoming(Montana State University - Bozeman, College of Nursing, 2014) Ostermiller, Janice Lynn; Chairperson, Graduate Committee: Dale MayerThe purpose of this study was to examine the accuracy of illness beliefs of individuals diagnosed with heart failure (HF) in the rural states of Montana and Wyoming. In 2012, 2.4% of the United States population had a diagnosis of HF and this was expected to increase to nearly three percent of the total population by 2030. Accurate heart failure beliefs have been linked to engagement in recommended self-care behaviors leading to better health outcomes. This study used a descriptive design to analyze illness beliefs of Montana and Wyoming residents living with HF. A convenience sample of 50 individuals was recruited from a 300-bed acute care hospital located in Montana. Each participant completed the Survey of Illness Beliefs in HF Instrument, a 14-item survey that measures the accuracy of HF beliefs. The overall sample had inaccurate HF illness beliefs. Rural participants had less accurate heart failure illness beliefs when compared to non-rural participants. Further research is necessary to determine predictors of inaccurate HF beliefs. Nursing interventions targeted at rural dwellers may help to improve the accuracy of illness beliefs.Item Use of an assessment tool to facilitate evidence based management of home health heart failure patients(Montana State University - Bozeman, College of Nursing, 2013) Mullins, Lovetta Maureen; Chairperson, Graduate Committee: Sandra KuntzHeart failure (HF) is a costly and debilitating disease that impacts the quality of life of not only the patients who suffer from its effects but also the ones who care for them. Home health is a post-acute care service that has the potential to impact the effects heart failure has on patients, their caregivers, and the healthcare system. Evidence-based management of home health HF patients improves self-care and decreases readmission and admission rates. Currently no standardized HF needs assessment tools exist for use in the target home health agency. Visiting clinicians need a tool to identify patient/caregiver self-care deficits in order to appropriately provide education and interventions. The purpose of this project is to utilize an existing guideline to create a HF needs assessment tool. This tool was implemented by home health clinicians when admitting a HF patient to services. The design of the tool was guided by the literature reviewed and customized to the home health setting. Age, gender, and race were included on the tool to capture basic demographic information. Other data consisted of differentiating HF type, class, and whether it is the patient's primary or secondary diagnosis. The tool was then divided into different assessment areas: Daily weight practices; Patient/caregiver's knowledge of reporting a weight gain; Guidelines for recommended medications; Knowledge of sodium intake; Knowledge of food labels; Past/present smoking; and Patient/caregiver's independence with identifying signs and symptoms of worsening heart failure. Fifteen females and fifteen males were assessed with the heart failure tool. The results showed that the majority of patients with any class or type of heart failure were not meeting the recommended guidelines. The reasons identified for not meeting the guidelines consisted of knowledge deficit, functional limitations, forgetfulness, lack of equipment, and refused. Many of the medication guidelines were not met due to the drug not being ordered. It is recommended that interventions be designed to address each assessment area and an evaluation tool be implemented to determine if the intervention made a difference. Information gathered should be stored electronically for quality improvement initiatives.Item Nurses' knowledge of heart failure guidelines in a Western Montana hospital(Montana State University - Bozeman, College of Nursing, 2009) Knopp, Anna Marie; Chairperson, Graduate Committee: Susan LuparellHeart failure (HF) is an epidemic. Five million people were diagnosed with the disease in 2006 and 550,000 new cases are being reported each year. HF is associated with a decreased quality of life and high mortality rate. It also accounts for 12-15 million office visits and 6.5 million hospital stays each year. Although there is no known cure for HF, understanding the disease and guidelines put forth by the American Heart Association as well as the Heart Failure Society of America, has been shown to decrease mortality, increase quality of life, and decrease hospital admissions. Healthcare workers play a vital role in educating HF patients about the disease, and as such, they themselves should be knowledgeable about what they teach. This study seeks to describe nurses' knowledge of the HF education guidelines in a western Montana hospital. A questionnaire was sent to 196 nurses working in a western Montana hospital testing their knowledge regarding the HF education guidelines. Only one nurse answered all questions correctly. The lowest score attained was 25% and the average score for the entire group was 72%. Demographic data explored was area worked (critical care versus non-critical care), years of experience, and educational preparation. The results of this study demonstrated that nurses working in a western Montana hospital may not be sufficiently knowledgeable regarding the HF education guidelines. Increased education may better prepare nurses to educate patients regarding the HF education guidelines. HF patients who are taught by educated nurses may receive a higher quality of education in which, perhaps, the patients will have a better understanding of their disease and the guidelines to increase quality of life and decrease mortality and hospital admissions rates.Item Evaluation of educational needs of persons with heart failure(Montana State University - Bozeman, College of Nursing, 2007) Mutchler, Leslie Renee; Chairperson, Graduate Committee: Charlene WintersFive million Americans are currently living with heart failure, and the numbers are expected to rise. Optimal self-management of heart failure requires a considerable amount of knowledge in order to make the recommended lifestyle changes and recognize the signs and symptoms of worsening heart failure. Educational interventions are more effective when they are tailored for the individual. The purpose of this study was to identify the information persons with heart failure believed to be most important to learn, as well as whether or not it is realistic to learn the information while hospitalized. A survey tool was administered to 24 hospitalized patients to assess their responses to heart failure topics in seven categories including: anatomy and physiology, psychological factors, risk factors, medication information, diet information, activity, and other pertinent issues. Respondents identified all of the categories as both important and realistic to learn while hospitalized. Medication information and anatomy and physiology of the heart were identified as most important and most realistic to learn, while diet information was believed to be the least important and least realistic to learn. Results support the recommendation that education about heart failure should be done before patients are discharged from the hospital and the need for continued assessment of learning needs. Implications for practice and areas for further research are presented.