Theses and Dissertations at Montana State University (MSU)
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Item Improving new patient cancer treatment education: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Wilcox, Jamie Michelle; Chairperson, Graduate Committee: Elizabeth A. JohnsonBackground: A cancer diagnosis invokes high levels of uncertainty and anxiety. Healthcare professionals task themselves with providing appropriate education to help patients traverse their cancer treatment experience. Effective communication and educational interventions help patients acquire appropriate coping strategies to manage the disease process and reduce uncertainty. Purpose: This project aimed to improve patient satisfaction and decrease anxiety and uncertainty through an enhanced patient education process. The project took place in a rural outpatient oncology center. Participants included newly diagnosed oncology patients receiving intravenous (IV) chemotherapy/immunotherapy and clinic staff. Method: This project used the Demming Cycle quality improvement method. The education components drew on the guidance of literature reviewed for best practices and national guidelines for patient education and teaching techniques. Data obtained through surveys from patients and RNs, observations from the project lead, and additional feedback from staff informed the development of the education visit components. Intervention: A nurse education visit was scheduled the week before IV treatment started and included a learning needs assessment, clinic tour, education on port-a-cath care, regimen-specific side effects and self-management, and how and when to contact the healthcare team. Nurses provided content using the teach-back method. Results: Patient and staff completed surveys over six weeks of implementation. Sixteen patients completed surveys. 100% (n=16) were confident they could manage their symptoms at home after the education visit. Thematic findings from survey responses regarding the most valuable education piece included Theme 1, logistics of treatment; Theme 2, anticipated side effects and management; Theme 3, other value of knowledge and education regarding managing the disease process. Nine nurses were surveyed 17 times during the project, with each nurse completing 1 to 2 education sessions. 88% (n=17) of nurses surveyed felt the education visit improved from the previous system, and 71% (n=17) of nurses found the teach-back method was supportive of patient outcomes surrounding patient education. Conclusion: Providing a structured education visit for new oncology patients receiving chemotherapy/immunotherapy improved patient confidence in identifying and managing symptoms and side effects of therapy at home. The teach-back method reinforced the education content and demonstrated an understanding of the material.Item The use of asthma action plans in improving asthma control: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Wenger, Mary Catherine; Chairperson, Graduate Committee: Alice Running; This is a manuscript style paper that includes co-authored chapters.Background: In the United States, approximately 1 in 13 adults and children suffer from the chronic condition asthma. Asthma is a disease in which the airways of the lungs become inflamed, narrowed, or blocked due to bronchoconstriction and increased secretions, reducing airflow and gas exchange. Without proper treatment, asthma exacerbations may lead to death in worst-case scenarios. An Asthma Action Plan (AAP) is a written, individualized template that lists actions patients can take to keep asthma symptoms from worsening. An AAP also provides guidelines that indicate when patients should call a provider or go to the emergency room. Methods: Current workflows, previously created when Asthma Control Tests (ACT) were implemented, were expanded upon to include implementation of AAPs. AAPs are created using the National Asthma Education and Prevention Program (NAEPP) guidelines. Implementation consisted of three two-week Plan-Do-Study-Act cycles with debriefing sessions after quantitative and qualitative data collection. Results: 70% of patients received AAPs in the final implementation phase compared to 25% in the first and 56% in the second implementation phases. The provider felt increased confidence in managing the patient's asthma through evidence-based guidelines. Nursing felt an increased strain on workload and moderate resistance from patients. Front desk staff noted minimal changes in daily work and believes patients appreciate receiving AAPs to take home. ACT rates were 85% in the first cycle, improving to 89% in the second and 100% in the final cycle. The provider and nursing believe the ACT is a useful tool for understanding patient asthma control. Conclusion: Implementing AAPs was monumental in the standardization of managing asthma in a small one-provider private practice clinic. Further research can now be completed to assess whether implementing AAPs actually improves patient asthma symptoms through ACT score evaluation. More work could be done on assessing the severity of asthma in patients and evaluating patient inhaler techniques.Item Efficacy of an educational tool implementation to decrease relapse utilization by asthma patients(Montana State University - Bozeman, College of Nursing, 2024) Webb, Cicily Gretchan; Chairperson, Graduate Committee: Alice Running; This is a manuscript style paper that includes co-authored chapters.Asthma exacerbation patients often rely on emergency departments (ED) and urgent care or acute care clinic settings to regain control of their symptoms with almost 10% of asthmatic adults having an asthma related ED visit between 2011 and 2016 (Centers for Disease Control and Prevention [CDC], 2023). The Global Initiative for Asthma (GINA), encourages the utilization of self-management plans, such as an Asthma Action Plan (AAP), by patients as the first step of care in an asthma exacerbation (GINA, 2022). 10% of Montanans carry an asthma diagnosis and in 2018 with 2,000 ED visits related to asthma exacerbation treatment. The purpose of this project was to decrease relapse utilization of urgent care facilities by asthma exacerbation patients by implementing an educational tool to help increase utilization of AAPs and foster the patient-primary care provider relationship. This project aimed to provide patients presenting to the urgent care a discharge packet containing an AAP and primary care resources upon visit completion to decrease relapse utilization of the urgent care setting by asthma patients. Additionally, the number asthma exacerbation patients presenting to the urgent care was to be monitored and with a focus on those presenting on more than one occasion. Additionally, barriers to implementation were evaluated. The project aims of decreasing relapse urgent care utilization by asthma patients was inconclusive due to absence of data points available during the study timeline of relapse asthma exacerbation patients in comparison to the same 6-week timeframe from the prior year. However, this project illuminated significant gaps in what is recommended for asthma exacerbation patients and what this practice implements. Additionally, the lack of data also encouraged discussion regarding triggers to asthma exacerbation and encouraged comparing trackable triggers from the 2022-2023 season to the 2023-2024 season. Interestingly, this project highlighted a need for further education and guideline-based training for system providers to align actual treatment of asthma patients more closely to guideline-suggested management of asthma patients. More data needs to be collected regarding the implementation of self-management tool impact on decreasing relapse utilization of urgent care facilities.Item Increasing medication HCAHPS scores using a standardized, simplified process to educate patients on commonly prescribed new medications(Montana State University - Bozeman, College of Nursing, 2021) Wurz, Stephen; Chairperson, Graduate Committee: Margaret HammerslaBackground: An estimated 40% to 50% of patients do not understand their medications leading to 125,000 preventable deaths annually and $100 billion in preventable healthcare costs. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is used to measure patients' perspectives of their care with two of the questions explicitly related to new medication and side effects education. HCAHPS scores drive reimbursement to hospitals. Care that the patient perceives as positive improves outcomes and increases healthcare value. Aim: The aim of this project was to increase patient knowledge of new medications, develop a tool to guide nurse medication education, and improve medication HCAHPS scores. Methods: This project implemented a simple medication education tool which listed 8 common classes of medications, their uses, and most common side effects. This was done to increase patient understanding of prescribed medications on a telemetry floor at a large central Montana hospital. The tool was developed using evidence-based research, RN's were educated on its use, and it was placed at the patient bedside as a resource for patient medication education. Results: A total of 87% of unit RN's were educated on the tool and its expected use. To check for tool at the patient bedside, 6 rooms out of a total of 33 were audited twice weekly for four weeks. Two PDSA Cycles were completed after low rates of tool at the bedside were discovered. Scores improved after each PDSA Cycle with a score of 100% obtained at the beginning of Week 4 of implementation. HCAHPS data was not available at the time of writing. Conclusions: The development of a new medication and side effects education tool was placed at the bedside and used as a guide to educate patients on their prescribed medications. This was done to increase patient comprehension and thereby satisfaction of medication understanding as an attempt to increase HCAHPS scores in the medication education category.Item Improving the utilization of Diabetes Self-Management Education and Support (DSMES) for patients with type II diabetes in the primary care setting(Montana State University - Bozeman, College of Nursing, 2022) Amy, Alison Grace; Chairperson, Graduate Committee: Christina BorstEvidence suggests that diabetes self-management education and support (DSMES) programs result in numerous clinical, psychosocial, behavioral, and cost benefits. The American Diabetes Association (ADA) recommends that all patients with a diagnosis of type II diabetes (T2DM) should participate in ongoing DSMES. The ADA provides an algorithm that highlights four critical criteria for referral to DSMES, but substantial evidence suggests that these referral guidelines are not widely followed. The purpose of this project was to implement a standardized referral process in a central Montana primary care clinic using the ADA Algorithm of Care. Participating providers were educated about the ADA referral guidelines and asked to follow them diligently. The referral algorithm was uploaded to the clinic share drive and displayed on the wall of each exam room to encourage its use. Both pre- and post-implementation data were collected via electronic health record (EHR) chart review. The number of referrals sent was compared to the number of patients who met criteria for referral and displayed as a percentage using individual run charts for three separate categories: (1) new diagnosis of T2DM, (2) existing diagnosis of T2DM and no previous DSMES participation, and (3) existing diagnosis of T2DM with previous DSMES participation, but due for follow-up. Between November and December, 2021, the average referral rate for patients who met category 1 criteria was 100%. There were no new diagnoses of T2DM during the implementation phase (January 3-February 28, 2022), so no post-implementation data were recorded for category 1. The average referral rate for category 2 patients improved from 3.45% pre-implementation to an average of 9.8% post-implementation. For category 3 patients, the average rate of reminder to schedule follow-up care increased from 0% pre-implementation to an average of 11.8% post-implementation. While these numbers fell short of the desired goal, improvement was made. Despite successful standardization of the referral process, lack of time, poor compliance with the algorithm, and patient declination of referral proved to be significant obstacles. A longer implementation period and integration of the algorithm into the EHR would likely improve provider compliance and increase utilization of DSMES for patients with T2DM.Item Increasing oncology patient engagement in treatment decisions: a CNL driven educational approach(Montana State University - Bozeman, College of Nursing, 2022) Northrop, Kayla Marie; Chairperson, Graduate Committee: Denise RiveraCancer is the second leading cause of death in Montana affecting 40% of men and 38% of women (MCTR, 2019). In the state of Montana Cancer is attributed to 452 new cancer cases per every 100,000 people, or one in every four persons (MCTR, 2019). Current best practice treatment options for cancer include chemotherapy and biosimilar medications of chemotherapy also known as Biologicals. Biosimilar medication is a product that contains a similar but not identical, version of an active compound of that of the originator medication authorized by the FDA for treatment of cancer (Edwards and Bellinvia, 2020). A literature review was conducted containing fifteen journal articles that included: four systemic reviews, a randomized double-blind study, two observational studies, and one retrospective study. When evaluating the information gathered, it was clear that due to the recent development and lack of public knowledge of biosimilars there is missing and unknown information. The missing information could alter the education needed and topics patients may want to know in an educational program. The plan for this quality improvement project is to create an educational program for biosimilars in oncology offices for providers to use with patients that may need to switch to a biosimilar in their treatment plan and allow for increase patient outcome and safety.Item Implementing advance directive screening and education in the primary care setting(Montana State University - Bozeman, College of Nursing, 2021) Nordlund, Sarah Lou; Chairperson, Graduate Committee: Yoshiko Yamashita Colclough and Polly Petersen (co-chair)Advance care planning is a topic that has become increasing important due to medical technology advancement and the growing population of elderly Americans. Although advance care planning has been proven to positively impact patient satisfaction and quality of care, education and advance directive formulation does not occur as often as it should. The primary aim of this project was to increase the number of completed advance directives in patient medical records by 10% at a small rural Critical Access Hospital. The intervention implemented was screening patients age 65 and older for the presence of an advance directive during the clinic intake process. Patients that reported having a completed advance directive were asked to provide the site a copy and patients that reported not having an advance directive were provided an educational packet. A total of 5 patients presented to the clinic during the 6-week data collection period that were age 65 and older. Of these patients, 40% (n=2) reported having a completed advance directive, and both returned a copy. There were 40% (n=2) that reported not having a completed advance directive and did not return a completed copy. One patient did not get screened by mistake. The site is considering adjusting the screening process to be the responsibility of the clinician instead of the receptionist. A social media post was created on the site's Facebook page requesting individuals that had a completed advance directive to provide the facility a copy resulting in three additional individuals (n=3) bringing in completed directives. The goal to increase completed advance directives in patient medical records was met. A secondary aim of this project was to have facility clinicians complete an advance care planning education course from the education platform Relias, promoting their comfort to have the conversation with the patients. Facility clinicians have not yet completed the education, but the course was added to the facility's annual requirements. Currently 16 out of 36 of the non-clinician employees have completed this education course. The interventions adopted for this DNP QI project brought awareness to important topic of advance care planning and increased advance directive formulation.Item Standardizing lactation education for home visiting staff to improve breastfeeding duration rates(Montana State University - Bozeman, College of Nursing, 2020) Reed, Samantha Alicia; Chairperson, Graduate Committee: Angela JukkalaBreastfeeding has been shown to improve short-and long-term health outcomes to both mother and child. Health departments are in a unique role to provide community level support in breastfeeding. Gallatin-City County Health Department provides breastfeeding support through multiple programs within the community, including maternal child health home visiting. Based on a recent survey, results showed that half of home visitors did not feel confident in educating prenatal clients on breastfeeding. In addition to this, home visitors did not feel they were providing the same education on breastfeeding. Stemming from this, the need for a standardized lactation curriculum was researched. Ready, Set, Baby is an evidence-based standardized curriculum that increases a mother's knowledge of breastfeeding benefits and practices. This scholarly project examines home visiting staff education on Ready, Set, Baby curriculum, improved breastfeeding education with home visiting families, and improved breastfeeding duration rates.Item Assessment of an educational binder for newly diagnosed oncology patients(Montana State University - Bozeman, College of Nursing, 2020) Woloszyn, Sarah Christine; Chairperson, Graduate Committee: Angela JukkalaNewly diagnosed oncology patients have many complex educational needs. These needs can be affected by stress, age, health literacy, and culture/ethnicity. It is important to take these factors into account when developing and evaluating patient health information. It is imperative that oncology patients are provided with quality health information to ensure that they are able to participate in shared decision making, thereby improving their outcomes. A new patient binder has been developed for patients seeking cancer care at the Benefis Sletten Cancer Institute. It is important that this educational tool be evaluated for readability, understandability, and actionability. The Patient Education Material Assessment Tool and the Flesch Reading Ease formula are two proven methods to evaluate patient health information. These tools will be used to evaluate the newly developed patient binder at the Sletten Cancer Institute. The results of the evaluation will be shared with the developers of the educational tool and leadership team. The continual evaluation of patient health information materials is essential to ensure that patients are receiving information that will meet their needs. The Clinical Nurse Leader can play an important role by acting as an educator, patient advocate, team leader, and expert clinician to ensure patients are receiving high quality patient health information.Item Assessing the readability of educational material for the urology patient with benign prostatic hyperplasia(Montana State University - Bozeman, College of Nursing, 2020) Cramer, Haily Lynn; Chairperson, Graduate Committee: Angela JukkalaEducation for the Bozeman Health Urology patient is not standardized and at the recommended AMA reading level. Patient education is outdated, either verbal or written, and differs between providers. A microsystem assessment, patient survey, and staff survey have presented the need to assess patient education and education readability. Results have presented the average urology patient is male with a diagnosis of benign prostatic hyperplasia (BPH). This assessment concluded patient education needs to be standardized and tailored specifically to this population to increase patient satisfaction and improve clinical processes. Using Up-to-Date and assessment readability tools, patient education can be created based on evidence-based information.
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