Theses and Dissertations at Montana State University (MSU)
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Item Measurement based care for improving clinical depression and attention-deficit/hyperactivity disorders(Montana State University - Bozeman, College of Nursing, 2024) Blouin, Patrick Daniel; Chairperson, Graduate Committee: Alice RunningBackground: Measurement based care is an evidence-based approach proven to enhance diagnosis and treatment of psychiatric disorders. This patient-centered strategy involves the routine use of clinically validated, self-report rating scales to quantify clinical outcomes over time and guide decision-making. Extensive research indicates that measurement based care improves the quality of psychiatric care and patient outcomes. Local Problem: Prior to implementation of the Doctor of Nursing Practice project, measurement based care for adults diagnosed with clinical depression and/or attention-deficit/hyperactivity disorders had not been implemented at a mental health clinic located in southwest Montana. Methods: Hence, the purpose of the Doctor of Nursing Practice project was to implement the Beck Depression Inventory II and the Adult ADHD Self-Report Scale for adult patients, treated in-person at the clinic, diagnosed with clinical depression and/or attention/deficit-hyperactivity disorder. Interventions: After approval by the Montana State University Institutional Review Board, qualifying patients were administered the appropriate self-report rating scale via iPad at the beginning of each clinical encounter. Immediately after patients completed the self-report rating scale, the clinician reviewed their scores and used this data to augment decision-making. Results: The results of the 11-week project revealed improved follow-up scores, suggesting that data collected from clinically validated, self-report rating scales may have enhanced earlier detection rates of deterioration and enhanced clinician responsiveness to subtle changes in morbidity. Conclusion: In summation, the Doctor of Nursing project underscores the importance of measurement based care for improving patient outcomes related to clinical depression and/or attention/deficit-hyperactivity disorders and provides valuable insights for future quality improvement initiatives.Item Development and implementation of a new referral process and dot phrase technology for a rural medication therapy management program to improve patient safety(Montana State University - Bozeman, College of Nursing, 2023) Scott, Jonathan Muir; Chairperson, Graduate Committee: Margaret HammerslaNo medication or procedure will cure dementia, and most patients will experience behavioral and psychiatric symptoms as the disease progresses. Medications to treat the symptoms of dementia are complex. Medication therapy management is a patient-centered collaborative agreement between provider and pharmacist that has shown positive outcomes in reducing adverse drug reactions. In January 2021, an outpatient clinic in Southwest Montana implemented the Rural Access to a Psychiatric Pharmacist for Seniors (RAPPS), an MTM pilot program to address the complex medication-related problems of elderly dementia. During the RAPPS process, an internal review identified two major concerns: (1) clinical information being communicated from provider to pharmacist needs to be more consistent and (2) the current system lacks a clearly defined referral process. This ongoing process improvement project used four Plan-Do-Study-Act cycles to develop, implement, and evaluate the dot phrase. A dot phrase is a section of text to be inserted into an electronic health record progress note. The dot phrase's utilization was analyzed at three different timepoints over the project's 6-week implantation period. A five-question visual analog scale provider-satisfaction survey was developed to be conducted at the fourth PDSA cycle. Preliminary data collected from the electronic health record from November 2022 to December 2022 found that 45% of providers' notes at the time of referral did not document a psychiatric diagnosis, and 81% of the notes did not confirm or deny outside psychiatric management. The primary, secondary, and tertiary SMART goals were not met. The QI project encountered many unforeseen problems throughout this study. The preliminary data collected in this project demonstrated that documentation deficits are occurring between providers and the clinical pharmacist. As more and more of our medical information becomes digital, health professionals will require additional training to become proficient in using these systems. IT systems are complex and challenging, so future quality improvement projects should have a dedicated IT specialist on their team. For collaborative agreement programs to succeed, clear communication between all stakeholders must be championed. Future research should examine technologies that encourage interprofessional communication within electronic referral systems.Item Barriers that prevent nursing staff on a non-critical care unit from effecting individualized documentation of patient care plans(Montana State University - Bozeman, College of Nursing, 2015) Smith, Janet Lee; Chairperson, Graduate Committee: Polly PetersenHistorically, patient care plans were introduced in the academic arena to teach a process that nursing students could use to identify and define a patient-centered problem. This method has evolved to a five step process known as the nursing process. The five steps include assessment, diagnosis, planning, implementation and evaluation. The nursing process is fundamental to providing quality, safe and individualized care that results in positive patient outcomes (Doenges, Moorhouse, & Murr, 2006). A major tool within the nursing process is the patient care plan. Patient care plans are multidisciplinary and are used to communicate and document patient care. They are required by government agencies, third-party payers and are part of hospital policy (Doenges et al., 2006). The impetus of this project was an audit by The Joint Commission of an acute care hospital. The audit revealed a deficit in compliance in regards to documentation of individualized care plans. Changes were instituted within the acute-care hospital however; it was felt by staff that these changes did not address the root cause of the problem. The purpose of this project was to identify barriers that prevent nursing staff on a non-critical care unit from effecting individualized documentation of patient care plans. Three focus groups assembled to discuss their insights regarding the barriers professional nurses face that prevent them from documenting on and making a patient's care plan individualized. This project proposed using the data from the focus groups for further investigation and research to develop nursing processes and technology that can truly benefit patient outcomes.