Theses and Dissertations at Montana State University (MSU)

Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/732

Browse

Search Results

Now showing 1 - 10 of 29

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.
Post-sepsis syndrome: improving morbidity & mortality following hospitalization
(Montana State University - Bozeman, College of Nursing, 2020) Woods-Tatarka, April Ann; Mauws, Amanda Frances; Chairperson, Graduate Committee: Angela Jukkala
Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection. Globally, statistics are grim with 19 million cases diagnosed annually. Each year in the United States (US) there are over 1.6 million people diagnosed with sepsis; over 250,000 of these will not survive. Currently, it is a leading cause of morbidity, mortality, and hospital readmissions in the US. The population of focus was those residing within the north-central Montana region. The purpose of this project was to explore the topic of post-sepsis syndrome (PSS) and its occurrence following a primary diagnosis of sepsis. The goal of this project was the development of a quality improvement initiative focused on establishing a care-management program for patients diagnosed with sepsis. Ultimately, maximizing patient health and healthcare organization outcomes. An interprofessional team was convened to develop an evidence-based quality-improvement plan to decrease the human and financial costs of sepsis and PSS. The purposed evaluation of the quality-improvement project includes monthly PDSA cycles with project goals reviewed bi-annually.
The nurse practitioner's perspective of the physician orders for life-sustaining treatment (POLST) form
(Montana State University - Bozeman, College of Nursing, 2020) McAllister, Sarah Elizabeth; Chairperson, Graduate Committee: Stacy Stellflug
The assessment, documentation, and implementation of a Physician Orders for Life-Sustaining Treatment (POLST) form are important for end-of-life care. As primary care providers, nurse practitioners have an important role in advanced-care planning, including the completion of POLST forms (Hayes et al., 2017). The purpose of this project was to better understand the self-reported practices and opinions of nurse practitioners as they assist patients in completing the form. The project was a partial needs assessment to inform later quality improvement (QI) work and used a survey design to assess and gain better understanding of the practices and opinions of nurse practitioners with the POLST form. Questions 1, 4, 6, and 8 were 'select all that apply' and Questions 2, 5, 7, and 9 required a single response. A total of 126 surveys were sent out with a response rate of 39.6%. Overall, nurse practitioners in Billings, Montana, were familiar with the POLST form (n=45, 90%). Half (n=28, 50%) of the nurse practitioners surveyed used the POLST form in their clinical practice despite having barriers to its completion such as it being time consuming (n=18, 25.7%). Over half (n=45, 60.0%) of the nurse practitioners surveyed believed that the most appropriate time to complete the POLST form was after a provider (any provider) discusses goals of care and medical treatments with the patient and/or family. Although some nurse practitioner respondents had no concerns with completing the POLST form (n=12, 21.1%), 21 of the respondents (n=21, 36.8%) reported issues regarding the understandability of the form for patients and/or families. Survey results showed familiarity of the POLST form is not a barrier to its completion in Billings, Montana, but 25.7% of the respondents believed the time it takes to complete the form was a barrier to completing it with patients and/or families. Nurse practitioners could include extra time in appointments or use annual wellness visits to discuss goals of care with patients and/or families. Future effort could also focus on reducing the amount of time nurse practitioners spend filling out a POLST form accurately and completely with their patients and/or families.
A systemic pedestrian safety planning tool for rural and small urban areas
(Montana State University - Bozeman, College of Engineering, 2018) Jamali, Amir; Chairperson, Graduate Committee: Yiyi Wang
Rural areas bear a disproportionate number of pedestrian fatalities: the fatality rate per 100 million vehicle miles traveled is 2.5 times higher in rural areas than in urban areas. To measurably improve pedestrian safety, it is paramount to predict crash hot spots and apply cost-effective countermeasures. This dissertation work developed a new systemic pedestrian safety tool to enhance crash hotspot identification and safety project prioritization for rural and small urban areas. This new tool suggested a six-step systemic safety framework: (1) initial screening, which identifies what type of facilities are more prone to pedestrian crashes, (2) pedestrian exposure estimation, which provides an area-level exposure metric using National Household Travel Survey (NHTS) 2009, (3) crash risk factor identification, which identifies the factors that contribute to the occurrence and high severity levels of pedestrian crashes, (4) hotspot identification, which identifies the locations that are more likely to experience pedestrian crashes using two-step floating catchment area (2SFCA) method, (5) countermeasure selection, which provides candidate countermeasures through literature sources, and (6) project prioritization, which ranks safety projects through a mixed linear programming. This study incorporated three states' pedestrian crash data from 2011 to 2013: Texas, Oregon, and Montana. It was found that in rural and small urban areas pedestrian safety is associated negatively with male and elderly drivers, shoulder presence, bike lane presence, higher speed limit, number of lanes, wet surface, pedestrian exposure, hospital distance, population density, median income, share of industrial and commercial areas, and dark hours. In contrast, the pedestrian safety is associated positively with signal control, sidewalk and warning sign presence, median presence, icy and snowy surface, higher AADT, and high densely household areas. To validate the proposed hotspot and project prioritization methods, this study used the pedestrian crash data set from 2014 to 2016 in the City of Bozeman, a small urban area. According to findings, about 60 percent of crash locations fall on areas with a high crash risk index. Reasonable countermeasures were suggested for twenty intersections with highest crash risk index. It was found that budget of $100,000 is the optimal budget, where the crash risk index was reduced by 63 percent.
Promoting advance care planning education and advance directive completion in the community setting
(Montana State University - Bozeman, College of Nursing, 2019) Smith, Mary Elizabeth; Chairperson, Graduate Committee: M. Jean Shreffler-Grant; Dale Mayer (co-chair)
The United States population is aging due, in part, to western medicine's ability to prevent, treat, and cure disease which has allowed the prolongation of life. End-of-life care has become more invasive and, despite the continued focus on patient autonomy, rates of advance directive (AD) completion remain low. Increased knowledge may increase the community dwelling adult population's ability to plan for end-of-life, have end-of-life conversations, complete ADs, and increase individual's autonomy at end-of-life. Purpose: The purpose of this project was to educate community-dwelling adults about the purpose and importance of ADs, encourage conversation about end-of-life planning, encourage completion of ADs in community-dwelling adults of all ages and in doing so, promote personal autonomy. Method: A sample of N=16 community-dwelling adults participated in an educational intervention that contained information on end-of-life planning with a focus on ADs. Pre- and post-intervention surveys were used to gather demographic information, assess AD knowledge and examine participant views on importance of understanding health information and autonomy. Descriptive statistics, qualitative description, and paired-sample t test was used to analyze the data. Outcome: The sample consisted of 16 community-dwelling adults between ages 30 and 84-years old. The five questions assessing AD knowledge Pre- and Post-intervention were scored as correct or incorrect for each participant and total correct responses were computed into a mean score. The results of the paired sample t-test indicates that there was a significant difference between scores for pre-intervention survey (M= 63.75, SD = 22.84) and post-intervention survey (M= 90.0, SD= 10.9, t(4)=3.015, p=.039). Conclusion: The project results indicate that this intervention was effective in increasing AD knowledge, although, the impact on actual AD completion rates was not assessed. Further research is needed to identify successful methods of increasing ACP and AD knowledge in the community-dwelling adult population and also to identify the impact of such programs on actual AD completion.
The effect of natural disaster on individual-level aspiration: evidence from rural Nepal
(Montana State University - Bozeman, College of Agriculture, 2019) Shrestha, Samyam; Chairperson, Graduate Committee: Diane Charlton
In this study, I analyze the effect of the 2015 Nepal earthquake on individual-level aspiration. I use the data from a longitudinal household survey in rural Nepal from 2014 and 2016, and the earthquake intensity data from the United States Geological Survey (USGS). Using a fixed effects model, I find that compared to those who experienced below median earthquake intensity in terms of Modified Mercalli Scale (MMI), those who experienced MMI between the 50th and 75th percentile had their aspiration index drop by 0.14 of a standard deviation. Similarly, the drop was 0.33 of a standard deviation for those experiencing MMI more than 75th percentile. This finding adds to the literature that natural disaster not only damages physical infrastructure but also curtails individual's overall aspiration, which, as the economic literature illustrates, has a negative effect on investment. There was, however, no consistent statistically significant effects on the individual components of aspiration.
Science and engineering practices in secondary science
(Montana State University - Bozeman, College of Letters & Science, 2018) Engebretsen, Derek Kelley; Chairperson, Graduate Committee: Greg Francis
This study investigated the effect of developing and using rubrics to assess students' abilities to plan and carry out investigations and engage in argument from evidence as defined by the Next Generation Science Standards. The intervention was carried out with a group of eighth-grade students in science and a high school physics class. A control group of similar eighth-grade students was also established in another class. Modest gains were seen with the eighth-grade intervention subgroup in a test of scientific reasoning skills, but the real value in the intervention was the ability for the assessment tools to communicate expectations for these practices.
Impact of leadership on early childhood education program quality
(Montana State University - Bozeman, College of Education, Health & Human Development, 2018) Barney, Norah Lee; Chairperson, Graduate Committee: William Ruff
The evaluation of early childhood education programs includes focus on child outcomes and later academic success, but little is known about the impact of preschool leadership on early childhood education program quality. The purpose of this qualitative comparative case study was to investigate the relationship between early childhood leadership and preschool program quality among Preschool Development Grantees (PDG) in a rural northwest state. Two research questions were used to guide the study (1) how does a preschool leaders approach to leadership influence preschool program quality? (2) How does the instructional delivery model influence the leaders approach to program quality? Results from this study hope to continue to advance early childhood initiatives in the state and perhaps suggest a leadership model which leads to higher quality programs. This study also hopes to inform organizations that are planning on starting preschools within their community and the impact of program structure. There are two program structures examined in this study. The first is a preschool located in a K-12 building. The second is a mixed-delivery model of preschool and Head Start students located in one school. Two PDG sites were purposefully selected using Classroom Assessment Scoring System (CLASS) data. School leaders were interviewed and assessed using the Leadership Practice Inventory (LPI) which was used to gather multiple perspectives about each leader's behavior. Data analysis revealed three themes: the importance of relationships, leadership orientation, and leadership candor. Results indicate that some leaders are more transactional than transformational and that the structure of the program assisted with a better understanding of Child Guidance. Further study needs to be done on the history and background of preschool sites to determine the type of leader that is needed at the time. Also, a more in-depth broader study could be completed to examine how leadership affects high quality programs.
The effect of organic certification on farmland value
(Montana State University - Bozeman, College of Agriculture, 2017) Boldbaatar, Munkhnasan; Chairperson, Graduate Committee: Joseph Janzen
This research considers the relationship between organic certification and farmland values. We employ the ARMS survey data from 2003 to 2011. We construct three models with different organic status classifications. We control for differences in farm type, NASS crop district, urbanization, and year fixed effects. We find that organic certification has a significant (statistically and economically) effect on farmland value. Our model suggests that a 1 percentage point increase in a farm's organic land would result a 0.23 percentage point increase in the farmland rental rate.
No little plans: making and breaking the 1992 Chicago World's Fair
(Montana State University - Bozeman, College of Letters & Science, 2017) Coletta, Sarah Louise; Chairperson, Graduate Committee: Robert Rydell
This dissertation analyzes the failed 1992 Chicago World's Fair through several lenses in order to explore four separate but connected processes: planning and designing a large urban fair, protesting that fair, and creating an archive. In doing so, I highlight the fact that all events are historically contingent, undermining the idea that events are the result of inexorable historical processes. The case of the 1992 Chicago Fair provides an opportunity to glimpse a historical process suspended in time: there is not a satisfying conclusion to a fair that didn't happen, but there are both memories and a sizable archive. The planning and design chapters focus on how the fair planners made decisions, and on how they worked both with and against city and state governments as well as the Bureau of International Expositions. Using newspapers and documents culled from several archives as well as the official depository for fair materials, the Chicago History Museum, this narrative reveals the many missteps of the fair planners, and points to several specific factors that contributed to the fair's failure. The protest chapter adds to the growing analysis of protest movements in the 1980s, and situates the protestors' strategies in the social and political contexts of Chicago. The last chapter looks at the archive of the archivist. Archivist Evelyn Wilbanks' personal papers regarding the fair are also housed at the Chicago History Museum, and reading them leads to an investigation of the place of the archivist in the production of history.

Theses and Dissertations at Montana State University (MSU)

Browse

Filters

Settings

Sort By

Results per page

Search Results