Theses and Dissertations at Montana State University (MSU)
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Item Development of an acuity scale for the inpatient hospice setting: a quality improvemtent project(Montana State University - Bozeman, College of Nursing, 2023) Blake, Angela Lynn; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: Nurse burnout and care fatigue are troubling, prevalent issue within our medical community. Research has shown that high acuity and inequitable staffing assignments contribute to the problem. No streamline solutions have been proposed in the literature. Patient safety events such as falls, and medication errors have been shown to be interrelated to nurse burnout. Balancing workload and patient demands are essential in promoting safe care environments. A 21-bed hospice unit in North Idaho recognized this correlation and requested help in developing an acuity scale to promote nurse to patient staffing equitability thus lessening care burden. Method: A literature review reviled numerous articles promoting staffing balance to stave off care fatigue. Acuity scales are an efficient, concise way to quantify workload and promote balanced staffing assignments. Staff surveys were conducted prior to and post implementation of the tool to measure staff assignment satisfaction. Data was collected on fall rates and medication errors to detect correlation between the two factors. Intervention: Only one published hospice specific acuity scale was identified in the literature review done for this project, Mary Potter Hospice Acuity Tool. A unit specific tool was developed based of the framework provided by this published scale. The acuity tool was trialed on fifty new admissions into the hospice unit between February and March 2023. Results: Limited data was collected as the implementation phase of the project was delayed due to IRB approval and facility specific setbacks. The marginal data collected demonstrates nurse assignment satisfaction improved post intervention while fall rates and medication errors actually increased. Conclusion: This projects objectives were not fully realized due to the previously mentioned delays. The data collected was minimal and greatly impacted. This project provides a solid framework for future developments in unit specific acuity tool development. Future projects such as this one would benefit from a larger timeframe in which to revise the tool being developed and facilitate better impact on the metrics being studied.Item Kennedy terminal ulcer : a retrospective chart review of ulcers in the hospice setting and educating providers and nurses on the importance of skin changes at life's end(Montana State University - Bozeman, College of Nursing, 2016) Nesovic, Anna Victoria; Chairperson, Graduate Committee: Donna A. Williams; Karen Zulkowski (co-chair)The geriatric population is growing in the United States and caring for geriatrics can be complex. This population is at an increased risk for skin injury. There are some skin changes that are seen specifically at the end of life. One of the ulcers that can be seen at the end of life is the Kennedy Terminal Ulcer (KTU). This type of ulcer is a result of hypoperfusion to the skin. Currently, there is a limited amount of literature available on the KTU. Also, some nurses and providers are unaware of this type of ulcer. The purpose of this study was to gather data on pressure ulcer prevalence, characteristics and location in hospice patients. Sacral/coccyx ulcers identified after hospice admission were used as a proxy for the KTU to gather data on the average length of life after ulcer onset and prevalence. A retrospective chart review at a local hospice home was completed to gather data on pressure ulcers and the KTU over an 18 month period. Three education sessions were also completed using the cognitive load theory to educate nurses and providers on the disease process and implications of the KTU. The pressure ulcer prevalence in a hospice setting was found to be 27.8%. The majority of pressure ulcers were stage 2 (43%). The coccyx (45%), buttock (18%) and heels (16%) were the most common areas for pressure ulcer development in this setting. The average length of life was 17.7 days and the median was 9.5 days after sacral/coccyx ulcer onset. The estimated prevalence in this sample of the KTU was 6.1%. During the education sessions only 61.5% of participants had previously heard of the KTU. The education session showed a significant difference in participant's knowledge in unavoidable pressure ulcers, pathophysiology of the KTU and usual presentation of the KTU. Being aware of the skin changes that occur at the end of life is important for providers and nurses. It gives them the opportunity to educate the family and patient about the disease process and implications. There is a need for further research on skin changes at life's end.Item The impact of learning on decision making by family members for hospice care(Montana State University - Bozeman, College of Education, Health & Human Development, 1995) Neff, Betty MarieItem Caring behavior in hospice(Montana State University - Bozeman, College of Nursing, 1997) Johnson-Smith, Teresa DaleItem Timely referrals to hospice and family satisfaction(Montana State University - Bozeman, College of Nursing, 2011) Colchin, Sharon Ann; Chairperson, Graduate Committee: Christina SieloffApproximately one-third of persons with a terminal illness utilize hospice care. Of those, ten percent only received hospice care during the last twenty-four hours of life. Late referrals to hospice can result in less time for the hospice team to perform assessments, establish relationships, and initiate mutually established goals requiring active interventions. Thus, the terminally ill person and their family may not receive the maximum benefits of hospice. The purpose of this study was to examine the relationship between the length of hospice care and the level of family satisfaction. King's Theory of Goal Attainment (1995) was used to guide the investigation of the personal and interpersonal concepts that may influence family satisfaction. These concepts included: pain and symptom management (personal), communication/education, and emotional/spiritual support (both personal and interpersonal). For the purpose of this investigation, high levels of satisfaction with hospice care would be considered to be reflective of goal attainment. The setting was a small hospice agency in a western state and a convenience sample of returned Family Satisfaction Surveys (Hospice A, 2000) spanning a three year period were used. The returned surveys were grouped by length of care into the Short Term group (less than a month of hospice care before death) and Timely group (one month as longer hospice care before death). A combination of Chisquare and t-test comparisons of means was used to test the hypothesis that longer lengths of hospice care resulted in higher levels of the family satisfaction. No significant differences existed between family satisfaction and length of care. Overall, this study found the satisfaction level with hospice care was high regardless of length of care (a mean satisfaction of 4.5 on 5 point scale).