Theses and Dissertations at Montana State University (MSU)
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Item Improving sleep opportunities in hospitalized postpartum mothers(Montana State University - Bozeman, College of Nursing, 2022) Cantwell, Lindsay Rose; Chairperson, Graduate Committee: Christina BorstSleep deprivation and the fatigue experienced by new mothers remain well-accepted facts of life after the birth of a newborn. In the past, most new mothers utilized hospital nurseries to aid them in caring for their infants after birth; but recent paradigm practice changes in hospitals emphasize rooming-in, breastfeeding, and strongly discourage separation of the mother/newborn couplet. In Baby-Friendly accredited hospitals, postpartum mothers are encouraged to prioritize their infant's needs often above their own, contributing to significant maternal sleep deprivation and fatigue. This quality-improvement project aimed to increase sleep/rest opportunities for mothers through the implementation of coordinated quiet times on a postpartum unit in a Baby-Friendly hospital in the northwestern area of the United States. The Knowledge to Action framework guided this project. Staff received education about the importance of postpartum sleep and the quiet-time practice change. The implementation took place over 4 weeks. Chart reviews were completed, and the mothers who received quiet times were tracked. Practice outcomes included 51% of postpartum moms having a quiet time during week 1; week 2, 64%; week 3, 57%; and week 4, 62%. The quality-improvement project successfully increased sleep/rest opportunities for mothers through quiet times. Prior to the project, there was no standardized effort on the unit to promote maternal sleep or rest. An increase of over 50% during all practice weeks was accomplished. Additionally, there was no significant increase in infants utilizing the nursery, making this intervention viable in the Baby-Friendly hospital setting.Item A pilot implementation of postpartum depression screening guidelines in the pediatric primary care setting(Montana State University - Bozeman, College of Nursing, 2019) Popa, Ryann Christine; Chairperson, Graduate Committee: Susan LuparellStatement of the problem. Postpartum depression (PPD) is a common postpartum complication. This condition can have a negative effect on family wellness and can impact the development of the infant. Unfortunately, it is estimated that only half of PPD cases are ever recognized and diagnosed by providers. Although evidence supports incorporating PPD screening guidelines into well-child visits, the pediatric providers at the project site do not routinely include this screening process in their practice. As a result, opportunities to identify mothers with PPD and provide them with education and resources were being missed. Methods. The project took place at an outpatient pediatric clinic in Montana. Four pediatric providers incorporated PPD screening guidelines utilizing the Edinburgh Postnatal Depression Screening tool into routine well-child checks for children ages 1 to 12 months. Using a data collection tool, providers recording data related to the screening process including the age of the child, whether or not the mother was screened, the EPDS score, and how the situation was addressed if the results of the EPDS were positive. The perspectives and beliefs of the providers were captured using a pre-implementation and post-implementation survey as well as a verbal debriefing at the end of the project. Results. Data were collected on 88 encounters where screening was indicated. Fifty-three of the 88 mothers were screened. Eight screenings were positive which suggested possible depression symptoms. Although providers were in favor of this practice change overall both before and after implementation of the PPD guidelines, some significant barriers and challenges emerged during the process. Discussion. Barriers to incorporating PPD screening guidelines into well-child visits include time constraints, cooperation and willingness of the mother to participate, remembering to administer the screening tool, and repetition of unnecessary screening in mothers who have already been diagnosed with depression. Changes could be made to the design of this project to reduce limitations and improve the implementation process. Overall, this project found that PPD screening at well-child visits has the potential to be feasible and valuable to the practice of this organization.Item Maternal and child nutrition support in the food environment(Montana State University - Bozeman, College of Education, Health & Human Development, 2015) Houghtaling, Bailey Elizabeth; Chairperson, Graduate Committee: Carmen Byker; Carmen Byker Shanks and Mica Jenkins were co-authors of the article, 'Factors associated with increased likelihood of breastfeeding among participants of the USDA's Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): a systematic review of literature' submitted to the journal 'Public health nutrition' which is contained within this thesis.; Carmen Byker Shanks, Teresa Smith and Selena Ahmed were co-authors of the article, 'Validation and adaptation of the nutrition environment measure in stores (NEMS-S) to assess infant feeding resource support in the food environment' submitted to the journal 'Preventing chronic disease' which is contained within this thesis.Infant feeding resources are often found within food environments yet have not been a main focus of food environment investigations. Food options in the retail environment are important, complex factor in dietary choices that can either be promotional or preventative of healthy behaviors. At the same time, breastfeeding is considered a top public health priority due to its unparalleled, favorable health outcomes that impact infants, mothers, and entire communities. For this reason the American Academy of Pediatrics recommends that breastfeeding continue for at least one year after birth. There are multiple practical and social barriers to breastfeeding for women that support the need for appropriate formula varieties in the food environment to support infant nutrition. The United States Department of Agriculture's (USDA) Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes breastfeeding as an optimal source of nutrition for infants, and offers breastfeeding incentives for enrolled mother-infant pairs resulting in higher assistance allotment for foods, or formula supplements for non-breastfed infants. This research includes a systematic review of literature conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines in order to identify factors associated with increased likelihood of breastfeeding among WIC participants. This research also introduces a measure adapted from the Nutrition Environment Measure in Stores (NEMS-S) formulated to capture infant feeding support in the food environment. The Infant Feeding Resource Survey (IFRS) captures WIC-supported brand formulas and alternate brand varieties in addition to resource support necessary for breast or formula feeding in store settings. Review findings indicate sociodemographic characteristics, environmental and media support, government policy, intent to breastfeed, attitudes toward breastfeeding, social support, and time exposed to WIC program are correlated with increasing breastfeeding rates within this population. Application of the IFRS indicated a reduced variety of infant feeding resource options in more rural locations in Montana. Data provides valuable information in extension of the state of the science of food environment focused research.Item Protein nutrition of expectant mothers in American Samoa and its effect on the health of the infant(Montana State University - Bozeman, College of Education, Health & Human Development, 1971) Baron, Kathleen Graney