Theses and Dissertations at Montana State University (MSU)
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Item Body dysmorphia disorder screening in medical aesthetic practice(Montana State University - Bozeman, College of Nursing, 2022) Berg, Sarah Marie; Chairperson, Graduate Committee: Lisa SluderBackground: Body dysmorphic disorder (BDD) is a concerning obsessive compulsive disorder and mental illness in which patients focus or are emotionally distraught with one or more physical flaws that most others do not observe with the same perspective. This illness is being seen at an increasing rate among patients seeking cosmetic medical treatments such as neuromodulator and dermal filler treatments. Currently, there lacks a standard of practice, including a screening process assessing for signs of this disorder. Across the literature, it has been shown that patients with undetected BDD symptoms treated with minimally invasive cosmetic treatments carry a high tendency of dissatisfaction with treatment results and pose a threat to themselves and the treating medical provider. Objectives: To implement a quality improvement project using an established BDD screening protocol within a medical aesthetic practice where minimally invasive cosmetic treatments are performed. A goal of a total of 200 screenings is to be collected by two medically licensed providers at two clinic sites. Methods: Initial screening of patient motivators for treatment, including three cryptic negative motivators. Upon selection of any of the negative motivators, automatic screening was performed using the Cosmetic Procedure Screening Questionnaire for Body Dysmorphic Disorder (COPS). Results: A total of 55 cryptic screenings examining patient motivators were collected in a four-week timeline from February 1, 2022 to March 1, 2022. The findings of initial screening results revealed 10 patients, or 18.18%, who selected one or more of the three negative motivators for treatment to be flagged for the Cosmetic Procedure Screening Questionnaire for Body Dysmorphic Disorder (COPS). Conclusions: The use of screening tools such as patient motivators for treatment and the COPS questionnaire are useful for a medical aesthetic practice to see baseline assessment of BDD symptomatology and consideration of use for a standard of practice change.Item Winning the race against diabetes with shared medical appointments at the U.S. Department of Veterans Affairs(Montana State University - Bozeman, College of Nursing, 2022) Gleason, Jason Michael; Chairperson, Graduate Committee: Margaret HammerslaDiabetes is a profound source of suffering for millions of people, as well as the seventh leading cause of death in the United States, resulting in 83,564 annual deaths (Mayer-Davis et al. 2017) Diabetes is more prevalent among US veterans at 25% compared to the general US population at 20% (Liu et al., 2017). The Veterans Health Administration (VHA) (2020) also reports that in addition to diabetes affecting 25% of the entire population of US veterans it is also the leading cause of blindness, end-stage renal disease, and amputation for VA patients. In 2001, the VHA added Type 2 diabetes to the list of health conditions caused by agent orange when it was used during the Vietnam War. Today, 270,000 Vietnam veterans are receiving disability payments for agent orange-related Type 2 diabetes (VHA, 2019). Shared medical appointments (SMAs) are a unique model of care delivery that provides an interactive setting to complete patient visits, improve access, enhance efficiency, promote peer support, build comradery, and most of all improve health outcomes. The purpose of this project was to utilize existing literature based on robust research regarding SMAs to assemble an interdisciplinary team, develop, launch, and land a 12-week diabetes SMA quality improvement project at the Montana VA--Great Falls Community Based Outpatient Clinic. This project aimed to utilize SMAs to improve six diabetes-related metrics, including hemoglobin A1 C, systolic blood pressure, low-density lipoproteins, body mass index, depression as measured by the patient health questionnaire 9 (PHQ-9) and patient satisfaction as measured by the diabetes treatment satisfaction questionnaire (DTSQ). The project resulted in clinical and statistically significant improvement in five of these metrics, making the project a best practice model of sustainable, innovative care delivery within the Veterans Administration.Item Rural healthcare assessment: identifying gaps between service and expectations(Montana State University - Bozeman, College of Engineering, 2020) Dorsey, Robert Kenneth; Chairperson, Graduate Committee: David ClaudioThis research project aims to improve patient satisfaction for customers in same-day clinics in rural areas, with emphasis on healthcare services and facilities at Native American Reservations. This project examined potential gaps between clinical staff services and the expectations of the patients. Due to the remote location and low-income level of the community, it is critical for patients to receive care at local healthcare facilities and not have to travel to other facilities for the same care. The low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) satisfaction scores also lead to less funding to the facility as well as lower-ranking in accreditation by Centers for Medicare and Medicaid Services (CMS). Utilizing survey tools and statistical analysis from Industrial and Management Systems Engineering the study looked to understand expectations on both sides. The initial phase used four open-ended questions along with a series of multiple-choice questions that were given to participants, both patients and staff. Data collected in the first phase showed a possible disconnect between the patients and staff from their responses. It also allowed the patients to rate service prior to the visit. Results showed some areas could have potential improvement but also the performance of staff is overall doing well with what they can control. The second phase revealed a more aligned view between the patients and staff in a ranking survey compiled from the first phase of the research. The ranking information allowed nonparametric testing to see if there existed statistically significant differences between the two groups. Results showed one significantly different item and two others that were borderline. The Service Value Gaps are not as prominent in this single clinic to warrant an in-depth improvement process. More information should be collected through other clinics to allow larger sample size to gain additional insight if multiple gaps exist. The items of actual or near significance were not a higher priority to either group.Item Implementation of Lean management in family practice to decrease overall clinic visit time(Montana State University - Bozeman, College of Nursing, 2020) Quist, Rochelle Eileen; Chairperson, Graduate Committee: Angela JukkalaVariations in the patient rooming process have created inefficient practices for staff in a clinic setting. Negative impacts from these variations have been correlated with increased patient wait times, delayed patient care and decreased patient satisfaction. Through patient complaints with frustrations in delayed care and wait times, this scholarly project found discrepancies in the patient flow process. Variations existed within several primary care patient settings based on individual provider training and personal habits, style, and preferences. Utilizing Lean Management ideals to improve rooming and throughput were strongly indicated within recent healthcare journals as a means to reduce waste and improve efficiency in patient care processes. Developing interventions based on Lean Management principles discovered in the literature review will be outlined for execution. Following implementation of interventions, a follow up time study will be completed to compare to the original data, as well as repeat patient satisfaction surveys. This scholarly project expands nursing knowledge by addressing the gaps in past studies by examining throughput in an outpatient clinic setting, potentially decreasing patient wait times, delays in care and increasing patient and provider satisfaction.Item A microsystem assessment : communication - the foundation for patient satisfaction(Montana State University - Bozeman, College of Nursing, 2015) Schlepp, Kathryn Michelle; Chairperson, Graduate Committee: Polly PetersenThe intent of this project was to focus on improving communication between total joint patients and care team with the aim to improve patient satisfaction. Communication between patient and care team is a large factor that can shape a patients care experience. A tool to improve communication between patients and their care team was implemented to address expected outcomes and improve patient satisfaction. This tool was a question prompting sheet that was used during the post-operative, inpatient period to help address patient specific questions and concerns, increase and improve communication with the care team and create a higher level of patient satisfaction. The tool created additional opportunities for direct patient communication related to their specific questions and concerns which created the ability to address the individual patient concerns.Item Getting fixed : perceptions of rural and urban patients who have experienced total knee or hip replacement surgery and their discharge planners in a Montana hospital(Montana State University - Bozeman, College of Nursing, 1991) McIntosh, Allison MarieItem ICU patients' and ICU nurses' perceptions of important nurse caring behaviors(Montana State University - Bozeman, College of Nursing, 1987) Vanek, Gretchen TorrenceItem Nurses' perceptions of the utility of patient scripting with regards to patient satisfaction(Montana State University - Bozeman, College of Nursing, 2012) Hasenkrug, Kally Marie; Chairperson, Graduate Committee: Susan LuparellThis research study was intended to determine the perceptions of nurses' regarding the utility of patient scripting with regards to patient satisfaction. Patient scripting refers to a script used by nurses while speaking to patients and/or their families to convey a consistent message from all nurses and employees. Hard copy surveys were delivered into the work mailboxes of 95 part-time and full-time nurses on the maternal child department of a local community hospital. It was found that nurses find patient scripting important to patient satisfaction, easy to use, and easy to incorporate. However, some nurses felt that it was awkward and not words they would generally use in conversations with patients or families. The nurses did not feel it increased their job satisfaction or hospital revenue. It appears that if the nurses were to develop a script that was easier to use or made up of words they would use more easily, they would utilize patient scripting more frequently.Item Does scripting by nurses in the emergency department increase patient satisfaction scores?(Montana State University - Bozeman, College of Nursing, 2009) Fuller, Melissa Lynn; Chairperson, Graduate Committee: Christina SieloffIncreased patient satisfaction has become has become a serious financial issue in hospitals for two reasons: (1) unfavorable patient satisfaction ratings may prompt high-cost decisions such as a new construction prompted by competition from other hospitals and (2) low satisfaction rating may affect a hospital's standing. Research indicates that the patient satisfaction scores in many emergency departments (EDs) around the world are low. The purpose of this study was to evaluate the use of scripting by nurses in the Emergency Department to increase patient satisfaction scores. Satisfaction scores have decreased tremendously in EDs all around the world. Improving emergency department patient satisfaction scores has been studied from several approaches, with a common theme being a lack of communication between emergency department staff and their patients. One method in particular that might help to foster better communication is the use of scripting by the nursing staff. The study design was a quantitative research study using overall patient satisfaction scores as well as well as scores from individual communication questions during the pre-scripting and post-scripting time frames to examine the use of scripting by emergency department nursing staff and its relationship to the increase in patient satisfaction scores. A retrospective, longitudinal analysis was conducted of patient satisfaction scores before and after the implementation of scripting by emergency department nursing staff. This was done to determine if there was an increase in the patient satisfaction scores. The primary focus of this study was patient satisfaction and its association with perception of care in the ED. This includes communication with patients regarding their perception of care as it relates to the process of informing patients about their specific tests and procedures. However, because no statistical analysis could be done, the null hypotheses were accepted.Item Satisfaction determinants : parents with children admitted to an adult inpatient surgical unit(Montana State University - Bozeman, College of Nursing, 2006) Dosier, Sharla June; Chairperson, Graduate Committee: Karen ZulkowskiWith the recent movement in healthcare to view the patient as a consumer, it has been recognized that patient satisfaction is an essential measurement of high quality healthcare. For populations of patients that have difficulty speaking for themselves, such as pediatrics, assessing the parent guardian satisfaction becomes essential. Rural areas face unique challenges with pediatric care including long distances from home to a healthcare facility and lack of specialized care. The causal model is used for the theoretical framework, which states that there are two factors that directly influence patient satisfaction. These are process quality and clinical quality. Demographic factors are also included because there is conflicting information of the correlation between demographics and satisfaction. There is little known about the factors that contribute to high levels of satisfaction in the pediatric population. The purpose of this study is to understand what factors play the greatest role in directly influence satisfaction of parents whose children are hospitalized. Specifically, the relationship between overall satisfaction and parent demographics, process quality and clinical quality were explored. The study is a descriptive correlational study with a non-random, convenience sample of parents whose children are admitted to adult in-patient surgical unit during an eight week period of time. The parents filled out a Pediatric Family Satisfaction Questionnaire (PFSQ) at the time of discharge. The total sample size was 13 with a 77% response rate. Overall, the satisfaction scores were very high. Correlations could not be established due to the lack of variability in certain factors. The study did reveal trends that are consistent with findings of previous studies. These trends include the reluctance to be critical of healthcare, higher satisfaction scores with lower levels of education and higher satisfaction with process quality.