Theses and Dissertations at Montana State University (MSU)
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Item Increasing patient support for chronic heart failure self-management through structured telephone support: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Pursell, Melissa Zoe; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Chronic heart failure (CHF) affects an estimated 6.2 million Americans and is the leading cause of hospitalization in adults older than 65 in the U.S. and has the highest 30- day readmission rate among all surgical and medical conditions. Experts suggest nearly 25% of these readmissions are preventable. Problem: A clinic in northwest Montana has a higher than the national CHF readmission rate. The clinic follows current guidelines for post-hospitalization follow-up. Evidence shows supplementing usual care with structured telephone support (STS) is an effective method for decreasing readmission rates. Methods: All CHF patients of the clinic are called within three days of hospital discharge to be enrolled into the STS program. The Care Coordinator calls the CHF patients twice weekly using the STS template to provide support for CHF self-management. The content of each biweekly call is documented using the STS template. Results: No patients were enrolled in the STS program during the eight-week QI implementation period. Two CHF patients were discharged but were not enrolled into the program for various reasons. Discussion: Inconclusive results related to insufficient data does not inherently mean this project provides no value. Recommendations were derived from the results of this QI project that may be useful for future STS QI projects. This project revealed that not all recently discharged CHF patients are good candidates for STS and the importance of developing candidate inclusion criteria.Item Integrated behavioral healthcare: examining barriers and facilitators to referring clients virtually in a rural primary care clinic(Montana State University - Bozeman, College of Nursing, 2023) Madson, Christian Ghilliam; Chairperson, Graduate Committee: Margaret HammerslaRural primary care providers are considered the first line for behavioral health and substance use disorder (SUD) treatment in Montana, which is designated as a Mental Health Professional Shortage Area (MHPSA). Virtual integrated behavioral health (IBH) is one approach primary care organizations use to support the efficient use of behavioral health resources. This quality improvement (QI) project aimed to examine barriers and facilitators to a current virtual IBH program at a rural Montana primary care clinic. During the pre-project process mapping and narrative member checks, areas of opportunity for improvement were identified. Areas of potential improvement included access to a warm handoff workflow, a desire for a behavioral health scripted communication tool, and modifications to the mood and SUD screening process. Surveys and narrative data from staff were collected weekly and informed ongoing changes to the IBH process, the scripted communication tool, and the mood and SUD screening process. An IBH "super user" was identified and accepted the role. The project resulted in a staff-approved warm handoff workflow and scripted communication tool and the emergence of an unexpected barrier to the IBH process: differences in the lived experiences of salaried versus hourly staff and their impact on the diffusion of change within the organization. The findings of this QI project demonstrate the importance of organizational buy-in among stakeholders and its importance to the success of collaborative projects. Electronic health record (EHR) documentation of mood and SUD screenings, inclusivity in design methods, and recognition of power differentials are recommended to create and sustain workflow and process modifications.Item Implementing an electronic patient portal enrollment program in primary care(Montana State University - Bozeman, College of Nursing, 2022) Cayer, Caitlyn MacKay; Chairperson, Graduate Committee: Amanda H. LucasPurpose: This the purpose of this quality improvement (QI) Project was to implement a portal enrollment program that includes staff training and a new workflow process to provide accessibility to patients' PHI and comply with federal regulations. Successful long-term implementation will positively affect the primary care clinic reimbursement by achieving the overarching goal of offering enrollment to all patients, thereby aligning the clinic with regulatory expectations of Health Information Technology (HIT). Methods: The project site was an FNP-owned clinic with approximately 888 active patients with an average of 160 patients seen monthly. The project purpose addressed through the implementation of three evidence-based methods, including (a) training employees on electronic patient portal use and enrollment; (b) providing marketing materials to patients presenting for visits; and (c) evaluating the success of offering 'on-the-spot' electronic patient portal account activation through an innovative workflow. Results: 175 adult patients presented to the clinic for an appointment during the six-week intervention period. Of these participants, 151 were provided with a brochure highlighting the portal per the project workflow which was fell under the goal of 100% of patients being given the brochure. Additionally, 38% of patients chose to activate their portal 'on-the-spot' which met and exceeded the goal of 20% for the intervention period. Implications for Practice: This quality improvement project provides insight into the effectiveness of using informational materials and a new workflow to introduce patients to a newly activated Electronic Patient Portal. The workflow established will continue at the clinical site with some minor adjustments to improve long-term sustainment. This continued process not only addressed the need to maintain compliance with federal regulatory expectations, but also laid the framework for the clinic to carry out similar quality improvement projects involving health information technology in the future.Item Clinical nursing education in a time of Covid-19: a comparison of virtual and in-person simulation debriefing methods(Montana State University - Bozeman, College of Nursing, 2021) Kirk, Meghan Anne; Chairperson, Graduate Committee: Jennifer SofieA global COVID-19 pandemic was declared in March, 2020, causing educators and students around the world to pivot toward virtual education when in-person education methods became impossible to safely deliver. This posed unique challenges within nursing education and other disciplines, which historically required experiential or hands-on training. Barriers and disadvantages to traditional in-person clinical nursing education methods such as: limited clinical site availability, competition between schools for clinical sites, cost, increased risk potential, increased patient acuity, decreased average length of hospital stay, and faculty shortages led to exploration of clinical education through in-person and virtual simulation methods predating the COVID-19 pandemic. One of the essential elements of simulation is debriefing, which describes an interactive and reflective discussion of simulation events, which aids in assimilation of new knowledge and ability to apply what is learned in future clinical experiences. The project lead explored and compared 3rd-year nursing student experiences with face-to-face simulation debriefing and virtual debriefing methods. Debriefing Assessment for Simulation in Healthcare survey scores for a small convenience sample of students (n=17) for each debriefing method were collected before and after the COVID-19 mediated educational shift. Qualitative responses were solicited only in the virtual debriefing survey, when students were asked to identify their preference for either face-to-face or virtual debriefing as well as any benefits or challenges associated with each method. Descriptive statistics along with a one-group two-tailed repeated measures Student's T-test was completed for analysis in The Statistical Package for the Social Sciences. T-test results of student scores for each debriefing element were all statistically insignificant at a 95% confidence interval, aside from Element #5 which describes instructor identification of success or failure modes. Student ratings for debriefing quality and subsequent T-test findings suggest that student experience with virtual and face-to-face methods is equal, except with regard to instructor feedback, but are limited due to diminished statistical power. However, qualitative results indicate students uniformly expressed a preference for traditional debriefing methods over virtual simulation debriefing. Virtual simulation debriefing, while not as familiar or easy in terms of communication, appears to be an effective alternative to traditional, face-to-face debriefing.Item Bridging the gap of care for chronic pain patients(Montana State University - Bozeman, College of Nursing, 2019) Lantz, Stormy Paige; Chairperson, Graduate Committee: Polly PetersenAim: Examine the need for multidisciplinary pain management support for primary care providers at a provider based ambulatory care setting in western Montana. Background: Although chronic pain ailments make up a significant portion of primary care provider visits, many providers do not feel equipped to manage nonmalignant chronic pain and often fear legal consequences of opioid prescribing. With gaps in pain specialist availability, provider comfort, and geographical and financial challenges, Telemedicine may help alleviate provider stress through the delivery of emotional support and structured case discussion and consultation, assisting providers with communication strategies, mental health referrals, and difficult decision-making surrounding opioid prescribing Method: Twenty six primary care providers received an electronic questionnaire to assess their pain management needs and views regarding the training, challenges, expectations, and impact of implementing Telehealth at their current organization. Results: Five out of twenty six providers participated in the project. Eighty percent (80% 'n=4') of providers said they would use Telehealth for pain management if it was available to them, identifying interprofessional collaborative practice, initial evaluation and treatment plan recommendation, ongoing treatments, and education as the most useful telehealth applications. Conclusion: Chronic pain management is a problem for primary care providers. Future research on small, rural organizations using telehealth to meet their patients' pain management needs and additional needs assessments are needed to gain insight into providers engagement levels prior to moving forward with implementation of a Telehealth program at this organization to ensure a successful implementation.Item Store and forward wound teleconsultation in rural home health: a practice improvement project(Montana State University - Bozeman, College of Nursing, 2019) Roche, Rebecca Lynn; Chairperson, Graduate Committee: Susan RaphWound prevalence is increasing due to the aging demographics of the population and a rise in chronic diseases. Home health organizations face many challenges managing the rural home health patient with wounds as this population consumes a high number of resources and lacks access to wound experts. Store-and-forward (SAF) wound teleconsultation allows the home health patient to receive treatment recommendations from a wound expert using photographs taken by the home health nurse. The purpose of this practice improvement project was to explore patient, nurse, wound expert, and primary care provider satisfaction and perceived benefits of wound photography and SAF wound consultation in rural adult home health patients with wounds. Rozzano Locsin's Technological Competency as Caring in Nursing theory provided the guiding framework for this project. A standardized wound photography protocol utilizing the NE1 Tool was developed and implemented in a home health department as an adjunct to the weekly written assessment. One month later, three adult patients were recruited to a 12-week SAF wound consultation pilot using AthenaText application on mobile devices. Following the project period, a quantitative survey assessment of satisfaction and perceived benefits was conducted using three group-specific surveys. Seventeen participants completed the survey: (1) wound expert, (2) patients, (5) providers and (9) nurses. All groups reported moderately high satisfaction with photography and 100% indicated agreement that photographs should be a standard component of care. Additional perceived benefits were noted in communication and identifying wound changes. All participant groups were highly satisfied with SAF wound consultation. Patients and the wound expert rated SAF wound consultation the highest citing benefits of reduced travel and promotion of rapid changes in treatment. Patients reported SAF consultation was equivalent to clinic care; however, comments suggest home-based wound care is superior to clinic-care in cases of severe immobility and difficult to reach wounds. This project demonstrated high satisfaction and multidisciplinary benefits related to wound photography and SAF wound consultation in the rural home health population. Standardized wound photography and SAF consultation is a cost-efficient, feasible, and essential component of wound management that improves access to wound expertise in the rural home health setting.Item The value of telemedicine in rural healthcare and associated financial obligation(Montana State University - Bozeman, College of Nursing, 2018) Nordlund, Sarah Lou; Chairperson, Graduate Committee: Polly PetersenThe purpose of this project was to raise awareness of the vital impact emergency room telemedicine has on rural residents and health care and the financial challenges facilities face to maintain these services following implementation. Limited knowledge is available to determine how rural critical access hospitals are able to financially sustain emergency room telemedicine long term. The study completed found that more than half of the Critical Access Hospitals utilize telemedicine in their emergency rooms. Funding emergency room telemedicine projects is an area of concern at many of these hospitals. As health care continues to advance with the use of technology, health care facilities are in need of more research in this area to develop policy that could potentially improve sustainability and increased reimbursement to offset the cost.Item Teleoncology for the delivery of oncology care in central Montana(Montana State University - Bozeman, College of Nursing, 2017) Linhart, Heidi Marie; Chairperson, Graduate Committee: Teresa SerightAround the globe telemedicine is being explored as a viable type of healthcare delivery for rurally located oncology patients. Telemedicine for oncology patients (teleoncology) is available for rural Central Montana patients through visiting oncologists. Despite this availability of teleoncology, there is no local evidence for the levels of patient or provider acceptability or satisfaction with teleoncology. The purpose of this project was to explore a practice change initiative for teleoncology practices in Central Montana through the gathering of baseline information from both outreach oncology patients and rural healthcare providers' satisfaction with teleoncology care. Two sample groups of oncology patients were surveyed, including: participants in face-to-face (F) appointments (N=21), and participants in telemedicine (T) appointments (N=21). Local primary care providers who refer to the visiting oncologist were also surveyed (N=12; 92% response rate). Two survey tools were used, 'Local Provider Survey of Satisfaction with Teleoncology' and 'Patient Survey of Satisfaction with Outreach Oncology Clinic'. Both patient groups were administered the same survey following appointments to compare results. Descriptive statistics and two-sample T-Tests were used to analyze the survey results. There were no significant differences in satisfaction with the care delivered when comparing the T and F patient groups, indicating teleoncology visits are comparable to face-to-face visits. Eighty-one percent (81%) of T patients reported being satisfied. There was an overall lack of awareness of the availability of teleoncology amongst all those surveyed; 93% of F patients, 46% of T patients, and 42% of providers were not aware teleoncology was available prior to the survey. Although providers reported neutral answers on the survey, the majority (58%) have no experience with teleoncology but 80% of providers denied concerns with this type of appointment. Overall, Central Montana patients report satisfaction with teleoncology as an augmenter to rural oncology care. Providers have minimal concerns with the current state of teleoncology despite limited experience with this modality of care. The evidence was disseminated to the local healthcare community and publicly in Central Montana.Item Utilization of telecommunications technologies in small businesses(Montana State University - Bozeman, College of Business, 1997) Jacobson, Calvin S.; Chairperson, Graduate Committee: Norman L. MillikinTelecommunications technologies means the science of communication at a distance by electronic transmission. The types of telecommunications technologies being used in commerce by small businesses in Montana were analyzed by the creation of a sample questionairre. All businesses registered with the Montana Department of Commerce for listing in the Montana Manufacturers and Product Directory was the population of interest. A representative sample of nearly 25% of the population returned usable questionnaires. The majority of business people state they have computers for their business needs. The average user time spent daily on a computer is between one and four hours. Continuing education course availability is within driving distance for business owners and managers in most geographic areas. The most readily available courses are Accounting, Computer Technology, Management and Marketing. More than half the respondents state they have taken continuing business education courses since formally attending school. For businesses, the most sought after continuing education courses were in the areas of: * Marketing * Management * Accounting * Computer Technology * Salesmanship * Customer Services Communications Technologies, Legal & Compliance Issues, Business & Office Equipment and International Business were ranked as a lower priority. The largest sector (31%) of businesses report annual gross sales income of less than one hundred thousand dollars ($100,000.). The second largest sector (23%) reported annual gross sales income greater than one million ($1,000,000.). Two to five (2-5) employees is the predominant number of employees in fifty percent (50%) of the Montana businesses and over seventy-two percent (72%) of the respondents had some college experience or a college degree in place. The majority of respondents (48%) were self-employed for longer than ten (10) years. The majority of respondents (55%) had been with their company longer than ten (10) years. The majority of people in business had come from a business-related education background. Seventy-one percent (71 %) of the respondents were over forty years old. Sixty-six percent (66%) of the respondents were male. The preferred way to experience continuing course work was in person. When asked about actual use of telecommunications technologies, distance computing was picked most frequently. Almost half of the respondents stated that they were not sure if they would choose to use technology to further their education. The identified groups were owners and managers having taken continuing business education courses and those that had not, time spent daily on computers and company annual gross sales. There were no significant relationships found.Item Personal computer data telecommunications development in Montana high schools(Montana State University - Bozeman, College of Education, Health & Human Development, 1992) Schorger, John Rodger