Scholarship & Research
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Item SBAR in long-term care: a quality improvement initiative(Montana State University - Bozeman, College of Nursing, 2024) van Houte, Alyshia Grace; Chairperson, Graduate Committee: Jamie M. Besel; This is a manuscript style paper that includes co-authored chapters.Background: The Situation-Background-Assessment-Recommendation (SBAR) tool was adapted by hospitals from the United States Navy in the late 1990s to improve communication during critical situations. SBAR is regularly used in the hospital setting, but its applicability to long-term care is often underutilized. Local Problem: At a 135-bed long-term care facility, there is no institutionally endorsed standard of communication between nurses and providers. Providers receive instant-messaging style communications from nursing staff that often lack structure and pertinent clinical information. An incomplete clinical picture increases the need for clarification, causing delays to patient care. Communication barriers serve as a source of frustration for nurses and providers. Methods: An interdisciplinary approach was used to develop an educational template that was incorporated into the facility's nursing orientation material. Attendance at staff huddles and face-to-face discussions with floor nurses provided education and introduced SBAR as the standard for nurse-provider communication. The Jefferson Scale of Attitudes Towards Nurse and Physician Collaboration (JSAPNC) measured staff satisfaction regarding interdisciplinary collaboration. SBAR utilization was monitored through regular audits of patient progress notes. Results: No statistically significant change was found in JSAPNC scores pre- and post-intervention; post-intervention rates did not meet the long-term goal of 75% utilization of SBAR for nurse-provider communication. Conclusion: Introductory and regularly interval education fosters high-fidelity use of SBAR, but the impact of SBAR utilization on nurse and provider satisfaction with interdisciplinary communication was indeterminate and requires further study.Item Implementing sexual orientation and gender identity (SO/GI) questions and providing LGBTQ education to staff in a rural outpatient clinic(Montana State University - Bozeman, College of Nursing, 2021) Fitzpatrick, Deni Mayliz; Chairperson, Graduate Committee: Casey ColeLesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are important members of every community. Collecting Sexual Orientation and Gender Identity (SO/GI) information and providing staff with proper LGBTQ training is essential for acknowledging LGBTQ patients health disparities and providing proper health services to patients. The purpose of the project was to implement SO/GI questions into the clinics health survey form and provide evidence-based LGBTQ education to clinic staff members. SO/GI questions were implemented into the yearly reviewed health survey form in the outpatient clinic setting. During four-week cycle clinic patients were provided with the SO/GI questions on the patient intake form and were calculated as a percentage of the total patient intake forms completed. Overall the total completed SO/GI question percentage increased over the four week cycle. Patients were accepting of answering the SO/GI questions on the health survey forms. A LGBTQ educational session was provided to staff members on LGBTQ health and terminology and the importance of obtaining SO/GI questions from patients. Staff members clinical preparedness, attitudinal awareness, and knowledge were measured pre and post the LGBTQ educational session utilizing the LBGT-DOCSS tool. Overall, the total mean score, clinical preparedness, and knowledge scores increased after the LGBTQ educational session was provided. Attitudinal awareness did not change before or after the LGBTQ educational session. Limitations included a receptionist turnover, which required reteaching receptionists about the SO/GI collection process from clinic patients. COVID-19 protocols also required that the LGBTQ educational session to be provided virtually. Part of making the outpatient clinic more LGBTQ inclusive involved adding patient brochures, education materials, and adding a viewable nondiscrimination statement to the outpatient clinic setting.Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.Item Introducing trauma-informed care in an acute inpatient psychiatric unit: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Thompson, Evan Robert; Chairperson, Graduate Committee: Julie RuffTraumatic experiences are common in society and are associated with an increased risk of development of adverse physical and psychological outcomes extending throughout the lifespan. Individuals accessing mental health services, such as inpatient hospitalization, are likely to have experienced interpersonal trauma at some point during their lives. Mental health professionals are well suited to provide supportive and effective trauma-informed care (TIC) to patients with trauma histories. TIC seeks to actively resist patient re-traumatization and caregiver secondary traumatic stress. An evidenced-based trauma-informed care training was presented to mental health professionals working on a psychiatric inpatient unit. The project involved a single group pre-post test design with a 1-month follow-up assessment. Staff attitudes towards trauma-informed care were evaluated by a psychometrically validated tool (ARTIC-35). Sums of the items on the ARTIC?35 for each participant were divided by the number of items, means and standard deviations for aggregate average scores for each time point were obtained, and percent change for participant average scores between time points were calculated. Additionally, participants were asked to share if they had incorporated trauma-informed care into their work with patients and if they experienced any barriers to implementing TIC since the training. Immediately following the training, ARTIC-35 scores increased on average by 11%, demonstrating that attitudes related to trauma-informed care improved as a result of the training. One month following the training, all six participants maintained their score on the ARTIC-35, representing a 12% increase from pre-training scores and 0.61% from immediately following training. Further, all participants indicated at the 1-month follow-up assessment that they changed their practice to incorporate trauma-informed care into their work with patients. A 1-hour TIC in-service training demonstrated the ability to improve psychiatric healthcare professional's attitudes toward trauma-informed care. Healthcare organizations serving patients with traumatic histories should consider TIC training for all personnel.Item Opioid guideline adherence for Tramadol in those with chronic nonmalignant pain(Montana State University - Bozeman, College of Nursing, 2020) Horine, Harold James, III; Chairperson, Graduate Committee: Susan LuparellPain is a very common problem affecting up to one-third of the entire population of the United States at any given time and for those with pain, 1 in 3 people have chronic nonmalignant pain lasting longer than 3 months (Centers for Disease Control and Prevention [CDC], 2016b). A majority of those with pain are seen in a primary care setting initially, and sometimes on an on-going basis (Gatchel, 2004; National Institute of Health [NIH], 2010). Ensuring comfort by addressing pain levels in patients is a primary, ethical nursing duty. Historically, one common modality used to treat pain is the use of opioids. However, the literature indicates that healthcare practitioners at all levels receive little education on how to manage chronic pain utilizing prescription opioids in the primary care setting. A lack of education on prescribing opioids has helped create an epidemic of dependence and overdoses on opioids. Additionally, the opioid crisis has continued despite many attempts at various levels, including executive and legislative bills, to try and stop opioid abuse and overdose. Although originally touted as a safe alternative to opioids and slightly stronger than over-the-counter analgesics, tramadol is an opioid with regulation by the Drug Enforcement Agency and Food and Drug Administration that, upon review, does not appear to be in line with the gold standards for prescribing opioids, such as the 2016 Center for Disease Control and Prevention guidelines or the 2018 Montana Utilization and Treatment Guidelines, for nonmalignant chronic pain management with opioids. The purpose of this project was to assess provider knowledge related to tramadol and providers' adherence to the present opioid guidelines when prescribing tramadol in a small, southwestern Montana community.Item Medical cannabis: healthcare professionals' attitudes, perceptions, and behaviors(Montana State University - Bozeman, College of Nursing, 2020) Earle, Kelly A.; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: The medical marijuana industry and the sociopolitical atmosphere in which it exists have evolved tremendously over the past decade. However, little is known about the healthcare professionals' attitudes, perceptions, and behavior toward patient use of medical marijuana. In order to understand the legitimacy of medical cannabis in the future of palliative care, it is important to understand the beliefs and perceptions of healthcare professionals. Objectives: The purpose of this scholarly project was to (1) assess the attitudes, perceptions, and behavior of healthcare professionals surrounding medical cannabis through an online survey, (2) provide a live learning opportunity about medical cannabis to staff at an 89-bed rural hospital, and (3) determine if the educational opportunity allowed for staff to feel more comfortable discussing medical marijuana with patients. Methods: A Survey pretest was sent out via email to the staff at Bozeman Health Deaconess Hospital. The largest number of participants were RNs or LPNs (67%, n=103) followed by MDs or DOs (15%, n=23) and NPs (10%, n=16). A live educational opportunity was provided for staff members. Those staff were asked to participate in a post-survey after the educational opportunity. Results: Most of the participants cared for patients who use medical marijuana (n=108, 70%). Furthermore, 13 (64%) MDs/DOs and 13 (67%) NPs/PAs either agree or strongly agree that medical cannabis is a legitimate therapy. Fifty people participated in the live educational opportunity, of which 20 participated in the post-survey. Post-survey demonstrated: 12 (60%) said they felt more comfortable discussing cannabis with patients, five (25%) said they were not more comfortable, and three (15%) said they did not know if they felt more comfortable after the educational opportunity. Discussion: With the growing number of users across the United States, it will be essential that those who work in patient-care areas are able to bring clarity to patients who may be curious about the use of medical cannabis for palliative measures. However, more research is needed, specifically surrounding the longitudinal effects of chronic use of cannabis.Item An asthma annual spirometry testing quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Abraham, Melissa Lynn; Chairperson, Graduate Committee: Laura LarssonAsthma is a chronic inflammatory lung disease that causes coughing, wheezing, shortness of breath and chest tightness. In the United States, 7.6% of adults are living with asthma, and the prevalence of asthma in Montana is 9.1% for adults. The aim for asthma management is to help people living with asthma maintain a better quality of life. In order to bridge the gap in care and provide access to asthma management, more providers need to be well-versed and equipped to meet these needs. Research shows spirometry testing helps a provider diagnose and understand the severity of a patient's asthma symptoms. The purpose of this project is to determine if implementation of a quality improvement (QI) project in clinical practice will improve annual spirometry testing for asthma patients. A 2.5-hour asthma diagnosis and management course was provided for staff implementing spirometry testing and a retrospective chart analysis was conducted, continued support over the course of a twelve-month project period and workflow changes were implemented to facilitate change. The outcome measure focused on was spirometry testing, with a goal of 85% of patients with asthma to receive annual spirometry testing. A survey was given to determine the staff's perspective on implementing the QI project. The QI project increased annual spirometry testing by 37% post intervention. Staff found the education informative and the workflow changes beneficial to improving patient care to meet the national asthma guidelines. Changes to workflow in clinical practice using a QI project could benefit future clinical practice.