Scholarship & Research
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Item Reducing 30-day hospital readmissions for chronic obstructive pulmonary disease in southwest Montana: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Brumbach, Kevin Christopher; Chairperson, Graduate Committee: Lindsey Davis; This is a manuscript style paper that includes co-authored chapters.Chronic obstructive pulmonary disease (COPD) recently joined the leading causes of hospital readmission. Readmissions range from 7% up to 82.2% with the highest rate amongst home-bound patients. Post-discharge programs demonstrate varied impacts on 30-day COPD readmission rates. Home health provides evaluation and treatment management opportunities for the most at-risk population and the literature lacks studies evaluating patient outcomes with a home health nurse-driven COPD protocol. At the project site, the hospital COPD 30-day readmission rate for patients > or = 65 years averaged 28.8% from 2018 to 2021. The clinic stakeholders recorded two 30-day readmissions during calendar year 2023. To reduce 30-day COPD hospital readmissions and identify home health qualifying patients a COPD Home Health Protocol and participant qualifying identification tool were created and evaluated with descriptive statistics. Two interventions were initiated: a provider approved, nurse-driven home health protocol managing COPD symptoms; an electronic health record .dotphrase identifying home-bound patients qualified for home health and the COPD nurse-driven protocol. The project aims were partially achieved with a 75% utilization rate of the home health qualifying .dotphrase and successful identification of one possible home health candidate who refused home health services. No patients received the COPD home health protocol during the eight-week study period. The project successfully identified participants qualifying for home health but lacked sufficient opportunity to evaluate the COPD home health protocol. Expanding age inclusion criteria to participants > or = 50 years will more effectively evaluate the at-risk population.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 Mindfulness and self-compassion: associations with sleep heath and pre-sleep arousal(Montana State University - Bozeman, College of Letters & Science, 2023) Deutchman, Dagny R.; Chairperson, Graduate Committee: Cara A. PalmerMore than half of college students are not getting adequate sleep. Burgeoning research suggests that mindfulness and self-compassion are both associated with better sleep health, potentially via a reduction in pre-sleep cognitive and somatic arousal. This study seeks to delineate: 1) how trait and pre-sleep mindfulness and self-compassion are associated with measures of sleep health (subjective sleep quality, daytime sleepiness, sleep duration, sleep onset latency, wake after sleep onset, sleep timing, and sleep regularity), 2) how mindfulness and self- compassion relate to measures of pre-sleep arousal, and 3) whether the effects of mindfulness and self-compassion on sleep health outcomes is mediated by cognitive and somatic pre-sleep arousal. Participants (n = 75) completed questionnaires and one week of daily diary reports and actigraphy. Results suggest that trait mindfulness and self-compassion were not significantly associated with pre-sleep arousal or sleep health. Pre-sleep mindfulness was not associated with cognitive pre-sleep arousal; however, pre-sleep self-compassion was negatively associated with cognitive pre-sleep arousal. Associations between mindfulness and sleep, and associations between self-compassion and sleep were not mediated by pre-sleep arousal. This study adds to a growing body of research to help illuminate possible protective factors such as mindfulness and self-compassion for increasing overall sleep health in college students.Item A quality improvement project to address veteran obesity(Montana State University - Bozeman, College of Nursing, 2022) Anderson, Mary Rebecca; Chairperson, Graduate Committee: Susan LuparellObesity is rising, and veterans have more risk factors than the general public. The health implications and financial burden are enormous. Established guidelines recommend weekly in-person intensive lifestyle counseling focused on diet, exercise, goal-setting, and self-monitoring. Despite referrals to free obesity management classes, few veterans choose to engage. Alternatives to these referrals include provider engagement and nurse follow-up. Research shows promising evidence that self-monitoring with the use of smart phone apps with nurse phone support results in reductions of BMI for some patients. By establishing a clinic workflow, this QI project sought to show that primary care teams can manage obesity alongside other chronic health conditions. The healthcare teams screened, assessed, and began treatment for obesity over an 8-week implementation period. Data from the pilot implementation show greater than 90% staff compliance with process measures. Provider referral rates increased 20% suggesting increased comfort with discussions about weight over time. The project demonstrated that the clinic process is feasible for staff to deliver. Future implementations can focus on patient-level outcomes, such as reduction in BMI and acceptability of the intervention to patients.