Scholarship & Research
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Item Improving access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Patera, Caitlyn Ashley; Chairperson, Graduate Committee: Margaret HammerslaCaregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.Item Childhood obesity: screening and interventions(Montana State University - Bozeman, College of Nursing, 2022) Upham, Meghan Karen; Chairperson, Graduate Committee: Tracy HellemChildhood obesity has been a growing concern in the United States for the last three decades. With the COVID19 pandemic, a substantial increase in weight gain has been noted in the pediatric population, leading to a more alarming obesity trend. The American Association of Pediatrics, Centers for Disease and Control and Prevention and the World Health Organization, have established a standard of care for measuring obesity in children using BMI percentiles for age and sex specific growth charts. However, at a pediatric clinic in Northwest Montana providers were not using BMI percentiles to assess for pediatric overweight/obesity. Therefore, the aim of this project was to standardize practice that included screening for childhood obesity using age and sex specific growth charts, document BMIs in provider charting, add overweight or obese to a child's problem list and refer overweight/obese children to a behavioral therapist or nutritionist. During a six-week data collection a total of 90 well child visits were documented, 92% of the children were screened for overweight/obesity using BMI, documented in the medical record, and added to the problem lists. The referral rate to a behavioral therapist or nutritionist was 41%. The conclusion of this project showed improvement with screening using BMI and documenting in the electronic medical record. However there were limitations for referring children to a behavioral therapist or nutritionist that included, finances, time, bias, and lack of conversations.Item Trauma screening in chronic disease management: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Vaughan, David James; Chairperson, Graduate Committee: Sandra Benavides-Vaello and M. Jean Shreffler-Grant (co-chair)More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.Item Developing a family based program to reduce the incidence of obesity in American Indian children(Montana State University - Bozeman, College of Nursing, 2021) Crowley, Jacy Kate; Chairperson, Graduate Committee: Angela JukkalaChildhood obesity is a significant health problem resulting in decreased lifespan related to chronic health problems. Prevalence of childhood obesity is experienced in American Indian (AI) children at greater rates than their non-native peers. Social determinants of health significantly impact AIs; socioeconomic status, geographic location of reservations, and family and community dynamics uniquely impact health outcomes and risk factors of AI families and communities. This scholarly project investigates the disparity of childhood obesity within the AI community and the potential of a culturally relevant and acceptable family-based program to reduce the prevalence. A community advisory board (CAB) and components of successful AI-specific programs will guide the development of a culturally relevant family-based program. This project aims to reduce the prevalence of childhood obesity in AI children by supporting nutritional knowledge and sovereignty, family engagement, and positive behavior support and coping mechanisms. A culturally relevant family-based program has the potential to reduce the prevalence of childhood obesity in AI children and improve health equity.Item Evaluating communication methods and their impact on vaccination rates in early childhood(Montana State University - Bozeman, College of Nursing, 2020) Antos, Kelly Suzanne; Chairperson, Graduate Committee: Angela JukkalaYearly vaccination against seasonal influenza is the most effective prevention against an illness with especially dangerous implications for young children. The Center for Disease Control and Prevention (CDC) recommends two doses of influenza vaccine in the first eligible flu season for young children under the age of two. Communication of reminders for the second dose can be an integral aspect of improving rates at which young children receive the recommended two doses of influenza vaccine. Not all methods of communication are as effective, and the understanding and evaluation of each respective method provides the healthcare professional with information about how to best reach their families/caregivers with important information. The purpose of this paper is to evaluate these methods as they pertain to not only influenza vaccination rates, but also other routinely recommended early childhood vaccines. While technological advances have brought about many new and innovative ways to communicate with families, the literature suggests that reminder telephone calls remain the most effective method to communicate regarding vaccines which are due. New research is also emerging on this topic and will likely further guide the way in which healthcare providers communicate with their patients and families/caregivers. Sustainable improvement in uptake of vaccine rates are specific to the type of vaccine. Trends specific to the seasonal influenza vaccine will also be evaluated through the course of this paper to identify and evaluate additional interventions which may be necessary to achieve sustained improvement to protect the youngest members of our population.Item Childcare as a protective factor for childhood obesity(Montana State University - Bozeman, College of Nursing, 2020) Carnahan, Brittany Anne; Chairperson, Graduate Committee: Susan RaphChildhood obesity is a major public health crisis. Obese children are at risk for developing chronic diseases and are more likely to become obese adults. Despite efforts to decrease the number of obese children, the rate has more than tripled since the 1980s. Since childhood obesity is multifactorial, any person involved in caring for a child outside of the home can have an impact on the child's life helping to minimize risk factors, such as poor nutrition, which is known to contribute to obesity. Purpose: The purpose of the project was to 1) assess ECE providers' understanding of national childhood nutrition guidelines in relation to whether or not they participate in the STARS to Quality program or the CACFP; 2) create and provide childhood nutrition education to ECE providers with the objective to reinforce or increase knowledge on childhood nutrition and the important role of the ECE provider to deliver sound nutrition; and 3) to evaluate the effectiveness and sustainability of the education tool in increasing ECE provider knowledge of national childhood nutrition guidelines. Methods: Licensed ECE programs in the State of Montana completed a demographic survey, pre-test, educational video viewing, and posttest regarding childhood nutrition recommendation guidelines. The project was developed using the National Dietary Guidelines for all Americans and the Child and Adult Care Food Program recommendations for reimbursable meals. Pre and posttest scores were compared and analyzed. Evaluation: Overall, there was an 11.5% improvement in correct answers from the pretest to the posttest indicating that viewing of the educational tool was successful in increasing knowledge. Discussion: The use of a guideline based educational tool for ECE programs has the potential to increase caregiver knowledge regarding childhood nutrition recommendations and contribute to prevention efforts concerning childhood obesity.Item Breaking the cycle of adverse childhood experiences: a program evaluation(Montana State University - Bozeman, College of Nursing, 2019) McAnally, Jennifer Lyles; Chairperson, Graduate Committee: Dale MayerAdverse childhood experiences (ACEs) are specific types of childhood trauma, that, when experienced, have been found to have dose-response relationship to poor health outcomes later in life, namely, many of the leading causes of death in adults. ACEs include psychological, physical, or sexual abuse, witnessing violence against the mother, living with household members who were substance abusers, mentally ill or suicidal, or who are imprisoned. Recognizing a need for intervention to disrupt this ACE to illness trajectory, The American Academy of Pediatrics has called upon medical providers to address ACEs through screening and community-building. Since there is currently no guideline for how to address ACEs, the purpose of this scholarly project was to evaluate the Lewis and Clark County Health Department (L&CHD) ACE program for effectiveness and alignment with evidence-based practice. Using the Centers for Disease Control and Prevention manual titled Introduction to Program Evaluation for Public Health Programs (IPEPHP), an evaluation was completed. Steps included engaging stakeholders, describing the program, developing an evaluation plan, gathering credible evidence, and analyzing the evidence in order to develop conclusions and make recommendations. The L&CHD ACE program was found to be a largely progressive model that is consistent with most program goals and literature. Those who participated in the program tended to complete the program successfully, however, a majority of those who were referred to the ACE program either chose not to take advantage of the referral or declined to participate in the program. This finding was unexpected and warrants further inquiry. It appears that an integrated behavioral health model may be more effective for engaging potential participants, where they are able to initially meet with mental and behavioral health experts in the familiar primary care setting.Item Interventions for the prevention of opiate use disorder in patients with high adverse childhood experience scores in northern New Mexico: a qualitative project(Montana State University - Bozeman, College of Nursing, 2019) Clawson, Kendra Sweeney; Chairperson, Graduate Committee: Maria WinesAdverse childhood experiences (ACEs) are known to be associated with chronic disease, various disorders, and social-emotional challenges (Anda et al., 2008). Furthermore, illicit drug use has been indicated to be associated with ACE scores, in a dose-dependent relationship (Centers for Disease Control and Prevention, 2016a). This DNP project explored the experience of patients with opiate use disorder (OUD) in northern New Mexico, who had ACE scores of four or greater. The purpose of the project was to identify, via structured interviews, interventions the participants felt may have been significant in preventing their OUD. The project sought to specifically examine interventions as they relate to ACEs. The project gave a voice to those who have the lived experience of both ACEs and OUD, to synthesize strategies to address ACEs, and conceivably build resilience. In analyzing the participant responses, the most prominent themes identified were intentional communication, understanding the home environment, creating a safe space for the pediatric patient, referring to counseling, and providing increased education regarding opiates and mental health respectively. These approaches were compared to similar interventions in the literature, to synthesize recommendations to inform the practice of primary care providers, school nurses, and counselors who interact with children with high ACE scores in the northern New Mexico region (Felitti et al., 1998).Item Attention deficit hyperactivity disorder treatment for pediatrics(Montana State University - Bozeman, College of Nursing, 2018) Brewer, John Mikkel; Chairperson, Graduate Committee: Tracy HellemAttention deficit, hyperactivity disorder (ADHD) is commonly diagnosed in children, and the frequency of this disorder being diagnosed and treated continues to rise each year. The research regarding treatment for pediatric ADHD has shown varied results ranging from pharmacological and behavioral therapies producing positive effects when combined to standalone behavioral therapy or medication producing positive effects with no therapeutic intervention. There are two published guidelines on the management of pediatric ADHD. The American Academy of Pediatrics and the National Collaborating Centre for Mental Health each created a guideline for evaluating, diagnosing, and treating pediatric patients with ADHD. This project analyzed ADHD treatments for children ages 4 to 18 years in an acute, inpatient psychiatric setting, and in an inpatient, residential-treatment-care setting. A comparison of these treatments with the national guidelines was conducted. This scholarly project compared pediatric ADHD treatment in an inpatient, acute-care unit versus a residential-care unit of a psychiatric children's hospital. Readmission rates within 30 days of discharge from a psychiatric children's hospital have been analyzed, and care practices have been compared with the national guidelines. Data was extracted from electronic medical records from the psychiatric children's hospital's healthcare record system. The types of data that were extracted included demographics, such as age, comorbid diagnoses, and concomitant medications; in addition to types of treatment, readmission rates, and treatment setting. Type-of-treatment data included type of medication versus treatment setting. The findings suggest that medications other than methylphenidate may have similar efficacy as methylphenidate for treating pediatric ADHD. The inpatient psychiatric unit is not necessarily following the National Clinical Guidelines for treating pediatric and adolescent ADHD, but the results reveal that methylphenidate versus non-methylphenidate treatment for ADHD does not demonstrate a statistically significant difference with respect to inpatient readmission rates. The research identified that patients receiving residential care for ADHD had a higher likelihood of being readmitted to the hospital than patients receiving acute care, and patients' readmission rates were not statistically significantly different regarding methylphenidate versus non-methylphenidate medication-treatment regimens. Overall, this research identified that medications other than methylphenidate can be effective in treating patients with ADHD.Item Addressing preventive oral health for pregnant women, childbearing age females & children age zero to six in primary care(Montana State University - Bozeman, College of Nursing, 2017) Johnson, Abrianna Lee; Chairperson, Graduate Committee: Elizabeth S. KinionMost oral health disease is preventable despite the availability of effective prevention and treatment (Nathe, 2016). Oral health conditions are becoming a silent epidemic and during pregnancy the risk increases for oral disease (Qualis Health, 2015; Vamos, Walsh, Thompson, Daley, Detman, & DeBate, 2015). About 40% of pregnant women have a varying form of periodontal disease (Lieff et al., 2004). The social impact on school-age children substantially affects their academics, as more than 51 million school hours are lost each year due to dental related illnesses (U.S. Department of Health and Human Services, 2003). The purpose of this project was to educate providers, nurses, and patients in a primary care clinic on the importance of oral health care and to create simple referral process for at risk patients. The author gave a pretest on oral health best practice to seven primary care nurses. After the pretest, the author gave an oral health education seminar. The nurses took a posttest based on content from the educational seminar. Patients who met the inclusion criteria were given oral health surveys to determine oral health status and need for referral to a dentist. Six of the seven nurses completed the seminar and testing showing a higher post-seminar test score. The V-statistic of 21 showed a p-value of 0.0178 suggesting strong evidence the nurses' scores tended to be higher after the seminar. Of the nineteen adults surveyed regarding their oral health status, 62% showed good oral health behaviors. Of the eleven pediatric patients surveyed regarding their oral health status, 75% answered positive oral health behaviors. The literature supported the value of oral health education in primary care. Awareness was created in the clinic with the use of posters and educational packets given to all participating patients. There is a great need for preventive oral health education to primary care providers, pregnant women, childbearing age females, and parents of children. Current research on the value of preventive oral health education and dental care is needed in primary care.