Scholarship & Research
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Item Beliefs and use of evidence-based practice by nurses: a needs assessment at a hospital in south central Montana(Montana State University - Bozeman, College of Nursing, 2018) Gipe, Leigh Ellen; Chairperson, Graduate Committee: Stacy StellflugNurses consistent use of evidence-based practice (EBP) will improve healthcare quality, improve patient outcomes, and decrease healthcare costs. Nurses constitute the largest group of healthcare providers and are in direct contact with patients, thus have an opportunity to make the largest impact using EBP. Despite EBP being accepted as the best method of providing care, many nurses may not be fully implementing it in daily clinical practice. The purpose of this project was to investigate nurses' beliefs about the readiness for and organizational culture for evidence-based practice, attitudes and beliefs about evidence-based practice, and nurses' implementation of evidence-based-practice at this organization. This was done by asking the following questions: What are nurses' current individual beliefs and attitudes about EBP at this organization? What are nurses' current levels of self-reported implementation of EBP at this organization? What are nurses' perceptions of organizational and cultural readiness for EBP at this organization? This project used a cross-sectional, descriptive design. A 75-question survey was sent via email in a SurveyMonkey to a convenience sample of 485 nurses. Nurses were asked demographic and professional characteristic questions, three open-end questions about EBP and to respond to three surveys: (1) The Organizational Culture & Readiness for System-Wide Integration of Evidence-Based Practice scale (2) The Evidence-Based Practice Beliefs scale (3) the Evidence-Based Practice Implementation scale. The findings were that nurses had positive attitudes and beliefs about evidence-based practice but reported low levels of implementation behaviors. Nurses report that they need more time, education and training, and resources to increase implementation of evidence-based practice. Interventions recommended to increase EBP implementation include encouraging more nurses to participate in the clinical ladder program, using mentors to assist and encourage use of EBP, and to provide more training and education opportunities for nurses.Item An assessment of surgical oncology patient education(Montana State University - Bozeman, College of Nursing, 2018) Bartholomew, Cody Sue; Chairperson, Graduate Committee: Susan RaphCancer patients are faced with tremendous amounts of information during a very vulnerable time, challenging the medical community to provide patients and families with up to date, relevant, evidence-based information to make informed decisions that promote positive health outcomes. Lack of standardized pre-operative patient educational efforts for adult surgical oncology patients has the potential to negatively impact system efficiency, patient outcomes, patient satisfaction and trust in their healthcare team. When patients possess understanding of their care process, their role in recovery, and trust in the healthcare team increases (Reiter, 2014). The aim of the project was to assess the current structure and process of surgical oncology patient education within one integrated health system in the northwest United States using the Donabedian framework for healthcare quality (Donabedian, 1980). A non-experimental descriptive exploratory survey was used for data collection. Project findings include identification of systematic structure and processes of surgical oncology education due in part to the complexity of the health system structure and lack of standardization across care settings. Documentation of education provided is varied by location and provider type with an absence of formal pre-operative or post-operative education plan within the system. Information collected will be used for future quality improvement projects and interventions to improve surgical oncology patient education across the continuum one of the integrated health system.Item Adolescent decision making and risk behavior(Montana State University - Bozeman, College of Nursing, 1996) Trombetta, Dolores JeanItem Discussing end-of-life care in the emergency department : to attempt resuscitation or allow a natural death(Montana State University - Bozeman, College of Nursing, 2014) Kelly, Catherine Grace; Chairperson, Graduate Committee: Dale MayerPatients on a known dying trajectory quite frequently present to the emergency department (ED), unprepared for some of the common and inevitable crises related to their disease process, and most of them have not prepared an advance directive. Near end-of-life (EOL) patients who present to the ED with an emergent need for symptom management may instead be faced with an incongruent treatment plan focused on lifesaving interventions. Time constraints, lack of prior patient-provider relationship, vague and misleading terminology, and patient misconceptions about attempted resuscitation interfere with discussions about EOL care preferences in the ED. Questions sometimes posed by ED providers such as "If your heart stops beating, do you want us to try and start it again?" or "If you stop breathing, do you want us to put in a breathing tube?" or the more loaded question "Do you want us to do everything?" are problematic because patients are offered no tangible alternatives; in essence, the choice they are presented with is between doing everything and doing nothing. Realistically, who will choose nothing? There is a growing movement toward using more precise language to discuss attempted resuscitation and allowing natural death. The purpose of this project was to explore the language used during patient-provider conversations about attempted resuscitation versus allowing natural death. A case study was used to interview emergency department physicians, nurse practitioners, and physician assistants. Twelve topics emerged during the interviews regarding how providers discuss attempted resuscitation versus allowing a natural death. The interviews revealed areas where patient-provider communication may be improved, and highlighted the need to replace ambiguous language with more frank and detailed discussions of EOL care options. ED providers need to become more comfortable discussing EOL care, and give patients and families the full benefit of making informed decisions in line with their goals of care.Item Electronic medical record implementation in nursing practice : a literature review of the factors of success(Montana State University - Bozeman, College of Nursing, 2009) Steiner, Bridget Anne; Chairperson, Graduate Committee: Christina SieloffThis is a review of the current literature to discern what factors need to be present in an electronic medical record (EMR) implementation in order for it to be successful for nurses. An extensive literature search was performed by using databases CINAHL, MEDLINE, and Health Reference Center for primary sources of research that specifically addressed EMR implementation and nursing. A coding scheme was developed and applied to each article for analysis. It was found that fit of the EMR with nurse functions, education, and positive nurse attitude were the three most common factors associated with successful EMR implementation for nurses. Lack of computer system quality, lack of fit of the EMR with nurse functions, and time requirements of its use were most commonly associated with lack of success.