Scholarship & Research
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Item Educating psychiatric nurses in cognitive behavioral therapy for adolescent patients: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Thralls, Claire Eileen; Chairperson, Graduate Committee: Tracy HellemIt is estimated that 20% of adolescents have a diagnosable mental health disorder. However, there is a deficit of providers that are available to treat this population. This gap in care can potentially be mitigated by increasing mental health caregivers' education on therapeutic interventions. Cognitive behavioral therapy (CBT) is considered to be the gold standard of care for the population of adolescent mental health patients. This project set out to educate nurses working on an inpatient adolescent unit on topics of evidence-based CBT and adolescent group therapy. Nurses interacted in a 3-hour educational intervention that reviewed topics of CBT, group therapy with adolescents, and the Creating Opportunity for Empowerment (COPE) program. Additionally, the nurses participated in a role-playing group therapy session to practice implementing CBT interventions to adolescent patient populations. This intervention was utilized to determine the feasibility and effectiveness in educating psychiatric nursing staff on CBT concepts with regard to group therapy for adolescent populations. After participation in the intervention, nursing staff reported benefits and satisfaction with the CBT and group therapy intervention, increased understanding of CBT concepts and interventions, and enhanced preparation for working with adolescent psychiatric patients. It is hoped that this project will guide adolescent-mental-health caregivers in seeking additional education in CBT practices to enhance their education in evidence-based interventions.Item Integrating pediatric oral health into a rural, public-health setting(Montana State University - Bozeman, College of Nursing, 2020) Bowden, Janelle Marie; Chairperson, Graduate Committee: Laura LarssonRural, low-income families in Montana experience individual and environmental barriers to oral healthcare access. In addition to knowledge deficits regarding pediatric milestones in oral health care, families in rural areas also have few, if any, pediatric dentists who accept Medicaid clients. The Centers for Disease Control and Prevention reported 2- to 5-year-olds are the only age group where the incidence of tooth decay is on the rise. This evidence-based demonstration research documents the baseline oral-health status of Park County Women, Infants, and Children (WIC) participants as well as the longitudinal efficacy of a bundled intervention to improve oral-health status in this high-priority population. Anticipatory guidance, caries risk assessment, repeated fluoride varnish application, and referrals for establishing a dental home and completing referrals for untreated decay are the bundled interventions under investigation in this project. Each level of intervention was documented in terms of state and national goals for the prevention of early childhood caries. The rate of signed forms consenting to treatment was used as a proxy measure that educating pregnant moms, parents, and caregivers about caring for baby teeth was effective. The long-term goal is to improve oral-health status in the Park County WIC population. The results of this research illustrated that performing oral-health assessments in a public-health setting provides an opportunity for nurses to promote sound oral-health practices, educate families on oral hygiene, and provide interventions aimed at preventing early childhood caries. Integrating oral health into public health as well as primary-care settings is a feasible and imperative practice in order to decrease the rates of ECC. A collaborative and integrative effort will ensure more children are screened for and educated on ECC. Introducing the intervention bundle at the WIC office in Park County proved to be a successful way of performing oral-health screenings, applying preventative FV, educating families on oral hygiene practices, and referring children to a dental home.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 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 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 Motivational interviewing education for home visiting asthma nurses(Montana State University - Bozeman, College of Nursing, 2020) Romine, Rebecca Ann; Chairperson, Graduate Committee: Polly PetersenMontana Asthma Program (MAP) nurses currently do not receive motivational interviewing (MI) training and have identified it as an area of development. The desired outcome for this Doctor of Nursing Practice (DNP) scholarly project is to positively affect MAP nurses' knowledge of MI strategies and theories and self-efficacy, or each nurses' belief that they can successfully execute behaviors necessary to produce an MI therapeutic interaction. A brief MI training to increase MI knowledge and self-efficacy of the MAP nurse by 1) attendance of a three-hour asthma-focused MI foundational training course and 2) triad of patient-nurse-recorder role-playing using MI foundations. Content was delivered using PowerPoint slides and lectures with integrated use of role-playing as skills and principles are introduced. A tool used in a previous study by Pyle (2015) was identified as an appropriate self-assessment of self-efficacy and knowledge after completing MI training. Nurses completed this assessment pre and immediately post-training as well as seven months after the educational intervention to see if there was a change. Knowledge question scores ranged from pre-test 3.5 to 2.3 (n = 9) M = 3.05, (SD = 0.33); post-test scores ranged from 3.4 to 3.7 (n = 9) M = 3.57, (SD = .09); and post-test seven-month scores ranged from 3.5 to 3.8 (n = 6) M = 3.6, (SD = 0.07). Self-efficacy question scores ranged from pre-test 2.6 to 3.6 (n = 9) M = 3.21, (SD = 0.37); post-test scores ranged from 3.4 to 3.8 (n = 9) M = 3.62, (SD = .14); and post-test seven-month scores ranged from 3.4 to 4.0 (n = 6) M = 3.67, (S = .18). Knowledge score improvements suggest education retention of background concepts and theories related to MI (Bailey et. al, 2017). Of particular interest is the increase in scores between the post-test and post-test seven-month assessments. The overall increase of mean scores, from pre-test, post-test, and post-seven-month tests indicates an increase in the understanding and self-efficacy of the nurses as it is related to their MI knowledge and use as a communication style.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 De-escalation training for pyschiatric/mental health nurse practitioner students(Montana State University - Bozeman, College of Nursing, 2020) Hatfield, Carly Jordan; Chairperson, Graduate Committee: Dale MayerWorkplace violence towards nurses is occurring at alarming rates throughout Montana and the United States. Verbal de-escalation is recommended for the prevention and management of aggressive patients in health care settings. However, de-escalation training is not required to be provided in nursing education programs. The purpose of this project was to develop, implement, and evaluate simulation-based verbal de-escalation training for psychiatric/mental health graduate nursing students on the prevention and management of aggressive patient behavior. The de-escalation training included an education module and simulated scenario using a simulated patient behaving as an agitated psychiatric patient. Confidence levels before and after the training were measured with the Confidence in Coping with Patient Aggression (CCWPA) scale and de-escalation techniques were assess with the English Modified De-escalating Aggressive Behavior scale (EMDABS). Strengths and weakness of the de-escalation techniques used in the simulation were identified and discussed. Overall scores on the CCWPA increased after the training. All participants received EMDABS scores representing acceptable de-escalation techniques. Identified strengths include use of a calm demeanor and maintaining a safe distance. Weakness include use of emotional suppression, limited use of inference, and lack of confidence. De-escalation training can positively affect nurses' confidence levels for coping with patient aggression. Use of a simulated patient scenario can provide a high-fidelity mental health experience that is effective for practicing de-escalation techniques. Participants reported that they felt the training was beneficial to their education and recommended that de-escalation training with a simulated patient be required in all nursing education.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 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.