Scholarship & Research
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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 Improving well water contaminant awareness among Big Horn County healthcare professionals through community engagement(Montana State University - Bozeman, College of Nursing, 2020) Schott, Raelene Ursula; Chairperson, Graduate Committee: Sandra Benavides-VaelloBighorn County, Montana sits in the Little Bighorn River Valley in the south-central part of the state. The Crow Reservation, a Northern Plains Indian Reservation, encompasses 2.3 million acres in the Little Bighorn River Valley; the majority of the reservation is in Bighorn County. Over 8,000 tribal members live on the reservation, many of whom reside near rivers and streams. Due in part to the rurality of the area, up to 60 percent of the people living on the reservation have home wells as their primary water source. A variety of contaminants has been discovered in well water in Bighorn County, including manganese, uranium, nitrate, and arsenic. Manganese has been shown to cause cognitive delays in children with minimal exposure, along with neurological effects in children and adults alike, known as 'manganism', signified by extrapyramidal dysfunction. Uranium exposure causes kidney damage, increases the risk for various types of cancer, and can have reproductive and developmental effects on women. With minimal exposure, arsenic can cause neurological effects, hypertension, peripheral vascular disease, cardiovascular disease, respiratory disease, diabetes mellitus, and malignancies - including skin cancer. Arsenic toxicity includes links to cancer, cardiovascular disease, immune dysfunction, diabetes, and altered neurodevelopment. There are clear public health implications to providing an educational intervention regarding the contaminants to the healthcare providers in Hardin, MT, a community in Big Horn County, in order for them to provide evidence-based information to their patients. This pre/post-quasi-experimental project was designed to evaluate the knowledge gained by healthcare providers in Hardin following a short PowerPoint presentation with voiceover that provided educational information about the common contaminants and their health effects. There were seven healthcare providers who participated in the project. Results of the survey showed an overall improvement in their knowledge about the contaminants, as well as their comfort speaking to patients about these contaminants. These results indicated that the educational intervention provided by the author was successful in meeting the goals of this scholarly project.Item Missing and murdered Indian women in Montana(Montana State University - Bozeman, College of Nursing, 2020) Cleavenger, Joyce Mabel; Chairperson, Graduate Committee: Susan LuparellProblem. Violence against women is more widespread and severe among American Indian women than among other North American women. Statistics reveal that American Indian and Alaska Native women experience ten times the murder rate of the national average and the highest lifetime rape (27.5%) prevalence in relation to all other ethnicities (14-21%). It is further estimated that three in five AI/AN women will be victims of domestic violence. There is a reason to believe that AI/AN women who are missing may be victims of human trafficking. Evidence suggests that chronic poverty, rape, homelessness, childhood abuse, and racism all play a part in human trafficking. Purpose. Nurse practitioners are a critical workforce in screening and early intervention for AI/AN women as these high-risk women often live in rural and isolated places where the safety net of police, social workers, support groups and safe houses are limited. The purpose of this project was to 1) explore nurse practitioners' knowledge and perceived educational needs related to Montana murdered and missing Indian women, and 2) provide appropriate follow up education with participants based on the findings. Methods. A convenience sample of ten Cascade County nurse practitioners with AI/AN women in their client panel participated in a semi-structured interview. A descriptive analysis of the transcribed interviews revealed gaps in what this sample of primary care providers knew about interventions for AI/AN women at risk for or who have experienced violence. Conclusions. The study produced updated recommendations on screening and referrals for Cascade County nurse practitioners.to use with clients. The results also suggest a need for the State Board of Nursing to offer continuing education on Montana's missing and murdered Indian women. It was also suggested the importance of sharing information on missing and murdered Indian women at one of the nurse practitioners' conferences.Item An evaluation tool to measure pregnancy outcomes and quality improvement interventions at Northern Cheyenne Service Unit(Montana State University - Bozeman, College of Nursing, 2020) Tallbull, Cheyenne Rose; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughQuality Improvement projects are not always evaluated for their effectiveness after they are implemented. This professional project was to address this shortcoming by developing an evaluation strategy on the Healthy Mother Healthy Tribe (HMHT) project which aims at improving pregnancy outcomes for Northern Cheyenne women and their babies. The Montana State Birth Certificate Data indicate that the percentage of Montana Native American Women entering prenatal care after the first trimester was 56.4% compared to Montana Caucasian Women at 24.2%. While early and regular prenatal care are crucial to have healthier babies, numerous difficulties to access prenatal care and the impact of illicit drug use during pregnancy increased the number of precipitous deliveries at the emergency room in the Northern Cheyenne Service Unit (NCSU). The NCSU was chosen as a pilot test site to overcome these barriers; the HMHT project started. Posavac's program evaluation theory, in particular examining the processes of the intervention and how the intermediate outcomes lead to the desired outcome, was used to guide this project. After process-mapping prenatal care and developing a gap analysis, the NCSU implemented the following interventions: policy update, practice changes in drug screening and drug testing, updating electronic prenatal records, education and contracting for a prenatal case manager. Then, two types of evaluation processes were compared in this project. One was a conventional, practical strategy which was used for the Joint Commission's Evidence of Standards Compliance Report as an accreditation survey follow-up. Another was theoretically developed, based on a logic model, for this project to measure the effectiveness and improve evaluation consistency. In comparison, the conventional strategy was action oriented to ensure that compliance is sustainable for going forward. On the other hand, the developed logic model showed relationships and had a focus on measurable outcomes. Unfortunately, implementation of the logic model was not possible due to a change of the work site and time limitation. The effectiveness of the HMHT interventions would be important information in order to optimize resources for the organization and determine sustainability of the project.Item Community-based prevention education on abusive head trauma in a Montana Native American community(Montana State University - Bozeman, College of Nursing, 2019) Schmitt, Emily Marie; Chairperson, Graduate Committee: Sandra KuntzThis scholarly project cultivated a partnership with a Montana Native American community to develop an implementation method of an evidence-based, abusive-head-trauma-prevention education program. The partnering community felt that more could be done to prevent abusive head trauma. Utilizing the framework of Community-Based Participatory Research and the Rural Nursing Theory, this project identified the best available evidence and then developed multiple methods to implement this prevention material. Multiple lessons were learned and important reflections developed from the project process. These lessons can be utilized to guide future projects. A model for program implementation was developed for future use and implementation of the evidence-based, abusive-head-trauma-prevention program.Item Community assessment of cancer screening services for women in Cascade County and perceptions of American Indian women regarding those services(Montana State University - Bozeman, College of Nursing, 2001) Rowell, Nancy Jo; Chairperson, Graduate Committee: Therese SullivanItem Implementing an oral health tool and motivation interviewing tool to improve oral health care among type II diabetics on a northern plains reservation(Montana State University - Bozeman, College of Nursing, 2016) Show, Jennifer Aurice; Chairperson, Graduate Committee: Elizabeth S. KinionType II diabetes and periodontal disease are two common chronic diseases that have been shown to have a physiologically bi-directional relationship. In recent years, type II diabetes and periodontal disease have reached epidemic proportions throughout the United States; disproportionately affecting racial and ethnic minorities such as American Indians. American Indians often have diabetes rates that are two times the general U.S. population and periodontal disease rates that are equally as high. Adding to the oral health disparity in American Indian populations, accessing dental care is often limited making oral health preventive behaviors especially important. This project chose to examine oral health in a group of American Indian adults with type II diabetes focusing on 1) the identification of oral health status using the Oral Health Assessment Tool 2) the facilitation of oral health care to the local Indian Health Service agency and 3) supporting and improving preventive oral health behaviors through motivational interviewing. Participants took part in bi-weekly face-to-face motivational interviewing sessions with their oral health status being evaluated using the Oral Health Assessment Tool concurrently. Participants were referred to the local Indian Health Service agency for dental care based on Oral Health Assessment scores. Scores could range from 0 (good oral health) to 16 (poor oral health). The overall analysis of data found a slight improvement in average Oral Health Assessment Tool scores from 2.75 at baseline to 2.25 at three months. Content analysis of the motivational interviewing sessions found an increased interest among participants to improve oral health behaviors such as brushing for longer periods of time or a desire to quit smoking. The findings of this study are encouraging. While the Oral Health Assessment Tool scores did not improve by leaps and bounds, it does show promise for the use of motivational interviewing to improve preventive oral health behaviors in the American Indian population while also showing the ease of integrating the Oral Health Assessment Tool into general diabetes care.Item Oral health outreach and education in a non-dental, American Indian setting(Montana State University - Bozeman, College of Nursing, 2016) Taubert, Kate Lisco; Chairperson, Graduate Committee: Laura LarssonTooth decay is the single most common chronic childhood disease (Centers for Disease Control and Prevention, 2014) and children with minority and low socioeconomic status are at an increased risk for early childhood caries (ECC) development. The number of children who routinely visit primary care providers is much higher than those who have seen a dental provider (American Academy of Pediatrics, 2008). Thus, pediatric primary care providers are in an opportune position to provide oral health screenings, interventions, and referrals. The purpose of this quality improvement project was to identify, implement, and evaluate a Doctor of Nursing Practice (DNP) pediatric oral health outreach and education quality improvement project in an American Indian, pediatric primary care setting. The intervention contained three parts including a caries risk assessment, caregiver education, and a same-day dental home referral. All caregiver/child dyads age birth - 5 years presenting to the pediatric clinic for a well-child visit were eligible and consented to the intervention (n = 47). The results determined that 86.84% of the sample population was at high risk for caries development and that 52.78% of children with first tooth eruption had previously seen a dentist. Of those children, 78.95% had caries. For children with first tooth eruption that had not seen a dental provider in the past three months, a successful completed referral rate of 72.41% was obtained. The average intervention duration was 4.73 minutes. The intervention was successful in integrating well-child and well-dental visiting into a combined visit that was feasible to sustain. All caregiver/child dyads consented to the intervention and received age appropriate oral health education. This interprofessional collaboration and was effective in addressing three aspects of oral health prevention and outreach. Oral health is part of total health, and thus should be incorporated into routine well-child visits.Item Heights and weights of Northern Cheyenne children : comparison to the international growth reference(Montana State University - Bozeman, College of Nursing, 1992) Dodson, Mary MargaretItem Factors contributing to emergency department utilization in a rural Indian Health Service hospital(Montana State University - Bozeman, College of Nursing, 1984) Magee, Cheryl