Scholarship & Research
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Item Managing metabolic side effects: a process improvement(Montana State University - Bozeman, College of Nursing, 2022) Scally, Shannon St. Onge; Chairperson, Graduate Committee: Lindsay BenesOne in 25 people live with severe mental illness (SMI) including schizophrenia, bipolar disorder, and major depressive disorder. People with SMI have an earlier mortality rate by up to 25 years. This is, in part, due to treatment with second-generation antipsychotics (SGAs). SGAs treat positive and negative symptoms but are associated with metabolic side effects (MSEs) such as increases in weight, body mass index (BMI), waist circumference, blood pressure, cholesterol, and blood glucose levels. These MSEs place a person at risk for metabolic syndrome (MetS). To mitigate the impact of MSEs and the development of MetS, patients on SGAs need to have regular screening of MSEs. At a mental health clinic in Western Montana, 32% of patients were prescribed SGAs, yet the clinic had no standardized process to address MSEs. Therefore, this project implemented a standardized process to address the management of MSEs. For each SGA prescription or renewal, patients received an MSE risk discussion, MSE screening, and education regarding lifestyle and diet strategies to prevent MSEs. The process-improvement method used was Plan-Do-Study-Act (PDSA). The results revealed an overall range of adherence to the standardized process: 43% of patients with a new or renewed SGA order had a documented MSE risk discussion and MSE screening ordered. Additionally, 89% of patients with an SGA order received education regarding lifestyle and diet management of MSEs by a nurse health educator. The success of this aspect of the process was facilitated by the nurse health educator and demonstrated a positive step in the sustainability of lifestyle and diet support as a first-line intervention in the prevention of MSEs. The organization now has a standardized process to manage MSEs and a new clinical workflow to support patients in mitigating MSEs. As the organization continues improving the process by adding the EHR automation and continuing support of the nurse health educator role in lifestyle and diet follow-up, the future impact of reducing morbidity and mortality of the SMI population is set in motion.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 Improving quality through the development of a benzodiazapine sparing protocol for treating alcohol withdrawal in a community correctional setting(Montana State University - Bozeman, College of Nursing, 2018) Hill, Wade G.; Chairperson, Graduate Committee: Maria WinesAlcohol detoxification within community correctional environments poses significant challenges to local jurisdictions that are called to manage rising rates of incarceration among citizens with complex health needs including multiple comorbidities and mental illness and substance abuse. Traditional methods for intervening during detoxification have relied upon benzodiazepine tapers to reduce chances of the most serious consequences of alcohol withdrawal syndrome (AWS) but these medications have been increasingly attributed to poor outcomes such as increased risks of delirium, medication interactions, and risk of diversion among others. This project describes an evidence-based benzodiazepine sparing protocol that can be used to avoid use of this class of medications as well as an associated education intervention for detention officers and healthcare staff in one community correctional institution designed to improve knowledge of monitoring and treatment for inmates suffering from AWS. In total, 28 staff participated in the training and results suggest excellent overall quality and accomplishment of objectives at a high level. Implications for advanced practice nursing are discussed as well as directions for future dissemination efforts for BZ-sparing treatment.Item Smoking cessation : implementation of a group intervention in a community mental health setting(Montana State University - Bozeman, College of Nursing, 2016) Hillenbrand, Carly Jean; Chairperson, Graduate Committee: Polly Petersen; Deanna Babb (co-chair)Individuals with mental illnesses smoke tobacco at a much higher rate than the general population. Given the elevated rate of morbidity and mortality in this population, providing tobacco cessation programs within community mental health clinics is an important step in improving health outcomes. The comprehensive literature review of 56 peer reviewed articles highlights key factors affecting tobacco use in mental illness, including biologic and psychosocial variables, evidence-based guidelines and interventions used to support tobacco cessation in this population, and barriers and incentives for treatment. Based on this literature, an eight-week, nurse-led smoking cessation program was implemented at a rural Montana based community mental health center. This pilot intervention was the first of its kind within the selected mental health center. In order to determine feasibility, the author shares outcomes in terms of participants' smoking cessation behaviors, cigarette use, and cigarette dependence before and after the eight-week group, as well as limitations and implications for future programs. It is hoped this project will inform practitioners and nurses about factors associated with tobacco use in clients with mental illness to guide future treatment at the community mental health center.Item Managing antipsychotic induced metabolic syndrome to improve treatment adherence and quality of life in Gallatin County(Montana State University - Bozeman, College of Nursing, 2015) Frye, Shelby Leigh; Chairperson, Graduate Committee: Laura LarssonAtypical antipsychotics are prescribed for patients suffering from serious mental illnesses. As these medications have become more widely used over the past 3 decades, practitioners have started to become more aware of metabolic side effects caused by them. Metabolic syndrome is a term for alterations in baseline metabolic functioning which result in weight gain, hyperlipidemia, hypertension, insulin resistance, diabetes, and cardiovascular disease. A correlation between obesity and mortality exists within the population of individuals diagnosed with a severe mental illness taking atypical antipsychotics and has been reported as responsible for decreased life expectancy of up to 30 years. However, monitoring the physical side effects has been a significant barrier to successful management for these patients, often due to unclear practice direction between psychiatric and primary care providers. Many patients with metabolic syndrome experience exacerbations in their mental illness such as increased depression, anxiety, and isolation related to discomfort and decreased self-esteem, which can lead to medication nonadherence causing further complications. Patients experiencing emotional decline may be unable to participate in necessary lifestyle modifications without assistance, leading to the progression of metabolic syndrome. Such health related spirals contribute to the development of treatment resistance and poor patient outcomes. At the Gallatin Mental Health Center in Bozeman, MT, 23 patients taking atypical antipsychotics were provided a qualitative satisfaction survey about medications, treatment plans, and adherence, in addition to being offered an opportunity to make recommendations that could improve their overall health. In accordance with research and successful interventions internationally, a significant number of the patients in Bozeman have experienced metabolic changes, have difficulty remembering or understanding treatment goals, and would like assistance with lifestyle interventions. Using evidence based research and recommendations for metabolic syndrome prevention assessments and interventions a physical health assessment checklist for psychiatric nurses at Gallatin Mental Health was created. An assessment key to assist the nurse with the checklist, a prefabricated order set of interventions, and a simple care plan to guide best practice policy implementation will provide for better treatment adherence and improved quality of life for patients taking atypical antipsychotics in Gallatin County.Item Attitudes of the mentally ill about utilizing telemental services in frontier states(Montana State University - Bozeman, College of Nursing, 2012) Motschenbacher, Russell Charles; Chairperson, Graduate Committee: Kathleen SchachmanThe purpose of this qualitative research study was to explore the feelings, opinions and attitudes of mentally ill people living in frontier states about telemental health service to access their mental health care. The current study explores the feelings of people diagnosed with a variety of mental illnesses. Participants in this study were chosen in a purposive criterion sample, and snowball sampling. This study included nine participants aged from 36 years of age to 68 years of age, diagnosed with a mental illness including, Paranoid Schizophrenia, Bipolar Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder. This study was limited by the numbers of willing participants with a mental illness living within the frontier areas of the state the study was conducted in. This limitation is overcome by utilizing the snowball effect for recruitment of willing participants. Eight of the nine participants of this study were willing to use telemental health for their mental health care. Others commented that they were acceptant and willing to utilize telemental health services for their mental health care needs after a period of time to build rapport with their provider. The major themes developed from the participant interviews were; savings, convenience, privacy and anonymity, rapport, crisis intervention and technology. The participants voiced an opinion that the general savings of time, money, travel and hours of work saved was a part of their acceptance of telemental health. The themes of acceptance can be developed in to methods to improve future models of telemental health. By understanding what would make this treatment modality more acceptable future providers can tailor a telemental health program that is fully acceptable to the clients who will utilize it.