Scholarship & Research
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/1
Browse
36 results
Search Results
Item Implementation of a nurse-driven algorithm for safety companion usage: a pilot study(Montana State University - Bozeman, College of Nursing, 2019) Phillips, Kahrin Lillian; Chairperson, Graduate Committee: Jennifer Sofie and Susan Luparell (co-chair)Safety companions, also known as sitters, are commonly placed in a 1:1 setting with patients in hospital settings to maintain their safety. These patients include (a) those that are suicidal, confused, delirious, or violent; (b) those with psychiatric issues; (c) those with behaviors that interfere with their medical treatment; and (d) those experiencing behavioral problems associated with substance abuse. However, several problems exist with the use of safety companions, such as cost, inconsistent evidence supporting their effectiveness, and lack of evidence-based guidelines for their use. The primary aim of this pilot study was to assist staff RNs on a 39-bed inpatient hospital unit in using more discernment in the use and management of safety companions. Based on the needs of key stakeholders at the pilot site and a thorough review of the literature, a nurse-driven, evidence-based algorithm for safety companion usage was developed and implemented over four months to meet this aim. In addition, the project investigated the issues surrounding safety companion use and compared these issues to those experienced at the pilot site. Five online surveys targeting different groups of stakeholders were used pre- and post-implementation of the algorithm to assess their perceptions of the algorithm and its effect on the management of safety companion usage. The success of the algorithm was determined by the level of nursing satisfaction with the algorithm and whether it was helpful to assess their patients for a safety companion. The primary aim of the project was successfully met, with all participating team leaders finding the algorithm to be 'somewhat' to 'very effective' in helping staff RNs in being more discerning with the use and management of safety companions. Most of the unit's participating team leaders (87.5%) were satisfied with the algorithm, and all of the participating staff nurses found the algorithm to be 'somewhat helpful' or 'very helpful.' Implications for improvement included room for additional education and training for safety companions, improved staffing and support when using the algorithm, and issues surrounding patient safety.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 nurse confidence, perception of individual impact, and view of professional responsibility to influence policy(Montana State University - Bozeman, College of Nursing, 2019) Chovanak, Lori Anne; Chairperson, Graduate Committee: Laura LarssonProfessional governing organizations call all registered nurses to engage in political advocacy to improve the delivery of care as well as to promote positive change in the health care system. Little is known about the confidence of nurses towards engaging this mandate as well as their attitudes regarding the impact on patient care. This project outlined the impact of educational content in a nurse's confidence level to engage political advocacy, perception of ability to impact health policy, and perception on professional responsibility to engage political advocacy. It includes a literature review on nurse views regarding their ability to address practice and health care issues, explore what inspires nurses to engage in professional advocacy, research nurse' attitudes regarding how political action affects them professionally, and a review of existing research regarding the impact of education on an individual nurse's confidence. Two state nursing associations developed continuing education activities which they provide regularly to nurses with content aimed specifically at increasing participation in political advocacy. The content of these events included information regarding historical political efforts that have advanced the nursing profession, updates of current issues, instruction on legislative process engagement and strategies for success, and information on resources and support that are available for engagement in political advocacy. Participants at these state events were surveyed before and after the educational event to learn if nurses' knowledge, confidence, perceptions, and disposition towards engaging political advocacy increased with receipt of educational content on the topic. The dependent samples t-test demonstrated significant difference (t(47) = -7.99, p < .001 ) between the scores before (M = 80.2, sd = 14.67) and after the intervention (M = 89.9, sd = 14.82) supporting the hypothesis that participant scores would positively change on engaging political advocacy.Item Empathy assessment in doctor of nursing practice curriculum(Montana State University - Bozeman, College of Nursing, 2019) Hardwick, Kimberly M.; Chairperson, Graduate Committee: Susan RaphNursing is a caring profession requiring empathetic care for positive patient outcomes. The doctor of nursing practice (DNP) degree has recently become the standard of educational preparation for advanced prepared registered nurses (APRNs). It is unknown how DNP programs currently incorporate empathy as a therapeutic communication skill imperative for today's APRNs. Limited literature exists related to affective learning activities within the DNP curriculum, and even less research exists regarding empathy. The purpose of this scholarly project was to perform a baseline assessment of an existing DNP curriculum for empathetic learning activities and to establish an understanding of DNP student and nurse faculty perceptions related to the importance of empathy as a skill set for APRNs. Kristen Swanson's Theory of Caring was utilized to provide a robust framework for curriculum assessment. The measurement of DNP student and nurse faculty perceptions regarding empathy was accomplished through the use of student-developed online surveys. Course materials, including Master Resource Outlines, were evaluated for affective learning content as defined by Bloom's Taxonomy of Educational Objectives and Graber et al. (2012) well as current literature recommendations. Limited affective learning activities existed in the evaluated DNP curriculum, paralleling the lack of literature related to empathy in DNP curriculum. Both DNP students and nurse faculty place value on the development of empathy as an essential skill set for APRNs. Additional research is needed regarding empathy development in DNP curriculum to obtain a more complete understanding of this essential attribute of a DNP-prepared-APRN. In addition, valid and reliable curriculum survey tools are needed to perform comprehensive, evidence-based curriculum assessments.Item Nurse willingness to implement iPad-based education in the care of heart-failure patients(Montana State University - Bozeman, College of Nursing, 2018) Phillips, Margaret Lynn; Chairperson, Graduate Committee: Jennifer SofieThe aim of this Doctorate of Nursing Practice (DNP) scholarly project was to investigate nurse willingness to accept the use of technology for implementation of standardized heart-failure self-care education in an acute-care setting. Integrating iPads into the usual acute-care workflow presents challenges for nurses. A pre-implementation and post-implementation questionnaire, based on the Davis model (1989) of perceived usefulness and perceived ease of use of technology, were created to evaluate nurse willingness to adopt the technology. Both questionnaires include a section for comments. Nurse participants attended a competency skills day prior to implementation of iPad-based patient education. Participants completed the pre- questionnaire, reviewed a demonstration of iPad use, viewed an Agency for Healthcare Research teach-back video, and completed a nurse competency checklist. The checklist included a nurse demonstration of the use of the iPad-based education and verbal acknowledgement of how to use the teach-back method. The post- questionnaire was completed six months after implementation of the iPad-based patient education. Data from the pre- and post- questionnaires were evaluated and the nurse-written comments reviewed for the final analysis. Overall, nurses had high levels of perceived usefulness and perceived ease of use with implementation of iPads for heart-failure self-care education, and the iPads will continue to be utilized in the acute-care setting.Item The attitudes of nurses involved in standardized inpatient comfort care: a pilot study(Montana State University - Bozeman, College of Nursing, 2017) Waldorf, Jamie Elizabeth; Chairperson, Graduate Committee: Jennifer SofieThis paper explores nurses' perceptions and attitudes utilizing a standard inpatient comfort-care order set in a critical-access hospital in Southwestern Montana. Comfort care is a subset of palliative care and has been defined as 'an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying. The goal is to prevent or relieve suffering as much as possible while respecting the dying person's wishes' (National Institute on Aging, 2012). With past research showing gaps in continuity of care for patients requiring palliative and comfort care, standardizing the care will give each patient nearing the end of their life, and their family, the opportunity for the best care. A pre- and post-trial-implementation qualitative survey was utilized with the nursing staff at this facility in order to identify areas of weakness with comfort care, and how these weaknesses could be addressed. Initial results showed that nurses felt that more education to both providers and nurses and standardizing care would lead to the most benefit for overall patient care. Providers at this facility worked together to build a standing order set utilizing The BEACON project from the Veterans Affairs (VA) department as well as the order set that was already in the electronic medical record system in order to build one order set that would work best for this facility. Providers and nurses were educated on how to use this order set, as well as the standards of care for nursing. Post-implementation nursing surveys showed that nurses were overall more satisfied with the care they were giving to patients near the end of life, and that they felt the order set was successful in setting the standard of care. Nurses also felt that, by receiving more education in the area of comfort care, this opened the lines of communication between staff members, thus improving patient care.Item Inpatient intravenous chemotherapy administration : nursing competence and confidence(Montana State University - Bozeman, College of Nursing, 2016) Anderson, Kristi Lynn; Chairperson, Graduate Committee: Sandra KuntzAn estimated 40% of people in the United States will receive a cancer diagnosis in their lifetime. This illness may be managed with intravenous (IV) chemotherapy, which requires specialized training and expertise for staff nurses. A microsystem assessment was completed on an inpatient medical, surgical, oncology unit at a northwest Montana hospital. Nurses in the microsystem expressed the inability to maintain competency standards and expertise with infrequent IV chemotherapy administration. A review of the literature was conducted to identify best practices in competence and confidence in nursing IV chemotherapy administration. A root cause analysis was conducted to discover factors contributing to low levels of competency and confidence in IV chemotherapy administration. Comparisons were made between the standards, guidelines, and policies, and themes were analyzed. Solutions were identified and prioritized. A protocol utilizing just-in-time training was developed along with an implementation plan and an evaluation plan. Just-in-time training utilizes checklists, demonstration, peer review feedback, and self-assessment as a measure of competence and confidence assessment. Feedback about the protocol, implementation plan, and evaluation plan was solicited from a key administrator and stakeholders. The Clinical Nurse Leader (CNL) is well suited to implement this protocol due to their ability to integrate care with an interdisciplinary team to identify, develop, implement, and evaluate care practices.Item A Continuing Education Program for improving relationships between staff nurses and nurse executives(Montana State University - Bozeman, College of Nursing, 1999) Munsell, Judith Ann; Chairperson, Graduate Committee: M. Jean ShrefflerItem Nurses' perception and assumption of responsibility for teaching minor surgical patients(Montana State University - Bozeman, College of Professional Schools, 1971) Dowell, Mary SusanItem A survey of registered nurses' concept of role as it relates to independent nursing function involved in restorative care of the geriatric patient(Montana State University - Bozeman, College of Professional Schools, 1967) Vivian, Betty Echols; Chairperson, Graduate Committee: Ethel Martha Mittal Nelson