Scholarship & Research
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Item A registered nurse care manager's role in implementing a veteran obesity program(Montana State University - Bozeman, College of Nursing, 2022) Fleming-Weiler, Denise Dawn; Chairperson, Graduate Committee: Denise RiveraAim: A link exists between obesity, hypertension, cardiovascular disease, diabetes, and numerous other comorbid conditions. Studies have shown that weight reduction has a positive effect on comorbid conditions. The aim is to develop an obesity management program that combats obesity in the veteran population by focusing on self-efficacy and the registered nurse (RN) care manager role. Design: Quality improvement project Methods: The databases searched include Montana State University: CatSearch, Google Scholar, ProQuest, CINAHL, MEDLINE, and EBSCO Web of Science. The study participants include adults who met the Center for Disease Control and Prevention's (CDC) definition of obesity, with a Body Max Index (BMI) greater than 30 kg/m 2. Results: Further research could yield better practices for successfully implementing weight management treatment and intervention plans if programs focus on self-efficacy and collaboration with established programs. Additionally, more research would help identify an obesity registered nurse care manager's impact in combating obesity in the veteran populationItem A quality improvement project to address veteran obesity(Montana State University - Bozeman, College of Nursing, 2022) Anderson, Mary Rebecca; Chairperson, Graduate Committee: Susan LuparellObesity is rising, and veterans have more risk factors than the general public. The health implications and financial burden are enormous. Established guidelines recommend weekly in-person intensive lifestyle counseling focused on diet, exercise, goal-setting, and self-monitoring. Despite referrals to free obesity management classes, few veterans choose to engage. Alternatives to these referrals include provider engagement and nurse follow-up. Research shows promising evidence that self-monitoring with the use of smart phone apps with nurse phone support results in reductions of BMI for some patients. By establishing a clinic workflow, this QI project sought to show that primary care teams can manage obesity alongside other chronic health conditions. The healthcare teams screened, assessed, and began treatment for obesity over an 8-week implementation period. Data from the pilot implementation show greater than 90% staff compliance with process measures. Provider referral rates increased 20% suggesting increased comfort with discussions about weight over time. The project demonstrated that the clinic process is feasible for staff to deliver. Future implementations can focus on patient-level outcomes, such as reduction in BMI and acceptability of the intervention to patients.Item Childhood obesity: screening and interventions(Montana State University - Bozeman, College of Nursing, 2022) Upham, Meghan Karen; Chairperson, Graduate Committee: Tracy HellemChildhood obesity has been a growing concern in the United States for the last three decades. With the COVID19 pandemic, a substantial increase in weight gain has been noted in the pediatric population, leading to a more alarming obesity trend. The American Association of Pediatrics, Centers for Disease and Control and Prevention and the World Health Organization, have established a standard of care for measuring obesity in children using BMI percentiles for age and sex specific growth charts. However, at a pediatric clinic in Northwest Montana providers were not using BMI percentiles to assess for pediatric overweight/obesity. Therefore, the aim of this project was to standardize practice that included screening for childhood obesity using age and sex specific growth charts, document BMIs in provider charting, add overweight or obese to a child's problem list and refer overweight/obese children to a behavioral therapist or nutritionist. During a six-week data collection a total of 90 well child visits were documented, 92% of the children were screened for overweight/obesity using BMI, documented in the medical record, and added to the problem lists. The referral rate to a behavioral therapist or nutritionist was 41%. The conclusion of this project showed improvement with screening using BMI and documenting in the electronic medical record. However there were limitations for referring children to a behavioral therapist or nutritionist that included, finances, time, bias, and lack of conversations.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 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 Adolescent, parent, and nurse practitioner contract for behavioral change : a booklet to guide the process(Montana State University - Bozeman, College of Nursing, 1999) Babb, Deanna Lynn; Chairperson, Graduate Committee: Daryl T. RiesItem Acanthosis nigricans and risks for type 2 diabetes in children(Montana State University - Bozeman, 2002) Mullenberg, Erin; Chairperson, Graduate Committee: Vonna BranamItem Family activity and eating habits questionnaire(Montana State University - Bozeman, College of Nursing, 2012) Donisthorpe, Nicole Ann; Chairperson, Graduate Committee: Karen ZulkowskiThe nationwide health concern of childhood obesity directly affects the western rural state of Montana. From 1990 to 2007, the childhood obesity rate in Montana has grown from affecting nine percent of the population of children to twenty-seven present (Daphane, 1990; NICH, 2007). The study's purpose is to examine family eating and activity habits that directly impact the likelihood of a child to develop childhood obesity including activity level, stimulus exposure, eating related to hunger, and eating styles. The instrument used in this research study was the Family Eating and Activity Habits Questionnaire contained four subcategories including activity level, stimulus exposure, eating related to hunger, and eating style. The Family Eating and Activity Habits Questionnaire use a wide variety of fill in the blank questions and rating scales in order to examine each of the subcategories. The specific target population for this study was parents who reside in the western rural state of Montana based on a convenience sample. The sample population was parents, with children between the ages of five to thirteen, who were willing to complete a parental questionnaire. The parental questionnaires were distributed in March and April of 2011 in two elementary schools. After the parental questionnaires were collected, the parental questionnaire scores were measured by adding up the mean of each score; the mother, father, child, and total family score. The central tendency of the data was analyzed and compared with the mean total score establish in the previous Family Activity and Eating Habit Questionnaire results. In the activity level section, the M score was 21.8. The SD computed was 22.96. In the stimulus exposure section, the M score was 10.7. The SD computed was 4.05. In the eating related to hunger section, the M score was 5.5. The SD computed was 2.42. In the eating styles section, the M score was 42. The SD computed was 15.07. In the overall scoring of the survey, the M score was 80. The results of overall score indicate that the higher the total scores, the less appropriate the eating and activity patterns.Item A descriptive study of childhood obesity monitoring practices used by Montana pediatric providers(Montana State University - Bozeman, College of Nursing, 2008) Schwarzkopf, Nancy Denise; Chairperson, Graduate Committee: Sandra KuntzINTRODUCTION: The global prevalence of childhood obesity is increasing. Overweight children face risks of compromised physical and mental well being, increased incidence of disease processes, and increased risk of adult obesity. Pediatric providers play a unique role in reversing the prevalence of obesity, yet there is little understanding of what practices are utilized to monitor children's weight. PROBLEM: Identifying children who are obese or are at risk for becoming obese may rely on evidence based weight monitoring practices. For many providers there may be a gap in knowledge regarding recommended practices for measuring growth in children. The purpose of this study was to describe current practices for monitoring obesity of children used by Montana primary pediatric providers. METHODS: A descriptive, cross-sectional study was conducted using a mailed pencil and paper survey, sent to 300 primary pediatric providers in Montana selected from 900 Child Health Insurance Plan (CHIP) providers. Eighty-five surveys were returned for a response rate of 28%. Data analysis utilized SAS software; results were analyzed using frequencies and percentages. RESULTS: A total of 85.7% of respondents offered care in family practice settings; 17.6% are pediatric specialists, 31.8% are practicing rurally and 57.6% of providers saw 5 or fewer children/per day. Over 95% of providers measured height and weight, 61.2% calculated body mass index (BMI). Just 55.8% of those who measure BMI accurately plotted it on age/gender specific chart, or 34% of total respondents. All respondents perceived childhood obesity as a concern, with patient/parent resistance cited as the most common barrier to treatment. CONCLUSION: Health disparities in Montana associated with rural populations include fewer pediatric specialists, fewer child healthcare visits, and barriers of access, education level and money for patient and their families. In Montana, height and weight measurements are used predominately to monitor children's growth; BMI was accurately used by one third of respondents which may interfere with the provider's ability to accurately identify adiposity. These findings suggest a focus area for provider education, promoting BMI guidelines for children. Perceptions of barriers: patient/parent resistance, time constraints, and reimbursement; suggest treatment protocols could improve outcomes for childhood obesity.Item Bariatric patients' knowledge of postoperative complications and lifestyle changes(Montana State University - Bozeman, College of Nursing, 2010) Herzog, Sarah Anne; Chairperson, Graduate Committee: Susan LuparellObesity is a growing epidemic in the United States. With obesity comes the comorbities associated with this disease such as hypertension, diabetes and sleep apnea. To help combat this growing epidemic bariatric surgery has become an acceptable and widely used procedure for the severely obese. Although bariatric surgery can help mitigate the comorbities, there are many possible complications and lifestyle changes that are associated with this surgery. Healthcare providers provide a critical role in educating bariatric patients about the process of the surgery, lifestyle changes, and possible complications that can occur postoperatively. The primary purpose of this study is to explore the extent of bariatric patient's knowledge related to specific post-surgical considerations associated with gastric bypass surgery. This study examined their knowledge of the postsurgical complications, postsurgical diet, fluid intake, and medication preparation following surgery. A descriptive, cross-sectional survey design was used to explore bariatric patient's knowledge related to specific post-surgical considerations associated with gastric bypass surgery in a Central Montana facility. Bariatric patients were given a twelve question quiz regarding possible complications from surgery, lifestyle changes, and diet regimes postoperatively. None of the patients answered all of the questions correctly. Areas where patients had the most knowledge were questions pertaining to home medication doses and preparation, signs of infection, normal drain color, pain that is not controlled by pain pills being uncommon, and pain, redness or swelling in the legs being abnormal. Questions answered incorrectly included minimum fluid intake, protein intake, when the greatest weight loss would occur, and avoidance of fluids before and after meals. Demographic data explored age, occupation, educational materials received and sources of materials given. The results of this study demonstrated that bariatric patients in this Central Montana facility may not have sufficient knowledge regarding postoperative care and lifestyle changes. The data also suggests that more emphasis needs to be placed on using different types of educational materials and individual learning preferences to facilitate improving patient outcomes.