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    Bridging the gap of care for chronic pain patients
    (Montana State University - Bozeman, College of Nursing, 2019) Lantz, Stormy Paige; Chairperson, Graduate Committee: Polly Petersen
    Aim: Examine the need for multidisciplinary pain management support for primary care providers at a provider based ambulatory care setting in western Montana. Background: Although chronic pain ailments make up a significant portion of primary care provider visits, many providers do not feel equipped to manage nonmalignant chronic pain and often fear legal consequences of opioid prescribing. With gaps in pain specialist availability, provider comfort, and geographical and financial challenges, Telemedicine may help alleviate provider stress through the delivery of emotional support and structured case discussion and consultation, assisting providers with communication strategies, mental health referrals, and difficult decision-making surrounding opioid prescribing Method: Twenty six primary care providers received an electronic questionnaire to assess their pain management needs and views regarding the training, challenges, expectations, and impact of implementing Telehealth at their current organization. Results: Five out of twenty six providers participated in the project. Eighty percent (80% 'n=4') of providers said they would use Telehealth for pain management if it was available to them, identifying interprofessional collaborative practice, initial evaluation and treatment plan recommendation, ongoing treatments, and education as the most useful telehealth applications. Conclusion: Chronic pain management is a problem for primary care providers. Future research on small, rural organizations using telehealth to meet their patients' pain management needs and additional needs assessments are needed to gain insight into providers engagement levels prior to moving forward with implementation of a Telehealth program at this organization to ensure a successful implementation.
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    Pain assessment tools for the nonverbal critical care adult: an integrative review of the literature
    (Montana State University - Bozeman, College of Nursing, 2019) Creek, Tami Julianne; Chairperson, Graduate Committee: Susan Raph
    Patients in critical care often lack the ability to report the presence of pain due to conditions such as altered levels of consciousness, sedation, and endotracheal tubes. Untreated or poorly managed pain may lead to adverse psychological sequelae, a longer duration of mechanical ventilation, and an increased risk of infection. Several behavioral pain assessment tools are available to clinicians to improve their ability to detect the presence of pain. A large intensive care unit in the Northwest lacks a pain instrument for the assessment of pain in adult, non-verbal patients. An integrative review of the literature was performed from the years 2012-2017 to identify evidence-based pain instruments available for use in this population. Nine instruments were identified representing ten behavioral pain assessment tools. The Joanna Briggs Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework was utilized to determine the best instrument for implementation into a general intensive care unit. Based on the FAME criteria, the Critical Care Pain Observation (CPOT) is recommended for implementation for non-verbal patients in a general critical care unit.
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    Identification of barriers and facilitators to the implementation of an opioid-alternative protocol to treat patients with migraine in the emergency department
    (Montana State University - Bozeman, College of Nursing, 2018) Carlson, Jennifer Angelique; Chairperson, Graduate Committee: Alice Running
    The Centers for Disease Control and Prevention list prescription medication (opioid) overdoses as the leading cause of death because of injury in the United States. This overwhelming statistic has led to what is now being considered an opioid epidemic and a national crisis. Provider opioid-prescribing practices have been recognized as one of the key components contributing to our nation's opioid epidemic. Hospital emergency departments (EDs) have been identified as one possible area for focused intervention. Even though ED providers write a small percentage of the total opioid prescriptions, many opioid-addicted patients have linked their first exposure to opioids with visits to the ED. To prevent a future generation of opioid-addicted individuals, literature reviews have shown education as well as the consistent use of pain management guidelines and protocols could help improve provider opioid-prescribing practices. Protocols for non-opioid pain management have the potential for great impact on the care patients receive in the ED as well as reducing opioid use and misuse in our country. For purposes of this quality improvement project, an opioid-alternative protocol for managing migraine was evaluated for use in a Pacific Northwest Hospital (PNWH) ED. This project utilized a constant comparison technique to evaluate the effectiveness of an educational intervention by evaluating results of surveys provided before and after the educational intervention. The intervention was based on a thorough review of the literature and current evidence-based migraine and opioid prescribing guidelines. The intended outcome of this project was threefold. The student investigator wanted to determine whether education could improve opioid knowledge among providers (MDs, NPs, PAs) and nursing staff at a PNWH ED; reduce perceived barriers toward implementation of opioid alternative protocols in the ED; and facilitate the implementation of an opioid-alternative protocol for migraine in the emergency department, thus improving provider opioid-prescribing practices. Survey comparisons showed how nursing and provider knowledge regarding the opioid epidemic and commonly used opioid-alternatives for managing migraine pain was improved, many perceived barriers toward the implementation of opioid-alternative protocols in the ED were reduced, and support for the implementation of an opioid-alternative protocol to treat patients with migraine in the ED was achieved as a result of this project.
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    Improving adherence among primary-care providers to clinical-practice guidelines for the diagnosis and treatment of acute low-back pain
    (Montana State University - Bozeman, College of Nursing, 2017) Briggs, Katelyn Rose; Chairperson, Graduate Committee: Alice Running
    Back pain is a condition primary-care providers will inevitably see among their patients. It is one of the most prevalent medical conditions, affecting between 50% and 90% of the general adult population in developed countries. Nonspecific low-back pain accounts for approximately 85% of all low-back-pain incidents in primary care, and the majority of these episodes will resolve within two weeks of onset. Care for low-back pain is often fragmented and results in a very heavy economic burden from both direct and indirect costs. Clinical-practice guidelines have been developed to improve patient care and outcomes, and decreased healthcare costs have been demonstrated when clinical-practice guidelines are followed. However, despite the wide availability of clinical-practice guidelines, adherence by primary-care providers is less than optimal. Therefore, the purpose of this project is to evaluate the effectiveness of an educational program for primary-care providers in a rural clinic regarding the proper management of acute low-back pain following available clinical-practice guidelines. A quasi-experimental project design with retrospective chart reviews was conducted. Data from the first review, along with current evidence-based protocols for back-pain management, were used to develop an educational presentation for the primary-care providers of a family-medicine clinic in a rural, southwest Montana town. A second chart review was performed after the educational presentation to evaluate utilization of the evidence-based protocol of the primary-care providers. Results indicated a significant improvement in the prescription of methylprednisolone by primary-care providers, decreasing from 40% during the initial retrospective chart review to 0% during the second retrospective chart review. Other areas of the outcomes data, although not significant, showed improvement related to adherence to the clinical-practice guidelines by the primary-care providers. This indicates the educational intervention was overall successful in fulfilling the purpose of this project.
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    Nursing intervention in the relief of pain
    (Montana State University - Bozeman, 1965) Sorenson, C. Hazel; Chairperson, Graduate Committee: Eleanore L. Mode
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    The pain experience of traditional Crow Indian
    (Montana State University - Bozeman, College of Nursing, 1996) Krumwiede, Norma Kay
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    Pain and quality of life in older osteoarthritic women living in different environments
    (Montana State University - Bozeman, College of Nursing, 1991) Christiaens, Phyllis Charlene
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    A study of nursing students' understanding of the concept of pain before and after clinical practice
    (Montana State University - Bozeman, College of Nursing, 1974) Mortensen, Mary Claire
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    Nurses' perceptions of the use of complementary and alternative medicine for pain management
    (Montana State University - Bozeman, College of Nursing, 2014) Esper, Sunshine Meralee; Chairperson, Graduate Committee: M. Jean Shreffler-Grant
    Use of complementary and alternative medical therapies (CAM) by adults for pain management is common practice. More hospitals and clinics are incorporating CAM into treatment plans. Nurses are key team members in planning and implementing care. Perceptions can influence care that is given. It is important to understand nurses' perceptions CAM use for pain management, their comfort level for recommending and initiating CAM therapies, and educational needs regarding CAM. Some studies have been conducted regarding nurses' perceptions of CAM, but not particularly CAM used for pain management. A descriptive qualitative approach was employed using a convenience, cross-sectional sample of 10 nurses who work at a northwest Montana medical center. Data were collected during semi-structured interviews. Imogene King's Theory of Goal Attainment provided a theoretical framework for the study. Results indicated nurses were optimistic about CAM and supported incorporating CAM into patients' pain management treatment plans. Nurses were generally comfortable recommending some kinds of CAM, but some desired the direction of a physician for certain types of CAM. Nurses seemed unsure of their role and responsibility regarding incorporating CAM into treatment plans. Themes that emerged were that nurses thought CAM could be useful for decreasing or even eliminating narcotic use, nurses felt there was a lack of resources and guidance regarding recommending CAM therapies to patients, and although they thought they had a good understanding about CAM, they would like more education about CAM. There are several implications for future research. Including; replicating the study in other geographic areas, exploring how increased education and available resources impact nurses comfort levels about discussing and incorporating CAM, understanding the relationship between CAM and narcotic use, and more research focusing on physicians' perceptions of CAM use for pain management. This research impacts the advanced practice registered nurse (APRN) practice in many ways. The expanded role of the APRN requires a focus on education and advocacy. The APRN could conduct professional educational offerings for medical professionals. Patients and nurses will look to the APRN for guidance. It is important for the APRN to be knowledgeable about CAM use and CAM resources.
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