Scholarship & Research

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Vaginal dilation after pelvic radiotherapy
(Montana State University - Bozeman, College of Nursing, 2021) Besel, Alecia Marie; Chairperson, Graduate Committee: Amanda Lucas
This quality improvement project addressed the inequity between assessment of female versus male sexual health in patients undergoing pelvic radiotherapy. Women undergoing pelvic radiotherapy suffer from the long-term side effect of vaginal stenosis which has been cited to decrease sexual satisfaction, result in pain with penetration, and decrease overall quality of life. Vaginal dilation has shown to decrease the degree of vaginal stenosis, and increase overall sexual satisfaction in this population. While national guidelines exist for the assessment of sexual health in men undergoing pelvic radiotherapy, no such guidelines exist for women. The setting of interest was a radiation oncology clinic in Montana, and the following procedures took place: phone calls to women who underwent pelvic radiotherapy between January 1, 2020 and September 9, 2020 to assess sexual health utilizing a validated screening form, the FSFI-6. At the initial phone call, adherence to twice per week vaginal dilation was asked, the woman was re-educated on vaginal dilation to prevent stenosis, and offered a vibrating dilator utilized at other radiation sites with increased adherence rates. Eight weeks later a follow-up call was placed, the FSFI-6 was reviewed and adherence to twice per week vaginal dilation was asked. Initial FSFI-6 and adherence scores were then compared to follow-up scores. The project sample consisted of 55 women meeting inclusion criteria, 13 women were lost to death or recurrence (23%); thus, phone calls took place to 42 women. Seven of these 42 (17%) women answered their phones and provided consent, five consented to the mailing of a vibrating dilator (one of these women was lost to recurrence). A mere two of the seven women (29%) were adherent to twice per week vaginal dilation at initial phone call. At eight-week follow-up phone call to those consenting to vibrating dilator, three of four women (75%) were adherent to at least twice per week dilation, and pain with penetration score on the FSFI-6 decreased by an average of three points, illustrating that issuing a vibrating dilator at completion of pelvic radiotherapy has the potential to increase adherence and decrease pain when a validated screening tool is utilized.
Interventions for the prevention of opiate use disorder in patients with high adverse childhood experience scores in northern New Mexico: a qualitative project
(Montana State University - Bozeman, College of Nursing, 2019) Clawson, Kendra Sweeney; Chairperson, Graduate Committee: Maria Wines
Adverse childhood experiences (ACEs) are known to be associated with chronic disease, various disorders, and social-emotional challenges (Anda et al., 2008). Furthermore, illicit drug use has been indicated to be associated with ACE scores, in a dose-dependent relationship (Centers for Disease Control and Prevention, 2016a). This DNP project explored the experience of patients with opiate use disorder (OUD) in northern New Mexico, who had ACE scores of four or greater. The purpose of the project was to identify, via structured interviews, interventions the participants felt may have been significant in preventing their OUD. The project sought to specifically examine interventions as they relate to ACEs. The project gave a voice to those who have the lived experience of both ACEs and OUD, to synthesize strategies to address ACEs, and conceivably build resilience. In analyzing the participant responses, the most prominent themes identified were intentional communication, understanding the home environment, creating a safe space for the pediatric patient, referring to counseling, and providing increased education regarding opiates and mental health respectively. These approaches were compared to similar interventions in the literature, to synthesize recommendations to inform the practice of primary care providers, school nurses, and counselors who interact with children with high ACE scores in the northern New Mexico region (Felitti et al., 1998).
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 Wines
Alcohol 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.
Concepts of patient care in the rehabilitation of the hospitalized patient
(Montana State University - Bozeman, 1961) Foss, Dorothy Boyd

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