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Item Reducing 30-day hospital readmissions for chronic obstructive pulmonary disease in southwest Montana: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Brumbach, Kevin Christopher; Chairperson, Graduate Committee: Lindsey Davis; This is a manuscript style paper that includes co-authored chapters.Chronic obstructive pulmonary disease (COPD) recently joined the leading causes of hospital readmission. Readmissions range from 7% up to 82.2% with the highest rate amongst home-bound patients. Post-discharge programs demonstrate varied impacts on 30-day COPD readmission rates. Home health provides evaluation and treatment management opportunities for the most at-risk population and the literature lacks studies evaluating patient outcomes with a home health nurse-driven COPD protocol. At the project site, the hospital COPD 30-day readmission rate for patients > or = 65 years averaged 28.8% from 2018 to 2021. The clinic stakeholders recorded two 30-day readmissions during calendar year 2023. To reduce 30-day COPD hospital readmissions and identify home health qualifying patients a COPD Home Health Protocol and participant qualifying identification tool were created and evaluated with descriptive statistics. Two interventions were initiated: a provider approved, nurse-driven home health protocol managing COPD symptoms; an electronic health record .dotphrase identifying home-bound patients qualified for home health and the COPD nurse-driven protocol. The project aims were partially achieved with a 75% utilization rate of the home health qualifying .dotphrase and successful identification of one possible home health candidate who refused home health services. No patients received the COPD home health protocol during the eight-week study period. The project successfully identified participants qualifying for home health but lacked sufficient opportunity to evaluate the COPD home health protocol. Expanding age inclusion criteria to participants > or = 50 years will more effectively evaluate the at-risk population.Item Increasing patient support for chronic heart failure self-management through structured telephone support: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Pursell, Melissa Zoe; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Chronic heart failure (CHF) affects an estimated 6.2 million Americans and is the leading cause of hospitalization in adults older than 65 in the U.S. and has the highest 30- day readmission rate among all surgical and medical conditions. Experts suggest nearly 25% of these readmissions are preventable. Problem: A clinic in northwest Montana has a higher than the national CHF readmission rate. The clinic follows current guidelines for post-hospitalization follow-up. Evidence shows supplementing usual care with structured telephone support (STS) is an effective method for decreasing readmission rates. Methods: All CHF patients of the clinic are called within three days of hospital discharge to be enrolled into the STS program. The Care Coordinator calls the CHF patients twice weekly using the STS template to provide support for CHF self-management. The content of each biweekly call is documented using the STS template. Results: No patients were enrolled in the STS program during the eight-week QI implementation period. Two CHF patients were discharged but were not enrolled into the program for various reasons. Discussion: Inconclusive results related to insufficient data does not inherently mean this project provides no value. Recommendations were derived from the results of this QI project that may be useful for future STS QI projects. This project revealed that not all recently discharged CHF patients are good candidates for STS and the importance of developing candidate inclusion criteria.Item 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 Group Diabetes Self-Management Education (DSME) for adolescents with type 1 diabetes to improve knowledge and understanding of self-management skills(Montana State University - Bozeman, College of Nursing, 2018) Stewart, Maria Lynn; Chairperson, Graduate Committee: Jennifer SofieThose with type 1 diabetes mellitus (T1DM) are required to perform many self-care activities, such as monitoring blood glucose and taking insulin, every day to prevent long term complications associated with the disease, such as retinopathy, neuropathy, nephropathy and heart disease (American Diabetes Association, ADA). Knowledge of the self-management skills required to care for diabetes is known as Diabetes Self-Management Education (DSME). Adolescents with T1DM struggle with management of their disease for many reasons, and most often it is the family who receives the education at diagnosis. This leaves the adolescent vulnerable to a gap in understanding their disease process and proper management skills. Implementation of group DSME that is led by a diabetes specialist is showing promise in the adult setting and has implications for youth with T1DM as well (Raymond, et al, 2015). Surveys assessing knowledge and confidence in management of T1DM were given before and after a group DSME class were given to nine participants. Results of the post surveys show that there was an increase in both knowledge and confidence after the class among all participants. These results suggest that there is a benefit to group, adolescent specific DSME classes.Item The nurse practitioner's use of printed health education materials : a process of selection and evaluation(Montana State University - Bozeman, College of Nursing, 1998) Youderian, Rosemary Gibson; Chairperson, Graduate Committee: Daryl T. RiesItem A study of the initial problems encountered by home dialysis patients related to proximity to the home training center(Montana State University - Bozeman, College of Nursing, 1979) Snyder, Teresa Elizabeth KellyItem The effect of silastic teaching models in a breast self-examination education program(Montana State University - Bozeman, College of Nursing, 1980) Stankey, Jacquelyn Sue BairItem Rural nurse knowledge of heart failure self-care principles(Montana State University - Bozeman, College of Nursing, 2014) Mitchell, Katherine Marie; Chairperson, Graduate Committee: Charlene WintersHeart failure is one of the leading causes of death in the United States and the most common reason for hospital admission among the elderly. It was estimated that in 2010, heart failure cost the U.S. $39.2 billion. The number of people with heart failure is predicted to increase by 25% by 2030 and the total direct costs may increase by 215%. In addition, in 2013, the Centers for Medicare and Medicaid Services began withholding 1% of all Medicare payments to hospitals for excess readmission rates for heart failure, pneumonia, and myocardial infarction. Those rates will increase to 2% in 2014 and 3% in 2015. One of the ways to decrease the human and financial cost of heart failure is to provide patients with the necessary education to effectively care for their disease. Heart failure self-care includes medication compliance, dietary restrictions, monitoring weight, monitoring for the signs and symptoms of heart failure, and exercise. Nurses are largely responsible for patient education but studies have shown that they may not be knowledgeable about heart failure. A descriptive study using a convenience sampling of nurses working at Critical Access Hospitals was undertaken to determine the extent of knowledge that they have regarding heart failure self-management guidelines. A 20-question instrument was used in an internet-based survey to discover nurses' overall knowledge of heart failure with the secondary aim of assessing knowledge in diet, fluids or weight, signs or symptoms of worsening condition, medications, and exercise. Seventy-seven completed surveys were returned. Baccalaureate- and masters-prepared registered nurses with more than 20 years nursing experience scored the highest on the questionnaire while licensed practical nurses, associate/diploma-prepared nurses, and those with less experience scored the lowest. The majority of respondents scored highest in areas concerning symptom recognition and had the most difficulty with questions regarding weight monitoring, using salt substitutes, and whether or not hypotension is concerning. Nurses may not have the information necessary to effectively educate their patients on heart failure self-care principles, and recommendations were made for adding targeted information to nursing education activities in the areas of weight monitoring, salt substitutes, and hypotension.Item Self-care practices of rural nurses in Montana(Montana State University - Bozeman, College of Nursing, 2013) Conner, Jeanne Randale; Chairperson, Graduate Committee: Susan LuparellNurses have an ethical obligation to maintain competence and to continue personal and professional growth. Promotion of self-care encourages the nurse's personal and professional development. Review of the literature indicates little is known about the self-care practices of rural nurses. The demanding nature of professional nursing practice coupled with an ongoing nursing shortage in the United States challenge nurses' efforts to maintain adequate self-care for personal and professional development. This study was a replication, extension nursing research study intended to collect data about and explore the self-care practices of rural nurses in Montana. The study used a mailed, paper survey tool to collect information directly from a sample of rural nurses practicing in Montana. In July 2011, a total of 360 surveys were mailed to actively licensed registered nurses in eight rural counties in Montana; 194 surveys were completed and returned yielding a response rate of 53.8%. A significant portion of the study's respondents were over fifty years of age and reported living with chronic health problems. Social support, workplace accommodations for chronic health problems, increased opportunities for physical activity and support for optimal nutritional choices are among the recommendations for practice discussed. Formal validation of the survey tool and replication with other populations is recommended.