Scholarship & Research
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Item Implementation of a tummy time protocol: a quality improvement project in a level 3B NICU(Montana State University - Bozeman, College of Nursing, 2024) Chaffin, Taylor Christine; Chairperson, Graduate Committee: Benjamin J. Miller; This is a manuscript style paper that includes co-authored chapters.Background: Infants who spend prolonged periods in the supine position, particularly in the NICU, face an increased risk of plagiocephaly and developmental delays. Supine sleeping is recommended by the American Academy of Pediatrics, "Back to Sleep" campaign, which has successfully reduced sudden infant death syndrome by 40-60%. However, an increase in cranial abnormalities was observed following the widespread adoption. Daily tummy time supports motor development, reduces the risk of plagiocephaly, and promotes parental bonding. Methods: A six-week tummy time protocol was implemented in a level 3b NICU for infants who were 32 weeks corrected gestational age and medically stable. Brief 1-2-minute tummy time sessions were completed in the infant's bed or while holding with a parent. Tummy time sessions, education, and return demonstrations were documented on a bedside tracker. Pre- and post-implementation surveys were distributed to staff to gather perspectives. Parent surveys were distributed at discharge to evaluate readiness to complete tummy time at home. Results: Between January 15th and February 25th, only 23 out of 42 eligible infants had tracker sheets returned (55%). Out of 504 eligible days, tummy time sessions were recorded on 214 days, accounting for 42%. Post-implementation staff surveys showed positive results regarding their confidence in educating parents (M=4.7, sd=0.47) and the ease of implementation (M=4.38, sd=0.65). Comparing the results of the pre-and post-implementation surveys using a t-test yielded no significance. Obstacles to compliance included difficulty integrating new workflows, time constraints for education completion, tummy time, and documentation. Conclusion: Implementing the Tummy Time Protocol was crucial in changing practice patterns to align with best practices for infants admitted to the NICU. However, more work must be done to integrate tummy time sessions, early education, and documentation into a new workflow. Suggestions for improvement were provided, focusing on incorporating documentation into the electronic health record (EHR) system to improve compliance and reduce the risk of losing tracking sheets. In addition, future research is necessary to evaluate the long-term effects of tummy time implementation within the NICU. Specifically, research should focus on rates of plagiocephaly and outpatient therapy referrals following discharge from the NICU.Item Improving sleep opportunities in hospitalized postpartum mothers(Montana State University - Bozeman, College of Nursing, 2022) Cantwell, Lindsay Rose; Chairperson, Graduate Committee: Christina BorstSleep deprivation and the fatigue experienced by new mothers remain well-accepted facts of life after the birth of a newborn. In the past, most new mothers utilized hospital nurseries to aid them in caring for their infants after birth; but recent paradigm practice changes in hospitals emphasize rooming-in, breastfeeding, and strongly discourage separation of the mother/newborn couplet. In Baby-Friendly accredited hospitals, postpartum mothers are encouraged to prioritize their infant's needs often above their own, contributing to significant maternal sleep deprivation and fatigue. This quality-improvement project aimed to increase sleep/rest opportunities for mothers through the implementation of coordinated quiet times on a postpartum unit in a Baby-Friendly hospital in the northwestern area of the United States. The Knowledge to Action framework guided this project. Staff received education about the importance of postpartum sleep and the quiet-time practice change. The implementation took place over 4 weeks. Chart reviews were completed, and the mothers who received quiet times were tracked. Practice outcomes included 51% of postpartum moms having a quiet time during week 1; week 2, 64%; week 3, 57%; and week 4, 62%. The quality-improvement project successfully increased sleep/rest opportunities for mothers through quiet times. Prior to the project, there was no standardized effort on the unit to promote maternal sleep or rest. An increase of over 50% during all practice weeks was accomplished. Additionally, there was no significant increase in infants utilizing the nursery, making this intervention viable in the Baby-Friendly hospital setting.Item Is music an effective intervention for improving sleep quality among adult postoperative open-heart patients: a feasibility project(Montana State University - Bozeman, College of Nursing, 2019) Olds, Jenna Leann; Chairperson, Graduate Committee: Alice RunningSleep deprivation is a common disorder known to impair the immune system and healing. Noise, pain, anxiety, and illness in general contribute to sleep deprivation. Patients admitted to the hospital setting are at heightened risk for complications related to decreased quality of sleep. Pharmacological interventions such as opioids and sleep aids are frequently administered to combat this issue. Integrative therapies are often overlooked as a way to increase quality sleep while hospitalized. One of the safest and easiest alternative interventions to employ is music. The purpose of this pilot feasibility project was to determine whether implementing music at the bedside during hours of sleep in the acute coronary-care setting addressed quality of sleep for postoperative open-heart patients. While statistical significance was not met in this project, promising results were found.Item A nursing care approach for promotion of natural sleep in the hospitalized individual(Montana State University - Bozeman, College of Professional Schools, 1970) Gill, Barbara PouItem A clinical study to test a nursing care approach designed to promote sleep(Montana State University - Bozeman, College of Professional Schools, 1971) Koehler, Vonna Lee WebbItem What interventions are successful in the treatment of sleep disturbances in veterans with PTSD? : an integrative literature review(Montana State University - Bozeman, College of Nursing, 2015) Huston, Erin Marie; Chairperson, Graduate Committee: Jennifer SofiePosttraumatic stress disorder (PTSD) is the most common mental disorder associated with military combat and is a significant health risk for military veterans (Nayback, 2009). The sleep disturbances associated with PTSD are some of the most disabling and difficult to treat aspects of the disorder (Nayback, 2009). The nightmares experienced by veterans are often resistant to typical psychological and pharmacological interventions and require a specifically tailored treatment to improve sleep (Nappi, Drummond, Thorp, & McQuaid, 2009). Interventions for sleep disturbances have not been widely studied in populations with PTSD (Swanson, Favorite, Horin, & Arnedt, 2009).The purpose of this integrative literature review was to gain knowledge of successful interventions for sleep disturbances in veterans with PTSD. Current literature was reviewed and analyzed to increase knowledge of the interventions available for improving sleep in this population. A total of seven articles met inclusion criteria and were utilized in the literature review. Articles were located by searching electronic databases and by hand searching abstracts and reference lists. A constant comparison method was utilized in which data were extracted from the research articles and then compiled into systematic categories (Whittemore & Knafl, 2005). The data were assembled into a large matrix allowing for the comparison of each research study (Whittemore & Knafl, 2005). When performing this literature review, it became evident that there are few interventions available to treat sleep in veterans with PTSD. There did not appear to be a single intervention that was most effective in treating sleep in veterans with PTSD. This review did find literature suggesting that Cognitive Behavioral Therapy (CBT), Imagery Rehearsal Therapy (IRT), and prazosin have all shown varying degrees of effectiveness in the treatment of sleep disturbances in veterans with PTSD. This review of literature suggests it may be beneficial for future research to focus on a combined approach of CBT, IBT, IRT, and prazosin.Item A description of sleep patterns and sleep hygiene practices for adults in cardiac rehabilitation programs in Southern Montana(Montana State University - Bozeman, College of Nursing, 2009) Barker, Tina Marie; Chairperson, Graduate Committee: Rita E. CheekDespite the importance of coronary heart disease (CHD) as a major health problem and cardiac rehabilitation as a means of secondary prevention, no previous studies have been found which describe sleep patterns and sleep hygiene practices in this population. Sleep is essential for mental and physical well being and good sleep hygiene practices promote high quality sleep. Poor sleep quality can increase the risk of a myocardial infarction in persons with CHD. The purpose of this descriptive study was to describe sleep patterns and practices of adults diagnosed with CHD and participating in a cardiac rehabilitation program. Two survey tools, the Pittsburgh Sleep Quality Index and the Sleep Hygiene Index, were used to collect data on a convenience sample of 31 adults participating in cardiac rehabilitation programs located in southern Montana. The questionnaires were returned with a response rate of 69.3%. Study results indicate poor sleep quality in this sample population which was primarily due to poor sleep efficiency and sleep disturbance. Sleep hygiene practices of this sample were relatively good, with only a few areas of deficiencies observed. The findings from this study provide a basis for future research. Future research needs to approach the cardiac rehabilitation population on a larger scale and determine if specific sleep hygiene practices correlate with poor sleep quality. Nurse practitioners and other providers can incorporate this knowledge into interventions to promote sleep and sleep hygiene practices.Item The effect of earplugs on perceived sleep quality of acute care patients(Montana State University - Bozeman, College of Nursing, 2008) Martin, Kristy Ann; Chairperson, Graduate Committee: Susan LuparellThe purpose of this study was to evaluate the use of earplugs to improve perceived sleep quality in hospitalized patients. Sleep disruption is a common problem for hospitalized patients and has been shown to lead to physical and emotional complications. A variety of factors such as pain, illness, stress, worry, noise, lights and patient care activities contribute to disturbed sleep. Studies on sound in hospitals have shown that levels exceed recommendations by the Environmental Protection Agency. Limited research has shown that earplugs are a cost-effective, nonpharmacologic intervention with clinical usefulness to improve sleep quality. The study design was a quasi-experimental pilot study using a pre-test and post-test with the participants serving as their own control. Participants were recruited from a telemetry unit at St. Vincent Healthcare in Billings, Montana. The Verran and Snyder-Halpern Sleep Scales were selected to measure sleep quality. Ten participants were able to complete the two nights of study. The proposed hypothesis was supported for the sleep characteristic, soundness of sleep, with an improvement greater than 15 mm on the night with the ear plugs. Subjective findings identified positive comments with only one participant unable to tolerate the earplugs. The improvement in sleep was clinically significant for these participants. Hospitals should consider creating a sleep promotion policy and re-evaluating their night care practices. Earplugs could be included as an option for patients, and patients experiencing sleep difficulties should be encouraged to try earplugs. Further research is needed with a variety of populations and a large sample size. Research should also be done on nurses' knowledge and beliefs regarding sleep and sleep interventions. This information could provide useful information on areas where additional education is needed.