Scholarship & Research
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Item Atypical antipsychotics and metabolic side effect monitoring: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Maricich, Allison Nicole; Chairperson, Graduate Committee: Lindsay BenesSecond-generation antipsychotics (SGAs) have increasingly been utilized by psychiatric providers for patients experiencing a wide array of psychiatric disorders. Originally, SGAs were approved for patients 18 years of age and older; they now have been more consistently utilized in patients under the age of 18. SGAs have significant benefits for many patients, although metabolic side effects from the medication can be detrimental to patients' overall sense of wellbeing. The doctor of nursing practice (DNP) quality improvement (QI) project aimed to improve the metabolic screening rates of adolescent patients admitted to an inpatient residential unit at a pediatric psychiatric hospital. This was done by implementing a paper screening tool that outlined which screening laboratory values had been completed, which needed completing, and when each of these laboratory values were ordered for completion, highlighting a fasting lipid panel, hemoglobin A1c, weight, and blood pressure. A four-week implementation period took place from February 4, 2022 to March 4, 2022. Participants in the project included four psychiatric providers: two psychiatric mental health nurse practitioners (PMHNP) and two psychiatrists. Procedures that took place included (1) providers were educated on the purpose of the QI project and the importance of metabolic screening, (2) the paper screening tool was completed for patients prescribed SGAs, (3) laboratory studies were ordered based on the provider's discretion after completing the paper document, and (4) the paper document was stored and scanned into the patient's chart upon discharge. The results indicated that 75% of patients prescribed SGAs had paper screening tools completed, 85% of patients prescribed SGAs had metabolic screening laboratory studies ordered, and 55% of patients prescribed SGAs had metabolic screening laboratory studies completed. These findings mirrored current literature regarding metabolic screening in patients taking SGAs, suggesting that with the implementation of consistent education, completion of a physical paper screening tool, and systematic ordering of metabolic screening laboratory values, metabolic screening rates improve. The QI project showed success in the preliminary stages and throughout the four-week implementation timeframe, indicating that continuing the project will likely have benefits for adolescent patients prescribed SGAs in residential psychiatric units.Item Educating psychiatric nurses in cognitive behavioral therapy for adolescent patients: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Thralls, Claire Eileen; Chairperson, Graduate Committee: Tracy HellemIt is estimated that 20% of adolescents have a diagnosable mental health disorder. However, there is a deficit of providers that are available to treat this population. This gap in care can potentially be mitigated by increasing mental health caregivers' education on therapeutic interventions. Cognitive behavioral therapy (CBT) is considered to be the gold standard of care for the population of adolescent mental health patients. This project set out to educate nurses working on an inpatient adolescent unit on topics of evidence-based CBT and adolescent group therapy. Nurses interacted in a 3-hour educational intervention that reviewed topics of CBT, group therapy with adolescents, and the Creating Opportunity for Empowerment (COPE) program. Additionally, the nurses participated in a role-playing group therapy session to practice implementing CBT interventions to adolescent patient populations. This intervention was utilized to determine the feasibility and effectiveness in educating psychiatric nursing staff on CBT concepts with regard to group therapy for adolescent populations. After participation in the intervention, nursing staff reported benefits and satisfaction with the CBT and group therapy intervention, increased understanding of CBT concepts and interventions, and enhanced preparation for working with adolescent psychiatric patients. It is hoped that this project will guide adolescent-mental-health caregivers in seeking additional education in CBT practices to enhance their education in evidence-based interventions.Item Family environmental risk factors for adolescent substance use: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2019) Walker, John Caleb; Chairperson, Graduate Committee: Tracy HellemSubstance use continues to be an ongoing problem throughout the United States and worldwide. In terms of substance use initiation, adolescence is characterized as an especially vulnerable developmental time period. There are many potential influences that can affect an adolescent's risk for initiating substance using behaviors. One particularly influential factor is the family environment the adolescent is exposed to on a daily basis. The purpose of this project was to summarize the evidence on the topic of adolescent substance use risk factors within the immediate family environment. Following an integrative review guideline, three library databases were searched utilizing a set of key search terms in order to obtain all relevant studies related to this topic. Each relevant research article found in the literature search that met the inclusion and exclusion criteria was included in the review process. Research findings were extracted from these research studies, organized into common categories, and integrative summaries were presented. The results of the review were categorized and presented based on commonly identified influential factors that were examined in the primary studies. As a result of this review, it was concluded that many significantly influential immediate family environment risk and protective factors have been identified in the literature. The significance of these findings and the potential implications for practice, prevention, and research, are discussed.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 Increasing health literacy in adolescents(Montana State University - Bozeman, College of Nursing, 2018) Buckingham, Claire; Chairperson, Graduate Committee: Jean M. Shreffler-GrantNearly half of American adults have difficulty understanding and using health information. Despite numerous efforts to address health literacy, measurable improvements have been limited. Measures and improvements in the health literacy of adolescents are even more inadequate. Adolescents are developing important life skills and health behaviors which makes this an opportune stage in life to intervene and improve health literacy. The purpose of this project was to measure and increase health literacy among adolescents. To achieve this purpose, a sample of 23 adolescents, age 15-16, participated in a pre-test survey to measure health literacy using the Newest Vital Sign and eHEALS, attended an educational intervention, and completed a post-test survey to re-measure health literacy. The educational intervention contained information on where to find health information online and how to evaluate those sources. The pre-test survey scores on the Newest Vital Sign indicate that most of the 23 participants (65%) had adequate health literacy prior to the educational intervention. Following the educational intervention, there was no significant change in the participants' Newest Vital Sign scores while there was a significant improvement in the eHEALS scores. The results indicate that the educational intervention improved participants' perceived skills at using electronic health information. Further research and programs are needed to continue to identify successful methods of improving health literacy in adolescents. Measuring the health literacy of patients allows providers to tailor communication and education to each patient and improve the patients' experience.Item Adolescent decision making and risk behavior(Montana State University - Bozeman, College of Nursing, 1996) Trombetta, Dolores JeanItem Perceived social support and self-esteem in pregnant adolescents choosing to parent(Montana State University - Bozeman, College of Nursing, 1994) Scofield, Nada DerryItem Implementation and assessment of a teen focused prenatal education seminar(Montana State University - Bozeman, College of Nursing, 2014) Skelton, Katie Elizabeth; Chairperson, Graduate Committee: Kathleen SchachmanTeen pregnancy is an increasingly common occurrence in the United States with approximately 34.3 birth per 1,000 teens aged 15 to 19 in 2010 ("Montana teen birth," 2012). Many teens do not seek prenatal education for a variety of reasons including cost, lack of transportation or time and fear of judgment from others. A teen focused prenatal education program may be helpful in increasing knowledge regarding pregnancy, childbirth and parenting. In this project, a teen focused prenatal education seminar was designed and presented to a group of pregnant teens. A pretest/posttest format was used to assess the understanding and retention of the information presented. A course satisfaction survey was administered with the posttest to assess the teens overall satisfaction with the course. The results of the pretest and posttest showed a statistically significant increase in knowledge on the posttest when compared to the pretest. The course satisfaction survey indicated that overall, teens were quite satisfied with the course, felt comfortable in the setting and would recommend it to their friends. The results of this study suggests that this teen focused prenatal education seminar helped to increase teens' knowledge of pregnancy, childbirth and parenting and that teens were satisfied with this type prenatal education.Item The lived experience of social support in adolescent diabetes patients(Montana State University - Bozeman, College of Nursing, 2012) Scott, Daen Eve; Chairperson, Graduate Committee: Charlene WintersAdolescence is a time of change in many aspects of a person's life, and this time is further complicated by the presence of a chronic illness such as diabetes. Further, the metabolic control exhibited by teens is generally worse than at other points in life, with as many as 30-50% being characterized as out of control Despite extensive research on the interaction between the social milieu and diabetes control, results have been inconclusive or contradictory. The purpose of this study was to explore how adolescents ages 12-18 experience social support from friends and peers. A convenience sample of adolescent patients from three clinics in a small city in south central Montana were interviewed regarding friendships, use of insulin delivery devices, social networking, and the impact of diabetes on social interaction and daily life. An inductive analysis approach revealed nine themes: full disclosure, taking care of myself, getting help, making it a part of life, people who know are important, sharing information as positive, adults as negative reactors, age differences make a difference and heavy issues early in life. Technology, such as insulin pumps and online social networking, was found to have a major positive impact in participants' social functioning and control. Peer relationships with other teens with diabetes were found to be important and different from friendships with non-diabetics. Negative reactions and social impacts were found to be much more prominent from adults than from same age peers. Implications include the need for further investigation of how technology might benefit teens with chronic conditions, the potential for positive impact from peer connection and mentoring programs, and the importance of clinicians' awareness of patients' social functioning as it impacts care behaviors and general well being.Item Drug education for rural middle school students in a resilience format(Montana State University - Bozeman, College of Nursing, 2006) Granger, Jamie Sue; Chairperson, Graduate Committee: Barbara Derwinski-RobinsonMontana has the nation's youngest average age for first use of alcohol and marijuana. Montana also ranks among the top five states in the highest rates of alcohol use among youth. In one Montana county, 31% of eighth grade students report having had five or more drinks in a 30-day period, 14% were current cigarette smokers, and 12% smoked marijuana. The principal of a rural Montana middle school, in this same county, requested a drug education program for his sixth, seventh, and eighth grade students. The goal of the program was resilience education. Resilience education allows for the development of decision-making abilities in adolescents. This gives them the skills and knowledge necessary to make informed decisions. Education was provided about alcohol, tobacco, marijuana, and methamphetamine through written materials, interactive classes, and an audio-visual presentation. Information was also given about peer use statistics, influences that promote drug use, and the harms associated with drug use. Drug resistance skills were introduced through the use of role-play scenarios and small group interaction in the classroom setting. A pretest and posttest, created by the project writer, were given to twenty-eight students. The pretest mean score was 57.39% and the posttest mean score was 80.64%. This is statistically significant at the .01 level. Eight student's posttest answers were more responsive on the short answer essay question than were their pretest answers, 16 students gave comparable pretest and posttest answers, and four gave more responsive pretest answers. Resilience drug education, combining factual drug information, consequences of drug use, and social skills training, has been found to be the most effective educational method in reducing drug use behavior. Further research of methods providing effective resilience education should be continued.