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Item A registered nurse care manager's role in implementing a veteran obesity program(Montana State University - Bozeman, College of Nursing, 2022) Fleming-Weiler, Denise Dawn; Chairperson, Graduate Committee: Denise RiveraAim: A link exists between obesity, hypertension, cardiovascular disease, diabetes, and numerous other comorbid conditions. Studies have shown that weight reduction has a positive effect on comorbid conditions. The aim is to develop an obesity management program that combats obesity in the veteran population by focusing on self-efficacy and the registered nurse (RN) care manager role. Design: Quality improvement project Methods: The databases searched include Montana State University: CatSearch, Google Scholar, ProQuest, CINAHL, MEDLINE, and EBSCO Web of Science. The study participants include adults who met the Center for Disease Control and Prevention's (CDC) definition of obesity, with a Body Max Index (BMI) greater than 30 kg/m 2. Results: Further research could yield better practices for successfully implementing weight management treatment and intervention plans if programs focus on self-efficacy and collaboration with established programs. Additionally, more research would help identify an obesity registered nurse care manager's impact in combating obesity in the veteran populationItem 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 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 Decreasing suicide among veterans(Montana State University - Bozeman, College of Nursing, 2014) Perry, Livia Csonka Marta; Chairperson, Graduate Committee: Polly PetersenEstimates are showing that approximately 22 veterans commit suicide per day. Those at highest risk for suicide are married, white males between the ages of 50-59 with a high school education or higher, located in specific western, central and eastern states. Research has shown that 45% of those who completed suicide have seen their PCPs in the month preceding their death, and 67% of those who attempt suicide receive medical attention as a result. Although PCPs may be in a strategic position to assess for suicide risk within the veteran population, research has shown that suicide screening is underutilized in the Primary Care Setting. A possible cause for this may be the inadequate training of practitioners in the area of suicide screening. Research has demonstrated that educating PCPs in this area resulted in an increase in suicide screening in their practice settings. To meet this educational gap, a podcast was created for the purpose of educating PCPs on the topic of veteran suicidality and suicide screening. To test the effectiveness of the podcast, Montana State University graduate students from the College of Nursing were invited to participate in listening to the podcast. Each participant completed a corresponding pre and posttest. Test results show an average increase of 21% in correct answers when comparing pre and posttest results, indicating that the podcast effectively served to convey intended information to participants.