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    An evaluation tool to measure pregnancy outcomes and quality improvement interventions at Northern Cheyenne Service Unit
    (Montana State University - Bozeman, College of Nursing, 2020) Tallbull, Cheyenne Rose; Chairperson, Graduate Committee: Yoshiko Yamashita Colclough
    Quality Improvement projects are not always evaluated for their effectiveness after they are implemented. This professional project was to address this shortcoming by developing an evaluation strategy on the Healthy Mother Healthy Tribe (HMHT) project which aims at improving pregnancy outcomes for Northern Cheyenne women and their babies. The Montana State Birth Certificate Data indicate that the percentage of Montana Native American Women entering prenatal care after the first trimester was 56.4% compared to Montana Caucasian Women at 24.2%. While early and regular prenatal care are crucial to have healthier babies, numerous difficulties to access prenatal care and the impact of illicit drug use during pregnancy increased the number of precipitous deliveries at the emergency room in the Northern Cheyenne Service Unit (NCSU). The NCSU was chosen as a pilot test site to overcome these barriers; the HMHT project started. Posavac's program evaluation theory, in particular examining the processes of the intervention and how the intermediate outcomes lead to the desired outcome, was used to guide this project. After process-mapping prenatal care and developing a gap analysis, the NCSU implemented the following interventions: policy update, practice changes in drug screening and drug testing, updating electronic prenatal records, education and contracting for a prenatal case manager. Then, two types of evaluation processes were compared in this project. One was a conventional, practical strategy which was used for the Joint Commission's Evidence of Standards Compliance Report as an accreditation survey follow-up. Another was theoretically developed, based on a logic model, for this project to measure the effectiveness and improve evaluation consistency. In comparison, the conventional strategy was action oriented to ensure that compliance is sustainable for going forward. On the other hand, the developed logic model showed relationships and had a focus on measurable outcomes. Unfortunately, implementation of the logic model was not possible due to a change of the work site and time limitation. The effectiveness of the HMHT interventions would be important information in order to optimize resources for the organization and determine sustainability of the project.
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    Implementation of an evidence-based policy and educational program on caring for neonates withdrawing from opioids: a quality improvement project
    (Montana State University - Bozeman, College of Nursing, 2020) Olson, Amy JoAnn; Chairperson, Graduate Committee: Stacy Stellflug
    The opioid use among pregnant women has increased, which has led to a rise in the rate of Neonatal Abstinence Syndrome (NAS). Infants with NAS are delivered at rural and urban locations throughout the country and require specialized treatment. The rural community access hospitals (CAH) often lack the resources (policy development and education updates) to prepare health care team members for safe care of infants that present with NAS. The purpose of this project was to improve team member confidence when providing care for neonates suspected of substance withdrawal at a CAH in Montana by: (a) developing and implementing a policy on care and treatment of a drug dependent newborn; (b) educating the team providing care to these neonates on the use of NAS scoring tools; and (c) evaluating the education and improved confidence levels of the health care team. A pretest/posttest design was used to evaluate change in nursing knowledge on NAS/scoring tools. The results suggest implementation of a NAS educational program including education regarding the implementation of a corresponding evidence-based policy, has a statistically significant effect on provider and nurse knowledge and confidence about NAS. Specifically, the results suggest NAS education improved provider/nurse knowledge and confidence in caring for neonates affected by NAS.
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    Delivering prenatal breastfeeding education to a vulnerable population in rural Montana
    (Montana State University - Bozeman, College of Nursing, 2019) Young, Cindy Rae; Chairperson, Graduate Committee: Julie Ruff; Helen Melland (co-chair)
    The educational project aimed to document the efficacy of delivering prenatal breastfeeding education on exclusive breastfeeding (EBF) rates of mothers identified as vulnerable in a rural western Montana community. A convenience sample was utilized to implement the pilot project that included three educational sessions, taught by certified lactation counselors scheduled to coincide with routine prenatal appointment. A control group (CG) was established from a two-month sample of mothers delivering at the implementation site one year before implementation. The education was expected to enhance breastfeeding intentions as evidenced by the scores on the Infant Feeding Intentions (IFI) Scale, thus leading to higher rates of EBF in the participant group (PG) versus a control group. The PG mothers had slightly higher rates of EBF at both hospital discharge (PG 62% vs. CG 59%) and 7-10 days after birth (PG 57% vs. CG 53%), which failed to show statistically significant differences. One statistically significant difference was noted in the higher rates of EBF at 7-10 after birth for PG first-time mothers versus CG first-time mothers (73% vs. 0%, p < .001, 95% CL), indicating prenatal breastfeeding education may have made a more significant impact with first-time mothers. However, the efficacy of delivering prenatal breastfeeding education to impact EBF rates in this vulnerable population can neither be supported nor refuted based on the project results. A review of medical records showed that over 90% of the participant mothers attempted to breastfeed in the hospital (control 76%) and 75% of participant mothers who were not EBF while in the hospital were still giving their infant their breast milk versus 33% of the CG mothers. Seventy-five percent of the PG and CG mothers who were not EBF at 7-10 days were offering breast milk with formula supplementation. Due to acknowledged limitations in design, measurement and data collection, it is not possible to credit the statistically significant results mentioned above to the educational project. This project did provide useful information to guide future project modifications in implementation design and significant suggestions for further study.
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    Father-specific education in the inpatient setting
    (Montana State University - Bozeman, College of Nursing, 2019) Smith, Pamela Alejandra; Chairperson, Graduate Committee: Sandra Benavides-Vaello
    The early postpartum period is an important period of time to prepare mothers and fathers for parenthood. Father's involvement in children's lives has shown to be beneficial for the child's health and the entire family dynamics too. Evidence shows that parental education increases knowledge and confidence levels in parents. Currently, the majority of educational efforts and programs target mothers, leaving men with none or minimal tools to succeed as fathers of a newborn. A major goal of Healthy People 2020 in relation to children's health is a ten percent reduction in infant and neonatal deaths. One key approach for reaching this goal includes increasing the amount of educational and community based programs for infant and child health to increase knowledge in parents (both mothers and fathers) of safe practices with infants and children. This pre/post-quasi-experimental project was designed to evaluate gender specific education and changes in parental confidence level when exposed to educational literature. The project was implemented in the maternity unit at St. Vincent's Healthcare in Billings, Montana. With a total of 32 fathers as participants. Results of the project indicated an overall maintenance or improvement of parent confidence level evidenced by a maintenance or increase in Karitane Parenting Confidence Scale scores. Results of the project are expected to facilitate fathers' responsiveness to baby and better bonding of baby to father in the immediate future. Outcomes are expected to lead to positive consequences in children's health and development. Results also indicate the educational intervention with fathers was overall successful in fulfilling the purpose of this scholarly project.
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    Community-based prevention education on abusive head trauma in a Montana Native American community
    (Montana State University - Bozeman, College of Nursing, 2019) Schmitt, Emily Marie; Chairperson, Graduate Committee: Sandra Kuntz
    This scholarly project cultivated a partnership with a Montana Native American community to develop an implementation method of an evidence-based, abusive-head-trauma-prevention education program. The partnering community felt that more could be done to prevent abusive head trauma. Utilizing the framework of Community-Based Participatory Research and the Rural Nursing Theory, this project identified the best available evidence and then developed multiple methods to implement this prevention material. Multiple lessons were learned and important reflections developed from the project process. These lessons can be utilized to guide future projects. A model for program implementation was developed for future use and implementation of the evidence-based, abusive-head-trauma-prevention program.
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    A pilot implementation of postpartum depression screening guidelines in the pediatric primary care setting
    (Montana State University - Bozeman, College of Nursing, 2019) Popa, Ryann Christine; Chairperson, Graduate Committee: Susan Luparell
    Statement of the problem. Postpartum depression (PPD) is a common postpartum complication. This condition can have a negative effect on family wellness and can impact the development of the infant. Unfortunately, it is estimated that only half of PPD cases are ever recognized and diagnosed by providers. Although evidence supports incorporating PPD screening guidelines into well-child visits, the pediatric providers at the project site do not routinely include this screening process in their practice. As a result, opportunities to identify mothers with PPD and provide them with education and resources were being missed. Methods. The project took place at an outpatient pediatric clinic in Montana. Four pediatric providers incorporated PPD screening guidelines utilizing the Edinburgh Postnatal Depression Screening tool into routine well-child checks for children ages 1 to 12 months. Using a data collection tool, providers recording data related to the screening process including the age of the child, whether or not the mother was screened, the EPDS score, and how the situation was addressed if the results of the EPDS were positive. The perspectives and beliefs of the providers were captured using a pre-implementation and post-implementation survey as well as a verbal debriefing at the end of the project. Results. Data were collected on 88 encounters where screening was indicated. Fifty-three of the 88 mothers were screened. Eight screenings were positive which suggested possible depression symptoms. Although providers were in favor of this practice change overall both before and after implementation of the PPD guidelines, some significant barriers and challenges emerged during the process. Discussion. Barriers to incorporating PPD screening guidelines into well-child visits include time constraints, cooperation and willingness of the mother to participate, remembering to administer the screening tool, and repetition of unnecessary screening in mothers who have already been diagnosed with depression. Changes could be made to the design of this project to reduce limitations and improve the implementation process. Overall, this project found that PPD screening at well-child visits has the potential to be feasible and valuable to the practice of this organization.
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    Management of heated high-flow nasal cannula with preterm and term neonates
    (Montana State University - Bozeman, College of Nursing, 2018) Belling, Nicole LeAnn; Chairperson, Graduate Committee: Jennifer Sofie
    This project addressed the need for education on using heated high-flow nasal cannula (HHFNC) on term and preterm neonates at a rural, centrally located hospital. The education needs were found in a two-part process: assessing the current special-care-nursery (SCN) nurses' knowledge on management of HHFNC and reviewing the current protocol for clarification. The nurses' understanding was assessed by using a survey that was quantitatively analyzed, and which identified two areas needing improvements: assessing the neonate when on HHFNC and education on the consequences of poor management of HHFNC. Survey data was used for an educational service on HHFNC provided by the Seattle Children's Respiratory Therapy (RT) manager. This seminar was provided to the SCN nurses, pediatricians, and RT department at the rural, centrally located hospital. Along with the seminar, a presentation was given by the author that reviewed the results of the survey and how to find and use the current policy.
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    Exposure to terrorism and birthweight outcomes in Nigeria
    (Montana State University - Bozeman, College of Agriculture, 2018) Matonte, James Philip; Chairperson, Graduate Committee: Brock Smith
    Using readily available vitality and GPS data from the Nigerian Demographic and Health Survey, in conjunction with terrorism data from the open sourced Global Terrorism Database, I estimate the effect of in-utero exposure to terrorism within three kilometers of individuals in Nigeria on the likelihood of an infant to be born low-birthweight. Previous economic studies have explored the similar impacts to birthweight from arguably exogenous violent shocks to fetuses in-utero, however, no previous study has yet performed such an analysis of in-utero violence exposure within such a defined geographic area. I claim that previous studies' inability to perform their analysis on a smaller geographic scale has likely underestimated the effects of in-utero violence exposure. Additionally, I exploit detailed information on each terrorism event to address varying degrees of violence severity. I find that exposure to a Boko Haram civilian targeted terrorism related fatality, anywhere within Nigeria and within three kilometers of an individual, as well as within the first trimester of pregnancy, is associated with an approximate 3.2 percentage point increase in the likelihood that a child is born less than or equal to 2500 grams. There is also evidence to suggest that exposure to terrorist events greater than three kilometers away and outside of the first trimester increase the likelihood of an infant being born low birthweight as well.
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    The relationship between weight gain in high-risk infants and mothers' levels of social support
    (Montana State University - Bozeman, College of Nursing, 1989) Jaeger, Kathleen Rae
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