Scholarship & Research
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/1
Browse
43 results
Search Results
Item Improving standardization in care of patients with chronic pain: a focus on harm reduction(Montana State University - Bozeman, College of Nursing, 2023) Locke, Erin Michelle; Chairperson, Graduate Committee: Amanda H. LucasBackground: The opioid crisis remains a major public health issue in the US, with escalating opioid-related deaths annually. Long-term opioid therapy (LTOT) for chronic pain carries a high risk of adverse events, including opioid use disorder (OUD), overdose, and mortality. Standardizing harm-reduction practices, like risk assessment, naloxone access, and early OUD identification, can mitigate risks and enhance patient outcomes. Local Problem: Primary care patients with chronic pain on LTOT need harm reduction to improve patient safety and quality of life. Methods: A six-week plan-do-study-act cycle was employed. Descriptive statistics assessed intervention feasibility. Intervention: The Opioid Risk Tool (ORT) evaluated individual risk for developing an OUD. Patients who screened positively (score > or = 3) on the ORT received provider evaluation, using DSM-5 criteria, for OUD diagnosis. If diagnosed, patients received education about OUD and treatment options with buprenorphine. Naloxone prescriptions were offered by nurses to all patients with chronic pain. Results: All 17 patients with chronic pain completed the ORT, with 9 (53%) identified as high-risk, and 2 (11.8%) diagnosed with OUD. No referrals were made for buprenorphine therapy. Additionally, 13 (76%) patients were offered naloxone prescriptions, and 100% of offered prescriptions were filled. Conclusion: Implementing harm-reduction practices for patients on LTOT for chronic pain is feasible. Further projects will assess the long-term sustainability and impact on patient outcomes.Item Integrating delirium screening and nonpharmacologic interventions in a rural progressive care unit(Montana State University - Bozeman, College of Nursing, 2022) Miller, Christine Kelli; Chairperson, Graduate Committee: Lisa SluderScreening for delirium in the hospital is often inconsistent in areas outside of the intensive care unit (ICU). Delirium is often missed in this patient population, and this negatively affects these patients. Research indicated that hospital acquired delirium can increase morbidity and mortality and impose a financial burden on the health care system. This quality improvement project aimed to implement delirium screening with subsequent nonpharmacologic interventions for those who screened positive for delirium. The setting was a rural progressive care unit in a nonprofit hospital in the Pacific Northwest. Research suggested delirium prevention utilizing nonpharmacologic interventions was the foundation for management. The interventions proven to be effective in delirium management that were utilized in this project included routine screening for delirium, bowel management, adequate nutrition and hydration, sleep hygiene, frequent reorientation, and mobility. This DNP project included daily screening for delirium using the Confusion Assessment Method (CAM) on patients who were hospitalized for two or more nights and a nonpharmacologic delirium order set for patients who screened positive for delirium. The results demonstrated increased clinical awareness and early identification of delirium; however, the goals of screening for delirium using the CAM assessment 80% of the time and ordering the Prevent Delirium order set on 50% of patients who screened positive for delirium were not met. Although the goals for this project were not met, the results indicated that the patients who were screened scored positive for delirium 7.2% of the time. Furthermore, the results revealed a total of 14.2% of the patients in the progressive care unit screened positive for delirium over the five-week implementation period. This finding was consistent with the literature that patients in units outside of the ICU were found to be positive for delirium during their hospitalization. Providing evidence-based delirium screening and delirium prevention strategies has the potential to increase patient outcomes and decrease the financial burden by reducing delirium and its associated negative sequelae.Item Implementation of measurement based care for bipolar disorder: systematic symptom assessment to improve patient care(Montana State University - Bozeman, College of Nursing, 2021) Linster, Rachel Corey; Chairperson, Graduate Committee: Margaret HammerslaMeasurement-based care (MBC) in psychiatry facilitates greater recognition and communication of problematic symptoms. MBC is not commonly utilized in the routine care of individuals with bipolar disorder, resulting in failure to recognize treatment failure or subsyndromal symptoms. The purpose of this project was to improve patient outcomes through implementation of the Altman Self-Rating Mania Scale and Quick Inventory of Depression-Self Report as way to incorporate MBC at a community mental health center. Paper and pencil copies of assessment tools were utilized by clinicians with individuals aged 18 and over with a diagnosis of bipolar 1 or 2 disorder at the beginning of their appointments. Information about assessment tool use was collected via a tracking sheet and reviewed weekly. Of the 11 patients with bipolar disorder seen during the project timeframe, seven completed one or more assessment tool, one patient presentation was not clinically appropriate for assessment tool use, one patient preferred not to respond, and in two instances the provider forgot to use the tools. Utilization of both tools is indicated in order to assess both manic and depressive symptoms. Results support the integration of MBC into the EMR in order to reinforce the process of care. The relatively high use of one tool (5 of 11 times) supports the switch to a single tool to assess both manic and depressive symptoms. The Internal States Scale was identified as the tool that best fits the identified clinical and patient needs.Item Improving treatment of metabolic side effects from atypical antipsychotics(Montana State University - Bozeman, College of Nursing, 2021) Galahan, Alicia Marie; Chairperson, Graduate Committee: Margaret HammerslaAtypical antipsychotics are commonly used to treat a variety of mental health disorders in children and adolescents. Prescribing atypical antipsychotics is not without risk as the development of metabolic side effects can lead to reduced life expectancy from chronic metabolic diseases. The metabolic side effects from atypical antipsychotics are considered treatable medical conditions requiring appropriate screening and intervention. Despite recommendations, psychiatric providers do not consistently screen and treat metabolic abnormalities, creating a gap in care for these individuals. This quality improvement project took place on an adolescent inpatient residential unit. This project focused on incorporating recommendations from clinical practice guidelines by focusing on improving rates of metabolic screening and utilization of treatment interventions when metabolic abnormalities are identified to reduce the burden of metabolic side effects for patients. The Plan-Do-Study-Act framework was used to guide this quality improvement project over six weeks with four separate cycles varying in duration from one to two weeks each. A metabolic screening bundle for psychiatric provider notes was created within the electronic health record to improve ease of interpreting metabolic screening values and identifying need for further intervention. At the end of the quality improvement project, rates of metabolic screening remained unchanged. The rate of patients receiving treatment interventions increased and multiple patients received more than one treatment intervention. Treatment modalities studied included metformin, individual physical activity, and nutritionist consult. This quality improvement project sought to decrease patients experiencing metabolic abnormalities after treatment with atypical antipsychotic medication, but effectiveness was unable to be measured due to the short time frame. Metabolic screening is a necessary part of atypical antipsychotic treatment that needs to be completed upon initiation of medication and at future appointments. Once metabolic screening is completed, further education on potential treatment interventions for metabolic abnormalities needs to be discussed with the patient and other professionals involved in their care to improve patient outcomes.Item Implementation of standardized trauma and resiliency screening in a youth therapeutic residential setting: a quality-improvement project(Montana State University - Bozeman, College of Nursing, 2021) Bugni, Katherine Tabije; Chairperson, Graduate Committee: Sandra Benavides-VaelloThe purpose of this DNP project was to establish standardized trauma and resiliency screening for patients within the youth therapeutic residential setting. A lack of standardized screening and documentation of trauma exposure and resiliency factors was identified internally by the organization. The establishment of routine screening for traumatic experiences provides valuable data, which will inform and be incorporated into the patient's treatment plan. Additionally, routine screening of the patient's resiliency measures complements the trauma information that was collected. This information is important as resiliency plays a critical role in countering the downward trajectory that is set by a child's experience of trauma. Resilience can act as a safeguard from the negative outcomes that are linked with experiencing early trauma. The major objectives for this project were (1) for staff to implement trauma screening and (2) resiliency screening with youth in a therapeutic setting. Not only does the trauma score provide key information about the patient, but it can also guide treatment and serves to establish a baseline for the continued tracking of trauma and resiliency experiences. Additionally, continued data tracking beyond discharge is a requirement of the recent Family First Prevention Services Act of 2018. This project's aim was for participants to utilize the organization's electronic health record to collect and house the screening data. At a later date, the information can be utilized for advocacy of funding, vitals tracking, and for future quality-improvement processes. The results include that staff obtained screenings for 100% of the organization's residential population, with screenings for trauma (ACEs) and resiliency (CYRM-R), incorporating the new process into routine practice within the short PDSA cycle. The results of staff success in incorporating the new screening process for trauma and resiliency with youth residents during weekly routine visits indicate that this practice change is not only achievable, but can be applied during already established weekly visit time between existing trained staff and the patients within the two communities' residential therapeutic group homes.Item An integrative review of the use of gabapentin in treatment-seeking adults with alcohol use disorder in an outpatient setting(Montana State University - Bozeman, College of Nursing, 2020) Schell, Angela Marie; Chairperson, Graduate Committee: Casey ColeBackground: Alcohol use disorders (AUD) and alcohol consumption are complex public health issues that involve multiple comorbidities and significant healthcare costs. In the United States, one-third of adults will be diagnosed with an AUD within their lifetime and over 59.5 million Americans are at risk for an AUD due to reported binge drinking. The State of Montana has one of the highest AUD statistics in the country costing Montanans millions of dollars managing AUD-related physical and psychological illnesses. Despite the high rate of AUDs in Montana, the State has very few inpatient treatment facilities for Medicaid recipients to address alcohol abuse and addiction, causing significant lag time to enter alcohol-abuse inpatient treatment. Gabapentin, an anticonvulsant, has recent evidence for use as a medication to aid in mild to moderate alcohol withdrawal symptoms, remedy symptoms of protracted abstinence, and help treatment-seeking individuals remain abstinent until inpatient alcohol addiction services are available. Objective: The purpose of this integrative literature review was to identify current knowledge related to the use of gabapentin in an outpatient setting for treatment-seeking adult patients (18-65 years) with an AUD, for preventing the symptoms of mild to moderate alcohol withdrawal syndrome, for treatment of symptoms related to protracted abstinence, and for assisting the individual to abstain from alcohol until initiation of inpatient substance-abuse treatment. Method: This topic was explored using an integrative literature review. Research articles were identified using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PubMed, PsycINFO, and Medline, from January 2014-December 2019. A review of abstracts using inclusion and exclusion criteria was conducted to determine relevant studies. Conclusion: The integrative review revealed limited evidence for the use of gabapentin to decrease symptoms of mild to moderate alcohol withdrawal and protracted abstinence in treatment-seeking adults on an outpatient basis. Heterogeneity of sample populations, interventions, and study aims should be addressed in future research studies.Item The repeal of Montana's medical marijuana act and traffic fatalities(Montana State University - Bozeman, College of Agriculture, 2020) Lantz, Scott Bryan; Chairperson, Graduate Committee: Mark AndersonOver the last several years, marijuana legalization has become a popular piece of state legislation. While most legislation is focused on the passage of these laws for marijuana use, Montana, in 2011, rescinded a previously passed medical marijuana law with Senate Bill 423. This thesis examines the relationship between rescinding a medical marijuana law and traffic fatalities, one of the leading causes of death in America, in Montana after Senate Bill 423 was passed. I test for a causal effect using a synthetic control approach along with a weighted regression using data from the Fatal Analysis and Reporting System with data from 2001-2017. I find that the synthetic control groups saw similar patterns in traffic fatalities despite not rescinding a medical marijuana law. The weighted regression analysis also shows that there is no statistical difference in traffic fatalities after the policy in Montana.Item Test anxiety interventions implemented before summative science assessments(Montana State University - Bozeman, College of Letters & Science, 2019) Bakken, Randi Martin; Chairperson, Graduate Committee: Greg FrancisThis investigation examined the effectiveness of tools to mitigate test anxiety on student performance and students' perceptions of anxiety. Additionally, this study explored whether or not students were impacted differently based on their age level. Participants included 3 classes of 9th-graders with 14, 15 and 16 students, and 1 class of 13 11th and 12th-graders. The investigation introduced students to three different anxiety-reducing techniques at the onset of three quizzes. At the semester final exam, students chose one strategy to implement. Quiz scores, final exam scores, surveys, and interviews were used as data collection instruments. The results suggested that students had an improved experience with the test anxiety intervention though there was not an impact on their performance. Students in 9th-grade and 11th or 12th-grade had similar levels of test anxiety. Students show a willingness to utilize test anxiety interventions in the future.Item Characterization of metabolic changes in osteoarthritis using global metabolomic profiling(Montana State University - Bozeman, College of Agriculture, 2018) Carlson, Alyssa Kay; Chairperson, Graduate Committee: Ronald K. June II; Rachel A. Rawle, Erik Adams, Mark C. Greenwood, Brian Bothner and Ronald K. June were co-authors of the article, 'Application of global metabolomic profiling of synovial fluid for osteoarthritis biomarkers' in the journal 'Biochemical and biophysical research communications' which is contained within this thesis.; Rachel A. Rawle, Cameron W. Wallace, Erik Adams, Mark C. Greenwood, Brian Bothner and Ronald K. June were co-authors of the article, 'Global metabolomic profiling of human synovial fluid for rheumatoid arthritis biomarkers' in the journal 'Clinical and experimental rheumatology' which is contained within this thesis.; Rachel A. Rawle, Cameron Wallace, Ellen Brooks, Erik Adams, Mark C. Greenwood, Merissa Olmer, Martin K. Lotz, Brian Bothner and Ronald K. June were co-authors of the article, 'Characterization of osteoarthritis phenotypes in human synovial fluid using global metabolomic profiling' submitted to the journal 'Arthritis and rheumatology' which is contained within this thesis.; Rachel A. Rawle, Erica Barboza, Albert Batushansky, Timothy M. Griffin, Brian Bothner and Ronald K. June were co-authors of the article, 'In vivio mechanotransduction: effect of acute exercise on the metabolomic profiles of mouse synovial fluid' submitted to the journal 'Journal of biomechanics' which is contained within this thesis.; Rachel A. Rawle, Erin Hutchison, Joanna Hudson, Brian Bothner, Timothy M. Griffin and Ronald K. June were co-authors of the article, 'The effect of long-term voluntary exercise on the metabolomic profiles of synovial fluid from high-fat diet-induced obese mice' submitted to the journal 'Arthritis and rheumatology' which is contained within this thesis.; Dissertation includes one article of which Alyssa Kay Carlson is not the main author.Osteoarthritis affects over 250 million individuals worldwide. It is a disease of the whole joint, exhibiting heterogenous pathology, and a multifactorial etiology consisting of obesity and joint trauma as important risk factors. This heterogenous nature contributes to the disparity in symptom presentation and response to treatments, presenting challenges for diagnosis and the development of targeted therapies for osteoarthritis phenotypes. Therefore, the goals of this work were to (1) enhance our understanding of osteoarthritis as a heterogenous disease for improved early diagnosis and (2) evaluate the interaction between osteoarthritis risk factors and therapeutic interventions. Because osteoarthritis and its risk factors are associated with aberrant metabolism, liquid chromatography-mass spectrometry-based global metabolomic profiling was employed to investigate changes in small molecules in response to osteoarthritis, risk factors, and therapeutic interventions. The first area of research focused on osteoarthritis diagnosis. The results show that global metabolomic profiling of human osteoarthritic synovial fluid is capable of identifying candidate biomarkers of osteoarthritis and classifying donors into subgroups representative of metabolic phenotypes. Metabolic phenotypes include structural deterioration, oxidative stress, and/or inflammation. The second area of research focused on osteoarthritis risk factors and therapeutic interventions. We investigated the effects of acute exercise in mouse synovial fluid to provide insight into exercise as a nonpharmacologic mechanobiology-based intervention prescribed for osteoarthritis. We found that acute exercise may have beneficial effects in maintaining overall joint health. We expanded on exercise as a nonpharmacologic treatment by investigating the effects of long-term exercise in an obesity-associated osteoarthritis mouse model. Long-term exercise did not exacerbate osteoarthritis in the knee joints of obese mice but did abrogate some obesity-induced metabolic perturbations in the synovial fluid. In addition, a pharmacologic intervention was investigated in posttraumatic osteoarthritis. Inhibition of early response genes by a Cdk9 inhibitor immediately after joint trauma was also capable of reversing a portion of injury-induced metabolic perturbations in whole joints of injured mice. Overall, this work demonstrates that global metabolomic profiling has potential for biomarker discovery and classifying patients into metabolic phenotypes. It also demonstrates the potential for exercise and inhibition of early response genes as therapeutic interventions for obesity-associated and post-traumatic osteoarthritis.Item Sepsis bundle evaluation for quality improvement(Montana State University - Bozeman, College of Nursing, 2019) O'Connor, Christine Elizabeth; Chairperson, Graduate Committee: Susan LuparellSepsis is a common diagnosis in the acute care setting. Left untreated, sepsis can result in many long-term complications including permanent organ damage and death. Sepsis has become such a common diagnosis that the Centers for Medicare & Medicaid (CMS) have implemented core measures that are meant to aid in quickly diagnosing and treating septic patients. Because sepsis requires prompt treatment, these guidelines have been divided into three- and six-hour bundles to assure prompt treatment after diagnosis. If hospitals fail to follow these core measures, the institution is not reimbursed for the cost of medical care for that patient. Implementation of the three and six-hour bundles have been shown to improve patient outcomes, decreasing mortality associated with sepsis. Compliance rates with these core measures in a rural hospital in Northwest Montana, which will be called Hospital X, have been consistently below the goal of 80% compliance. This quality-improvement project (QIP) utilized interventions to identify where non-compliance was occurring and interventions to improve overall institution compliance rates. Chart review and process flow observation were used to identify which parts of the bundle were not being implemented according to CMS guidelines. Use of a newly created sepsis handoff tool and implementing nurse education on the core measures were interventions used in an effort to increase overall institution compliance. Results: Overall compliance rates improved from 57% in May, 2018 to 87% in June, 2018 after implementation of interventions. For the months of June, 2018 - September, 2018, compliance rates remained >70%. Conclusion: The two interventions that were implemented during the course of this project seemed to improve compliance based off a significant improvement in overall compliance rates during months where the interventions were implemented. There are many recommendations for future research and interventions based off the findings from this project.