Scholarship & Research
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Item Transportation of ST-segment elevated myocardial infarctions in rural Montana to percutaneous coronary intervention capable medical centers and achievement of goal treatment times(Montana State University - Bozeman, College of Nursing, 2019) Bothman, Nicole M.; Chairperson, Graduate Committee: Casey ColeBackground: Rapid reperfusion via primary percutaneous coronary intervention or thrombolytic therapy is critical to limit death and disability associated with ST-elevated myocardial infarction. However, the majority of Montanans reside in rural areas and require time consuming interfacility transportation for specialized cardiac care. Purpose: The aim of this scholarly project is to analyze the treatment and transfer process of adult patients experiencing a ST-elevated myocardial infarction with initial presentation to a rural medical facility requiring interfacility transfer for specialized cardiac care to generate quality improvement recommendations for changes in the care and transfer process to decrease door-to-needle, door-to-door, and door-to-balloon times among this patient population. Sample: Subjects were adults (18 years of age and older) diagnosed with a ST-elevated myocardial infarction at a rural medical facility and transferred to the nearest STEMI receiving medical facility for specialized cardiac services. Subjects transferred for primary PCI and post thrombolytic therapy were included in this project (n = 8). Methods: Retrospective data analysis of deidentified quality metric data was utilized to examine if treatment benchmarks set forth by the American Heart Association were met during the data collection period of January 2018 through September 2018. A voluntary survey was implemented at the rural medical facility to provide supplementary and clarifying information related to the treatment and coordination of transportation of ST-elevated myocardial infarction cases from February 2018 through August 2018 (n=3). Conclusions: Of the eight cases reviewed in this project, none met all of the applicable quality metric benchmarks; all eight met the door-to-ECG benchmark, one met the door-to-needle benchmark, none met door-to-door or door-to-balloon benchmarks. Providers in rural areas can provide quality care with positive clinical outcomes among ST-elevated myocardial infarction patients though adherence to treatment guidelines and working as a collaborative team with transporting agencies to facilitate rapid interfacility transportation (American Heart Association, 2015; National Clinical Guideline Centre, 2013).Item The role of hemoglobin A1c testing in undiagnosed diabetes and myocardial infarction in emergency and intensive care settings(Montana State University - Bozeman, College of Nursing, 2018) Nicola, Marcus; Chairperson, Graduate Committee: Teresa SerightStatement of the Problem: The disease of diabetes is insidious. Its complications can be devastating and, if left untreated, often leads to early mortality. With the effects of diabetes being so extensive within body systems, complications like myocardial infarction are all too common. To complicate the matter further, a large portion of the population of diabetics is undiagnosed. Having no knowledge of this disease process allows the disease to progress unfettered for an indeterminate amount of time. If diabetic status is unknown, an increased risk of mortality from MI exists. Systematic Hgb A1C testing for myocardial infarction patients may provide prognostic data for undiagnosed diabetics and increase our ability, as providers, to develop treatment plans to address the increased risk of mortality posed to these individuals. Methods: All MI patients admitted to ED and ICU charts were screened for hemoglobin A1C testing and diabetic care planning as evidenced in their discharge summary. Results: This project found that testing with Hgb A1C only occurred in 40% of MI patients. Of those tested, 8% were found to be new diabetics. This project also found that 16.3% of the patients tested were pre-diabetic and that this was only noted in 1.8% of these patients' discharge summaries. Conclusions: Currently, Hgb A1C testing is underutilized in MI patients. Identification of new diabetics in this population allows providers to address this diagnosis in a manner that can prevent the complications all too common to diabetics with heart disease.Item An integrative review of utilizing mutual goal setting with the elective coronary artery bypass graft patient to improve postoperative physiotherapy adherence(Montana State University - Bozeman, College of Nursing, 2018) Funderburk, Courtney Lee; Chairperson, Graduate Committee: Charlene WintersThe purpose of this integrative literature review was to determine if mutual goal setting improved postoperative adherence to physiotherapy in adult patients undergoing elective coronary artery bypass graft (CABG) surgery. The integrative review was conducted using the methodology outlined by Whittemore and Knafl (2005). Literature was gathered by searching databases with key search terms related to physiotherapy adherence and goal setting. A review of abstracts and full-text using inclusion and exclusion criteria was conducted to determine which reports to include in the review. There no reports or studies that discussed the effects of mutual goal setting on physiotherapy adherence in the adult elective CABG patient. Reports and studies that looked at the effects of mutual goal setting in patients with heart disease and patients in cardiac rehabilitation programs were analyzed. The results from those reports and studies were extrapolated and applied to the adult elective CABG patient on the basis that the groups share similar levels of anxiety and depression, which evidence has shown affects adherence to physiotherapy. The results were analyzed based on outcome measurement of adherence (objectively measured levels of adherence or subjectively reported by participants' perception of how adherent they were). Results were inconclusive, but most of the studies suggest that goal setting, used alone or in conjunction with other motivational techniques, can improve adherence to physiotherapy in heart disease patients.Item Coronary heart disease knowledge, health promoting behaviors and perceived benefits and barriers to exercise and healthy eating in Montana females(Montana State University - Bozeman, College of Nursing, 2014) Baldwin, Sadie Ann Schwenk; Chairperson, Graduate Committee: Dale MayerThe purpose of this study was to gain an understanding of rural women's knowledge of coronary heart disease risk factors, current health promoting behaviors, and perceived barriers and benefits to health promoting behaviors. The research questions posed were: What is the coronary heart disease knowldge of women living in rural areas; are women in a rural western state engaged in health promoting behaviors; and what benefits and barriers to health promoting behaviors do rural women perceive related to diet and exercise? The Health Promotion Model served as the guiding framework for this study. This descriptive study utilized a non-random convenience sample of women living in non-metropolitan or non-core counties in Northwest Montana seeking healthcare at one of four designated clinics. Inclusion criteria included female gender, age 21-55 years olds, premenopausal status, ability to read and write English, and residence within a designated non-metropolitan county. The following instruments were used to collect data: Coronary Heart Disease Knowledge Tool for Women, Health Promoting Lifestyle Profile II, Exercise Benefits/Barriers Scale, and Healthy Eating Benefits and Barriers Scale. The sample (n = 25) population was predominantly white and non-Hispanic. The average Coronary Heart Disease Knowledge Test for Women score was 71% with a range of scores from 40%-80%. Health promoting behaviors were ranked in the following order from most to least practiced: interpersonal relations, spiritual growth, nutrition, stress management, physical activity, and health responsibility. The sample perceived moderately high benefits to exercise and healthy eating and moderately low barriers to exercise and healthy eating. Findings from this study support a need for healthcare providers to discuss heart disease risk factors with their premenopausal clients and to encourage participation in health promoting behaviors, especially those ranked lowest, physical activity and health responsibility. Research is needed with a larger population to better understand the relationship between heart disease knowledge, health promoting behaviors, and perceived barriers and benefits to healthy eating and exercise in rural dwelling women.Item Identifying perceptions of health promotion barriers and benefits in individuals at risk for coronary heart disease(Montana State University - Bozeman, College of Nursing, 2008) Weston, Nicolett Marie; Chairperson, Graduate Committee: Charlene WintersCoronary Heart Disease (CHD) is the single largest cause of death in the U.S., and is also the leading cause of death in Montana. In addition, the estimated direct and indirect costs of cardiovascular disease in the U.S. for 2007 were $431.8 billion. Anticipated barriers to health promotion behavior have been shown to affect intentions to engage in and execute the behaviors. Exploring individual's perception of the benefits of health promotion behaviors is equally important when addressing barriers to making lifestyle changes. CHD is strongly associated with modifiable risk factors including physical inactivity, poor diet, and tobacco use. Although CHD risk factors have been studied extensively, few studies have assessed individuals' combined perceptions of barriers and benefits as reasons for non-adherence to recommended health promotion behaviors related to CHD risk and most of these studies included only women. The purpose of this research study was to examine perceived barriers and benefits to CHD risk modification in men and women living in a rural western state. Two survey tools were used to collect the data from a convenience sample of persons seen in the cardiac care areas at a local hospital in a rural western state. The findings of this study provided important information about the perceived barriers and benefits to CHD risk modification of persons previously diagnosed or at risk for CHD. Results from this study imply that in order to develop effective interventions, it is important to understand the individual and his or her unique characteristics including gender, socioeconomic status, and education level in relation to his or her perceived barriers and benefits to health promotion. Nurse practitioners and other primary care providers can incorporate this knowledge into future strategies to reduce or eliminate barriers, increase perceived benefits, and promote health promotion behaviors in individuals who are at risk for developing CHD. Advocating for health promotion behavior adoption and CHD risk modification offer a very important and practical tool for providers to help individuals address and lower risk factors as well as prevent CHD and treat individuals with established CHD.Item Is an individualized educational intervention more effective in enhancing risk factor awareness in a population of people with coronary artery disease?(Montana State University - Bozeman, College of Nursing, 2011) Schaefer, Margaret Frevert; Chairperson, Graduate Committee: Charlene WintersCoronary artery disease is the leading cause of death in males in the United States and the leading cause of death in females over the age of fifty. It is largely a preventable disease with several risk factors being linked to life styles that could either be modified or indeed changed completely in order to prevent its occurrence or at least slow its progression. The problem lies in determining the best way to educate the general population with regard to the risk factors for coronary artery disease or as in secondary prevention, educating those who already have the diagnosis, so that they recognize their own risk factors, maybe modify them and thus have a better chance to decrease their own morbidity and mortality from this disease. There have been many approaches documented in the literature that have investigated a variety of educational intervention techniques. The current study is in regard to whether or not an individualized approach to education could be more successful in creating an awareness of the risk factors for coronary artery disease, in patients who already have the diagnosis. A pre and post questionnaire was used to assess the knowledge level of participants who either watched an educational video alone or watched the video followed by a period of ten minutes one on one time with a registered nurse. The results from this study indicate that there is no significant improvement in the knowledge of risk factors for coronary artery disease in individuals who were given ten minutes one on one time with an RN over those who simply watched the educational video on CAD risk factors. The conclusion then is that even given the limitations of the study, it is likely that in order to be successful in communicating the risks of coronary artery disease to people who already have this diagnosis the intervention needs to be more substantial. In addition it is discussed as to whether or not a knowledge deficit is in fact the primary obstacle and that the focus in halting disease progression should be on life style change motivation.