Scholarship & Research
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Item Addressing access barriers for geriatric Montanans: a CNL approach(Montana State University - Bozeman, College of Nursing, 2022) Martini, Melissa Lynne; Chairperson, Graduate Committee: Denise RiveraRural residents experience risk factors that contribute to health disparities and lower life expectancy (CDC, 2017; Skoufalos et al., 2017). Rurality and the associated social settings of rural communities have direct relation to difficulty in accessing healthcare which is further complicated by distance and weather-related issues common to Montana. The overarching purpose of this review is to determine if the health of elderly rural Montanans is improved with the creation and use of a mobile care clinic in the community to serve these individuals. This quality improvement project will be conducted using survey's via convenience sampling of elderly members in a rural community in Montana.Item Rural healthcare assessment: identifying gaps between service and expectations(Montana State University - Bozeman, College of Engineering, 2020) Dorsey, Robert Kenneth; Chairperson, Graduate Committee: David ClaudioThis research project aims to improve patient satisfaction for customers in same-day clinics in rural areas, with emphasis on healthcare services and facilities at Native American Reservations. This project examined potential gaps between clinical staff services and the expectations of the patients. Due to the remote location and low-income level of the community, it is critical for patients to receive care at local healthcare facilities and not have to travel to other facilities for the same care. The low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) satisfaction scores also lead to less funding to the facility as well as lower-ranking in accreditation by Centers for Medicare and Medicaid Services (CMS). Utilizing survey tools and statistical analysis from Industrial and Management Systems Engineering the study looked to understand expectations on both sides. The initial phase used four open-ended questions along with a series of multiple-choice questions that were given to participants, both patients and staff. Data collected in the first phase showed a possible disconnect between the patients and staff from their responses. It also allowed the patients to rate service prior to the visit. Results showed some areas could have potential improvement but also the performance of staff is overall doing well with what they can control. The second phase revealed a more aligned view between the patients and staff in a ranking survey compiled from the first phase of the research. The ranking information allowed nonparametric testing to see if there existed statistically significant differences between the two groups. Results showed one significantly different item and two others that were borderline. The Service Value Gaps are not as prominent in this single clinic to warrant an in-depth improvement process. More information should be collected through other clinics to allow larger sample size to gain additional insight if multiple gaps exist. The items of actual or near significance were not a higher priority to either group.Item The effects of limiting access to abortion on domestic violence(Montana State University - Bozeman, College of Agriculture, 2020) Salemo, Katherine Marie; Chairperson, Graduate Committee: Isaac SwensenThis paper estimates the effect of access to abortion on the number of reported domestic violence victims using abortion clinic closures in the state of Texas that resulted from a statewide policy change. Results suggest that a decrease in access to abortion services causes a decrease in the number of reported intimate partner victims, though the evidence is weak. When analyzing the effects by relationship type, the results appear to be driven by victims with no legal ties to their offender, such as dating partners. The results indicate that a law enforcement agency that no longer has an abortion clinic within 100 miles reports 13.8% fewer dating partner victims. Because domestic violence crimes are vastly underreported and the data I use are exposed to this issue, the results could be due to a change in the frequency of the crime or a change in the decision to report the crime. This is the first paper to estimate this causal relationship, contributing to the literature by analyzing a policy that could have unintended impacts on victims of domestic violence.Item The effects of Medicaid expansion on special education enrollment(Montana State University - Bozeman, College of Agriculture, 2021) Schultz, Gunnar Marcus; Chairperson, Graduate Committee: Wendy A. StockThis paper examines the effects of Medicaid eligibility on special education enrollment, exploiting variation in childhood Medicaid eligibility arising from the Medicaid expansions of the 1980s and 1990s. I find that these expansions led to increased special education enrollment rates, particularly among children with 'non-severe' disabilities. Further, I find evidence that the effects are largely concentrated in late elementary school. The results suggest that broadened public healthcare access promotes student welfare through improved evaluation and identification of children with disabilities, primarily among low-income children.Item Outcome measurement in direct primary care(Montana State University - Bozeman, College of Nursing, 2021) Davis, Lindsey Michelle; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughThe cost of healthcare in the United States compared to the quality of outcomes achieved is disproportionately high. Limitations in access to primary care result in poorer population health, increase in frequency and severity of exacerbations of chronic conditions, higher numbers of emergency room visits, surgical interventions and specialty consultations which increase healthcare expense. A novel model of primary care delivery, Direct Primary Care (DPC), claims anecdotal improvement in cost, access, satisfaction, and clinical outcomes but the results have not been validated in the literature. This project aimed to gain insight to the degree of improvement in access and care outcomes achieved at a direct primary care clinic in Montana. A valid and reliable, patient-reported outcome measure (the Person-Centered Primary Care Measure) was implemented to identify the extent to which this DPC clinic achieved improvements in these areas. The results of this project indicated that efforts in DPC have the capacity to advance population health, improve clinical outcomes and reduce cost through increased access to care. Further evaluation is recommended including repetition of this project in other geographic locales. Others wishing to continue the work may desire to include demographic information such as age, gender and length of practice membership.Item Rural nurse residency: promoting the nurse graduate transition to frontier critical access hospital(Montana State University - Bozeman, College of Nursing, 2018) Williams, Christine Dee; Chairperson, Graduate Committee: Polly PetersenPurpose/Aim: The purpose of this pilot project was to test the feasibility of a rural nurse residency program to support the new graduate nurse in their transition to the role of a professional rural nurse, resulting in increased retention. It was hypothesized that graduate nurses' function with increased competence as a nurse clinician in a critical access hospital (CAH) following participation in a rural nurse residency program and remain in practice in the rural healthcare setting. Organizing framework for this project focuses on Duchscher (2008) Process of Becoming: The Stages of New Graduate Professional Role Transition. Background: Current research demonstrates that graduate nurses are not fully prepared to transition from the role of student to nurse (Fink, Krugman, Casey, Goode, 2008). Molinari et al., (2008) found that graduate nurses do not have the ability to assess complex situations, develop flexible problem solving, and direct limited resources to manage patient care, all needed to serve as a rural generalist. Providing a new graduate with a residency transition-to-practice supports development of skills needed to function in the complex rural healthcare setting (Kulig et. al., 2015, Molinari et. al., 2008). Methods: A quantitative pilot project with survey methodology to measure intervention effectiveness. Rural Nurse Residency (RNR) meetings occurred monthly for 12-months, for four hours sessions. Curriculum is based on Quality and Safety Education for Nurses (QSEN) and the Institute of Medicine's (IOM) core competencies; focusing on civility, communication, conflict resolution, critical thinking, delegation, leadership, and prioritization. Graduate nurses work with a preceptor during the first six months of the RNR. Three evaluation tools were utilized: Hagerty-Patusky (1995) Sense of Belonging Instrument (SOBI) measuring nurse confidence, Schwirian Six-Dimensional Scale of Nursing Performance Measures, a self-reflection of skill competency and Organizational Commitment Questionnaire, measuring integration into the organization through commitment to organizational goals and values (Anderson, et al., 2012). Questionnaires were distributed to participants at program onset, month six and program conclusion. Results: The RNR pilot study started in November 2017 and concluded in October 2018. Participants learned from reflecting on personal experiences and gained group support, decreasing a sense of isolation (Duchscher, 2008). Participants reported feelings of support and growth, increased confidence after participation in the RNR at month six. Implications: RNR programs have potential to increase nurse retention and quality of care in rural healthcare settings.Item The value of telemedicine in rural healthcare and associated financial obligation(Montana State University - Bozeman, College of Nursing, 2018) Nordlund, Sarah Lou; Chairperson, Graduate Committee: Polly PetersenThe purpose of this project was to raise awareness of the vital impact emergency room telemedicine has on rural residents and health care and the financial challenges facilities face to maintain these services following implementation. Limited knowledge is available to determine how rural critical access hospitals are able to financially sustain emergency room telemedicine long term. The study completed found that more than half of the Critical Access Hospitals utilize telemedicine in their emergency rooms. Funding emergency room telemedicine projects is an area of concern at many of these hospitals. As health care continues to advance with the use of technology, health care facilities are in need of more research in this area to develop policy that could potentially improve sustainability and increased reimbursement to offset the cost.Item Integrating oral health into a doctor of nursing practice curriculum(Montana State University - Bozeman, College of Nursing, 2017) Hausauer, Janice Donaldson; Chairperson, Graduate Committee: Elizabeth S. KinionCurrently, the United States oral health care delivery system does not reach the populations with the highest need for oral health services, resulting in continued oral health disparities in underserved populations. Incorporating oral health education in the formal education of primary care providers is a strategy to achieve the overall goals of primary health care by improving care for individuals and populations and lowering overall health care costs. The role of nurse practitioners in improving oral health outcomes and expanding access to care is dependent upon the improvement of oral health education in graduate nursing curricula. The purpose of this DNP professional project was to incorporate oral health content into one course in the DNP curriculum and to explore the potential opportunities for expanding oral health education throughout the DNP curriculum. The PDSA Model of Improvement (Institute for Healthcare Improvement, 2017) was utilized to pilot the integration of oral health content into a graduate health assessment course and to review ten DNP courses for oral health content. Graduate students enrolled in the class were surveyed regarding oral health perceptions and experiences. The majority of participants indicated that patients in their agencies had unmet dental needs. Participants reported knowledge of the oral-systemic health connection. Participants indicated that oral health should be included in the overall health assessment of patients and that oral health education should be included in non-dental curricula such as nursing. Student responses were consistent with the literature indicating the most common barriers to implementing oral health in practice were time, lack of oral health education, and lack of referral mechanisms. Although oral health content was noted in nine of the ten DNP courses reviewed, the content was highly variable throughout the courses. Oral health was not a thread throughout the curriculum. There is a need for integration of oral health content in graduate nursing curricula. The first step for developing a nursing workforce with core competencies in oral health promotion is to prepare nurse practitioner students with oral health knowledge, skills, and abilities.Item Telemental health care: provider's knowledge and beliefs(Montana State University - Bozeman, College of Nursing, 2018) Damberger, Kathleen Gail; Chairperson, Graduate Committee: Susan LuparellUniversity X, a state university in a northwestern state, offers a wide range of health care services for its students, one of which is mental health care. For students living on or near the university's main campus, access to care is generally not a problem. However a majority of nursing students are located on its distant satellite campuses 200 miles or more away, and distance serves as a barrier to access. This barrier to services is especially concerning when a student is experiencing an emergency or crisis, and it could potentially be mitigated by the use of telemental health. The purpose of this DNP project was to explore University X mental health care providers' knowledge and beliefs regarding telemental health. Providers were recruited from the counseling center (CC) and the student health center (SHC) on the University X campus. Providers completed an online survey that examined self-assessed knowledge and beliefs regarding telemental health. Fourteen providers completed the survey; two that identified as previous or current users of telemental health and 12 as nonusers of telemental health. The survey results highlighted the knowledge and beliefs regarding telemental health of both users and nonusers regarding quality of interactions with clients, inconveniences, and licensure. Baseline survey results were presented to the staffs of both agencies, accompanied by a presentation of literature that addressed these concerns and supported the use of telemental health. A follow up survey demonstrated some change in select attitudes.Item Transportation to health care for populations at risk : a tool for assessing available resources(Montana State University - Bozeman, College of Nursing, 2001) Shea, Lorna Marie; Chairperson, Graduate Committee: Teresa K. Henry