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Item Pain management of buprenorphine patients in the perioperative setting(Montana State University - Bozeman, College of Nursing, 2024) Hildner, Kate Ella; Chairperson, Graduate Committee: Julie Ruff; This is a manuscript style paper that includes co-authored chapters.Background: Buprenorphine is an FDA-approved medication for the treatment of opioid use disorder and a useful tool in helping patients recover from opioid addiction. Due to the mechanism of action of buprenorphine on opioid receptors, treatment of acute pain in the perioperative setting can be challenging. Local problem: At the facility site, buprenorphine patients who present for surgery have a longer average length of stay in the post-anesthesia care unit (PACU). Nurses also expressed a need for further education and increased proficiency in caring for buprenorphine patients. Methods: The purpose of this project was to increase staff communication, provide specific education to staff about buprenorphine, and decrease the length of stay for buprenorphine patients in the PACU. Interventions: This project involved the implementation of three interventions. The first intervention involved adding chart documentation of buprenorphine status, allowing for notification to the operating room and PACU staff. The second intervention was the initiation of improved communication between the preoperative department and the PACU. The third intervention was an educational presentation and reference sheet that was provided to the PACU staff. Results: After implementation, 80% of buprenorphine patients had a note in their chart alerting the OR and PACU staff of their buprenorphine status, however direct communication between departments only occurred for 20% of patients. 100% of PACU staff nurses reported increased proficiency in caring for buprenorphine patients after education implementation. Conclusion: The QI project resulted in increased staff proficiency and interdepartmental communication, indicating improved care for buprenorphine patients in the perioperative setting.Item Medical flight handoff: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Sunden, Peter Scott; Chairperson, Graduate Committee: Alice RunningBackground: Flight medicine, transporting patients from small facilities over long distances, is essential in rural areas. Providing pertinent patient information to receiving care teams is critical and evidence suggests that over half of the pertinent patient information is omitted. Problem: Incomplete patient information provided by the flight medicine community can negatively impact patient safety and receiving team care. Methods: This QI project intended to increase efficiency of patient handoff to receiving care teams by way of a "drop sheet". The drop sheet was developed using the Mechanism Injuries Signs/Symptoms Treatment (MIST) mnemonic. One carbon copy of the drop sheet was left with the receiving nurse; the flight crew retained the other. A QR code was printed at the bottom of the drop sheet linked to a Likert-type survey assessing the comfort, completeness, timeliness, and effectiveness of the flight crew's patient handoff. Interventions: Training on the drop sheet and survey coincided with the project roll-out January 10th, 2023. Flight crews were instructed to complete a drop sheet on every patient and to leave a copy of the drop sheet with staff on the receiving team. Results: At the projects conclusion, (03/10/2023), 64 flights were completed; drop sheets were used 67% of the time. Four surveys were completed during the data collection time. Conclusions: According to the literature, consistent information provided by flight crew handoffs can improve patient safety and report completeness to the receiving care team. Drop sheets were successfully utilized though receiving care team satisfaction with the process remains inconclusive.Item Implementing an electronic patient portal enrollment program in primary care(Montana State University - Bozeman, College of Nursing, 2022) Cayer, Caitlyn MacKay; Chairperson, Graduate Committee: Amanda H. LucasPurpose: This the purpose of this quality improvement (QI) Project was to implement a portal enrollment program that includes staff training and a new workflow process to provide accessibility to patients' PHI and comply with federal regulations. Successful long-term implementation will positively affect the primary care clinic reimbursement by achieving the overarching goal of offering enrollment to all patients, thereby aligning the clinic with regulatory expectations of Health Information Technology (HIT). Methods: The project site was an FNP-owned clinic with approximately 888 active patients with an average of 160 patients seen monthly. The project purpose addressed through the implementation of three evidence-based methods, including (a) training employees on electronic patient portal use and enrollment; (b) providing marketing materials to patients presenting for visits; and (c) evaluating the success of offering 'on-the-spot' electronic patient portal account activation through an innovative workflow. Results: 175 adult patients presented to the clinic for an appointment during the six-week intervention period. Of these participants, 151 were provided with a brochure highlighting the portal per the project workflow which was fell under the goal of 100% of patients being given the brochure. Additionally, 38% of patients chose to activate their portal 'on-the-spot' which met and exceeded the goal of 20% for the intervention period. Implications for Practice: This quality improvement project provides insight into the effectiveness of using informational materials and a new workflow to introduce patients to a newly activated Electronic Patient Portal. The workflow established will continue at the clinical site with some minor adjustments to improve long-term sustainment. This continued process not only addressed the need to maintain compliance with federal regulatory expectations, but also laid the framework for the clinic to carry out similar quality improvement projects involving health information technology in the future.Item A description of a project on the use of mindfulness for stroke survivor caregivers(Montana State University - Bozeman, College of Nursing, 2021) Kirby-Johnson, Valerie Katherine; Chairperson, Graduate Committee: Tracy HellemSome stroke survivor caregivers experience caregiver burden and depression after their family member experiences a life-altering cerebrovascular accident. Stroke survivor caregivers may face negative mental and physical health impacts when providing stroke survivors' care within their home, which can lead to the stroke survivor encountering negative health outcomes. Educating stroke survivor caregivers on mindfulness cognitive behavioral therapy provides them with a tool that can allow them to better cope with caregiver burden and depression that can be experienced when providing care. Therefore, the purpose of this project was to provide stroke survivor caregivers with education about the use of mindfulness to improve mental health. Data collection consisted of the Caregiver Burden Scale and Patient Health Questionnaire at baseline, at time of stroke survivors' discharge and two weeks after discharge to home. Largely related to the onset of the COVID-19 pandemic, this project had limited recruitment (n=2) and retention (n=0). Given the mounting evidence on the benefits of mindfulness practices, this project could be implemented in the future when social interactions, such as in-person support groups, resume post COVID-19 era.Item Educating psychiatric nurses in cognitive behavioral therapy for adolescent patients: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Thralls, Claire Eileen; Chairperson, Graduate Committee: Tracy HellemIt is estimated that 20% of adolescents have a diagnosable mental health disorder. However, there is a deficit of providers that are available to treat this population. This gap in care can potentially be mitigated by increasing mental health caregivers' education on therapeutic interventions. Cognitive behavioral therapy (CBT) is considered to be the gold standard of care for the population of adolescent mental health patients. This project set out to educate nurses working on an inpatient adolescent unit on topics of evidence-based CBT and adolescent group therapy. Nurses interacted in a 3-hour educational intervention that reviewed topics of CBT, group therapy with adolescents, and the Creating Opportunity for Empowerment (COPE) program. Additionally, the nurses participated in a role-playing group therapy session to practice implementing CBT interventions to adolescent patient populations. This intervention was utilized to determine the feasibility and effectiveness in educating psychiatric nursing staff on CBT concepts with regard to group therapy for adolescent populations. After participation in the intervention, nursing staff reported benefits and satisfaction with the CBT and group therapy intervention, increased understanding of CBT concepts and interventions, and enhanced preparation for working with adolescent psychiatric patients. It is hoped that this project will guide adolescent-mental-health caregivers in seeking additional education in CBT practices to enhance their education in evidence-based interventions.Item Evaluation of interdisciplinary patient care conferences for the complex patient population in a rural state(Montana State University - Bozeman, College of Nursing, 2021) Posada, Britt Kristen; Chairperson, Graduate Committee: Wade G. HillPrimary care practice in the 21st century requires innovative and visionary transformation. With the prevalence of chronic diseases continuing to increase, the management of diseases and patients has to change in order to make an impact on outcomes and healthcare costs. As needs for primary care expand, the population ages and patient complexity increases, collaborative care is vital in providing optimum patient care. In 2018, the United States healthcare costs were $3.6 trillion, averaging $11,000 per person and are projected to increase to $6.2 trillion by year 2028. With care that is often fragmented between large hospital systems and community resources, rural states have shown that coordinated care teams have had a dramatic impact on healthcare costs. Monthly de-identified interdisciplinary patient care conferences were evaluated using the Collaborative Case Conference form. In the spring of 2021 an electronic survey was delivered to 18 historical participants of the interdisciplinary patient care conferences via email with goals of obtaining formative and summative evaluations. Formative evaluation found that 100% of participants responded Very Good-Excellent in usefulness of discussions as well as collaborative nature. The summative evaluation revealed that 93.34% of participants Agreed-Strongly Agreed that, as a result of the care conferences, they had a clearer sense of other health professionals roles. All participants reported that they Agreed-Strongly Agreed that there was greater value in interprofessional collaboration after participating in the conferences. Limitations of the evaluation included technology, recall bias, poor survey choices, and low scalability of project. In conclusion, the evaluation of the interdisciplinary patient care conferences for complex patients in a rural state was an overall success. Unfortunately, the program is no longer ongoing as it was halted after funding ended, making sustainability one challenge of convening statewide care conferences of this type. On a positive note, after the initiative was finished individual organizations did implement similar localized care conferences within their settings.Item Implementation of a nurse-driven algorithm for safety companion usage: a pilot study(Montana State University - Bozeman, College of Nursing, 2019) Phillips, Kahrin Lillian; Chairperson, Graduate Committee: Jennifer Sofie and Susan Luparell (co-chair)Safety companions, also known as sitters, are commonly placed in a 1:1 setting with patients in hospital settings to maintain their safety. These patients include (a) those that are suicidal, confused, delirious, or violent; (b) those with psychiatric issues; (c) those with behaviors that interfere with their medical treatment; and (d) those experiencing behavioral problems associated with substance abuse. However, several problems exist with the use of safety companions, such as cost, inconsistent evidence supporting their effectiveness, and lack of evidence-based guidelines for their use. The primary aim of this pilot study was to assist staff RNs on a 39-bed inpatient hospital unit in using more discernment in the use and management of safety companions. Based on the needs of key stakeholders at the pilot site and a thorough review of the literature, a nurse-driven, evidence-based algorithm for safety companion usage was developed and implemented over four months to meet this aim. In addition, the project investigated the issues surrounding safety companion use and compared these issues to those experienced at the pilot site. Five online surveys targeting different groups of stakeholders were used pre- and post-implementation of the algorithm to assess their perceptions of the algorithm and its effect on the management of safety companion usage. The success of the algorithm was determined by the level of nursing satisfaction with the algorithm and whether it was helpful to assess their patients for a safety companion. The primary aim of the project was successfully met, with all participating team leaders finding the algorithm to be 'somewhat' to 'very effective' in helping staff RNs in being more discerning with the use and management of safety companions. Most of the unit's participating team leaders (87.5%) were satisfied with the algorithm, and all of the participating staff nurses found the algorithm to be 'somewhat helpful' or 'very helpful.' Implications for improvement included room for additional education and training for safety companions, improved staffing and support when using the algorithm, and issues surrounding patient safety.Item Introducing trauma-informed care in an acute inpatient psychiatric unit: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2020) Thompson, Evan Robert; Chairperson, Graduate Committee: Julie RuffTraumatic experiences are common in society and are associated with an increased risk of development of adverse physical and psychological outcomes extending throughout the lifespan. Individuals accessing mental health services, such as inpatient hospitalization, are likely to have experienced interpersonal trauma at some point during their lives. Mental health professionals are well suited to provide supportive and effective trauma-informed care (TIC) to patients with trauma histories. TIC seeks to actively resist patient re-traumatization and caregiver secondary traumatic stress. An evidenced-based trauma-informed care training was presented to mental health professionals working on a psychiatric inpatient unit. The project involved a single group pre-post test design with a 1-month follow-up assessment. Staff attitudes towards trauma-informed care were evaluated by a psychometrically validated tool (ARTIC-35). Sums of the items on the ARTIC?35 for each participant were divided by the number of items, means and standard deviations for aggregate average scores for each time point were obtained, and percent change for participant average scores between time points were calculated. Additionally, participants were asked to share if they had incorporated trauma-informed care into their work with patients and if they experienced any barriers to implementing TIC since the training. Immediately following the training, ARTIC-35 scores increased on average by 11%, demonstrating that attitudes related to trauma-informed care improved as a result of the training. One month following the training, all six participants maintained their score on the ARTIC-35, representing a 12% increase from pre-training scores and 0.61% from immediately following training. Further, all participants indicated at the 1-month follow-up assessment that they changed their practice to incorporate trauma-informed care into their work with patients. A 1-hour TIC in-service training demonstrated the ability to improve psychiatric healthcare professional's attitudes toward trauma-informed care. Healthcare organizations serving patients with traumatic histories should consider TIC training for all personnel.Item Motivational interviewing education for home visiting asthma nurses(Montana State University - Bozeman, College of Nursing, 2020) Romine, Rebecca Ann; Chairperson, Graduate Committee: Polly PetersenMontana Asthma Program (MAP) nurses currently do not receive motivational interviewing (MI) training and have identified it as an area of development. The desired outcome for this Doctor of Nursing Practice (DNP) scholarly project is to positively affect MAP nurses' knowledge of MI strategies and theories and self-efficacy, or each nurses' belief that they can successfully execute behaviors necessary to produce an MI therapeutic interaction. A brief MI training to increase MI knowledge and self-efficacy of the MAP nurse by 1) attendance of a three-hour asthma-focused MI foundational training course and 2) triad of patient-nurse-recorder role-playing using MI foundations. Content was delivered using PowerPoint slides and lectures with integrated use of role-playing as skills and principles are introduced. A tool used in a previous study by Pyle (2015) was identified as an appropriate self-assessment of self-efficacy and knowledge after completing MI training. Nurses completed this assessment pre and immediately post-training as well as seven months after the educational intervention to see if there was a change. Knowledge question scores ranged from pre-test 3.5 to 2.3 (n = 9) M = 3.05, (SD = 0.33); post-test scores ranged from 3.4 to 3.7 (n = 9) M = 3.57, (SD = .09); and post-test seven-month scores ranged from 3.5 to 3.8 (n = 6) M = 3.6, (SD = 0.07). Self-efficacy question scores ranged from pre-test 2.6 to 3.6 (n = 9) M = 3.21, (SD = 0.37); post-test scores ranged from 3.4 to 3.8 (n = 9) M = 3.62, (SD = .14); and post-test seven-month scores ranged from 3.4 to 4.0 (n = 6) M = 3.67, (S = .18). Knowledge score improvements suggest education retention of background concepts and theories related to MI (Bailey et. al, 2017). Of particular interest is the increase in scores between the post-test and post-test seven-month assessments. The overall increase of mean scores, from pre-test, post-test, and post-seven-month tests indicates an increase in the understanding and self-efficacy of the nurses as it is related to their MI knowledge and use as a communication style.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.