Scholarship & Research
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Item Implementing birth trauma screening at the post-partum appointment: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Milam, Kelsey Rene; Chairperson, Graduate Committee: Margaret HammerslaBirthing individuals perceive their birth experience as a traumatic experience in 30-45% of births. This can lead to negative consequences such as increased maternal stress, fears of subsequent pregnancies, and impaired infant bonding. Post-Partum Post Traumatic Stress Disorder (PP-PTSD) after childbirth is a significant clinical problem, as 4-9% of birthing individuals develop it. In order to prevent and reduce the negative impacts of traumatic births, perinatal providers can implement birth trauma screening into their assessments of perinatal mood disorders, increasing the identification and implementation of treatment. An Ob/Gyn clinic in Southwestern Montana sought to improve the identification of birth trauma in their population, as they relied on the patient to self-report concerns and post-traumatic symptoms. The Iowa Model of Evidence-Based Practice informed the implementation of birth trauma screening at the 2-week post-partum appointments over a 3-week period. At the 2-week post-partum appointment, birth trauma screening was implemented by the RN using the first two questions of the City Birth Trauma Scale (CBTS). If the patient screened positive, they were given a counseling referral and supportive education from the RN. The electronic health record (EHR) was modified for documentation. 37 patients attended a 2-week post-partum appointment. 37.84% received birth trauma screening. Of the patients screened, 100% received correct documentation of screening in the EHR. 14.29% screened positive for birth trauma. 100% of positive screens received an offer for a counseling referral and 50% attended that appointment. This project was effective at increasing the screening rate of birth trauma in birthing individuals and provided increased access to counseling and education on this topic to every patient screened, regardless of the result. By including involvement of Ob/Gyn providers, nursing staff and mental health clinicians in the development of this project, allowed for an increased knowledge base of this clinical issue, leading to increased commitment for the early identification of birth trauma for this organization.Item Reducing instances of PTSD in ICU survivors(Montana State University - Bozeman, College of Nursing, 2016) Wozniak, Becky Ann; Chairperson, Graduate Committee: Charlene WintersRational: As many as 20-30% of adult ICU survivors will experience PTSD related to their time as a patient in the ICU. The symptoms of PTSD can last months or years and prevent a full recovery from critical injury or illness. Patients that experience ICU delirium are at the highest risk for developing post-ICU PTSD. Many hospitals in Europe have begun using ICU after care programs to help patients cope with traumatic ICU memories and prevent a PTSD diagnosis. Purpose and Methods: The purpose of this project was to develop a nurse-led ICU after care program to prevent instances of PTSD in adult ICU survivors. Patients volunteered to participate in this project after seeing advertisements posted in the ICU and after receiving invitation letters in the mail at home. Patients were screened for PTSD using the PTSS-14, had a chance to speak with an ICU nurse about their experiences in ICU, and one patent was even able to return to the ICU and speak about that experience. Patients were then re-screened for PTSD approximately 2 weeks after their after care experience. Findings: Small sample size precludes any evaluation of this intervention. However, all participants did demonstrate evidence of decreased anxiety scores after their participation. Implications: Future ICU aftercare programs may have increased participation if the data collection period is extended to at least six months and if the patients are contacted closer to 3 months post ICU discharge. PTSD itself and the Rural Nursing Theory may decrease participation in these programs without specific interventions to address them.Item What interventions are successful in the treatment of sleep disturbances in veterans with PTSD? : an integrative literature review(Montana State University - Bozeman, College of Nursing, 2015) Huston, Erin Marie; Chairperson, Graduate Committee: Jennifer SofiePosttraumatic stress disorder (PTSD) is the most common mental disorder associated with military combat and is a significant health risk for military veterans (Nayback, 2009). The sleep disturbances associated with PTSD are some of the most disabling and difficult to treat aspects of the disorder (Nayback, 2009). The nightmares experienced by veterans are often resistant to typical psychological and pharmacological interventions and require a specifically tailored treatment to improve sleep (Nappi, Drummond, Thorp, & McQuaid, 2009). Interventions for sleep disturbances have not been widely studied in populations with PTSD (Swanson, Favorite, Horin, & Arnedt, 2009).The purpose of this integrative literature review was to gain knowledge of successful interventions for sleep disturbances in veterans with PTSD. Current literature was reviewed and analyzed to increase knowledge of the interventions available for improving sleep in this population. A total of seven articles met inclusion criteria and were utilized in the literature review. Articles were located by searching electronic databases and by hand searching abstracts and reference lists. A constant comparison method was utilized in which data were extracted from the research articles and then compiled into systematic categories (Whittemore & Knafl, 2005). The data were assembled into a large matrix allowing for the comparison of each research study (Whittemore & Knafl, 2005). When performing this literature review, it became evident that there are few interventions available to treat sleep in veterans with PTSD. There did not appear to be a single intervention that was most effective in treating sleep in veterans with PTSD. This review did find literature suggesting that Cognitive Behavioral Therapy (CBT), Imagery Rehearsal Therapy (IRT), and prazosin have all shown varying degrees of effectiveness in the treatment of sleep disturbances in veterans with PTSD. This review of literature suggests it may be beneficial for future research to focus on a combined approach of CBT, IBT, IRT, and prazosin.Item Sudden loss of an adult sibling : the bereavement experience(Montana State University - Bozeman, College of Nursing, 1999) Long, Julie E.Item Color and healing(Montana State University - Bozeman, College of Arts & Architecture, 2010) Anderson, John Moyle, Jr.; Chairperson, Graduate Committee: Steven Juroszek; Ralph Johnson (co-chair)Post Traumatic Stress Disorder (PTSD) affects approximately 20-30% of Veterans. It can be very mild with little effect on the person to debilitating depression and suicide. Some of the symptoms Veterans with PTSD may experience are: depression, flashbacks, inability to sleep, re-experiencing the event, recurring dreams of the event, and many others. In the United States we have an opportunity to give back those who have served the US with honor. We have the ability to create spaces and environments to help heal our returning Veterans who are afflicted with PTSD. By utilizing individual colors and interaction of colors we can create healing spaces to help Veterans reintegrate into society. Vet Centers' primary mission is the treatment of Veterans with PTSD and sexual truma. Currently there is not a Vet Center located in the Gallatin Valley area for treatment of Veterans living here. Color is performative. Color will react to the environment in which it is placed. The ways in which color will react are many; including how natural light interacts with color, how color interacts with artificial light, how color reacts with reflectivity of materials of the built environment, the placement of the colors in a built environment as well as the attributes of the colors themselves.Item The utility of selected measures for the initiation of treatment for PTSD in the VA healthcare system : a review of contemporary literature(Montana State University - Bozeman, College of Nursing, 2011) Sheppard, Ronald Matthew; Chairperson, Graduate Committee: Patricia A. HolkupThrough appropriate use of available instruments, recognition and diagnosis of posttraumatic stress disorder (PTSD) can be accomplished, leading to the initiation of treatments vital to achieving optimal health outcomes. Inappropriate use of these same instruments can lead to delayed, inappropriate or ineffective condition treatment, and squandering of limited resources. It was the purpose of this project to identify and analyze factors related to accurate identification through exploration of contemporary literature evaluating psychometric properties of a collection of selected screening tools commonly used within the Veterans Administration (VA) system. A limited journal article search was performed using three electronic health science databases, focusing on the Primary Care PTSD Screen (PC-PTSD), Posttraumatic Stress Disorder Checklist (PCL-M), Mississippi PTSD Scale (M-PTSD) and the Clinician Administrated PTSD Scale (CAPS). Emphasis was placed on each instrument's reported psychometric properties, specifically, the internal consistency, test-retest reliability, discriminant validity, convergent validity and diagnostic utility. Journal results were separated by instrument and organized into table form for ease of comparison. Additional instrument administration details were added in efforts to assemble a comprehensive assessment. Psychometric incongruencies between instruments were found. Specifically between the simple four question PC-PTSD and the comprehensive CAPS instrument. Significant disparity was observed in terms of diagnostic utility when one instrument is used for the purpose of the other. Sensitivity and specificity varied considerably dependent on cut-off scores utilized. Considerable inequality exists in relationship to administration details, resource, and time requirements. The author concluded that with many appropriate instruments available to assist providers with diagnostic efforts, it is unwarranted and inapposite to attempt to attain equivalent results through the use of instruments with inferior psychometric abilities. It is the responsibility of the practitioner to ensure that the strengths and limitations of an instrument are considered before making a diagnosis or treatment decisions based upon results from the administration of any given instrument.