Scholarship & Research

Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/1

Browse

Search Results

Now showing 1 - 10 of 29

The effects of guiding climate change education through a social justice lens
(Montana State University - Bozeman, College of Letters & Science, 2023) Arnold, John Francis; Chairperson, Graduate Committee: C. John Graves
Climate change is one of the largest environmental and justice issues facing our world. Many young people are listening to the science and taking action, but many more are not. This project addressed climate change through exploring consequences on society, addressing public health, and impacts on societal infrastructure and stability. The social inequality of climate impacts was highlighted throughout to better engage students. Baseline, survey data was collected before we addressed climate change. After learning about public health concerns, students took the survey again and completed a short reflection. Students finished the study, after learning about impacts on societal infrastructure by taking a third survey, completing a second reflection, and with an interview. Results varied due to inconsistent participation throughout the study. Many students demonstrated an increase in understanding of climate change, but evidence to demonstrate their depth of understanding examples of people most disproportionately affected by climate change was inconsistent. Finally, students underreported eco-anxiety in survey results compared to interview results.
ACE questionnaire implementation: creating a trauma-informed approach in an integrated community health setting
(Montana State University - Bozeman, College of Nursing, 2023) Killian, Anne Kathryn; Chairperson, Graduate Committee: Lindsay Benes
Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (0-17 years) and can have a significant impact on adult high-risk behavior and chronic diseases such as heart disease, cancer, diabetes, and mental health disorders. Despite ACE screening being the recommended practice, primary care and community health providers do not consistently screen for ACEs. Screening for ACEs in these settings offers an opportunity for recognition, early intervention, and prevention of poor long-term health outcomes. This quality improvement project aimed to implement ACE screenings in a community health setting in southwestern Montana. Screening and identification of ACEs facilitated early interventions such as referrals to psychotherapy and would ultimately aid in the prevention of long-term negative health outcomes. The DNP student and lead behavioral health consultant (BHC) used the Plan Do Study Act (PDSA) framework to guide implementation. Data collection included ACEs administered, returned, scores, and referrals made. Data collection occurred over a six-week period. The Identified Adult ACE Questionnaire was included in new patient assessment packets and administered to all new behavioral health patients. Of the 18 patients who returned an ACE questionnaire, 14 (78%) completed a follow-up visit with a behavioral health consultant. The average ACE score was 3.83. Fifteen patients (83%) received referral resources for psychotherapy. Nine patients (50%) screened as "high risk" for poor long-term health outcomes. Implementing ACE screenings in a community health setting allows providers to screen high-risk patients and intervene with evidence-based practices to promote health and limit long-term negative health outcomes. ACEs, if recognized, can be mitigated through early intervention and trauma-informed care.
Implement ACE screening tool in a psychiatric outpatient clinic: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2022) Herron, Michelle Marie; Chairperson, Graduate Committee: Susan Luparell
Adverse childhood experiences (ACEs) can decrease some of the identified leading causes of death in adults. These leading causes of death include heart disease, cancer, respiratory diseases, diabetes, and suicide. Adverse childhood experiences cause toxic stress, and the long-term effects of which follow people their entire lives. Screening of ACEs can identify ACEs early and allow for early prevention, referrals for additional services and supports to reduce long term health effects. Despite recommendations, psychiatric providers do not consistently screen for ACEs, ultimately missing opportunities to prevent ACEs with early intervention in childhood for those with higher risk or occurrence of ACEs. This quality improvement project took place a pediatric psychiatric outpatient clinic. This project focused on incorporating recommendations from studies completed by Centers for Disease Control and Prevention and Kaiser Permanente focusing on identifying high ACE scores and offering preventative supports. Lewin's three step change theory was used to guide this quality improvement project. The project was conducted for six weeks, collecting data on an excel spreadsheet identifying patients with high ACE scores for psychiatric providers. At the end of the quality improvement project, minimal data was able to be collected due to the barriers of the pandemic. The quality improvement project sought to identify patients with high ACE scores in order to offer additional preventative interventions, supports and referrals to decrease long term health issues. ACEs are a critical public health issue due to the profound negative and lasting effects on the health and wellness of a child later in life. Psychiatric pediatric outpatient clinics are settings in which ACEs can be identified and implementing interventions and supports can help children build resilience and decrease the effects of the adverse experiences and improve patient outcomes.
Guiding criticism of systems of oppression through the lens of a biomedical science course: working in the classroom to improve public health and society
(Montana State University - Bozeman, College of Letters & Science, 2021) Sandner, Alyssa; Chairperson, Graduate Committee: Greg Francis
This study was conducted to enrich critical thinking experience within a technical Biomedical Science class. This was achieved by challenging student misconceptions and guiding higher order thinking to develop students' original ideas as they discussed the intersectionality of -isms (race, gender, etc) & public health. Students analyzed specific assessment criteria and determined ethical solutions to common issues in public health. Within this assessment criteria data was collected in the form of three performance tasks, two student perception surveys and individual student interviews. In this qualitative analysis, it follows the growth and struggles of white and BIPOC (Black, Indigenous, and People of Color) students respectively grappling with countering the culture of predominant whiteness in medicine. Alongside use of real medical research technology, students synthesized equitable policies to service people of all walks of life resulting in varying success and engagement.
Pharmaceutical biomarkers to inform public and environmental health law and policy
(Montana State University - Bozeman, College of Agriculture, 2020) Margetts, Miranda Lee; Chairperson, Graduate Committee: Robert K. D. Peterson and Deborah Keil (co-chair); Aparna Keshaviah, Cindy Hu, Victoria Troeger, Jordan Sykes, Nicholas Bishop, Tammy Jones-Lepp, Marisa Henry and Deborah E. Keil were co-authors of the article, 'Using wastewater-based epidemiology with local indicators of opioid and illicit drug use to overcome data gaps' submitted to the journal 'Journal of the American Medical Association' which is contained within this dissertation.; Terri Mavencamp, Jordan Sykes, Tammy Jones-Lepp, Nicholas Bishop, Victoria Troeger, Robert K. D. Peterson and Deborah E. Keil were co-authors of the article, 'The environmental impact of substance use in Montana's waterways: investigation of prescription, illicit, and recreational drug metabolite concentrations into receiving waters' which is contained within this dissertation.; Trent McCallson and Deborah E. Keil were co-authors of the article, 'Wastewater testing to support new environmental health compliance obligations in the healthcare industry' which is contained within this dissertation.
The increasing awareness of the prevalence of prescription and illicit drug metabolites in wastewater is affecting changes to public and environmental health laws and policies. Drug takeback laws have been enacted to limit environmental pollution from drugs flushed into sewers; however, these laws only apply to legally prescribed drugs. Wastewater-based epidemiology, which relies on the measurement of drug concentrations in untreated wastewater, is also emerging as a complementary drug-use data tool to estimate drug consumption patterns by a community in near real-time. We sampled both the untreated influent and treated effluent at two locations in Montana over three months from April to June, 2019, to ascertain the concentrations of certain prescription and illicit drugs of abuse. The concentrations of drugs obtained from the untreated influent were used to inform a wastewater-based epidemiology study that compared drug-dose estimates from our wastewater samples against existing local drug-use sources (emergency medical services calls, drug seizures, and prescription dispense data). We also measured the treated effluent to determine the concentration at which drugs of abuse are persisting through the wastewater-treatment process and potentially affecting aquatic life exposed to those concentrations in receiving waters. We undertook a risk assessment whereby measured drug concentrations were assessed against corresponding ecotoxicology thresholds. Our results indicate that both codeine and morphine concentrations were above predicted no-effect concentrations. The overall results indicate that (1) wastewater-based epidemiology may be an effective tool to better describe substance abuse in communities and (2) drugs are persisting at levels above ecotoxicological thresholds from wastewater treatment plants into receiving waters. To our knowledge, these investigations are the first of their kind to have been conducted in Montana.
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 Hammersla
Measurement-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.
Integrating pediatric oral health into a rural, public-health setting
(Montana State University - Bozeman, College of Nursing, 2020) Bowden, Janelle Marie; Chairperson, Graduate Committee: Laura Larsson
Rural, low-income families in Montana experience individual and environmental barriers to oral healthcare access. In addition to knowledge deficits regarding pediatric milestones in oral health care, families in rural areas also have few, if any, pediatric dentists who accept Medicaid clients. The Centers for Disease Control and Prevention reported 2- to 5-year-olds are the only age group where the incidence of tooth decay is on the rise. This evidence-based demonstration research documents the baseline oral-health status of Park County Women, Infants, and Children (WIC) participants as well as the longitudinal efficacy of a bundled intervention to improve oral-health status in this high-priority population. Anticipatory guidance, caries risk assessment, repeated fluoride varnish application, and referrals for establishing a dental home and completing referrals for untreated decay are the bundled interventions under investigation in this project. Each level of intervention was documented in terms of state and national goals for the prevention of early childhood caries. The rate of signed forms consenting to treatment was used as a proxy measure that educating pregnant moms, parents, and caregivers about caring for baby teeth was effective. The long-term goal is to improve oral-health status in the Park County WIC population. The results of this research illustrated that performing oral-health assessments in a public-health setting provides an opportunity for nurses to promote sound oral-health practices, educate families on oral hygiene, and provide interventions aimed at preventing early childhood caries. Integrating oral health into public health as well as primary-care settings is a feasible and imperative practice in order to decrease the rates of ECC. A collaborative and integrative effort will ensure more children are screened for and educated on ECC. Introducing the intervention bundle at the WIC office in Park County proved to be a successful way of performing oral-health screenings, applying preventative FV, educating families on oral hygiene practices, and referring children to a dental home.
Multiple domain social determinants of health screening in adults
(Montana State University - Bozeman, College of Nursing, 2021) Gillaspie, Danielle Rae; Chairperson, Graduate Committee: Amanda H. Lucas
This DNP project sought to identify and address two social determinants of health (SDOH) negatively affecting adult patients ages 18 and older at the chosen primary care site in southwestern Montana. It was guided by the Centers for Disease Control's definition of five classifications of SDOH found to influence individuals' long-term health outcomes. The two SMART goals identified in this DNP project were firstly the successful screening rate of 50% of all adults ages 18 and older seen by participating providers at the primary care site. Secondly, two SDOH would be identified reflecting the highest rate of disparities in unmet social needs. These aims were accomplished through the utilization of the PRAPARE screening tool into providers' existing workflows and the creation of a patient resource guide addressing the two identified social determinants of health. The PRAPARE questionnaire was used as a self-administered screening tool to assess unmet social needs of participating individuals. Specific questions from the PRAPARE questionnaire were paired with the overarching SDOH and were scored. When patients reported one unmet need, it was recorded as one point under the corresponding SDOH. Data was then aggregated to determine the two social determinants demonstrating the highest rate of disparities within adult participants at the project site. The patient resource guide (Appendix E) aimed to address the two social determinants of greatest need at the site and provide community services available for the two SDOH.
Outcome measurement in direct primary care
(Montana State University - Bozeman, College of Nursing, 2021) Davis, Lindsey Michelle; Chairperson, Graduate Committee: Yoshiko Yamashita Colclough
The 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.
Improving well water contaminant awareness among Big Horn County healthcare professionals through community engagement
(Montana State University - Bozeman, College of Nursing, 2020) Schott, Raelene Ursula; Chairperson, Graduate Committee: Sandra Benavides-Vaello
Bighorn County, Montana sits in the Little Bighorn River Valley in the south-central part of the state. The Crow Reservation, a Northern Plains Indian Reservation, encompasses 2.3 million acres in the Little Bighorn River Valley; the majority of the reservation is in Bighorn County. Over 8,000 tribal members live on the reservation, many of whom reside near rivers and streams. Due in part to the rurality of the area, up to 60 percent of the people living on the reservation have home wells as their primary water source. A variety of contaminants has been discovered in well water in Bighorn County, including manganese, uranium, nitrate, and arsenic. Manganese has been shown to cause cognitive delays in children with minimal exposure, along with neurological effects in children and adults alike, known as 'manganism', signified by extrapyramidal dysfunction. Uranium exposure causes kidney damage, increases the risk for various types of cancer, and can have reproductive and developmental effects on women. With minimal exposure, arsenic can cause neurological effects, hypertension, peripheral vascular disease, cardiovascular disease, respiratory disease, diabetes mellitus, and malignancies - including skin cancer. Arsenic toxicity includes links to cancer, cardiovascular disease, immune dysfunction, diabetes, and altered neurodevelopment. There are clear public health implications to providing an educational intervention regarding the contaminants to the healthcare providers in Hardin, MT, a community in Big Horn County, in order for them to provide evidence-based information to their patients. This pre/post-quasi-experimental project was designed to evaluate the knowledge gained by healthcare providers in Hardin following a short PowerPoint presentation with voiceover that provided educational information about the common contaminants and their health effects. There were seven healthcare providers who participated in the project. Results of the survey showed an overall improvement in their knowledge about the contaminants, as well as their comfort speaking to patients about these contaminants. These results indicated that the educational intervention provided by the author was successful in meeting the goals of this scholarly project.

Scholarship & Research

Browse

Filters

Settings

Sort By

Results per page

Search Results