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Item Improving screening of eating disorders in rural community adolescents(Montana State University - Bozeman, College of Nursing, 2021) Smelser, Ryann Lyn; Chairperson, Graduate Committee: Susan LuparellEating disorders are the least likely to be screened for in adolescents aged 12 to 21 years. In many rural communities the only screening done is during a school physical questionnaire in which the child is asked if they are happy with their weight. Many clinicians are not comfortable investigating these concerns and are unsure what resources are available. A rural clinic was observed to have no formal screening tool in place for eating disorders among adolescents aged 12 to 21 years. This project sought to improve screening in the stated age group within the clinic setting. The SCOFF screening tool, consisting of five questions, was administered to adolescents during any clinic visit to any of three providers in the facility. Nursing staff offered the SCOFF tool during intake of the patients and prior to seeing the clinician. Out of 67 patients who were seen in an 8-week period, 19 were offered the SCOFF screening, equating to an overall 28.4% increase in screening. Plan-Do-Study-Act (PDSA) evaluations were done at 4-week intervals with the intention to further improve the number of screenings. This did improve screenings periodically throughout the project showing improvement in some weeks as high as 100%.Item Implementing sexual orientation and gender identity (SO/GI) questions and providing LGBTQ education to staff in a rural outpatient clinic(Montana State University - Bozeman, College of Nursing, 2021) Fitzpatrick, Deni Mayliz; Chairperson, Graduate Committee: Casey ColeLesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are important members of every community. Collecting Sexual Orientation and Gender Identity (SO/GI) information and providing staff with proper LGBTQ training is essential for acknowledging LGBTQ patients health disparities and providing proper health services to patients. The purpose of the project was to implement SO/GI questions into the clinics health survey form and provide evidence-based LGBTQ education to clinic staff members. SO/GI questions were implemented into the yearly reviewed health survey form in the outpatient clinic setting. During four-week cycle clinic patients were provided with the SO/GI questions on the patient intake form and were calculated as a percentage of the total patient intake forms completed. Overall the total completed SO/GI question percentage increased over the four week cycle. Patients were accepting of answering the SO/GI questions on the health survey forms. A LGBTQ educational session was provided to staff members on LGBTQ health and terminology and the importance of obtaining SO/GI questions from patients. Staff members clinical preparedness, attitudinal awareness, and knowledge were measured pre and post the LGBTQ educational session utilizing the LBGT-DOCSS tool. Overall, the total mean score, clinical preparedness, and knowledge scores increased after the LGBTQ educational session was provided. Attitudinal awareness did not change before or after the LGBTQ educational session. Limitations included a receptionist turnover, which required reteaching receptionists about the SO/GI collection process from clinic patients. COVID-19 protocols also required that the LGBTQ educational session to be provided virtually. Part of making the outpatient clinic more LGBTQ inclusive involved adding patient brochures, education materials, and adding a viewable nondiscrimination statement to the outpatient clinic setting.Item Missing and murdered Indian women in Montana(Montana State University - Bozeman, College of Nursing, 2020) Cleavenger, Joyce Mabel; Chairperson, Graduate Committee: Susan LuparellProblem. Violence against women is more widespread and severe among American Indian women than among other North American women. Statistics reveal that American Indian and Alaska Native women experience ten times the murder rate of the national average and the highest lifetime rape (27.5%) prevalence in relation to all other ethnicities (14-21%). It is further estimated that three in five AI/AN women will be victims of domestic violence. There is a reason to believe that AI/AN women who are missing may be victims of human trafficking. Evidence suggests that chronic poverty, rape, homelessness, childhood abuse, and racism all play a part in human trafficking. Purpose. Nurse practitioners are a critical workforce in screening and early intervention for AI/AN women as these high-risk women often live in rural and isolated places where the safety net of police, social workers, support groups and safe houses are limited. The purpose of this project was to 1) explore nurse practitioners' knowledge and perceived educational needs related to Montana murdered and missing Indian women, and 2) provide appropriate follow up education with participants based on the findings. Methods. A convenience sample of ten Cascade County nurse practitioners with AI/AN women in their client panel participated in a semi-structured interview. A descriptive analysis of the transcribed interviews revealed gaps in what this sample of primary care providers knew about interventions for AI/AN women at risk for or who have experienced violence. Conclusions. The study produced updated recommendations on screening and referrals for Cascade County nurse practitioners.to use with clients. The results also suggest a need for the State Board of Nursing to offer continuing education on Montana's missing and murdered Indian women. It was also suggested the importance of sharing information on missing and murdered Indian women at one of the nurse practitioners' conferences.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 Perceptions of nurse practitioners among Montana critical access hospital leadership(Montana State University - Bozeman, College of Nursing, 2018) Deffinbaugh, Zachary Lee; Chairperson, Graduate Committee: Polly PetersenChallenges associated with provider recruitment, as well as rural populations' access to healthcare, are well-documented in the literature. While primary care physician numbers continue to fall behind demand, nurse practitioners (NPs) are forecasted to drastically increase in numbers in upcoming years. Montana is a full-practice state for advanced practice registered nurses (APRNs), and critical access hospitals (CAHs) commonly employ APRNs, including NPs. Little is known regarding perceptions of NPs among CAH boards of directors, chief executive officers, or other senior-management officials. It is important to understand how leadership teams perceive NPs, as these are the individuals who will collectively make decisions affecting the number and type of providers employed within their respective facilities. This study employed focus-group methodology to interview four CAH leadership teams spanning the entire state of Montana. Focus-group analysis suggests CAH leadership teams have primarily positive perceptions of NPs. There is a lack of consistency regarding comprehension of the NP's scope, role, and autonomy. Lastly, the challenges of provider recruitment were affirmed. However, it was noted that a number of NPs currently employed at CAHs previously worked as registered nurses within the facility, suggesting a potential provider recruitment advantage with regard to hiring NPs. Future implications include expanding research to include larger health systems within Montana, in addition to studying CAHs in states with restricted NP practice. Finally, more work should be done to raise CAH leadership awareness of the NP's role, scope, and autonomy.Item Teleoncology for the delivery of oncology care in central Montana(Montana State University - Bozeman, College of Nursing, 2017) Linhart, Heidi Marie; Chairperson, Graduate Committee: Teresa SerightAround the globe telemedicine is being explored as a viable type of healthcare delivery for rurally located oncology patients. Telemedicine for oncology patients (teleoncology) is available for rural Central Montana patients through visiting oncologists. Despite this availability of teleoncology, there is no local evidence for the levels of patient or provider acceptability or satisfaction with teleoncology. The purpose of this project was to explore a practice change initiative for teleoncology practices in Central Montana through the gathering of baseline information from both outreach oncology patients and rural healthcare providers' satisfaction with teleoncology care. Two sample groups of oncology patients were surveyed, including: participants in face-to-face (F) appointments (N=21), and participants in telemedicine (T) appointments (N=21). Local primary care providers who refer to the visiting oncologist were also surveyed (N=12; 92% response rate). Two survey tools were used, 'Local Provider Survey of Satisfaction with Teleoncology' and 'Patient Survey of Satisfaction with Outreach Oncology Clinic'. Both patient groups were administered the same survey following appointments to compare results. Descriptive statistics and two-sample T-Tests were used to analyze the survey results. There were no significant differences in satisfaction with the care delivered when comparing the T and F patient groups, indicating teleoncology visits are comparable to face-to-face visits. Eighty-one percent (81%) of T patients reported being satisfied. There was an overall lack of awareness of the availability of teleoncology amongst all those surveyed; 93% of F patients, 46% of T patients, and 42% of providers were not aware teleoncology was available prior to the survey. Although providers reported neutral answers on the survey, the majority (58%) have no experience with teleoncology but 80% of providers denied concerns with this type of appointment. Overall, Central Montana patients report satisfaction with teleoncology as an augmenter to rural oncology care. Providers have minimal concerns with the current state of teleoncology despite limited experience with this modality of care. The evidence was disseminated to the local healthcare community and publicly in Central Montana.Item Development of a family nurse practitioner position at a community clinic for the medically underserved(Montana State University - Bozeman, College of Nursing, 1998) Marcus, Alison Leigh; Chairperson, Graduate Committee: Janice A. BuehlerItem Rural Family Nurse Practitioner level of confidence for providing emergency care(Montana State University - Bozeman, College of Nursing, 2002) Neal, Judith Elaine; Chairperson, Graduate Committee: Jean Shreffler-GrantItem Perceptions of rural women's experiences with infertility services in Montana(Montana State University - Bozeman, College of Nursing, 2002) Timmer, Kelly Angelos; Chairperson, Graduate Committee: Therese SullivanItem Community as partner : a frontier community's perception of health care services(Montana State University - Bozeman, College of Nursing, 2001) McGuire, Mary Clair; Chairperson, Graduate Committee: Elizabeth D. Metzgar