Scholarship & Research
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Item Tobacco cessation: a quality improvement project in an ear, nose, and throat clinic(Montana State University - Bozeman, College of Nursing, 2023) Myers, Cierra Nicole; Chairperson, Graduate Committee: Amanda H. Lucas; Lindsay Benes (co-chair)Background: Due to the correlation of head and neck cancers with tobacco use, tobacco cessation conversations are crucial. Healthcare professionals play a vital role in consistently identifying and documenting the smoking status of their patients. Problem Statement: While the clinic nurses at one Montana ear, nose, and throat (ENT) clinic are aware of the cancer risks involved with tobacco use, they were not screening 100% of their patients or providing tobacco users with educational materials to assist in cessation. Methods: During a six-week project, the Replicating Effective Programs (REP) quality improvement model was used. Data was evaluated using descriptive statistics. Interventions: Three nursing interventions were initiated: new ENT adult patients were screened for tobacco use (intervention 1), tobacco users were offered a Montana Quitline educational brochure (intervention 2) and referral (intervention 3). Results: The screening rate increased from 63% during the pre-implementation phase to 100% during the fourth week of the implementation phase. During the implementation phase, 16% of the tobacco users identified were agreeable to a Montana Quitline brochure and 5% were agreeable to a referral to the Montana Quitline. Conclusion: The project did increase nurses' rates of tobacco screening. However, the implications of time constraint on the nurses and a patient's readiness to quit proved to minimally impact the accepted number of brochures and referrals.Item Tobacco cessation program utilization(Montana State University - Bozeman, College of Nursing, 2022) Rishavy, Airica Linne; Chairperson, Graduate Committee: Molly SecorPurpose: Every year in the United States, tobacco use kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. In Montana, 440 million dollars a year are spent on illnesses directly related to tobacco use and 1,600 adults die from smoking-related illnesses. The American Lung Association Freedom from Smoking Program (FFSP) is an evidence-based, gold-standard tobacco cessation program in place at a medical facility in Helena, Montana but is not being utilized due to a cumbersome referral process and lack of provider knowledge about this program. The aim of this quality improvement (QI) project is to increase providers' knowledge about the FFSP and create a streamlined electronic medical record (EMR) referral process to increase the utilization of the FFSP. Methods: A new referral process in the existing EMR was created and information about the FFSP and the new ordering process was disseminated to all relevant providers. Results: The number of results to the FFSP was tallied each week for five weeks. At the end of five weeks, there were 21 referrals, up from zero before the start of this QI project. Twenty-one referrals are only 8% out of the average 240 smokers seen at this medical facility per month. Implications: Referrals to the FFSP will occur if providers have knowledge and buy-in about the importance of the program and access to an easy-to-use referral system in the existing EMR.Item A formalized approach to remedy tobacco addiction: e-referrals and the ability of documentation to influence opportunities through motivational interviewing(Montana State University - Bozeman, College of Nursing, 2021) Hoffman, Matthew Douglas; Chairperson, Graduate Committee: Casey ColeIt is an understatement to report that there is an inconsistent approach for tobacco cessation therapy (TCT) techniques, and this is negatively affecting those with the desire to pursue cessation. Therefore, it is long overdue to better address and incentivize a more consistent quality improvement process to remedy the multifaceted dynamic of tobacco cessation (TC). According to the World Health Organization (WHO) tobacco globally affects 1.2 billion people, and annually imposes an economic damage of $500 billion worldwide (Caponnetto et al., 2019; Epku & Brown, 2015; Gonzales et al., 2020). With attention to detail in the foreground of billing, coding, and documentation, it is anticipated that increased opportunities for a more formalized approach to remedy tobacco addictions through motivational interviewing (MI) have been encouraged. Ultimately, this project guided a synergistic effect between the financial integrity of the medical clinic and the health of the rural Montana population that it serves. In a small rural family medicine clinic and over a six-week timeframe, a provider instituted basic MI techniques to enroll patients interested in TCT via an electronic (e-Referral) to the Montana Tobacco Quit Line (MTQL) to remedy tobacco addiction. Data collection was facilitated and contained within the EPIC EHR system, monitoring the number of known tobacco users, ready to quit statuses, and those both currently and newly enrolled for counseling with an e-Referral to the MTQL. Prior to the project's implementation, a total 23 patients were known as tobacco users at this clinic, two of which were being counseled; three new e-Referrals submitted increase the total to five. Nonetheless, there are now 51 patients that are newly known tobacco users after this project's screening and documentation. The thematic underpinnings that surfaced include a lack of healthcare engagement with documenting tobacco users and the need for continued pursuit of TCT. The generalization that this data infers is that the rural population at this clinic is asking for help, but the health system is not responding adequately.Item Smoking cessation : implementation of a group intervention in a community mental health setting(Montana State University - Bozeman, College of Nursing, 2016) Hillenbrand, Carly Jean; Chairperson, Graduate Committee: Polly Petersen; Deanna Babb (co-chair)Individuals with mental illnesses smoke tobacco at a much higher rate than the general population. Given the elevated rate of morbidity and mortality in this population, providing tobacco cessation programs within community mental health clinics is an important step in improving health outcomes. The comprehensive literature review of 56 peer reviewed articles highlights key factors affecting tobacco use in mental illness, including biologic and psychosocial variables, evidence-based guidelines and interventions used to support tobacco cessation in this population, and barriers and incentives for treatment. Based on this literature, an eight-week, nurse-led smoking cessation program was implemented at a rural Montana based community mental health center. This pilot intervention was the first of its kind within the selected mental health center. In order to determine feasibility, the author shares outcomes in terms of participants' smoking cessation behaviors, cigarette use, and cigarette dependence before and after the eight-week group, as well as limitations and implications for future programs. It is hoped this project will inform practitioners and nurses about factors associated with tobacco use in clients with mental illness to guide future treatment at the community mental health center.