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Item Pediatric Preparedness in a Rural Health System(North Dakota State University, 2024) Nielsen, SarahPediatric emergencies present significant challenges and emotional strain in healthcare settings. In critical access hospitals, the provision of safe, effective, and high-quality emergency response for pediatric cases is especially demanding. Many rural hospitals have infrequent exposure to pediatric emergency care, which can contribute to a lack of confidence when caring for this population. Diminished confidence in pediatric skills and procedures has been linked with a reduction in overall patient safety. Research on pediatric emergency preparedness in rural settings outlines the need for further multi-faceted education to achieve increased provider comfort and preparedness. The practice improvement project aimed to understand health provider comfort related to pediatric trauma preparedness at a critical access hospital in rural southwest North Dakota. A pediatric education-based seminar was developed in response to the facility healthcare providers’ educational needs and was implemented to further evaluate the impact that simulation, didactic education, and hands-on skills have on perceived comfort and knowledge. Evaluation of the concluded practice improvement project showed valuable insights into the state of pediatric preparedness in rural healthcare. A pre-seminar needs assessment and post-survey were administered. Post-survey results reflected an increase in knowledge related to caring for pediatric patients after the seminar. The positive influence of education reflected an increase in comfort levels among participants. Many participants felt that their future practice would be changed due to the seminar education. Findings supported a need among healthcare providers for regular education and training. Overall, the analysis and results of the project supported the need for future pediatric preparedness training and the positive impact that education can have on healthcare providers. These findings support the project's potential to influence the future direction and emphasis of rural health education.Item A Collaborative Hypertension Clinic Pilot Program in a Rural Primary Care(North Dakota State University, 2020) Pink, Nicole CatherineIn 2019, there were about seventy-million Americans with uncontrolled high blood pressure (BP) or hypertension (HTN) (Kitt, Fox, Tucker & McManus, 2019). Hypertension is the leading cause of preventable deaths worldwide (Stephen, Halcomb, McInnes, Batterham & Zwar, 2019). Uncontrolled HTN contributes to stroke, myocardial infarction, and renal failure, and is the most modifiable risk factor for heart disease and death (American Academy of Family Physicians [AAFP], 2019; Oparil & Schmider, 2015). Patients living in rural America have an increased prevalence of HTN and their access to preventative health services is lower (Buford, 2016; Caldwell, Ford, Wallace, Wang & Takahashi, 2016). The increased prevalence of HTN in rural communities does not positively correlate with optimized blood pressure control, which poses a gap in care (Buford, 2016). A multidisciplinary collaboration between registered nurses (RNs) and providers may improve patient outcomes (Ford et al., 2018). The implementation of a collaborative HTN Clinic in a rural setting had the potential to improve BP outcomes by increasing access to services. The practice improvement project established a HTN Clinic as a collaborative effort between RNs and providers in a rural community. Providers and RNs were educated via modules regarding the protocol and participants took surveys before and after implementation to determine effectiveness and if the HTN Clinic should continue after conclusion of the practice improvement project. The HTN Clinic intervention implemented education for hypertensive patients with an emphasis on medication compliance and lifestyle modifications, as well as medication adjustments through nurse-led protocols. Despite a short duration of implementation and evaluation, positive results were observed. All HTN Clinic patients had improvement in BP measures and were controlled by the end of the four-week implementation period. Overall, patient access, wait times for appointments, and BP measures for all hypertensive patients improved after implementation. The providers’ and nurses’ knowledge increased through completion of a detailed curriculum. The provider and RN surveys indicated support for continuing the HTN Clinic to improve HTN management and clinic providers felt that the HTN Clinic helped improve their time with patients and quality metrics.Item Assessment of Health Literacy and Preferred Learning Style of Patients in a Rural North Dakota Primary Care Clinic(North Dakota State University, 2022) Holt, Cassie RoseIndividuals with low health literacy face many difficulties within the healthcare system, including seeking medical care in inappropriate places, foregoing appointments and preventative health screenings, and misunderstanding self-care instructions. This leads to more hospitalizations, increased healthcare expenses, and use of healthcare resources. Low health literacy is especially significant in rural populations, where there are additional barriers to healthcare such as geography, distance, weather, inadequate financial resources and lower socioeconomic status, and lack of primary care and specialty providers. Furthermore, providers often do not consider patients’ preferred learning styles, which may be significant for those who have difficulty understanding instructions. Patient education may be more effective if teaching strategies are individualized to each patient. The purpose of this project was to assess the health literacy and preferred learning style of patients at a primary care clinic in rural North Dakota and educate healthcare providers in the respective clinic on health literacy and teaching methods, which has the potential to enhance patient education and learning. The implementation of this practice improvement project included assessing patients’ health literacy levels and preferred learning styles and an educational session for rural healthcare providers. Health literacy levels and preferred learning styles were tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Visual, Auditory, Reading/Writing, and Kinesthetic (VARK) tools, respectively. The education session utilized a presentation to discuss health literacy in rural populations and the importance of assessing health literacy and learning style. A pre- and post-test and follow-up survey assessed providers’ knowledge of the importance of testing health literacy and preferred learning style, available tools, and their intent to utilize these tools in practice. The results of the project indicate there continues to be gaps in knowledge related to risk factors of low health literacy, tools available to measure health literacy and learning styles, and consistent utilization of health literacy and learning style information when educating patients. The project was successful in raising awareness of the problem of low health literacy in rural populations but reflects the need for healthcare facilities to provide education for their healthcare team on these topics.Item C.O.P.E. Influence on Resiliency and Self-Efficacy in a Rural North Dakota School (Creating Opportunities for Personal Empowerment)(North Dakota State University, 2021) Schwarzrock, Ariel KristineOne in three teens is estimated to experience an anxiety disorder between 13 to 18 years of age. Developed mental health burdens in adolescents can go undetected and untreated. About 50% of those with mental health disorders noted in adulthood started by age 14 years. Therefore, adolescence may be a critical phase for developing positive coping mechanisms and one where nurse practitioners can proactively impact outcomes. Cognitive behavioral therapy (CBT) is an evidence-based strategy effective in decreasing mental health burden. Creating Opportunities for Personal Empowerment (COPE) is a program created for pediatrics using CBT strategies to manage emotions and promote healthy lifestyles. The purpose of the practice improvement project (PIP) was to improve resiliency and self-efficacy in junior high students at a rural North Dakota (ND) junior high school through COPE program implementation. Objectives included assessing if adolescent resilience and self-efficacy scores increased after implementation of the program with evaluation to make recommendations based on literature findings and project outcomes. The Integrated Theory of Health Behavior Change (ITHBC) helped guide the PIP and suggests adolescents can be taught to engage in healthy behaviors for effective mental health management through healthy coping skills and behaviors. A logic model helped guide and evaluate the program. The school counselor in a rural ND school became certified in COPE to facilitate and identified five students willing to participate. The COPE Teen seven-session program was implemented with parental consent and IRB approval; each session lasted approximately 30 to 45 minutes weekly in the school. Qualitative and quantitative data were collected via paper pre- and post- surveys for evaluation. Descriptive statistics were used to evaluate objectives. All data collected was entered and stored online in a Qualtrics database to aide security and statistical analyzation. Despite implementation during the COVID-19 pandemic, overall resiliency and self-efficacy scores increased for students after implementation. Students indicated they enjoyed the program and identified learned skills to be beneficial. The COPE program was recommended to continue in the school with further research and larger sample sizes to support proactive approaches to mitigate adolescent mental health care between the NP and school settings.Item Colorectal Cancer: Utilizing Educational Handouts, Endorsement Letters, and Questionnaires to Increase Screening and Identify Barriers and Facilitators at a Rural Clinic in Elgin, North Dakota(North Dakota State University, 2020) Hadsell, Joshua JamesIntroduction: Although colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women combined in the United States, only 61% of eligible adults are up-to-date with current screening recommendations. Effective screening is hindered by numerous barriers and underutilization of evidence-based interventions. The purpose of this clinical dissertation project was to increase CRC screening in the rural community of Elgin, North Dakota, determine the efficacy of providing targeted educational handouts and endorsement letters, and to identify screening barriers and facilitators. Methods: Educational handouts and screening endorsement letters were developed and distributed to 75 average risk patients (without personal or family history of CRC or certain types of polyps, personal history of inflammatory bowel disease, personal history of receiving radiation to the abdomen or pelvic region, and confirmed or suspected hereditary CRC syndrome). Additional handouts were placed around the community of Elgin. Patients who presented for CRC screening were sent a questionnaire to determine the impact of the interventions. These 75 patients were also contacted via telephone and completed a questionnaire to identify barriers and facilitators and to highlight the effectiveness of the educational handout and the endorsement letter. Results: Five patients contacted the clinic to receive CRC screening. Ninety-seven percent of patients who recalled receiving the endorsement letter and educational handout (n=32) found the material to be informative, 91% of patients appreciated being contacted on behalf of the clinic, and 59% found the handwritten signature on the endorsement letter to be influential. Fifty-one patients identified screening barriers including (in descending order) lack of awareness/knowledge, cost, unpleasant previous experience, embarrassment, lack of motivation, and fear of abnormal findings. Forty-one patients identified screening facilitators including (in descending order) recommending during office visits, providing education on different screening options, sending letter reminders, calling patients, utilizing social media, and sending email reminders. Conclusion: The clinical dissertation project increased CRC screening compliance in Elgin, ND, identified barriers, and highlighted screening facilitators that can be utilized. Future projects should focus efforts on alleviating these barriers via targeted patient education and provider recommendation in order to decrease CRC morbidity and mortality.