Building Building Evidence Based Evidence Based Practice in the Practice in the

Community:Community:A Collaborative Faculty-A Collaborative Faculty-Student ModelStudent Model

1818thth Annual Nursing Annual Nursing Research CongressResearch Congress

Authors:Authors: Daryl Canham, EdD, RN, BCDaryl Canham, EdD, RN, BC Marian Yoder, EdD, RNMarian Yoder, EdD, RN Phyllis Connolly, PhD, APRN, BCPhyllis Connolly, PhD, APRN, BC Chia-Ling Mao, PhD, RN, CChia-Ling Mao, PhD, RN, C

IOMIOM Environment Environment Changes Changes (2003) & NMCs(2003) & NMCs

Applying evidence to health care deliveryApplying evidence to health care delivery Using information technologyUsing information technology Aligning payment policies with quality Aligning payment policies with quality

improvementimprovement Preparing the workforcePreparing the workforce

Nurse Managed CentersNurse Managed Centers

PURPOSES:PURPOSES: Provide nursing services for medically Provide nursing services for medically

underserved, multicultural clientsunderserved, multicultural clients Arena for community health nursing Arena for community health nursing

educational experiences for studentseducational experiences for students Opportunity for faculty and student Opportunity for faculty and student

research regarding outcomes of research regarding outcomes of nursing carenursing care

Omaha System in NMCsOmaha System in NMCs

BSN students easily develop BSN students easily develop understanding of systemunderstanding of system

Framework for evidence based Framework for evidence based practicepractice

Facilitates documentation and Facilitates documentation and information management information management

Omaha SystemOmaha System

Developed by the VNA of Omaha, NebraskaDeveloped by the VNA of Omaha, Nebraska Community focused documentation systemCommunity focused documentation system 3 Components3 Components

Problem Classification Scheme Problem Classification Scheme (Environmental, (Environmental, Psychosocial, Physiological, Health Related Behaviors)Psychosocial, Physiological, Health Related Behaviors)

Intervention Scheme Intervention Scheme (Categories andTargets)(Categories andTargets) Problem Rating Scale Problem Rating Scale (Likert type scale to rate (Likert type scale to rate

changes)changes) Knowledge Knowledge Behavior Behavior StatusStatus

Research QuestionsResearch Questions

Are client outcomes improved when Are client outcomes improved when measuring pre and post outcome ratings measuring pre and post outcome ratings based on the Omaha System for specific based on the Omaha System for specific problems?problems?

What are the most frequently occurring What are the most frequently occurring health problems of older adults and persons health problems of older adults and persons with serious mental illness living in the with serious mental illness living in the community?community?

What nursing interventions are used most What nursing interventions are used most frequently in academic nurse managed frequently in academic nurse managed centers?centers?

Findings from Persons Findings from Persons With With

Psychiatric/Mental Psychiatric/Mental Health Problems Living Health Problems Living

in the Communityin the Community

Table 1. Mean score and Results of paired t-test of Omaha System Outcome Ratings

Health problem Health problem KnowledgeKnowledge BehaviorBehavior StatusStatus

Ini-Ini-tial tial visitvisit

Post Post visit visit

% of % of changechange

Initial Initial visitvisit

Post Post visit visit

% of % of changechange

Initial Initial visitvisit

Post Post visitvisit

% of % of changechange

Mental HealthMental Health 2.672.67 3.243.24 21%*21%* 3.093.09 3.423.42 11%11% 3.063.06 3.303.30 8%8%

Social contactSocial contact 2.872.87 3.233.23 13%*13%* 3.103.10 3.263.26 5%5% 2.972.97 3.163.16 6%6%

Inter-personal Inter-personal Relation-shipRelation-ship

2.482.48 3.133.13 26%*26%* 2.872.87 3.263.26 14%14% 3.003.00 3.133.13 4%4%

Nutrition Nutrition 2.552.55 3.303.30 29%*29%* 2.502.50 3.003.00 20%*20%* 2.532.53 3.163.16 25%*25%*

Prescribed Prescribed Medication Medication RegimenRegimen

2.442.44 3.223.22 32%*32%* 3.063.06 3.783.78 24%*24%* 2.722.72 3.723.72 37%*37%*

Personal Personal hygienehygiene

2.592.59 3.243.24 25%*25%* 2.592.59 3.293.29 27%*27%* 2.592.59 3.123.12 20%*20%*

Note: ** Statistically significant difference between pre and post ratings, p≤ .05.

Table 2. Most Frequently Identified Omaha Problems, Interventions and Related Targets

Domain Domain SchemaSchema

Problem Problem Major Major InterventionsInterventions

Target 1Target 1 Target 2Target 2 Target 3Target 3

PsychosocialPsychosocial Emotional Stability Emotional Stability (N=33 ; 38.8%)(N=33 ; 38.8%)

HTGC ( N=59)HTGC ( N=59)SUR (N=9)SUR (N=9)

Coping Coping (N=17)(N=17)

Signs & Signs & Symptoms Symptoms (N=11)(N=11)

Support Support system system (N=11)(N=11)

Social contactSocial contact(N=31; 36.5%)(N=31; 36.5%)

HTGC (N=42)HTGC (N=42)SUR (N=9)SUR (N=9)

Interaction Interaction (N=25)(N=25)

Communica-Communica-tiontion (N=18)(N=18)

Support Support System System (N=8)(N=8)

Interpersonal Interpersonal RelationshipRelationship(N=23; 27.0%)(N=23; 27.0%)

HTGC (N=42)HTGC (N=42)SUR (N=7)SUR (N=7)

Communica-Communica-tion (N=17)tion (N=17)

Support Support system system (N=13)(N=13)

Interaction Interaction (N= 9)(N= 9)

Health Health Related Related BehaviorBehavior

Nutrition Nutrition (N= 20; 23.5%)(N= 20; 23.5%)

HTGC (N=28)HTGC (N=28)SUR (N=7)SUR (N=7)

Nutrition Nutrition (N=22)(N=22)

Behavior Behavior modification modification (N=8)(N=8)

Food Food (N=6)(N=6)

Prescribed Prescribed Medication RegimenMedication Regimen(N=18; 21.2%)(N=18; 21.2%)

HTGC (N=23)HTGC (N=23)SUR (N=16)SUR (N=16)

Medication Medication administratioadministration (N=12)n (N=12)

Side effectSide effect(N=11)(N=11)

Medication Medication set up set up (N=4)(N=4)

Personal Hygiene Personal Hygiene (N=17; 20.0%)(N=17; 20.0%)

HTGC (N=25)HTGC (N=25)SUR (N=5)SUR (N=5)

Personal Personal care (N=15)care (N=15)

Behavior Behavior modification modification (N=6)(N=6)

Skin Care Skin Care (N=4)(N=4)

Note: HTGC: Health Teaching, Guidance, and counselingTP: Treatment & Procedure; SUR: Surveillance

Findings: Adult Elder Findings: Adult Elder PopulationPopulation

Multi-ethnic population (Caucasian, Multi-ethnic population (Caucasian, Hispanic, Asian/Pacific Islander, Hispanic, Asian/Pacific Islander, African American) N=134African American) N=134

50-99 years; 71% female50-99 years; 71% female Intervention Target Examples:Intervention Target Examples:

NMS function: exercises, safety, NMS function: exercises, safety, mobility/gait training, positioningmobility/gait training, positioning

Pain: signs/symptoms physical, med. Pain: signs/symptoms physical, med. Action, relaxation techniques, coping Action, relaxation techniques, coping skills, medical careskills, medical care

Table 3ADULT ELDERS: 5 MOST FREQUENT HEALTH PROBLEMSMean Score and Results of paired t-test of Omaha System Outcome Ratings

Knowledge Behavior Status

HealthProblem

Pre- Post- %Change

Pre- Post %Change

Pre- Post- %Change

NeuroMuscu

loSkelet

al

2.91 3.33 14%* 3.24 3.7 14%* 2.75 3.25 18%*

Med.Regimen

2.83 3.41 20%* 3.07 3.55 16%* 3.1 3.48 36%

Pain 2.87 3.83 33%* 3.48 4.17 20%* 2.7 3.17 17%

PhysicalActivity

2.93 3.43 17%* 3.11 3.57 15%* 2.86 3.43 20%*

Circulation 3.13 3.57 14%* 3.35 3.65 9% 2.87 3.09 8%

Note: * Statistically significant difference between pre and post ratings p< .05

Outcomes of the Faculty-Outcomes of the Faculty-Student Collaborative Student Collaborative

ModelModel Developed a plan for research and a Developed a plan for research and a protocol for data collectionprotocol for data collection

Students actively participated in data Students actively participated in data collection and client carecollection and client care

Analyzed data to determine Analyzed data to determine populations’ problems, nursing populations’ problems, nursing interventions, and client/population interventions, and client/population outcomesoutcomes

Utilized data for program Utilized data for program (curriculum & service) improvements (curriculum & service) improvements and identifying strategies for more and identifying strategies for more effective client careeffective client care

SummarySummary

Use of data from the Omaha System in the Use of data from the Omaha System in the Nurse Managed Centers provides internal Nurse Managed Centers provides internal benchmarks for continuous improvement benchmarks for continuous improvement and building of evidence based teaching and building of evidence based teaching and practice (Connolly, Mao, Yoder & and practice (Connolly, Mao, Yoder & Canham, 2006).Canham, 2006).

Thank you for the Thank you for the opportunity to opportunity to

share our research share our research with you!with you!The authors wish to thank The authors wish to thank

their colleagues at SJSU their colleagues at SJSU School of Nursing for their School of Nursing for their

supportsupport

Contact InformationContact Information

Daryl Canham, EdD, RN, BCDaryl Canham, EdD, RN, BC

San Jose State University, School of San Jose State University, School of NursingNursing

One Washington SquareOne Washington Square

San Jose, CA 95192-0057San Jose, CA 95192-0057

Email: canham@son.sjsu.eduEmail: canham@son.sjsu.edu