feasibility of studying the effects of using nanda, nic and noc on health outcomes
DESCRIPTION
Feasibility of Studying the Effects of Using NANDA, NIC and NOC on Health Outcomes. Margaret Lunney, RN, PhD & Laurence Parker, PhD. Acknowledgements. Co-Investigators: Sylvia Contessa, RN, MA & Linda Fiore, RN, MA (NYC Dept. of Health) Roberta Cavendish, RN, PhD, CPN (College - PowerPoint PPT PresentationTRANSCRIPT
Feasibility of Studying the Effects of Using NANDA, NIC and NOC on Health Outcomes
Margaret Lunney, RN, PhD
&
Laurence Parker, PhD
Acknowledgements
Co-Investigators:– Sylvia Contessa, RN, MA & Linda Fiore, RN,
MA (NYC Dept. of Health)– Roberta Cavendish, RN, PhD, CPN (College
of Staten Island/CUNY)– Margaret Grey, DrPH, CPNP, CDE, FAAN
(Yale University)– Joyce Pulcini, RN, PhD, CPNP (Boston
College)
Acknowledgements
Agency Facilitators & Nurses
– NYC DOH School Health Program
– NYC Board of Education
– Public Health Nurses• 5 nurses from District 22 (Brooklyn)• 7 nurses from District 31 (Staten Island)
– BS degree nurses from CSI
Partially Funded By:
AREA grant, National Institutes of Health, National Institute of Nursing Research, # 41355-00-01, $107,700
Marlene Springer, President, College of Staten Island (CSI); CSI Foundation
Professional Software for Nurses, Inc., Sharon and Peter Redes
Need for Research
Objections to & avoidance of using SNLs:– Standardization – High cost– Time & effort for teaching/learning
National concern re: children’s healthNursing care elements NOT
communicatedUse of NNN improves communication communication may improve actions
Conceptual Framework
Three theories: 1) The nursing process;
2) Barrett’s theory of power;
3) Hayakawa’s theory of language
NNN = Pooled nursing knowledgeUse of language, knowledge, & power has
positive effects on thinking and actions (Hayakawa & Hayakawa, 1990)
Aims of the Study
Investigate the effects of using NNN on: 1) nurses power to participate knowingly in
changes for children’s health;
2) children’s effectiveness of coping;
3) children’s health self concept;
4) children’s health behaviors.
Methods: Design
Quasi-experimental, two group designControl group- SNAP without NNNIntervention group- SNAP with NNN4 hypotheses predicting positive effects Pre & Posttests: Nurses and children Same protocols for each groupField study, limitations expected
Methods: Sample
14 nurses/schools enrolled in Bklyn & SIMinimum needed: 10 nurses, 100 childrenTwo groups of schools matched on:
– Race/ethnicity– SES– Attendance rate– Reading– Total registration
Random assignment to two groups
Methods: Sample
Nurses-Two withdrawalsSample = 12 nurses in 12 schools (6 per gp)(450-1590 children registered, 12-24 enrolled in study)
Children-Attrition r.t. relocation, absences– 236 parents gave permission– 232 children (4th and 5th grades) signed assents– 220 children completed pre and posttests;
103 control; 117 intervention– Total numbers vary based on missing tools/items
Methods: Instruments
Barrett’s PKPCT, vII • 52 semantic differential items, 4 subscales: Awareness,
Choices, Freedom to Act Intentionally, & Involvement in Creating Change, alpha = .98 (pre) & .99 (post)
Coping Strategies (CS) Inventory• 26 CSs, Effectiveness subscale: How much does it help? 0=
never do it to 3 = helps a lot, alpha = .78 & .72 Child Health Self Concept Scale
• 45 items; two alternatives; child decides which describes him or her, 1 = worst CHSC to 4 = best CHSC, alpha = .88 & .88
How Often Do You? (Health Behaviors)• 36 appropriate health behaviors, 0 = never, 1= not very
often, 2 = sometimes, 3 = very often, alpha = .80 & .79
Methods: Procedures
Informed consent– Reviewed by four IRBs
– Informed consent of nurses and parents
– Written assent of children
7 BS degree students conducted pre-testing of children, 6 conducted post-testing– Successful completion of research course
– Trained by PI and co-investigator in procedures
Methods: Procedures
Education of nurses (3days), e.g.,– Documentation issues (paper vs computer)– Community-based care & Healthy People 2010– Strategies for health promotion and health protection– Intervention group: NNN and critical thinking– Control group: Nursing process and critical thinking– How computers work– How to use SNAP with and without NNN
Computer equipment purchased & installed– 14 computers, printers, & security systems
Methods: Procedures
Pre-testing: – Nurses pre-tested on Day 1 of education, June 00– Children pre-tested in Nov & Dec 00
Nurses met with children-12/00 to 06/014 – 8 sessions with each child– Individuals and/or small groups– Nurses selected topics: Needs assessment & other– Unable to use computers every day as planned
Post-testing of nurses & children-June 01
Data Analysis
Data entered in ExcelData cleaningData converted to SAS and SPSSExamination of frequency distributionsDescriptive analysesReliability analysesPaired T test
Findings: Nurses
Pretest (m, sd, n)– Control 262, ± 40.59 (6)– Intervention 290, ± 17.6 (6)
Change, Post-Pre, groups compared:– Control 17.2, ± 22.5 (6)– Intervention 12.8, ± 22.5 (6)– T-test: N.S.
Overall change, Post-Pre:15.2 ± 21.6 (12)T-test: t = 2.43 (p = .03)
Findings: Children’s Effectiveness of Coping
Pretest (Item m, sd, n)– Control 1.62, .40 (102) – Intervention 1.60, .45 (117)
Change, Post-Pre, groups compared– Control -0.02, .45 (96)– Intervention 0.008, .49 (94)– T-test: N.S.
Overall change, Post-Pre-0.008, .47 (190)T-Test: N.S.
Findings: Health Self Concept
Pretest (Item m, sd, n)– Control 2.98, 0.36 (95)– Intervention 2.94, 0.4 (116)
Change, Post-Pre, groups compared– Control -.03, .35 (83)– Intervention 0.009, .38 (98) – T-test: N.S.
Overall change, Post-Pre– -0.007, .37 (181)– T-Test: N.S.
Findings: Health Behaviors
Pretest (Item m, sd, n)– Control 2.18, 0.29 (103)– Intervention 2.14, 0.33 (117)
Change, Posttest-Pretest, groups compared– Control 0.08, .31 (98)– Intervention -0.01, ± .36 (92)– T-test: N.S.
Overall change, Post-Pre– .03 ± .34 (190)– T-test: t = 3.03 (p = .003)
Findings: Use of NNN
High percentages of NNN labels usedUse of NNN illustrated comprehensive and
complex SN servicesVisit logs showed logical relations of
NDxs, NRxs, & NOC Outcomes (validity & reliability implied)
NOC outcome measures were not optimally used
Findings: Use of NNN
Agency paper record requirements limited the use of computer systems to only the health visits of these children
Nurses’ workload responsibilities limited the use of NNN
Positive reports from children & parents:– Children were enthusiastic
– Parents & children reported positive effects
Discussion: Nurses
Higher power scores than other staff nurses:– Community–based practice?– Ongoing opportunities to work with children?– Socially desirable responses?
Hypothesis not supported:– Insufficient use of NNN?– Small effects & sample not large enough?
Increase in power from pre to posttests: – Study effects?– Naturally occurring in one year time period?
Discussion: Children
Matching of groups achieved its purposesHypotheses not supported:
– Small effects & larger sample size needed?– Insufficient use of NNN?– Instruments not sensitive enough?
Means on health variables were comparable to means from other studies
Improvement in freq. of health behaviors:– Exposure to health promotion activities?– Naturally occurring in 7 month time period?
Conclusions/Implications
Experimental field studies are probably not feasible
Evaluation studies are critically important to demonstrate effectiveness
NNN are useful to communicate SN services
Once computerized, school-wide data collection & aggregation are feasible
Study was published in CIN
Lunney, M., Parker, L., Fiore, L., Cavendish, R., Pulcini, J. (2004). Feasibility of studying the effects of using NANDA, NIC and NOC on children’s health outcomes. CIN:
Computers, Informatics, Nursing, 22(6), 316-325.