Nurse Managed Center:Psychiatric-Mental Health Nursing Practica Nurs 147A

Dr. Connolly

Dr. Mao

Mr. Crider

Mrs. Judith Berkley

Student & Client Population

Population Served Widely diverse in

cultural, and ethnic background

typically 60 (MH) 90 students in CH course in clinical groups of 10 students per section -

Type of Clinical Rotation: Service Learning

Nursing 147B-Practicum First Semester of Senior Year Community Health Experience

Home Visits & Community Agencies Most students have prior home care experience and had at

least one lecture on the Omaha system Nursing 147A-Practicum IV

Community Psych/Mental Health Experience Nurse Managed Center, Community

Structure

History – background and evolution Settings

Zoe House, 1993 Crossroads, 1994 San Jose, Morgan Hill, San Jose Casa Feliz, 1995, closed f05 Litteral House, 2003 Donna’s Day Program, 2005 John 23rd, 2005

Staff – Faculty & Students

Process

Course objectives Service learning Faculty as staff; role models for students Documentation

Omaha System

Outcome

Direct service to the clients Identification of health problems – Validity issue Implementation of interventions Targets selection – inter-rater reliability Evaluation of final outcomes – K, B, S.

Others Collaboration – bake sale, health education, staff

education, Advocacy – improvement of physical care,

identification of medical disorders, improved nutrition, exercise, and symptom management

Outcome Student Evaluation Tool, NURS 147A Scope & Standards of Psychiatric-Mental Health Nursing Practice (APNA, ISPN, ANA, 2000)

Standard V. Interventions are documented in a format that is related to patient outcomes, accessible to the interdisciplinary team, and retrievable for future data analysis and research

Omaha Rating Scale

Concept 1 2 3 4 5

Knowledge Noknowledge

Mini-mal

Basic Adequate Superior

Behavior Notappropriate

Rarely Incon-sistently

Usually Consis-tently

Status ExtremeS&S

SevereS&S

ModerateS&S

MinimalS&S

No S&S

CCF # 9075, Problem 42,Medication Regimen, Fall 98

Knowledge 2

Behavior 2

Status 2

Knowledge 3

Behavior 3

Status 3

Initial RatingInitial Rating Final RatingFinal Rating

CCF #9523, Problem 35, Nutrition, Fall 2000

Knowledge: 4

Behavior: 1

Status: 1

Knowledge: 4

Behavior: 2

Status: 2

Initial Rating Final Rating

Rating Change of the Problem-Personal Hygiene S 2002

0

0.5

1

1.5

2

2.5

3

3.5

Knowledge Behavior Status

PrePost

N = 20

Rating Change of the Problem –Nutrition S 2002

0

0.5

1

1.5

2

2.5

3

3.5

Knowledge Behavior Status

PrePost

N = 20

Fall 2001 N = 47T-Test for Pre and Post Rating Intervention top 3 Omaha Problems

Paired Differences

Mean Std. Deviation t df Sig.(2 tailed)

Pair1Rating1K-Rating1K -0.64 1.03 -3.315 27 0.003

Pair2Rating2K-Rating2K -0.73 1.20 -2.873 21 0.010

Pair3Rating3K-Rating3K -0.93 0.96 -3.761 14 0.002

Pair4Rating1B-Rating1B -0.36 1.06 -1.780 27 0.086

Pair5Rating2B-Rating2B -0.74 1.51 -2.341 22 0.029

Pair6Rating3B-Rating3B -0.19 1.52 -0.495 15 0.628

Pair7Rating1S-Rating1S -0.67 0.83 -4.163 26 0.000

Pair8Rating2S-Rating2S -0.77 1.07 -3.400 21 0.003

Pair9Rating3S-Rating3S -0.81 1.33 -2.448 15 0.027

Most Frequently Identified Omaha Problems, Interventions and Targets (Spring, 2005 N=85)

Problem Intervent Target 1 Target 2 Target 3

Emotional stability

HTGC

SUR

Coping Signs & Symptoms

Support

system

Social contact HTGC

SUR

Interaction Communi

cation

Support

system

I P R HTGC

SUR

Communication

Support system

Interaction

Nutrition HTGC

SUR

Nutrition Beh.mod Food

Med. Regimen HTGC

SUR

Med. Adm. Side effect Medication

set up

Personal hygiene

HTGC

SUR

Personal care

Beh.mod Skin Care

HTGC = Health Teaching Guidance/Counseling

SUR = Surveillance

Results of Paired t-testOutcome Ratings, K, B, S Spring 2005 N= 85

Omaha problem Knowledge Behavior Status

Emotional stability *

Social contact *

I P R *

Nutrition * * *

Med. Regimen * * *

Personal hygiene * * *

* statistical significance p ≤ .05* statistical significance p ≤ .05

Student Outcomes

Experience with measuring client outcomes Recognizing change in persons with chronic health

problems Experience applying Omaha System to diverse

populations Data available for graduate student projects Barrera, C., Machanga, M., Connolly, P. M., & Yoder,

M. (2003). Nursing care makes a difference: Application of the Omaha documentation system. Outcomes Management, 7 (4), 181 – 185.

Improved nursing care Better prepared for job market

Challenges & Opportunities

Training Maintaining System in NMCs Faculty changes Resources for data collection,

analysis & reporting Involving more faculty Sustaining high levels of

resilience

Challenges and Issues (Continued)

Lack of university support Staff turnover Client hospitalizations Communications Cutbacks in county funding Obtaining permission to provide services from

conservators and case managers HIPPA regulations Conflicts with OT clinic schedule

Faculty Outcomes

Improved teaching effectiveness Redesigning the learning paradigm Publications & presentations

Case Study on-line Improved student evaluations Meeting retention, tenure and promotion

expectations Better supervision of students Collaboration opportunities Participation in research Submission of grants

Summary

Link the use of the Omaha System to program outcomes and accrediting bodies’ standards

Identify course (s) for teaching the System Develop teaching strategies: Modules; Omaha System

website: case studies; Videos; Webcasting Involve faculty: Research; Presentations &

Publications; Report data results back to faculty; Mentor new faculty

“It’s a good thing,” Martha Stewart