Transcript Effects of Using NANDA, NIC and NOC on Health Outcomes

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 health
Nursing care elements NOT
communicated
Use 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 knowledge
Use 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 design
Control group- SNAP without NNN
Intervention group- SNAP with NNN
4 hypotheses predicting positive effects
Pre & Posttests: Nurses and children
Same protocols for each group
Field study, limitations expected
Methods: Sample
14 nurses/schools enrolled in Bklyn & SI
Minimum needed: 10 nurses, 100 children
Two groups of schools matched on:
–
–
–
–
–
Race/ethnicity
SES
Attendance rate
Reading
Total registration
Random assignment to two groups
Methods: Sample
Nurses-Two withdrawals
Sample = 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 06/01
4 – 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 Excel
Data cleaning
Data converted to SAS and SPSS
Examination of frequency distributions
Descriptive analyses
Reliability analyses
Paired T test
Findings: Nurses
Pretest (m, sd, n)
– Control
– Intervention
262, ± 40.59 (6)
290, ± 17.6 (6)
Change, Post-Pre, groups compared:
– Control
– Intervention
– T-test: N.S.
17.2, ± 22.5 (6)
12.8, ± 22.5 (6)
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
Intervention
1.62,  .40 (102)
1.60,  .45 (117)
Change, Post-Pre, groups compared
– Control
–
–
Intervention
T-test: N.S.
-0.02,  .45 (96)
0.008, .49 (94)
Overall change, Post-Pre
-0.008,  .47 (190)
T-Test: N.S.
Findings: Health Self Concept
Pretest (Item m, sd, n)
– Control
– Intervention
2.98,  0.36 (95)
2.94,  0.4 (116)
Change, Post-Pre, groups compared
– Control
–
–
Intervention
T-test: N.S.
-.03, .35 (83)
0.009, .38 (98)
Overall change, Post-Pre
–
–
-0.007, .37 (181)
T-Test: N.S.
Findings: Health Behaviors
Pretest (Item m, sd, n)
– Control
– Intervention
2.18,  0.29 (103)
2.14,  0.33 (117)
Change, Posttest-Pretest, groups compared
– Control
–
–
Intervention
T-test: N.S.
0.08,  .31 (98)
-0.01, ± .36 (92)
Overall change, Post-Pre
–
–
.03 ± .34 (190)
T-test: t = 3.03 (p = .003)
Findings: Use of NNN
High percentages of NNN labels used
Use of NNN illustrated comprehensive and
complex SN services
Visit 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 purposes
Hypotheses 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.