Transcript Nurse Managed Center: Psychiatric-Mental Health Nursing Practica Nurs 147A Dr. Connolly Dr. Mao Mr. Crider Mrs.

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
Mini- Basic
Knowledge No
knowledge mal
4
5
Adequate Superior
Behavior
Not
appropriate
Rarely Inconsistently
Usually
Status
Extreme
S&S
Severe Moderate Minimal
S&S S&S
S&S
Consistently
No S&S
CCF # 9075, Problem 42,
Medication Regimen, Fall 98
Initial Rating
Final Rating
 Knowledge
2
 Knowledge
3
 Behavior
2
 Behavior
3
 Status
2
 Status
3
CCF #9523, Problem 35, Nutrition,
Fall 2000
Initial Rating
Final Rating
 Knowledge: 4
 Knowledge: 4
 Behavior:
1
 Behavior:
2
 Status:
1
 Status:
2
Rating Change of the ProblemPersonal Hygiene S 2002
3.5
3
2.5
2
Pre
Post
1.5
1
0.5
0
Knowledge
Behavior
Status
N = 20
Rating Change of the Problem –
Nutrition S 2002
3.5
3
2.5
2
Pre
Post
1.5
1
0.5
0
Knowledge
Behavior
Status
N = 20
Fall 2001 N = 47
T-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
IPR
HTGC
SUR
Communica Support
tion
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-test
Outcome Ratings, K, B, S
Spring 2005 N= 85
Omaha problem
Knowledge
Behavior
Status
Emotional stability
*
Social contact
*
IPR
*
Nutrition
Med. Regimen
*
*
*
*
*
*
Personal hygiene
*
*
*
* 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