Building Evidence Based Practice in the Community: A Collaborative Faculty-Student Model

18th Annual Nursing Research Congress Authors: Daryl Canham, EdD, RN, BC Marian Yoder, EdD, RN Phyllis Connolly, PhD, APRN, BC Chia-Ling Mao, PhD, RN, C

IOM Environment Changes (2003) & NMCs Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce

Nurse Managed Centers PURPOSES: Provide nursing services for medically underserved, multicultural clients Arena for community health nursing educational experiences for students Opportunity for faculty and student research regarding outcomes of nursing care

Omaha System in NMCs BSN students easily develop understanding of system Framework for evidence based practice Facilitates documentation and information management

Omaha System Developed by the VNA of Omaha, Nebraska Community focused documentation system 3 Components Problem Classification Scheme (Environmental, Psychosocial, Physiological, Health Related Behaviors) Intervention Scheme (Categories andTargets) Problem Rating Scale (Likert type scale to rate changes) Knowledge Behavior Status

Research Questions Are client outcomes improved when measuring pre and post outcome ratings based on the Omaha System for specific problems? What are the most frequently occurring health problems of older adults and persons with serious mental illness living in the community? What nursing interventions are used most frequently in academic nurse managed centers?

Findings from Persons With Psychiatric/Mental Health Problems Living in the Community

Table 1. Mean score and Results of paired t-test of Omaha System Outcome Ratings Health problem Knowledge Behavior Status Ini- tial visit Post visit % of change Initial visit Mental Health 2.67 3.24 21%* 3.09 3.42 11% 3.06 3.30 8% Social contact 2.87 3.23 13%* 3.10 3.26 5% 2.97 3.16 6% Inter-personal Relation-ship 2.48 3.13 26%* 14% 3.00 4% Nutrition 2.55 29%* 2.50 20%* 2.53 25%* Prescribed Medication Regimen 2.44 3.22 32%* 3.78 24%* 2.72 3.72 37%* Personal hygiene 2.59 3.29 27%* 3.12 Note: ** Statistically significant difference between pre and post ratings, p≤ .05.

Table 2. Most Frequently Identified Omaha Problems, Interventions and Related Targets Domain Schema Problem Major Interventions Target 1 Target 2 Target 3 Psychosocial Emotional Stability (N=33 ; 38.8%) HTGC ( N=59) SUR (N=9) Coping (N=17) Signs & Symptoms (N=11) Support system Social contact (N=31; 36.5%) HTGC (N=42) Interaction (N=25) Communica-tion (N=18) System (N=8) Interpersonal Relationship (N=23; 27.0%) SUR (N=7) Communica-tion (N=17) Support system (N=13) (N= 9) Health Related Behavior Nutrition (N= 20; 23.5%) HTGC (N=28) (N=22) Behavior modification (N=8) Food (N=6) Prescribed Medication Regimen (N=18; 21.2%) HTGC (N=23) SUR (N=16) Medication administration (N=12) Side effect Medication set up (N=4) Personal Hygiene (N=17; 20.0%) HTGC (N=25) SUR (N=5) Personal care (N=15) Behavior modification (N=6) Skin Care (N=4) Note: HTGC: Health Teaching, Guidance, and counseling TP: Treatment & Procedure; SUR: Surveillance

Findings: Adult Elder Population Multi-ethnic population (Caucasian, Hispanic, Asian/Pacific Islander, African American) N=134 50-99 years; 71% female Intervention Target Examples: NMS function: exercises, safety, mobility/gait training, positioning Pain: signs/symptoms physical, med. Action, relaxation techniques, coping skills, medical care

Neuro Musculo Skeletal Table 3 ADULT ELDERS: 5 MOST FREQUENT HEALTH PROBLEMS Mean Score and Results of paired t-test of Omaha System Outcome Ratings Knowledge Behavior Status Health Problem Pre- Post- % Change Post Neuro Musculo Skeletal 2.91 3.33 14%* 3.24 3.7 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%* 4.17 2.7 3.17 17% Physical Activity 2.93 3.43 17%* 3.11 3.57 15%* 2.86 Circulation 3.13 3.35 3.65 9% 3.09 8% Note: * Statistically significant difference between pre and post ratings p< .05

Outcomes of the Faculty-Student Collaborative Model Developed a plan for research and a protocol for data collection Students actively participated in data collection and client care Analyzed data to determine populations’ problems, nursing interventions, and client/population outcomes Utilized data for program (curriculum & service) improvements and identifying strategies for more effective client care

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

Thank you for the opportunity to share our research with you! The authors wish to thank their colleagues at SJSU School of Nursing for their support

Contact Information Daryl Canham, EdD, RN, BC San Jose State University, School of Nursing One Washington Square San Jose, CA 95192-0057 Email: canham@son.sjsu.edu