1 Application of the Cloutterbuck Minimum Data Matrix To a Community Health Nursing Course Joanne M. Dalton, PhD, APRN, BC Regis College Weston, Massachusetts

2 Objectives Discuss the Cloutterbuck Minimum Data Matrix (CMDM) Apply the CMDM to a community health nursing baccalaureate course Discuss how the CMDM prepares nursing students for practice in the 21st century

3 Overview of the Matrix Model published by Cloutterbuck and Cherry (1998) Application of model- in press in the Journal of Nursing Education

4 Overview of the Matrix Guides education, research, and practice in community health nursing in the 21 st century Based on Von Bertanlanffy’s General Systems Theory (1968)

5 Overview of Matrix Provides a framework for critical thinking problem solving for community health many units of analysis: Individual family population community

6 Four Assumptions Critical thinking is integral to effective nursing practice Biomedical perspective for the provision of health care is necessary but not sufficient for effective nursing practice in the community

7 Four Assumptions Socio-political, economic and other related variables that contribute to the “root” causes of health and illness are integral to the health of the population and must be recognized and addressed by nurses Advocacy for social change is an expected professional behavior

8 Wellness Illness The Cloutterbuck Mimimum Data Matrix (CMDM ) Independence----Dependence Health Status Functional Status Levels of Prevention Figure 1 Acute Care Hospital Community Long-Term Care Facility Primary Secondar y Tertiary Locus of Care I I IIIII I Personal----- II Situational-- III Structural-- Cyclical Phases of the CMDM Care Outcomes CMDM Consumer ProfileConsumer Health and Functional Status

9 Personal Dimension Variables Internal Context (intrinsic variables of concern )

10 Situational Dimension Variables Micro-Context (family/neighborhood/community variables of concern) Micro-Context (family/neighborhood/community variables of concern) Income: source/ amount Health insurance coverage Marital status, living arrangement Family: structure/dynamics Community: structure/dynamics Social program eligibility Support systems: informal/formal Availability of help: emergency/regular Housing: type/adequacy Transportation: public/private Physical environment, safety Socio-cultural/ideological mileau

11 Structural Dimension Variables Macro-context (National/state-level variables of concern Physical environment Social-economic-political milieu Cultural/ideological milieu Population demographics Business, industry, the media Health care providers: number/type Health policy and regulations Social policy and regulations Public policy and regulations

12 Application of the CMDM Conceptual models guide nursing education by: 1.distinctive focus of the curriculum and the purposes to be fulfilled by nursing education. 2.general nature and sequence of the content to be presented. 3.settings in which nursing education occurs. 4.characteristics of legitimate students. 5.teaching-learning strategies to be employed (Fawcett, 2005, p. 37).

13 Focus of the Curriculum 1.Builds on student’s knowledge from personal dimension: Adds the situational and structural dimensions 2.Focus on populations and community units of analysis 3.Focuses on the three dimensions and five phases: Provides a big picture view of health and health care delivery system

14 Nature and Sequence of Content Nature of Content Titles of lectures are in terms of personal, situational, and structural dimensions Class discussions center on the 5 phases of the model

15 Nature and Sequence of Content Sequence of Content First class present the model and application of the model to an individual patient, then school age population Community assignment Structural variables stressed in the health care financing and organization

16 Settings Settings for the nursing practicum are selected to facilitate students’ application of the CMDM model Opportunity for critical analysis of the multiple variables that affect health and the provision of health care. Consumers who are at various levels of health and functional capacity

17 Characteristics of Legitimate Students Have typically completed most of their disciplinary prerequisite courses such as adult medical- surgical nursing, mental health, pediatrics, and maternal-child health. It is expected that students can, with the support and supervision of the faculty, practice with relative autonomy in a variety of community settings such as schools, homeless shelters, and certified home health agencies.

18 Characteristics of Legitimate Students Provide nursing care to children in schools consumers in homeless shelters frail elders receiving home care older well adults in councils on aging, elder service organizations home visits to new mothers and infants

19 Teaching-Learning Strategies Teaching- Learning Strategies Classroom Case Examples Clinical Conference Case Examples Course Examinations Weekly Clinical Journals Community Assessment Project

20 Student Impressions Assists in structuring their thinking about the many factors that impact on health Assists in visualizing the community as the unit of analysis as a “living entity” that is subject to nursing interventions

21 Student Critical Thinking Incident

22 Thank You From Boston

23 References Brathwaite, A. C. (2003). Selection of a conceptual model/framework for guiding research Interventions. Internet Journal of Advanced Nursing Practice, 6, Retrieved June 12, 2006, from Cloutterbuck, J. C., & Cherry, B. S. (1998). The Cloutterbuck minimum data matrix: A teaching mechanism for the new millennium. Journal of Nursing Education, 37, Fawcett, J. (1985). Theory: Basis for the study and practice of nursing education. Journal of Nursing Education, 24, Fawcett, J. (2005). Contemporary nursing knowledge: Nursing knowledge: Nursing models and theories (2nd ed.). Philadelphia: F. A. Davis. McKeown, R. E. & Hilfinger Messias, D.K. (2006). Epidemiologic Applications. In M. Stanhope & J. Lancaster, Eds. Foundations of nursing in the community, Community oriented practice (2nd ed., p. 156). St. Louis, MO: C. V. Mosby. Stanhope, M., & Lancaster, J. (2006). Foundations of nursing in the community, Community oriented practice (2nd ed.). St. Louis, MO: C. V. Mosby. Von Bertalanffy, L. (1968). General systems theory. New York, NY: Braziller