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

CCF # 9075, Problem 42, Medication Regimen, Fall 98 Knowledge2 Behavior 2 Status2 Knowledge3 Behavior 3 Status3 Initial Rating Final Rating

CCF #9523, Problem 35, Nutrition, Fall 2000 Knowledge: 4 Behavior: 1 Status: 1 Knowledge: 4 Behavior: 2 Status: 2 Initial RatingFinal Rating

Rating Change of the Problem- Personal Hygiene S 2002 N = 20

Rating Change of the Problem – Nutrition S 2002 N = 20

Fall 2001 N = 47 T-Test for Pre and Post Rating Intervention top 3 Omaha Problems Paired Differences Mean Std. DeviationtdfSig.(2 tailed) Pair1Rating1K-Rating1K Pair2Rating2K-Rating2K Pair3Rating3K-Rating3K Pair4Rating1B-Rating1B Pair5Rating2B-Rating2B Pair6Rating3B-Rating3B Pair7Rating1S-Rating1S Pair8Rating2S-Rating2S Pair9Rating3S-Rating3S

Most Frequently Identified Omaha Problems, Interventions and Targets (Spring, 2005 N=85) ProblemInterventTarget 1Target 2Target 3 Emotional stability HTGC SUR CopingSigns & Symptoms Support system Social contactHTGC SUR InteractionCommuni cation Support system I P RHTGC SUR Communica tion Support system Interaction NutritionHTGC SUR NutritionBeh.modFood Med. RegimenHTGC SUR Med. Adm.Side effectMedication set up Personal hygiene HTGC SUR Personal care Beh.modSkin Care HTGC = Health Teaching Guidance/Counseling SUR = Surveillance

Results of Paired t-test Outcome Ratings, K, B, S Spring 2005 N= 85 Omaha problemKnowledgeBehaviorStatus Emotional stability* Social contact* I P R* 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