1. Omaha System and QSEN Competencies were Mapped to the Case Study for Public Health Nursing Education Linda Garner, PhD, RN Conni DeBlieck, DNP, RN Debra Eardley, DNP, RN, APHN-BC Kelly Ann Krumweide, PhD, RN Selda Secginili, PhD, RN Jolon Vaughn, MSN, RN

2. Disclosure T he members of the team involved in this research study declare no financial interest or support from any organization for the submitted work; no financial relationships with any organization that may have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work.

3. Learning Objectives 1.Disseminate innovations in curricular design and teaching strategies that accomplish QSEN competency development in academic and/or practice settings. 1.Describe research findings related to quality and safety education and competency integration in academic and/or practice settings. 1.Share innovations that translate or evaluate QSEN competencies (patient-centered care, evidence-based practice, and informatics) in academic and/or practice settings.

4. Purpose ●Identify an innovative approach for teaching students public health nursing content, holistic assessment, EBP and QSEN competencies. ●Demonstrate use of a standardized terminology to teach BSN Essentials (those relating to nursing informatics, EBP, and QSEN) ●Demonstrate use of a standardized terminology to teach public health nursing Core Competencies (those relating to nursing informatics, EBP, and QSEN)

5. Background on the Omaha System ●Developed by the Visiting Nurses Association of Omaha 1975- 1992 ●Four federally funded grants ●Background in MN ●Minnesota Omaha System Users Group started in 2001, led by state and county public health nurses ●Minnesota statutes mandated local health departments to have interoperable electronic health records systems by January, 2015. ●Recommendation from MDH eHealth Standards Committee and signed by commissioner– use standardized terminologies such as the Omaha system as client care documentation standard

6. Overview of the Omaha System ●Research-based taxonomy for integrating and sharing clinical data ●Used for documentation, clinical decision support and research ●Provides EBP at point of care ●Three classification schemes: ●Assessment component—Problem Classification Scheme (42 client problems) ●Intervention component—Intervention Scheme ( 4 categories of action, 75 targets) ●Outcomes component—Problem Rating Scale for Outcomes (3 scales)

7. Problem Classification Scheme ●Assessment component—Problem Classification Scheme is composed of 4 domains: EnvironmentPsychosocial PhysiologicalHealth-related behaviors ●42 Problems ●Modifiers identify the problem as either an individual, family, or community problem and as either a health promotion, potential, or actual problem ●There are signs and symptoms specific to each problem

8. Intervention Scheme ●I ntervention component—Intervention Scheme is composed of 4 categories: Health teaching, guidance, and counseling (TGC) Treatments and procedures (TP) Case management (CM) Surveillance (S) ● 75 targets

9. Problem Rating Scale for Outcomes ●Outcomes component—Problem Rating Scale for Outcomes: Knowledge, Behavior and Status scores ●Uses a simple 5 point scale C ONCEPT 12345 KnowledgeNo knowledgeMinimal knowledge Basic knowledge Adequate knowledge Superior knowledge BehaviorNot appropriateRarely appropriate Inconsistently appropriate Usually appropriate Consistently appropriate StatusExtreme signs & symptoms Severe signs & symptoms Moderate signs & symptoms Minimal signs & symptoms No signs & symptoms

10. Project Overview ●Began in 2013 with development of two nursing informatics case studies by Eardley and Monsen (latent TB bacterial infection content and holistic care of the adult client with pneumonia) ●Student cohorts were used to pilot the case study with positive student content mastery ●Invitation extended to consider piloting the case studies in October 2014 ●Partnerships formed in November 2014

11. Informatics Collaborative Members ●Debra L. Eardley, DNP, RN, APHN-BC, Assistant Professor, Metropolitan State University, St. Paul, MN ●Jolon Vaughn, MSN, RN, Department of Nursing, Southeast Missouri State University, Cape Girardeau, MO ●Linda Garner, PhD, RN, APHN-BC CHES, Assistant Professor, Department of Nursing, Southeast Missouri State University, Cape Girardeau, MO ●Conni DeBlieck, DNP, MSN, RN, RN-BSN Coordinator, Assistant Professor, New Mexico State University ●Kelly Ann Krumwiede, PhD, RN, Assistant Professor, Minnesota State University Mankato, School of Nursing ●Selda Secginli, PhD, RN, Professor, Istanbul, Universitesi Florence Nightingale ●Roberta Hovarter, MS, APHN, RNBC, CPH, University of Wisconsin, Green Bay, WI ●Madeline Kerr, Professor, University of Minnesota, School of Nursing, Mpls, MN

12. Officially named our group and developed logo

13. Case Study Components ●B SN Essentials ●Incorporates Item #11 (use of informatics) and #12 (EBP) from Quad Council PHN Competencies Domain #1: Analytic and Assessment Skills ● Evidence-based content ●Integrates Omaha System Problem Classification (assessment), Intervention Schemes (care plans and services) and Problem Rating Scale for Outcomes and Intervention Scheme (client change/evaluation) were mapped to the case study ●Integrates QSEN components of informatics, patient-centered care, and evidence-based practice ●End product serves as a tool for nursing education

14. E xample: LTBI Evidence-Based Case Study ●Anatomy and physiology – disease process ●Screening procedures – Interpretation of TST & x-rays, blood tests ●Signs and symptoms ●Specimen collection ●Community outreach worker services; supervision by RN ●Continuity of care – coordination among providers ●Medication regimen – action, side effects, administration, DOT ●Laboratory findings – liver function studies

15. Case Study Delivery Format: Tutorials ●Content of the case study is presented in a narrated tutorials guide; requires approximately 45 minutes to complete online ●Part 1: Simple tutorial about the Omaha System ●Part 2: Clinical scenario (LTBI), clinical summary, Omaha System assessment, evidence-based interventions, and evaluation. ●Upon completion of the case study, students take a quiz to measure content mastery.

16. Students receive an overview of the Omaha System at the start of the case study audio (Part 1)

17. Integration of QSEN Content Information Technology Data + Information + Knowledge = problem solving and decision making Patient-Centered Care Partnership with client to improve quality and safety of care Evidence-Based Practice CDC EBP interventions/guidelines for LTBI drug therapy, direct observation therapy, and client education Source: AACN 2015

18. Case study begins with client presenting to the local health department

19. Relevant content is shared with the student as the case study unfolds

20. Screenshots of the Omaha System Charting components prompt students to consider connections to the EHR (Champ Software, 2014)

21. Results LTBI case study presented Spring 2015 at two separate pilot sites to 37 students enrolled in Community Health theory courses Students were 3rd semester (N=16) and 4th semester (N = 21) Both tutorials were viewed as a group in a classroom setting Quiz was administered immediately after completion of Part 2 tutorial

22. POST TEST RESULTS 3rd Semester Students 4th Semester Students Students recognized the client had an infection100%76% Students connected the infection to a positive sputum screening100%90% Students identified the client had no knowledge of the disease & treatment 67%52% Students identified the behavior of the client as usually appropriate & engaged in treatment 100%48% Students determined that there were minimal signs/symptoms & medication side effects along with improving lab results 93%43% Students correctly identified the interventions of: Teaching Direct Observed Therapy (DOT) Surveillance Case management 13% 100% 13% 76% 81% 62% 52%

23. Student Comments STRENGTHSOPPORTUNITIES FOR IMPROVEMENT Tutorials were short & to the point. LTBI scenario was interesting & well organized. Omaha System screen shots were helpful. Time to complete the entire case study was manageable. Tutorials could be more interactive/ Some difficulty reading the screen shots; print too small. Quiz format/questions somewhat confusing; add more information to stem of question. Allow for debriefing after completion of Quiz to review correct answers & discuss case study further.

24. Where do we go from here? ●Continue pilot testing of current case studies ●Revise case study formatting to enhance student learning ●Recruit additional partners to plan, develop and evaluate additional case studies ●Disseminate our findings; Dr. Karen Monsen, Omaha System Expert, has generously agreed to publish our case studies on the Omaha System Community of Practice websiteOmaha System Community of Practice

25. How to join the team Contact Team Leader: Debra Eardley, DNP, RN, APHN-BC, Assistant Professor, School of Nursing Metropolitan State University College of Nursing & Allied Health Services St. Paul, MN Phone: (651) 793-1385 Email: debra.eardley@metrostate.edu Cell: 651-398-9730 Informatics Collaboration for Improving Nursing Education

26. What to expect if you join the team…. ●Gain knowledge about EBP and HIT ●Innovative opportunities ●Pilot studies ●Development of case studies ●Access to case studies ●Monthly online meetings (highly motivated support team)

27. QUESTIONS?

28. References Martin KS. (2005). The Omaha System: A key to practice, documentation, and information management (Reprinted 2nd ed.). Omaha, NE: Health Connections Press. The Omaha System. (2015). The Omaha System: Solving the clinical-data information puzzle. Retrieved from: http://www.omahasystem.org/ Omaha System Community of Practice. (n.d.). The Minnesota Omaha System users group. Retrieved from: http://www.omahasystemmn.org/