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

2. 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

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

4. 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

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

7. 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

8. 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?

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

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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).

16. 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

17. Contact Information
Daryl Canham, EdD, RN, BC
San Jose State University, School of Nursing
One Washington Square
San Jose, CA