Nursing Care Makes A Difference

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Nursing Care Makes A Difference

• The Application of Omaha Documentation System on
  Clients with Mental Illness

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Abstract

• The use of nursing classification systems has
  enabled nurses to describe patients needs and
  nursing contributions to patient care.
• The results of the study indicated a statistical
  positive difference in the outcome ratings as a
  result of nursing interventions for 47 clients
  with chronic mental illness in three academic
  nurse managed centers.
• The Omaha Documentation System demonstrates its
  usefulness as a valid and reliable nursing
  documentation tool for outcomes and quality of
  care measurements for clients with mental illness.

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Background Literature

• The rapid increase in a variety of new models of
  community-based care has created a crucial need
  for data base measurements of quality.
• In health care definition of quality has been
  expanded to include the expectations of patients,
  of their representatives, and of society (Walker
  et al, 1997).

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Background Literature

• Donabedian defined quality as the result of
  assessment of structure, process, and outcomes.
• Market driven reforms in managed care are
  changing the face of the delivery and evaluation
  of health care in the US. (Chisholm et al 1997)
• In the context of this change there is a renewed
  interest in the measurements of quality of care.

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Omaha Documentation System

• Develop over 20 years with federal funded
  research
• Primary test site was the visiting nurses
  association of Omaha
• Provides comprehensive problem oriented
  nomenclature that describes, classifies and
  quantifies nursing care.

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Omaha Documentation System

• It is a tool that promotes problem solving and
  nursing process.
• Uses the problem classification scheme.
• The intervention scheme has the ability to
  describe most of the nursing interventions.
• The problem rating scale for outcomes allows the
  user to use clinical knowledge to determine
  clients health status outcome.

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Omaha Documentation System

• WHY this tool?
• Problem classification scheme effectively
  describes the wide variety of health problems
  that are encounter in the NMC.
• The intervention scheme has the ability to
  describe most of the nursing interventions that
  occur in a community based practice.
• The problem rating scale for outcomes is
  uncomplicated and allows the user to use clinical
  knowledge in determining the health status
  outcome.

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Nurse Managed Center

• A nursing center is a place and a concept.
• Nursing centers are not a new concept, they have
  served as fertile ground for the definition and
  advancement of nursing practice.
• The common themes identified among all the
  definitions are that nursing care is directly
  accessible to the client, family, or community
  and that the practice is controlled by nurses
  (Frenn, et. al 1996).

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Nurse Managed Center

• Academic nurse managed care centers provide 2
  categories of services, chronic illness nursing
  care services, and health promotion services.
• The mission of these centers is to provide
  quality community based health care services in
  an innovative educational environment.

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The Purpose

• To describe the Omaha system and demonstrate its
  usefulness as a valid and reliable nursing
  documentation tool for outcome and quality of
  care measurement for persons with mental illness.

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Research Question

• Do nursing interventions make a difference in
  knowledge, status, and behavior in persons with
  mental illness receiving care in a Nurse Managed
  Center as measured by the Omaha outcome rating
  scale?

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Setting

• Conducted in 3 Nurse Managed Centers in Northern
  California
• Target population clients with mental illness
• 47 nursing students participated in the research
• Data collected during 13 week period Fall 2001
• During this time the students met with residents
  on a weekly basis and provided health-teaching,
  treatment, surveillance and case management when
  appropriate

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Design

• Quantitative research study
• Students assessed clients knowledge, behavior,
  and status pre and post visits using the problem
  rating scale.
• Two instruments in a scantron form were used, the
  client contact form and the Omaha data base form.
• Protection of human subjects was addressed prior
  to providing any services. A general standardized
  consent form was completed by each client
  providing specific permission for care and to use
  the data.

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The Sample

• Sample size 47 clients
• Clients age 17 - 69 years
• Females 55.3
• Males 44.7
• African American 4.3
• Asian Pacific Islander 10.6
• Caucasian 44.7
• Hispanic Latino 40.4

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Ethnic Distribution
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THE DATA
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Data Analysis

• The pair sample statistical means of the
  descriptive statistics of the 9 pairs pre and
  post interventions were analyzed, which indicated
  differences.

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Mean and Standard Deviation Pre and Post
Interventions
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Data Analysis

• The correlated paired t test was found to be
  statistically significant with p value less than
  0.05 with the exception of pairs 4 and 6.

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t Test for Pre and Post Rating Intervention
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Data Analysis

• In this study 16 of the 43 Omaha problems were
  identified with the most frequent problems being
  social contact, interpersonal relationships,
  emotionally stability, nutrition, and personal
  hygiene.

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Omaha Problems
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Nursing Interventions

• In everyone of the problems Health
  teaching-guidance, and counseling was used 87 of
  the time, surveillance, 11.1 case management
  1.2.
• The lower use of case management was expected
  because the majority of clients were under formal
  case management of the mental health system.

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Nursing Interventions
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Discussion

• The results of this study are not similar to
  previous studies, there are no other studies that
  have done pre and post testing with this tool.
• Regarding the physical health problems, the data
  collection tool in this study only allowed for 3
  problems
• The interventions of these 47 nursing students
  made a significant improvement in the quality of
  care for these 47clients, outcomes improved.

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Limitations

• The study had a small sample size and all the
  problems were analyzed together.
• The student data collectors did not prioritize
  the problems thus problem 1 on the data
  collection tool was not necessarily the highest
  priority problem.
• The study lack randomization.

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Recommendations

• Future research needs to include a larger random
  sample size.
• Data should be analyzed by individual problems.
• The Omaha outcome rating tool should be used to
  measure nursing interventions in all settings
  thus assisting in the increase in evidence based
  nursing practice.
• Cost savings and client satisfaction data should
  be included in future research.

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Conclusion

• The ability to define and measure the quality of
  nursing care, determine cost and set care
  standards across a variety of practice settings
  requires continued testing of information system
  that reflect practice.
• Research generated from these databases has the
  potential to yield rich new knowledge related to
  the issues of access, quality and cost of health
  care.

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Conclusion

• Nurse Managed Care Centers do provide alternate
  models for the delivery of primary health care
  prevention and health promotion.
• The use of the Omaha Documentation System
  including the outcome rating scale provides
  students with an opportunity to experience the
  use of a reliable and valid outcome measurement
  tool.

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Conclusion

• The effect of therapeutic nursing interventions
  for a population with chronic physical and mental
  health problems becomes evident.
• The findings also suggest that the nursing
  interventions of health teaching and counseling
  are an effective intervention it was used 87 of
  the time. This is important for future health
  care funding and suggests that there maybe cost
  savings related to this intervention.