Building Evidence Based Practice in the Community:

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Building Evidence Based Practice in the Community

• A Collaborative Faculty-Student Model

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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

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IOM Environment Changes (2003) NMCs

• Applying evidence to health care delivery
• Using information technology
• Aligning payment policies with quality
  improvement
• Preparing the workforce

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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

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(No Transcript)
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Omaha System in NMCs

• BSN students easily develop understanding of
  system
• Framework for evidence based practice
• Facilitates documentation and information
  management

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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

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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?

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Findings from Persons With Psychiatric/Mental
Health Problems Living in the Community
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Table 1. Mean score and Results of paired t-test
of Omaha System Outcome Ratings
Health problem Knowledge Knowledge Knowledge Behavior Behavior Behavior Status Status Status
Health problem Ini- tial visit Post visit of change Initial visit Post visit of change Initial visit Post visit of change
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 2.87 3.26 14 3.00 3.13 4
Nutrition 2.55 3.30 29 2.50 3.00 20 2.53 3.16 25
Prescribed Medication Regimen 2.44 3.22 32 3.06 3.78 24 2.72 3.72 37
Personal hygiene 2.59 3.24 25 2.59 3.29 27 2.59 3.12 20
Note Statistically significant difference
between pre and post ratings, p .05.
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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 (N33 38.8) HTGC ( N59) SUR (N9) Coping (N17) Signs Symptoms (N11) Support system (N11)
Psychosocial Social contact (N31 36.5) HTGC (N42) SUR (N9) Interaction (N25) Communica-tion (N18) Support System (N8)
Psychosocial Interpersonal Relationship (N23 27.0) HTGC (N42) SUR (N7) Communica-tion (N17) Support system (N13) Interaction (N 9)
Health Related Behavior Nutrition (N 20 23.5) HTGC (N28) SUR (N7) Nutrition (N22) Behavior modification (N8) Food (N6)
Health Related Behavior Prescribed Medication Regimen (N18 21.2) HTGC (N23) SUR (N16) Medication administration (N12) Side effect (N11) Medication set up (N4)
Health Related Behavior Personal Hygiene (N17 20.0) HTGC (N25) SUR (N5) Personal care (N15) Behavior modification (N6) Skin Care (N4)
Note HTGC Health Teaching, Guidance, and
counseling TP Treatment Procedure SUR
Surveillance
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Findings Adult Elder Population

• Multi-ethnic population (Caucasian, Hispanic,
  Asian/Pacific Islander, African American) N134
• 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

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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 Pre- Post Change Pre- Post- Change
Neuro Musculo Skeletal 2.91 3.33 14 3.24 3.7 14 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 3.48 4.17 20 2.7 3.17 17
Physical Activity 2.93 3.43 17 3.11 3.57 15 2.86 3.43 20
Circulation 3.13 3.57 14 3.35 3.65 9 2.87 3.09 8
Note Statistically significant difference
between pre and post ratings plt .05
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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

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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).

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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

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Contact Information

• Daryl Canham, EdD, RN, BC
• San Jose State University, School of Nursing
• One Washington Square
• San Jose, CA 95192-0057
• Email canham_at_son.sjsu.edu