Nurse Managed Center: Psychiatric-Mental Health Nursing Practica Nurs 147A

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Nurse Managed CenterPsychiatric-Mental Health
Nursing Practica Nurs 147A
Dr. Connolly Dr. Mao Mr. Crider Mrs. Judith
Berkley
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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 -

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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

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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
• Donnas Day Program, 2005
• John 23rd, 2005
• Staff Faculty Students

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Process

• Course objectives
• Service learning
• Faculty as staff role models for students
• Documentation
• Omaha System

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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

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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

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Omaha Rating Scale
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CCF 9075, Problem 42,Medication Regimen, Fall
98
Initial Rating
Final Rating

• Knowledge 2
• Behavior 2
• Status 2

• Knowledge 3
• Behavior 3
• Status 3

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CCF 9523, Problem 35, Nutrition, Fall 2000
Initial Rating
Final Rating

• Knowledge 4
• Behavior 2
• Status 2

• Knowledge 4
• Behavior 1
• Status 1

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Rating Change of the Problem-Personal Hygiene S
2002
N 20
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Rating Change of the Problem Nutrition S 2002
N 20
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Fall 2001 N 47T-Test for Pre and Post Rating
Intervention top 3 Omaha Problems
Paired Differences
Mean Std. Deviation t df Sig.(2 tailed)
Pair1Rating1K-Rating1K -0.64 1.03 -3.315 27 0.003
Pair2Rating2K-Rating2K -0.73 1.20 -2.873 21 0.010
Pair3Rating3K-Rating3K -0.93 0.96 -3.761 14 0.002
Pair4Rating1B-Rating1B -0.36 1.06 -1.780 27 0.086
Pair5Rating2B-Rating2B -0.74 1.51 -2.341 22 0.029
Pair6Rating3B-Rating3B -0.19 1.52 -0.495 15 0.628
Pair7Rating1S-Rating1S -0.67 0.83 -4.163 26 0.000
Pair8Rating2S-Rating2S -0.77 1.07 -3.400 21 0.003
Pair9Rating3S-Rating3S -0.81 1.33 -2.448 15 0.027
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Most Frequently Identified Omaha Problems,
Interventions and Targets (Spring, 2005 N85)
Problem Intervent Target 1 Target 2 Target 3
Emotional stability HTGC SUR Coping Signs Symptoms Support system
Social contact HTGC SUR Interaction Communi cation Support system
I P R HTGC SUR Communication Support system Interaction
Nutrition HTGC SUR Nutrition Beh.mod Food
Med. Regimen HTGC SUR Med. Adm. Side effect Medication set up
Personal hygiene HTGC SUR Personal care Beh.mod Skin Care
HTGC Health Teaching Guidance/Counseling
SUR Surveillance
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Results of Paired t-testOutcome Ratings, K, B, S
Spring 2005 N 85
Omaha problem Knowledge Behavior Status
Emotional stability
Social contact
I P R
Nutrition
Med. Regimen
Personal hygiene
statistical significance p .05
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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

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Challenges Opportunities

• Training
• Maintaining System in NMCs
• Faculty changes
• Resources for data collection, analysis
  reporting
• Involving more faculty
• Sustaining high levels of resilience

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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

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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

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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
• Its a good thing, Martha Stewart