nursing care makes a difference the application of omaha documentation system on clients with mental...

Nursing Care Makes A Difference

The Application of Omaha Documentation System on Clients with Mental Illness

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.

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).

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.

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.


• 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.


• 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.

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).

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.

The Purpose

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

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?

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

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.

The Sample• Sample size 47 clients• Client’s 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%

Ethnic Distribution

11%

45%

40%

4%

A fric an A meric an

A s ian Pac ific

Cauc as ian

Hispanic

THE DATA

Data Analysis

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

Mean N Std. Deviation

Pair RATING1K1 RATING1K

2.683.32

2828

0.90.82


2.553.27

2222

1.011.08


2.43.33

1515

0.910.9

Pair RATING1B4 RATING1B

3.213.57

2828

1.130.79


2.73.43

2323

1.021.08


2.943.13

1616

1.061.31

Pair RATING1S7 RATING1S

2.813.48

2727

0.740.89


2.683.45

2222

0.721.01


2.563.38

1616

0.731.02

Mean and Standard Deviation Pre and Post Interventions

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.

t Test for Pre and Post Rating Intervention

Paired Differences

Mean Std. Deviation t df Sig.(2 tailed)

Pair1Rating1K-Rating1K -0.64 1.03 -3.315 27 0.003



Pair4Rating1B-Rating1B -0.36 1.06 -1.780 27 0.086



Pair7Rating1S-Rating1S -0.67 0.83 -4.163 26 0.000



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.

Omaha ProblemsProblems Frequency Percent

Social Contact 17 18.09%

Interpersonal Relationship 13 13.83%

Emotionally Stability 12 12.77%

Nutrition 11 11.70%

Personal Hygiene 9 9.57%

Communication Community Resources 5 5.32%

Physical Activity 4 4.26%

Prescribed Medication 4 4.26%

Sleep and Rest 4 4.26%

Growth and Development 3 3.19%

Cognition 3 3.19%

Pain 3 3.19%

Substance Use 3 3.19%

Neuro-Musculo Skeletal 1 1.06%

Digestion-Hydration 1 1.06%

Genito-Urinary Function 1 1.06%

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.

Health Teaching - Guidance - Counseling

87.7%

Surveillance11.1%

Case Management1.2%

Nursing Interventions

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.

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.

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.

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.

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.

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.

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