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Application of the Cloutterbuck Minimum Data Matrix To a

Community Health Nursing Course

Joanne M. Dalton, PhD, APRN, BCRegis College

Weston, Massachusetts

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Objectives

• Discuss the Cloutterbuck Minimum Data Matrix (CMDM)

• Apply the CMDM to a community health nursing baccalaureate course

• Discuss how the CMDM prepares nursing students for practice in the 21st century

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Overview of the Matrix

• Model published by Cloutterbuck and Cherry (1998)

• Application of model- in press in the Journal of Nursing Education

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Overview of the Matrix

• Guides education , research, and practice in community health nursing in the 21st century

• Based on Von Bertanlanffy’s General

Systems Theory (1968)

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Overview of MatrixProvides a framework for

• critical thinking

• problem solving for community health nursing @ many units of analysis:

• Individual

• family

• population

• community

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Four Assumptions

• Critical thinking is integral to effective nursing practice

• Biomedical perspective for the provision of health care is necessary but not sufficient for effective nursing practice in the community

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Four Assumptions

• Socio-political, economic and other related variables that contribute to the “root” causes of health and illness are integral to the health of the population and must be recognized and addressed by nurses

• Advocacy for social change is an expected professional behavior

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Wellness----------------Illness

The Cloutterbuck Mimimum Data Matrix (CMDM)

Independence----Dependence

Health Status

Functional Status

Levels of Prevention

Figure 1

Acute Care Hospital

Community

Long-Term Care Facility

Primary Secondary

Tertiary

Locus of Care

I

I

II III

I Personal-----

II Situational--

III Structural--

Cyclical Phases of the CMDM

Care Outcomes

CMDM Consumer Profile Consumer Health and Functional Status

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Personal Dimension Variables Internal Context (intrinsic variables of concern )

• Age, Gender

• Race, ethnicity/culture

• Country or state of origin, language

• Health status: objective/subjective

• Functional status: ADL/IADL

• Mental status, cognitive status

• Medical diagnosis, related information

• Treatment regimen, knowledge of condition

• Education, literacy level

• Occupation: status/work history

• Health beliefs/practices

• Life style, sexuality

• Risk factors, self-care

• Religion, spirituality

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Situational Dimension Variables Micro-Context (family/neighborhood/community variables of concern)

Micro-Context (family/neighborhood/community variables of concern)

• Income: source/ amount

• Health insurance coverage

• Marital status, living arrangement

• Family: structure/dynamics

• Community: structure/dynamics

• Social program eligibility

• Support systems: informal/formal

• Availability of help: emergency/regular

• Housing: type/adequacy

• Transportation: public/private

• Physical environment, safety

• Socio-cultural/ideological mileau

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Structural Dimension Variables Macro-context (National/state-level variables of concern

• Physical environment• Social-economic-political

milieu• Cultural/ideological milieu• Population demographics• Business, industry, the media• Health care providers:

number/type• Health policy and regulations• Social policy and regulations• Public policy and regulations

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Application of the CMDM

Conceptual models guide nursing education by:1. distinctive focus of the curriculum and the purposes

to be fulfilled by nursing education.

2. general nature and sequence of the content to be presented.

3. settings in which nursing education occurs.

4. characteristics of legitimate students.

5. teaching-learning strategies to be employed (Fawcett, 2005, p. 37).

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Focus of the Curriculum

1. Builds on student’s knowledge from personal dimension: Adds the situational and structural dimensions

2. Focus on populations and community units of analysis

3. Focuses on the three dimensions and five phases: Provides a big picture view of health and health care delivery system

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Nature and Sequence of Content

Nature of Content

• Titles of lectures are in terms of personal, situational, and structural dimensions

• Class discussions center on the 5 phases of the model

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Nature and Sequence of Content

Sequence of Content

• First class present the model and application of the model to an individual patient, then school age population

• Community assignment

• Structural variables stressed in the health care financing and organization

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Settings

• Settings for the nursing practicum are selected to facilitate students’ application of the CMDM model

• Opportunity for critical analysis of the multiple variables that affect health and the provision of health care.

• Consumers who are at various levels of health and functional capacity

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Characteristics of Legitimate Students

• Have typically completed most of their disciplinary prerequisite courses such as adult medical-surgical nursing, mental health, pediatrics, and maternal-child health.

• It is expected that students can, with the support and supervision of the faculty, practice with relative autonomy in a variety of community settings such as schools, homeless shelters, and certified home health agencies.

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Characteristics of Legitimate Students

Provide nursing care to • children in schools • consumers in homeless

shelters• frail elders receiving

home care• older well adults in

councils on aging, elder service organizations

• home visits to new mothers and infants

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Teaching-Learning Strategies

Community Assessment

Project

Community Assessment

Project

Weekly Clinical

Journals

Weekly Clinical

Journals

CourseExaminations

CourseExaminations

Clinical Conference

Case Examples

Clinical Conference

Case Examples

Classroom Case

Examples

Classroom Case

Examples

Teaching-Learning Strategies

Teaching-Learning Strategies

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Student Impressions

• Assists in structuring their thinking about the many factors that impact on health

• Assists in visualizing the community as the unit of analysis as a “living entity” that is subject to nursing interventions

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Student Critical Thinking Incident

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Thank You From Boston

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ReferencesBrathwaite, A. C. (2003). Selection of a conceptual model/framework for guiding research Interventions. Internet Journal of Advanced Nursing Practice, 6, 38-49. Retrieved June 12, 2006, from http://search.epnet.com.eresources.lib.umbCloutterbuck, J. C., & Cherry, B. S. (1998). The Cloutterbuck minimum data matrix: A teaching mechanism for the new millennium. Journal of Nursing Education, 37, 385-393.Fawcett, J. (1985). Theory: Basis for the study and practice of nursing education. Journal of Nursing Education, 24, 226-229.Fawcett, J. (2005). Contemporary nursing knowledge: Nursing knowledge: Nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.McKeown, R. E. & Hilfinger Messias, D.K. (2006). Epidemiologic Applications. In M. Stanhope & J. Lancaster, Eds. Foundations of nursing in the community, Community oriented practice (2nd ed., p. 156). St. Louis, MO: C. V. Mosby.Stanhope, M., & Lancaster, J. (2006). Foundations of nursing in the community, Community oriented practice (2nd ed.). St. Louis, MO: C. V. Mosby. Von Bertalanffy, L. (1968). General systems theory. New York, NY: Braziller