Facilitating student learning with electronic health care data management: Outcomes from the Nightingale Tracker Project
Phyllis M. Connolly, RN, CS, PhD, Co-Project Director, NT, San Jose State University, San Jose, CA
Mary Jo Gorney-Moreno, RN, PhD,Co-Project Director, NT, San Jose State University, San Jose, CA
Victoria L. Elfrink RN,C, PhD, Project Manager, FITNE, Athens, Ohio
Nightingale Tracker Project
Based on the perceived changing needs of nursing education, the Helene Fuld Health Trust funded a three year research and development project named the Nightingale Tracker.
San Jose State University, San Jose, California
California population- 32 million 383 thousandGross State Product would make it the 7th largest country in world
Student Subjects SJSU School Of Nursing
Generic Baccalaureate & Advanced Placement for RNs & LVNs
Graduate Programs: Family Nurse Practitioner; CNS; Gerontology, School Nurse; Educator and Administration options
Innovator in integrating community-based instruction in the curriculum, all students have at least 71/2 weeks in Med/Surg home care, at least one OB and Peds home care experience prior to going into community health semester
Student Subject Make-Up
Population Served Widely diverse in
cultural, and ethnic background
450 undergraduate students, 100 graduate
typically 60 (MH) 90 students in CH course in clinical groups of 10 students per section -
Type of Clinical Rotation
Nursing 147B-Practicum IV-Spring 97 First Semester of Senior Year Community Health Experience
Home Visits & Community Agencies
All students had prior home care experience and had at least one lecture on the Omaha system
Nursing 147A-Practicum IV Fall 98 - Spring 00 Community Mental Health Experience 3 Transdisciplinary Collaboration Sites Nurse Managed Center, Community
Student Demographics Fall 98 - Spring 2000
N = 37Undergraduates Juniors and seniorsAge range 22 - 46Most commutersPrior computer training 40 - 50%
noneAll used word processing
Fall 99 & Spring 2000-Information Technology Competencies
All students had word processing experience-multiple years.
All students had experience with email.50% of students had experience with
electronic patient documentation.55% of students had a formal course
on computers, however half of those students only had courses in highschool.
Student Evaluation Tools
NT User CharacteristicsNT Impact Questionnaire, Pre; post
teaching; 6 weeks; and finalWeekly NT logTraining session evaluation toolCourse satisfaction tool
Population Served F 98 - S 00
Persons with serious mental illness Schizophrenia Bipolar Disorder Affective Disorders
Community health clients Nurse Managed Center
30 different clients481 episodes of care
Omaha Nursing Documentation System
Domains Interventions
I. Environmental
II. Psychosocial
III. Physiological
IV. Health Related Behaviors
I. Health TeachingGuidance,Counseling
II. Treatments & ProceduresIII. Case ManagementIV. Surveillance
Domain II. Psychosocial IV. Health Related Behaviors
Communication with community resources
Social contact Role change Interpersonal relationship Spiritual distress Grief Emotional stability Human sexuality Caretaking/parenting Neglected child/adult Abused child/adult Growth & development
Nutrition Sleep and rest
patterns Physical activity Personal hygiene Substance use Family planning Health care
supervision Prescribed
medication regimen Technical procedure
Client Problems Encountered
25 of the 44 Omaha problems were identified
3 most frequent problems Interpersonal relationship (50%) Social Contact (44%) Emotional stability(25%)
Problems Most Frequently Encountered F 98 - S 00
0
20
40
60
80
100
Problem 09InterpersonalRelationship
Problem 07Social Contact
Problem 12EmotionalStability
Interventions for Problems
0
5
10
15
20
25
Problem
09
Problem
07
Problem
12
HealthTeaching/G/C
Surveillance
Case Manage
Omaha Rating Scale
Concept 1 2 3 4 5
Knowledge Noknowledge
Mini-mal
Basic Adequate Superior
Behavior Notappropriate
Rarely Incon-sistently
Usually Consis-tently
Status ExtremeS&S
SevereS&S
ModerateS&S
MinimalS&S
No S&S
CCF #9075, Problem 07, Social Contact, F 98 - S 99
Knowledge: 1
Behavior: 2
Status: 2
Knowledge: 3
Behavior: 3
Status: 3
Initial RatingInitial Rating Final RatingFinal Rating
CCF # 9075, Problem 42,Medication Regimen, Fall 98
Knowledge 2
Behavior 2
Status 2
Knowledge 3
Behavior 3
Status 3
Initial RatingInitial Rating Final RatingFinal Rating
CCF # 9547, Problem 09,Interpersonal Relationships, Spring 2000
Knowledge 2
Behavior 2
Status 2
Knowledge 4
Behavior 4
Status 4
Initial RatingInitial Rating Final RatingFinal Rating
Client Population Trends
Finding 1: Population has multiple health problems requiring primary health care
Finding 2: Reinforces need for sustaining social support and long term rehabilitation
Evidence Based Nursing Education Trend
Increase the use of our Nurse Managed Centers which provide opportunity for continuity of care for persons with chronic health care problems
Assess the curriculum for relevance for meeting needs for primary care
Outcomes: Information Technology Competencies
Electronic information processing skillsIncreased efficiency in documentationA unique experience with cutting-edge
technologyBetter prepared for job marketIncreased confidence in using
technologyIncreased use of internetImproved health care delivery
Student Outcomes
Increased communication with facultyActively engaged in researchImproved client careIncreased professionalism (client’s view)Increased understanding of relationship
between research and practicePublication opportunityAwards and recognitions
Student Reflections
Frustration during early use
Improved careUse in other courses
Actual participation in research
Sense of connectivity with faculty
Advice For Other Students
Have patienceActive participation--
use itBe flexibleUse creative thinkingHave funIntegrate technology
Faculty Outcomes
Improved teaching effectivenessPublications & presentations
Case Study on-line Improved student evaluationsBetter supervision of students Increased technology skillsCollaboration opportunitiesParticipation in researchSubmission TOP grantRedesigning the learning paradigm to include
formal education & clinical experiences in IT.
Challenges
TrainingMaintaining
equipmentPhone lines at sitesHardwareData collectionSecuring more
technical human resources
Involving more faculty
Future Plans for Integration
Utilize with additional courses, pilot faculty and 1-2 students Physical Assessment (Semester 5) Nurse Practitioner Students (Fall 2000) RN to BSN students (Semester 7 & 8) Semester 8 clinical
Add resources to web browserDissemination
Implications for Future Research
Better understanding of factors contributing to user frustration.
Distinguishing among factors that promote better student/faculty communication.
Measuring differences in critical thinking skills.