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.