Mary Jo Baisch, PhD, RN Kathleen Sawin, PhD, CPNP-PC, FAAN Pei-Yun Tsai, PhD, RN
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Transcript of Mary Jo Baisch, PhD, RN Kathleen Sawin, PhD, CPNP-PC, FAAN Pei-Yun Tsai, PhD, RN
Nursing Interventions to Support Low-Income Individuals with Hypertension
Application of Self-Management Theory Using Clinical Data from Nurse Managed Health Centers
Mary Jo Baisch, PhD, RN
Kathleen Sawin, PhD, CPNP-PC, FAAN
Pei-Yun Tsai, PhD, RN
Bev Zabler, PhD, RN
Jean Bell-Calvin, MS, RN
Rachel Schiffman, PhD, RN, FAAN
UWM Nurse Managed
Health Centers
• Founded in 1978 – Community Nursing Centers (CNC) co-located in two
community social service agencies– Serve about 1000 clients per year in 5000 visits– Underserved populations across the lifespan
• Document outcomes of the Lundeen CNC model• Academic/practice model supports student and faculty
community health/primary care practice• Model of advanced practice nursing
Silver Spring Community Nursing Center
House of Peace Community Nursing Center
Documentation of NMHC Practice
• Developed a data system: ACHIS (Automated Community Health Information System) – Relational database– Longitudinally tracks nursing practice (began in 1986) – Includes demographic, billing, provider information
and health services for individuals and groups – Problems, interventions and outcomes coded using
Omaha System (ANA approved standard terminology for nursing)
Research Collaborative• UWM Self Management Science Center (SMSC)
– Initial funding by US National Institute of Nursing Research
– Expands programs of research that enhance the science of self-management in individuals and families
– Supports researchers in development, implementation, & evaluation of self-management interventions.
• UWM Institute for Urban Health Partnerships– Administrative home for CNCs– Mission: Promote health and reduce health disparities– Links practice and research
Goals of This Collaboration• Apply Individual and Family Self-Management
Theory as a conceptual model for improving outcomes in patients with hypertension.
• Determine how the ACHIS/Omaha System captures health care practices at the NMHCs.
Value of Theoretical Models for Practice
• Connects nursing “World-Views”
• Offers a systematic structure for nursing process
• Supports nursing as a discipline – knowledge building
Conceptual Frameworks
http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm
Conceptual Frameworks
Specific Aims1. Map the ACHIS/Omaha System data elements
to the components of the Individual and Family Self-Management Theory
2. Describe the context data elements of the IFSMT
3. Determine if there are differences between the context data elements of IFSMT for clients with hypertension and those without.
MethodSetting
– 2 Nurse Managed Health Centers in a US midwestern, urban community
Sample– Hypertension defined in ACHIS/Omaha System
• Domain: Physiological • Focus/Problem Area: Circulation• Symptom: Abnormal blood pressure reading
– Clients identified with hypertension n=432• # of visits: Range 1-714 (M=20.22 + 45.31)
– Matched (age, race) control n=432• # of visits: Range 1-140 (M=7.15 + 10.96)
Data Analysis• Aim 1: A semantic mapping process was conducted
between Individual and Family Self-Management Science and ACHIS/OS data elements
• Aim 2-3: Descriptive statistics
Compared demographics between groups (Chi Square)
Compared groups for contextual and risk factors associated with hypertension (Chi Square)
http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm
Complexity of Condition Variables in ACHIS/OS Specific to Hypertension
Significant level: p < 0.001
* Significant level: p < 0.001
IFSMT ACHIS/OS
Non-HTN group
HTN groupChi-
Squaren % n %
Complexity of Condition Specific: HTN
Role change 9 1.1 16 0.6 1.536Respiration 113 13.4 341 13.7 0.040Nutrition 287 34.0 1004 40.3 10.299*Physical activity 36 4.3 86 3.4 1.205Health care supervision
337 40.0 669 26.8 51.652*
Medication regimen
61 7.2 377 15.1 34.352*
* Significant level: p < 0.001
Client ID #
Problem/Focus Area Interventions
Signs and Symptoms
Outcomes Rating Scale
Targets
Omaha System Structure
http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm
Physical & Social Environment
IFSMT ACHIS/OS
Non-HTN group
HTN group Chi-
Squaren % n %
Access to Care
Uninsured medical expense
256 40.1 670 46.7 7.700*
Health care supervision
337 52.8 669 46.6 6.799*
Setting and Provider Transitions
Inconsistent source of health care
76 11.9 122 8.5 5.946*
Transportation Transportation barrier
18 2.8 8 0.6 NA
*Significant level: p < 0.05
Physical & Social Environment
IFSMT ACHIS/OS
Non-HTN group
HTN group Chi-
Squaren % n %
Culture EthnicityAfrican AmericanCaucasianHispanicOthersMissing
377276
1012
87%6%1%2%3%
377276
1012
87%6%1%2%3%
Language barrier 6 0.9 4 0.3 NACultural barrier 3 0.5 2 0.1 NA
Social Capital
Neighborhood/workplace safety
4 0.6 14 1.0 NA
Interpersonal relationship 14 2.2 68 4.7 NA*Significant level: p < 0.05
http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm
Individual & Family Factors
IFSMT ACHIS/OS
Non-HTN group
HTN group Chi-
Squaren % n %
Developmental Stages, Perspective
Age0-18 years old19-35 years old36-64 years old65 years or older
644
35923
110835
644
35923
110835
Abnormal weight/height/head circumference for age
0 0 0 0
Literacy Education barrier 6 11.5 18 15.9 NAInformation Processing
Cognitive 10 19.2 9 8.0 NA
Capabilities Physical activity 36 69.2 86 76.1 NA
ConclusionImplications for Practice
.
There is added value when applying theory to guide practice
• Systematic documentation of nursing practice and outcomes using standard terminologies is needed
• Standard terminologies used to document nursing practice can be used to test theoretical models for public health nursing.
• IFSMT offers a guide for understanding the context of individual and family self-management