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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

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Mary Jo Baisch, PhD, RN Kathleen Sawin, PhD, CPNP-PC, FAAN Pei-Yun Tsai, PhD, RN

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  1. Nursing Interventions to Support Low-Income Individuals with HypertensionApplication 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

  2. 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 UWM Nurse Managed Health Centers Silver Spring Community Nursing Center House of Peace Community Nursing Center

  3. 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)

  4. 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

  5. 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.

  6. Value of Theoretical Models for Practice • Connects nursing “World-Views” • Offers a systematic structure for nursing process • Supports nursing as a discipline – knowledge building

  7. Conceptual Frameworks http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm

  8. Conceptual Frameworks

  9. Map the ACHIS/Omaha System data elements to the components of the Individual and Family Self-Management Theory Describe the context data elements of the IFSMT Determine if there are differences between the context data elements of IFSMT for clients with hypertension and those without. Specific Aims

  10. Method Setting • 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)

  11. 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)

  12. http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfmhttp://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm

  13. Significant level: p< 0.001 Complexity of Condition Variables in ACHIS/OS Specific to Hypertension * Significant level: p < 0.001 * Significant level: p< 0.001

  14. Client ID # Problem/Focus Area Interventions Signs and Symptoms Targets Outcomes Rating Scale Omaha System Structure

  15. http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfmhttp://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm

  16. Physical & Social Environment *Significant level: p < 0.05

  17. Physical & Social Environment *Significant level: p < 0.05

  18. http://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfmhttp://www4.uwm.edu/nursing/about/centers-institutes/self-management.cfm

  19. Individual & Family Factors

  20. 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

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