OBQI THROUGH THE USE OF CLINICAL PATHWAYS

OBQI THROUGH THE USE OF CLINICAL PATHWAYS PROGRAM GUIDE FOR HEALTH CARE PROFESSIONALS National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama 5-97, California CEP8803, Kentucky 7-0045 and West Virginia WV96-0025RN. This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation. NATIONAL EDUCATIONAL VIDEO, INC. TM 2003

PROGRAM DESCRIPTION Clients with chronic diseases lose functional abilities. Through oasis assessment, restorative techniques, complimentary/alternative therapy and clinical pathways, some measure of health becomes an attainable goal for everyone; and nurses play a key role in providing this costeffective quality health care. This program will discuss Parkinson s, Depression, and COPD. Video running time: 50 minutes (3 contact hours). OBJECTIVES Upon completion of this program the participant will be able to: 1 Describe attitudes conducive to restorative nursing. 2 Define the wellness continuum. 3 Discuss Maslow's hierarchy as it relates to the principles and practice of restorative nursing. 4 Describe the phases of chronic illness. 5 Discuss the four cardinal symptoms of Parkinson s. disease. 6 List 3 secondary symptoms of Parkinson. 7 Describe the cause of Parkinson. 8 Describe the signs of depression common to the Parkinson s disease client. 9 Identify the cardinal symptom of COPD. 10 List the teaching points for a client with COPD. NATIONAL EDUCATIONAL VIDEO, INC. TM 2 2003

GLOSSARY OF KEY TERMS Restorative Nursing Activities of Daily Living Functional Potential Wellness Continuum Rehabilitation Maslow s Hierarchy Self-Esteem Oasis Assessment Clinical Pathways The power or ability to restore or renew a person to a normal state of health. Functions of daily living. Some examples are: eating, bathing, brushing teeth, hair, choosing clothes and dressing. The highest level of emotional and physical ability the client is able to perform. The physical, mental and social aspects of life encompassing the individual s desire for growth and change. The restoration of an individual to normal or near normal function after a debilitating disease or injury. A categorization of the basic needs of humans; physiological, safety and security, love and belonging, self-esteem, and self actualization. The degree of worth and competence one attributes to oneself. Provides the standardized data from which the outcome measures are derived. A set of predetermined visit-by-visit, diagnosis-based guidelines for nursing interventions and patient goals. OBQI Outcome-Based Quality Improvement: A two-stage quality improvement approach, using patient outcomes to measure and improve the quality of care delivered. NATIONAL EDUCATIONAL VIDEO, INC. TM 3

Supplemental Hand Out for Nurses: Nursing Process The nursing process is a systematic method of problem solving. It is based on the scientific method. The nursing process is called "process" because it is ongoing. These are the steps of the nursing process: Assessment: This is the systematic, ongoing collection of information from multiple sources. Assessment is done when a nurse interviews a client and the client s significant others. A physical assessment of the client is also completed observing the following: laboratory data, daily client actions, assessing the client s ability to carry out daily activities, symptoms and the client s response to treatment. In long term care, resident assessment instruments are used to provide a comprehensive multi-disciplinary assessment. Problem Identification or Nursing Diagnosis: Assessment data leads to identifying client strengths and client problems. These may be actual problems the client currently experiences, or potential problems that may occur with that client in the future. Problems are stated and related to a cause or influencing factor. Planning: The systematic steps that the nurse will enact, with others, to assist the client to meet the goals (or outcomes) that are set. For each problem, a measurable, specific goal is identified. The plan includes nursing actions, based on aspects of nursing theory, nursing science, other sciences, and research findings. The beliefs and values of the nursing profession as well as the values of the client are taken into account. Implementation: Carrying out the plan. Evaluation: This is the systematic process of examining each client goal-related outcome to determine if it were met and to revise the plan accordingly. Evaluation may also identify the resources that are needed for the client or the health care provider in their continuing plan of care. Professional Nursing Roles As the nurse carries out the nursing process, the nurse enacts a variety of professional roles. These are: clinician teacher client advocate leader These roles may overlap. In the clinician role, the nurse may provide direct "hands on" care, or may assess a client's needs and direct others to provide services to meet those needs. The nurse may conduct patient and family teaching in a teaching role. The nurse may also teach other health professionals when a multidisciplinary team addresses the client's needs. The nurse is a client advocate when collaborating with the client, finding resources for the client, and acting on behalf of the client. The nurse is a leader when planning and assigning the care of a client to others, maintaining overall responsibility and accountability for that care, assisting other members of the health care team to set and meet goals or when providing resources to other health care providers. NATIONAL EDUCATIONAL VIDEO, INC. TM 4

PRE TEST PART 1 If the following statements are true, circle T. If the statements are false, circle F. T F 1. Our perception of older clients often affects our expectations of them. T F 2. The assumption that all aged people are in declining health is an accurate one. T F 3. Restorative nursing is based on the fundamental belief that many aged people can be returned to some level of independence and function with the proper care and guidance. T F 4. Good health means more than just the absence of disease. T F 5. The traditional health continuum moves from the absence of illness toward illness and death. T F 6. The wellness continuum includes everyone, even the aged, because it emphasizes independence and the promotion of function rather than cure. T F 7. Nurses play a minor role in restorative care. T F 8. Restorative nursing has no role in the client's psychological or emotional health. T F 9. Restorative nursing of the elderly takes less time than other forms of nursing. T F 10. Very few of the elderly have chronic illnesses. NATIONAL EDUCATIONAL VIDEO, INC. TM 5

DISCUSSION QUESTIONS PART 1 1. Discuss the notion that body function is affected by psychological, spiritual and adaptive strategies unique to each individual. 2. Describe how the definition of health has changed in recent years. 3. Discuss the reasons why the wellness continuum views health from a more positive point of view than the traditional health model. 4. Describe and discuss the physical, emotional and psychological goals of restorative nursing. 5. Discuss the phases of a chronic illness. NATIONAL EDUCATIONAL VIDEO, INC. TM 6

POST TEST PART 1 Choose the response that most accurately answers the following questions: 1. The assumption that all aged people are in declining health leads some caregivers to treat these clients as if they were: a. ill and feeble b. wealthy c. depressed 2. The primary goal of restorative nursing is: a. cure b. reaching the optimum level of function that is realistic for a client c. as little personal contact with clients as possible 3. The traditional medical community: a. overestimates the potential of older people b. ignores the potential of older people c. underestimates the potential of older people 4. Until recently, good health meant: a. the absence of illness b. the presence of a chronic illness c. the presence of an acute illness 5. The idea of wellness encompasses: a. a purely technological response to illness b. the physical, mental and social aspects of life c. only people under the age of 50 NATIONAL EDUCATIONAL VIDEO, INC. TM 7

POST TEST PART 1 (continued) 6. According to the wellness model, health begins with the client's: a. desire for growth and change b. entry into a long-term care facility c. recovery from an acute illness 7. Many of the aged can achieve wellness if the emphasis is placed on: a. optimum independence and the promotion of function for a specific individual b. cure c. physical therapy 8. As compared with nursing actions that are performed for a client, restorative nursing takes: a. less time b. more time c. as much time 9. It's a mistake to assume that a chronic illness automatically signals: a. the end of independence b. the need for a long-term care facility or full-time nursing care c. all of the above 10. Maintaining the stable phase of a chronic illness is primarily the work of the: a. restorative nurse b. the physician c. the caregiver d. all of the above NATIONAL EDUCATIONAL VIDEO, INC. TM 8

PRE TEST PART 2 If the following statements are true, circle T. If the statements are false, circle F. T F 1. Parkinson's disease is the most prevalent neurologic disease of the elderly. T F 2. Restorative techniques for Parkinson's disease emphasize movement. T F 3. Parkinson s disease can affect younger individuals. T F 4. The oasis assessment tool is useful in describing client health and functional status. T F 5. Depression is not commonly found in Parkinson s disease clients. T F 6. Signs of depression can include sleeping a lot, complaining about problems with nerves and not following plan of care. T F 7. Major depression is defined as a depressed mood on a daily basis for six or more months. T F 8. The cardinal symptom of COPD is shortness of breath. T F 9. The lungs act as agents to clean the air we breath. T F 10. When a person feels overwhelmed, you can help him by simplifying decision-making. NATIONAL EDUCATIONAL VIDEO, INC. TM 9

DISCUSSION QUESTIONS PART 2 1. Using the oasis assessment tool, discuss the clinical observations you would observe for a client with Parkinson s disease. 2. Discuss four useful tips for developing clinical pathways. 3. Discuss a teaching plan specific to the Parkinson s disease client. 4. Discuss a care plan for the client who suffers from depression. 5. Discuss a teaching plan for the client with COPD. NATIONAL EDUCATIONAL VIDEO, INC. TM 10

POST TEST PART 2 Choose the response that most accurately answers the following questions: 1. One of the major debilitating aspects of a chronic illness is: a. client fatigue b. dealing with the medical team c. caregiver incompetence 2. Clients sometimes refuse to comply with measures to improve or stabilize their illnesses because they: a. don't really want to get well b. don't believe the action required will have an effect on their condition c. they are just old and stubborn 3. One of the most difficult jobs of the restorative nurse is: a. to accept the client's limitations b. to believe any change is possible among the elderly clients c. to persuade some clients that one can grow within one's limitations 4. Restorative nursing techniques for Parkinson's disease emphasize: a. bedrest b. reading silently c. movement 5. Major depression is defined as a depressed mood on a daily basis for: a. two weeks or longer b. four weeks or longer c. 6 months or longer NATIONAL EDUCATIONAL VIDEO, INC. TM 11

POST TEST PART 2 (Continued) 6. The percentage of depression found in Parkinson s disease client is: a. 20% b. 40% c. 60% 7. The cardinal symptom for COPD is: a. cyanotic nails beds b. barrel chest c. shortness of breath 8. A Parkinson s disease client s care plan should include: a. effective communication b. grooming skills c. safety skills d. all of the above 9. As a means of exercise, restorative nursing takes advantage of: a. activities of daily living b. health clubs c. personal trainers 10. When a client's spirits are low and he feels overwhelmed, it is helpful to: a. give the client many choices b. keep decisions simple c. provide a cluttered environment for a lot of stimulation d. avoid the client NATIONAL EDUCATIONAL VIDEO, INC. TM 12

ANSWER SHEET PRE TEST PART 1 PART 2 1. T 1. T 2. F 2. T 3. T 3. T 4. T 4. T 5. T 5. F 6. T 6. T 7. F 7. F 8. F 8. T 9. F 9. T 10. F 10. T POST TEST PART 1 PART 2 1. a 1. a 2. b 2. b 3. c 3. c 4. a 4. c 5. b 5. a 6. a 6. b 7. a 7. c 8. b 8. d 9. c 9. a 10. d 10. b NATIONAL EDUCATIONAL VIDEO, INC. TM 13

RESOURCE ADVISORS DEBORAH UNSWORTH, M.S. ARNP: Received her Bachelor of Science Degree from the University of South Florida and her Master of Science Degree from State University of New York. She has worked as a nurse since 1973 in the areas of med-surg, obstetrics and ER. She has been a nurse practitioner and women s health educator since 1990 and is currently the Director of Education at National Educational Video, Inc. WILLIAM W. HANSELL, B.S.: Received his Bachelor of Science degree from the University of South Florida in Fort Myers, Florida. He has worked as a fire fighter/emt since 1982. He has been an officer with the North Naples Fire Control District since 1989 during which time he received his associate of fire science degree. Currently, he is an inspector with the fire department. NEVCO video educational programs are prepared using specific criteria designed by National Educational Video, Inc. TM All educational programs are coordinated and reviewed under the direction of the NEVCO Director of Education, who is a master s prepared nurse. NATIONAL EDUCATIONAL VIDEO, INC. TM 14 2003

REFERENCES Bailey, D., Litaker D., & Mion, L. (1998). Developing better clinical paths in healthcare: Combining best practice and the quantitative approach. Journal of Nursing Administration, 28(7), 21-26. Beers, M. & Berkow, R. (Eds). (2000). Chronic obstructive pulmonary disease. The Merck Manual of Geriatrics, (3 rd ed.). New Jersey: Merck & Co., Inc. 779-787. Bertholf, L. (1998). Clinical pathways from conception to outcome. Topics in Health Information Management, 19(2), 30-34. Eliopoulos, C. (1999). Using complementary and alternative therapies wisely. Geriatric Nursing, 20(3), 139-142. Herring, L. (1999). Clinical pathways: An efficient way to manage care. Nursing Standard, 13(47), 36-37. Huggins, C., & Phillips, C. (1998). Using case management with clinical plans to improve patient outcomes. Home Healthcare Nurse. 16(1), 14-20. Landry, M., Landry, H., Beare, P., & Roe, C. (2002). Guidelines for developing clinical paths in your agency. Home Healthcare Nurse, 19(2), 69-74. Lieberman, A. (2002). Depression in Parkinson s Disease. The National Parkinson Foundation, Retrieved December 9, 2002, from http://www.parkinson.org/depression.htm Micozzi, M., (2001). Complementary medical approaches. Fundamentals of Complementary and Alternative Medicine, (2 nd ed.). New York: Churchill Livingstone. 193-256. Rohrbach, J. (1999) Clinical pathways as an essential part of a disease management program. Journal of Nursing Care Quality, 14(1), 11-15. NATIONAL EDUCATIONAL VIDEO, INC. TM 15

Participant Evaluation of Objectives Please evaluate this program by circling the number that best represents how well this program met the following objectives: 4=Excellent 3=Good 2=Average 1=Poor 1. Describe attitudes conducive to restorative nursing. 4 3 2 1 2. Define the wellness continuum. 4 3 2 1 3. Discuss Maslow s hierarchy as it relates to the principles and practices of restorative nursing. 4 3 2 1 4. Describe the phases of chronic illness. 4 3 2 1 5. Discuss the four cardinal symptoms of Parkinson s. disease. 4 3 2 1 6. List 3 secondary symptoms of Parkinson. 4 3 2 1 7. Describe the cause of Parkinson. 4 3 2 1 8. Describe the signs of depression common to the Parkinson s disease client. 4 3 2 1 9. Identify the cardinal symptom of COPD. 4 3 2 1 10. List the teaching points for a client with COPD. 4 3 2 1 Do you feel you met personal objectives? Time required to complete this program? minutes COMMENTS: Return this form with the Participant Evaluation to your facilitator who distributed the learning materials. Thank You. NATIONAL EDUCATIONAL VIDEO, INC. TM 16 2003

NEVCO Account # REQUEST FOR CERTIFICATES FOR CONTACT HOURS TYPE the NAMES, LICENSE NUMBERS AND JOB TITLES (RN, LPN, MSW, CNA, PT, etc.) of the people who are to be issued a certificate for contact hours for attending the continuing education program: (Facility Name) (Title and Number of Video Program) This request must be submitted along with the completed roster and evaluation sheets for the above named program. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. NAME LICENSE NO. JOB TITLE

Must be completed by the facilitator EVALUATION OBJECTIVES: TIB Bank Center 599 9 th Street N., Suite 207 Naples, Florida 34102-5625 (800) 252-5604 Fax (888) 877-7255 www.nevcoeducation.com FACILITATOR S EVALUATION (NEVCO Video Education Program) (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning 4 3 2 1 The amount of material covered was adequate and accurate 4 3 2 1 There was effective use of time to cover the subject 4 3 2 1 CONTENT OF THE FACILITATOR S GUIDE List total number of objectives in this facilitator s guide List by number the objectives that were met The test material reflected the objectives listed 4 3 2 1 Content can be used to improve nursing practice 4 3 2 1 Content reflected knowledge level and needs of learner 4 3 2 1 The material was current 4 3 2 1 Evaluate Test Questions Pre-Test 4 3 2 1 Discussion Questions 4 3 2 1 Post-Test 4 3 2 1 FACULTY PRESENTING (Video) The presentation was 4 3 2 1 The presenter explained the material 4 3 2 1 The presenter demonstrated knowledge of material 4 3 2 1 OVERALL RATING I felt this teaching method was 4 3 2 1 COMMENTS (Please make suggestions for future topics and additional comments about the presentation or instructor) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

EVALUATION (NEVCO Video Education Program) TIB Bank Center 599 9 th Street N., Suite 207 Naples, FL 34102-5625 (800) 252-5604 Fax (888) 877-7255 www.nevcoeducation.com Must be completed by every participant EVALUATION OBJECTIVES: (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title OBJECTIVES Total number of objectives in program Circle the number of objectives that WERE met 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Circle the number of objectives that were NOT met 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning 4 3 2 1 The amount of material covered was adequate and accurate 4 3 2 1 CONTENT OF THE PRESENTATION The test material reflected the objectives listed 4 3 2 1 Content and/or skills demonstrated can improve my ability to perform my job 4 3 2 1 Content reflected knowledge level and needs of learner 4 3 2 1 The material was current 4 3 2 1 Time for questions was 4 3 2 1 Effective use of time to cover subject was 4 3 2 1 Graphics were beneficial 4 3 2 1 NEVCO FACULTY (who prepared the program and/or appeared in interviews) The presentation was well prepared 4 3 2 1 The presentation explained the material well 4 3 2 1 The presenter demonstrated knowledge of material 4 3 2 1 OVERALL RATING I felt this teaching method was 4 3 2 1 Facilities and classroom were adequate 4 3 2 1 COMMENTS (Please make suggestions for future topics, content of program and instructors) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

TIB Bank Center 599 9 th. Street N., Suite 207 Naples, FL 34102-5625 (800) 252-5604 Fax: (888) 877-7255 www.nevcoeducation.com CONTINUING EDUCATION ROSTER This form must be completed and returned to NEVCO. Keep a copy for your facility, but return the original to NEVCO. PRINT OR TYPE Account # Number and title of Video Program Dates Given Contact Hours Name of Facility Address of Facility City/State/Zip RN Facilitator Signature ROSTER OF PARTICIPANTS Participant Name Participant Signature License # Soc. Sec. # 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama 5-97.0, California CEP8803 and Kentucky 7-0045. This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. Participant Name Participant Signature License # Soc. Sec. #

599 9 th Street N., Suite 207 - Naples, FL 34102-5625 800-252-5604 Fax: 888-877-7255 www.nevcoeducation.com Certificate of Completion This is to certify that Attended and Completed National Educational Video, Inc. TM Program Number and Title For contact hours On Date Facility / Agency Name Facility / Agency Address RN / Facilitator CERTIFICATE FOR ASSISTANTS ONLY National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama 5-97.0, California CEP8803 and Kentucky 7-0045. This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

CERTIFICATE OF COMPLETION For each participant who has successfully completed a continuing education program, please make a copy of the blank NEVCO Certificate (on reverse side) and fill in the following information: 1. Name of the learner 2. Program title and number 3. Number of contact hours 4. Date the program was completed 5. Name and address of your Agency / Facility 6. Signature of the RN / Facilitator responsible for offering the program