Evaluation of the Omaha System in an Academic Nurse Managed Center

Phyllis M. Connolly, PhD, APRN-BC, CS
Chia-Ling Mao, PhD, RN-C
Marian Yoder, EdD, RN
Daryl Canham, EdD, APRN-BC

Citation:
Connolly, P., Mao, CL., Yoder, M. & Canham, D.  (October, 2006). Editorial: Abbreviation Frenzy. Online Journal of Nursing Informatics (OJNI), 10, (3) [Online]. Available at http://ojni.org/10_3/connolly.htm

Abstract

This article describes the results of a continuous improvement project of the care received by 85 clients in an academic Nurse Managed Center. Undergraduate nursing students provided services for community living persons with mental illnesses utilizing the Omaha System. Data were collected from fall 2002 until fall 2004. A t-test was applied to the pre and post client Omaha Outcome Ratings. Statistical significance in the Omaha Outcome Rating Scales was found in the areas of Knowledge, Behavior, and Status for the problems of nutrition, prescribed medication regimen and personal hygiene.  Evidence was found that the Omaha System was a valid and effective data collection tool, a scientific guide for interventions, a positive teaching/learning tool, a structure for building evidence-based teaching and practice, and a reliable outcome measurement tool.  Limitations in this study included the use of a convenience sample, and the lack of a control or comparison group.

Key Words: Omaha, outcomes, mental illness, education

Evaluation of the Omaha System in an Academic Nurse Managed Center

This article describes the results of a continuous improvement study in an academic Nurse Managed Center (NMC) utilizing the Omaha System with undergraduate nursing students and faculty providing services for persons with serious mental illnesses living in the community. In addition, the study attempted to determine if best practices were being used in the NMC and to provide a benchmark for future studies.}

According to the Professional Standards for Psychiatric Mental Health Nursing Care, the assessment and treatment of the patient should be based on standardized classification systems (ANA, 2000). Moreover, the American Psychiatric Nurses Position Statement on Psychiatric-Mental Health Nurse Roles in Outcomes Evaluation and Management (APNA, 1998) specifically states that there is a  need to “provide PMH nurses with education on utilizing outcome evaluation measures in context of an interdisciplinary team within a variety of patient care settings,” and to “promote the use of valid and reliable data for the measurement and evaluation of nursing-sensitive indicators with the provision of the PMH services.”
Faculty providing services in the San Jose State University (SJSU) Nurse Managed Centers (NMCs) have found that the Omaha System provides the structure and facilitates meeting the educational goals for students to learn about the need to practice according to the Standards of Psychiatric-Mental Health Nursing Practice. It also builds their competencies in utilizing outcome measurements (ANA, 2000; APNA, 1998; Connolly & Elfrink, 2002; Connolly,Huynh, Gorney-Moreno,1999; Connolly & Novak, 2002). Furthermore, data collected over time allows faculty to observe for trends in patient populations and to monitor nursing interventions during a specific semester as well as over the years. Along with the emphasis on nursing outcomes, there is a demand for evidence-based practice (EBP). However, there is as much confusion around what is evidence-based as there is regarding defining what is quality. It is important to understand the terms and rules of EBP and the specific sources of knowledge (Jennings Mowinski & Loan, 2001). The main resource for EBP is the Agency for Healthcare Research and Quality (AHRQ). Sharing best practices and benchmarking against recognized effective practices are important activities in the effort toward continuous improvement.

Methodology

This retrospective evaluative study collected data from fall 2002 through fall 2004 in order to answer the following study questions:

1. Are client outcomes improved when measuring pre and post outcome ratings based on the Omaha System for specific problems?
2. Are the Omaha System problems identified those generally found among persons with serious mental illness living in the community?
3. Are the categories of intervention used appropriate for the identified problems?
4. Are the targets used for the interventions appropriate and relevant to the identified problems?

The review and analysis of the data were used by the Nurse Managed Centers care providers as one component of the continuous quality improvement process, benchmarking, and building evidence based teaching and practice in the Nurse Managed Centers. The Omaha Research Team collaborates in the research process and opportunities afforded by the on-going data collection. The study was approved by the University Institutional Review Board. Client identity was protected by use of a numbered coding system.

The four sites for the study included: 2 licensed board and care sites; 1 independent housing site, and 1 mixed site with transitional residential care. A system is in place for documentation within the four NMCs and specific protocols were established for the data collection for the fall 2002 through fall 2004 data collection period. Students were instructed to collect data on the 3 top priority problems for their clients during weeks 1 through 5 of each semester for the Pre-test data. Post-test data were collected during weeks 13 through 14. Clients admitted to the service after week 5 were not included in the study. A minimum of 6 weeks between the initial assessment of the outcome ratings (pre-test) and the final visit outcome ratings (post-test) was required for inclusion in the study. In order to ensure the reliability and validity of the ratings, the scanable form (data collection tool) was reviewed by each of the four faculty participants at the study site. All faculty were well trained and experienced users of the Omaha System.

The teaching of the Omaha System is integrated into the curriculum of the School of Nursing. The content is required as part of a Nursing Process Course and a self-paced Module provides the standardized learning experience for all students using the Omaha System (Connolly & Elfrink, 2002). Faculty in the clinical sites at the NMCs provide additional instruction for the use of the System as well as ensuring the reliability and validity of the data collection procedure. In addition, a published Case Study (Connolly, 1998) was used for the students in the psychiatric-mental health NMCs to ensure reliability and validity of the students’ use of the System and outcome ratings. Faculty did review and consult with the students regarding both pre and post ratings. Initially students tended to either overrate or underrate their client.

Approximately 200 ethnically diverse undergraduates participated in the study between fall 2002 and fall 2004, averaging 40 each semester. An electronic scantron form was used to collect data, titled, “Nurse Managed Centers Data Base: Problems, Interventions, Ratings” (Barrera, Machanga, Connolly, & Yoder, 2003). These forms and study protocol limited data collection to the three highest priority problems.

The data from 85 unduplicated clients were analyzed based on a program developed by the statistician and SPSS Version 11.0.  Analysis of these data provided reports of frequency, and percentages. The pre and post t-test on the difference in the mean of the paired t-tests was completed for the most frequently encountered problems for the Knowledge, Behavior, and Status Omaha outcome ratings. A separate data collection tool (Barrera, 2003) was used to collect demographic data for all the clients receiving services from the NMCs. The 85 subjects in this study are a subset of the population served by the NMCs.

Literature Review

The Omaha System

The Omaha System has been used since 1993 with the clients in the psychiatric/mental health Nurse Managed Centers at SJSU.  The Omaha System was developed for community-based practice between 1975 and 1986 (Martin & Scheet, 1992). A revision of the Omaha System was completed and published in 2005 (Martin, 2005).  One of the theoretical underpinnings of the System is Donabedian’s model (Donabedian, 1988) to the approach of assessing quality along the dimensions of structure, process and outcome. The Omaha System includes a Problem Classification Scheme, Intervention Scheme, and a Problem Rating Scale for Outcomes. The four Domains (environmental, psychosocial, physiological, and health related behaviors) compose Level 1 of the system. Level 2 includes the 42 Problems (Martin, 2005) that reflect specific health related areas of client needs.  The Problems can be viewed as foci, nursing diagnoses, problems, concerns and/or strengths. Once a problem is assessed and the type of problem determined, it is modified (Level 3) by client type – individual, family or community. After selecting the appropriate signs and symptoms, the problem is identified as an actual or potential problem for the client. The nurse then selects an action of care planning to document what will be done to help the client manage the problem. When a problem is added to the care plan, a baseline rating and a desired outcome is established regarding the client’s Knowledge (K), Behavior (B), and Status (S). The outcome rating scale is a 5-point-scale: 1 represents no knowledge; never appropriate behavior; and extreme signs/symptoms. And, 5 represents superior knowledge; consistently appropriate behavior; and no signs/symptoms. A higher rating number indicates that the client has better knowledge, more appropriate behavior and decreased signs and symptoms of the problem. The Intervention Scheme has 3 levels: the Category, Target(s), and client-specific information. The Categories, level 1, are composed of actions and activities which the practitioner performs and include: teaching, guidance, and counseling; treatment and procedures, case management, and surveillance. The definitions for the interventions are as follows (Martin, 2005, pp. 465-466):

Case Management: Activities such as coordination, advocacy, and referral that facilitate service delivery; promote assertiveness; guide the individual, family, or community toward use of appropriate resources; and improve communication among health and human service providers.

Surveillance: Activities such as detection, measurement, critical analysis, and monitoring intended to identify the individual, family or community’s status in relation to a given condition or phenomenon.

Teaching, Guidance, and Counseling: Activities designed to provide information and materials, encourage action and responsibility for self-care and coping, and assist the individual, family or community to make decisions and solve problems. Earlier versions of the Omaha System titled this intervention as Health, Teaching Guidance, and Counseling (Martin & Scheet, 1992).

Treatments and procedures: Technical activities such as wound care, specimen collection, resistive exercise, and medication prescriptions that are designed to prevent, decrease, or alleviate signs and symptoms for the individual, or community.

There are 62 Targets, in level 2. Lastly, level 3 includes client-specific information that may be needed for detailed information in the client’s care plan (Martin, 2005).   Reliability and validity of the Omaha System has been established in previous studies (Martin, 2005; Martin & Scheet, 1992).

Standardized Terminologies

Patient care documentation has changed in response to payer demands for defined outcomes of care, patient safety and quality care as well as the healthcare demands for interdisciplinary communication by using standardized terminologies in Electronic Health Records (ANA, 1996; Elfrink, 1999; Mallette, 2003; Martin, 2005).  In 2004, President Bush issued an Executive Order establishing the position of the National Coordinator for Health Information Technology and called for all Americans to have an interoperable electronic health record within 10 years. The Omaha System was selected for one form of the electronic health records since it is nationally recognized by the American Nurses Association (ANA), is simple, and easy to use by nursing and other disciplines, and includes the nursing process elements of diagnoses, interventions, and outcomes (Westra, 2005). Although application of computer use in the clinical and educational arenas needs to be emphasized for both management of patient data and nursing knowledge, integration of information technology skills and knowledge into nursing education has been slow with no consistent curricula existing in nursing education programs (McNeil et al.2003). However, the NMCs in this study already had experience with the Nightingale Trackers, a computer-based electronic communication system integrated with the Omaha System and one of the baccalaureate program outcomes is “to employ informatics at the basic practice level to improve health care delivery” (Connolly & Elfrink, 2002).

Standardized Nursing Languages (SNL) such as the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification System (NIC), and the Omaha System, are replacing problem-oriented narrative notes (Elfrink, 1999; Mallette, 2003; Sloan & Delahoussaye, 2003; Westra, 2005). One of the benefits of using a standardized language is that data elements have uniform definitions and codes. This allows the data to be aggregated for purposes of quality improvement, program evaluation, and research (Mallette, 2003; Martin, 2005; Westra, 2005).  In fact, this is how the data are used in the SJSU Nurse Managed Centers. Students in the NMCs use the Omaha System for documentation, it is required. Thus data are used to document and report progress over time. That same data are use for evaluation and research on the practice in the NMCs.

There are 13 standardized languages recognized by the ANA yet less than one third of the nursing programs address the use of standardized languages or terminologies in their nursing curriculum (McNeil et al. 2003).  It is essential that educators and health care providers in the next millennium possess information and communication skills in Web research, data management, and documentation that include the use of standardized vocabularies and electronic information processing (Elfrink & Martin, 1996).  These are skills today’s nursing graduates need to function successfully in many of the entry-level community and acute care positions (Connolly & Elfrink, 2002; Elfrink & Martin, 1996; McCannon & O’Neal, 2003).

Learning Environments

Selected clinical learning environments and teaching strategies that meet the increasing demands for a higher skill mix of nurses are critical elements for preparing nursing students to enter and remain in the workforce (Connolly & Elfrink, 2002; McNeil et al., 2003; Sloan & Delahoussaye, 2003).  Nurse Managed Centers provide a collaborative community-based experience by assisting students to synthesize the nursing role and develop clinical competencies in a more independent setting (Connolly & Elfrink, 2002; Connolly, Huynh, & Gorney-Moreno, 1999; Sloan & Delahoussaye, 2003). As a learning environment, experiences in NMCs, using the Omaha System, prepare new nurses for their first job. And, this plays an important role in shaping perceptions of nurses’ role in healthcare delivery, professional growth opportunities, and in turn perceptions of job satisfaction (Roberts, Jones & Lynn, 2004).

Health Problems Among Persons with Mental Illness

The Surgeon General’s report of 1999 states that, mental-health clients often have limited access to necessary health care services, suffer from chronic physical problems, frequently neglect physiological and self-care needs, and may not obtain help for their physiological problems because their psychiatric diagnosis interferes with appropriate identification and treatment (USDHHS, 1999).  The mortality rate is twice that of the general population; 50% have known medical disorders and 35% undiagnosed medical disorders (Jeste, Gladsjo Akiko, Lindamer, & Lacro, 1996). Furthermore, one in five persons with a brain disorder has a medical problem that may be causing or exacerbating his or her psychiatric condition (Jeste, 1996). Problems are related to multiple factors including denial of the illness, use of alcohol and street drugs, medication side effects, an unwillingness to manage the illness, stigma, and lack of family or social support.

Getty and Knab (1998) found that persons with mental illness living in the community have problems in understanding their health problem, performing health care and maintaining a healthy lifestyle. And, 81% of their study subjects had only fair to poor understanding of what were healthy foods. Moreover, the lifestyle of the population, smoking, poor nutrition, and physical inactivity increase the risk of cardiovascular disease, hypertension, diabetes and respiratory illness (Farnam, Zipple, Tyrell, & Chittinanda, 1999).  While there are connections between the need to smoke and schizophrenia, most consumers in one study had only fair to poor understanding of how smoking affected their health and many did not know how to quit even though they said they wanted to quit (Forchuk et al.). In an earlier study (Crosson, Lipscomb, Petkoff, & Petty, 1986) subjects were unaware of the effects of a diet high in sodium, sugar, and animal fats on diabetes or hypertension.

Recommendations for future health planning interventions from a study involving 154 consumers included health education programs that promoted teaching illness prevention and self-care with specific attention to the special learning problems such as: slower rate of learning, shorter attention span, limited complexity of learning, short-term memory deficits, less general knowledge and limited ability to adapt or cope with new and unfamiliar situations (Farnam, 1999). The need to implement these recommendations is evident in yet another study in which 92% of the subjects reported that medications had been prescribed for their health problems but nearly half were unable to give responses that were congruent with the medications recorded in their health records (Getty & Knab,1998). Eighty-two percent of the subjects claimed that their health care providers did tell them what they should do to take care of their problems on a day-to–day basis; 68% said they were able to carry out the health care action. However, only 40% described a health care action that was congruent with those recommended in their health record.

The strategies to meet the special learning needs of the population are important and could have a positive impact on medication adherence to both psychiatric medications and others. Most studies investigating factors related to medication compliance report that self-medication is a very difficult task (Barr, 2000; Kapur, Ganguli, Ulrich, & Raghu, 1991).

Results

Data from the 85 unduplicated participants who met the study criteria and received services during fall 2002 and fall 2004 were analyzed. The most frequently identified high priority Omaha System problems for the clients were: emotional stability (now titled mental health)(Martin, 2005), social contact, interpersonal relationship, nutrition, prescribed medication regimen, and personal hygiene. Although the data collection tool only allowed the students to identify 3 priority problems, from all the clients 6 problems were identified with statistical significance.

A statistically significant difference was found at the significance level of .05 for the paired t-test of the difference between the pre and post outcome ratings for the problems of Nutrition, Prescribed Medication Regimen and Personal Hygiene in Knowledge, Behavior, & Status (see Table 1). There was also a statistically significant finding for Knowledge for the problems of Emotional Stability (Mental Health), Social Contact, and Interpersonal Relationships. Although ratings increased for these same problems for Behavior and Status it did not reach significance. Thus the answer to study Question One was “yes,” the nursing care provided to these 85 clients did make a positive difference in the Omaha outcome rating scales (see Table 1).

The Omaha problems identified were those generally found among persons with serious mental illness living in the community (Connolly & Elfrink, 2002; Getty & Knab, 1998). Thus, the answer to study Question Two was “yes.” The data regarding the category of intervention used for the problem indicated that for Question Three, students were using the appropriate interventions for the identified problems. The primary intervention for the problems was health teaching, guidance, and counseling. Moreover, Question Four was also answered positively, the targets used by the students for the interventions were relevant for the identified problems (see Table 2). Overall, the most commonly selected targets focused on support system, interaction, and communication (Martin, 2005) (see Table 2).

Limitations

Clearly, there are limitations of this study, there was no control or comparison group. There is also no way to determine if these clients would have improved without the nursing interventions. No randomization was attempted although all clients met the study criteria for minimum length of care and data collection points. It is also possible that clients improved as a result of the therapeutic relationship established by the students over the semester, because clients were seen by the same student each week. In addition, there could be rater bias related to a belief or unconscious desire of the student to increase the ratings based on a less stigmatizing view of the symptoms and increased tolerance of the client’s behaviors.

The problems identified in this study only reflect the top 3 priority problems recorded by the students on the initial visit thus the study does not represent all the health problems of these clients. For example in an earlier study of the clients in the study sites, 34 of the 44 Omaha System Problems were identified by students (Connolly & Elfrink, 2002). Students did identify and provide care for other problems however those were not included in the data for this study.

Discussion

The 85 clients in this study appear to have benefited from the nursing care received as measured by the positive outcome ratings in the Omaha System. In addition, the context for the practice, the Nurse Managed Centers may also have influenced the positive outcomes. There is a continuous need to look for the synergistic relationships between context, professional nursing practice, and patient outcomes. The problems identified by the students do represent those identified in the literature (Connolly & Elfrink, 2002; Crosson et al., 1996; Farnam et al., 1999; Getty & Knab, 1998). The improved adherence to the prescribed medication regimen demonstrates the benefits of ongoing consistent teaching, guidance and counseling. Emphasis was placed on using appropriate teaching strategies for the special learning needs of the population as recommended by Farnam et al. (1999). and the need for continuous clarification about necessary health care action (Getty & Knab, 1998). Although the problem of Substance Abuse which would include smoking, was not among the highest frequency among the study problems, many of the clients smoke, thus it is a concern for the population. Because the identified problems needed to be those which the client agreed to work on, they may not have been as frequently identified as expected. The students were eager to list the problem however, when asked if they were collaborating with the client on the problem, frequently the answer was “No”, the client had not agreed to work on the problem. The issue was approached with several group educational programs on both the problems related to smoking as well as strategies and resources for smoking cessation. Later in the semester the problem became part of several client care plans.

Beyond a doubt, the major intervention used by the students was health teaching, guidance, and counseling and the targets used were both appropriate and relevant to the identified problems. Although the findings of this study may not be generalized, it suggests that continued use of the Omaha System in the Nurse Managed Centers is a positive teaching/learning approach and a method to achieve quality care through positive client outcomes. Finally, for these students, learning has occurred by successfully applying a standardized nursing classification system and effectively utilizing reliable and valid outcome measurements of their nursing care.

Future plans include revising the teaching module to reflect the changes in the Omaha System (Martin, 2005);  purchasing revised video materials with the revised System; revising the research protocols to ensure the collection of all study data; developing more web-based teaching materials for the Omaha System; and revising the documentation materials for client records.

The Omaha System has provided both faculty and students with a rich resource upon which to integrate the scholarship of teaching into research and service. Moreover, the use of the data from the Omaha System in the NMCs provides internal benchmarks for continuous improvement and building of evidence based teaching and practice.

References

American Nurses Association. (1996). Nursing quality indicators. Washington, DC: American Nurses Publishing.

American Psychiatric Nurses Association (1998, August). Psychiatric – Mental health nurse roles in outcomes evaluation and management  (Position Statement). Washington, DC: Author.

American Nurses Association, American Psychiatric Nurses Association, International Society of Psychiatric-Mental Health Nurses. (2000). Scope and standards of psychiatric-mental health nursing practice. Washington, DC: American Nurses Publishing.

Barger, B. S. (2004). Academic nursing centers: The road form the past, the bridge to the future. Journal of Nursing Education, 43, 6-65.

Barr, W. (2000). Characteristics of severely mentally ill patients in and out of contact with community mental health service. Journal of Advanced Nursing, 31, 1189-1198.  

Barrera, C., Machanga, M., Connolly, P. M., & Yoder, M. (2003). Nursing care makes a difference: Application of the Omaha documentation system. Outcomes Management, 7 (4), 181-185.

Connolly, P. M. (1998). Omaha System: Psychiatric home care case. [On–line], HYPERLINK   http://omahasystem.org/case1.htm

Connolly, P. M., & Elfrink, V. (2002). Using information technology in community-based psychiatric nursing education: The SJSU/NT project. Home Health Care Management and Practice. 14 (5), 344–352.

Connolly, P. M., Huynh, M. T., & Gorney-Moreno, M. J. (1999, Winter). On the cutting edge or over the edge? Implementing the Nightingale Tracker. On-Line Journal of Nursing Informatics [On-Line], 3(1), Available: http://www.eaa-knowledge.com/ojni/.

Connolly, P. M., & Novak, J. (2000). Teaching collaboration : A demonstration project. Journal of American Psychiatric Nurses Association, 6(6), 1–8.

Crosson, L. Lipscomb, E. Petkoff, M & Petty, R. (1986). Nutritional adequacy of meals in community residences.  Hospital and Community Psychiatry, 37(7), 736-737.

Donabedian, A. (1988). The quality of care. How can it be assessed? Journal of American Medical Association, 260, 1743–1748.

Elfrink, V. L. (1999, Winter). The Omaha System: Bridging nursing education and information technology. On-line Journal of Nursing Informatics [On-line]  3(1)Available: http://www.eaa-knowledge.com/ojni/.

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Forchuk, C., Norman, R., Malla, A., Martin, M.L, McLean, T., Cheng, S., Diaz, K., McIntosh, E., Rickwood, A., Vos, S., Gibney, C. (2002). Schizophrenia and the motivation for smoking. Perspectives in  Psychiatric Care, 38(2), 41-49.

Getty, C. & Knab, S. (1998). Capacity for self-care of persons with mental illness living in community residence and the ability of their surrogate families to perform health care functions.  Issues in Mental Health Nursing, 19(1), 53-70.

Jennings Mowinski, B., & Loan, L. (2001). Misconceptions among nurses about evidence-based practice. Journal of Nursing Scholarship, 33(2), 121–127.

Jeste, D. V., Gladsjo Akiko, J., Lindamer, L., & Lacro, J. (1996). Medical comorbidity in schizophrenia. Schizophrenia Bulletin, 22, 413 – 430.

Kapur, S., Ganguli, R., Ulrich, R., & Raghu, U. (1991). Use of random sequence riboflavin as a marker of medication compliance in chronic schizophrenics. Schizophrenia Research,6, 49-50.

Mallette, C.(2003). Nursing minimum data sets. In D. M. Doran (Ed.) Nursing-Sensitive outcomes: State of the science. (pp. 319– 53 ). Sudbury, MA: Jones & Bartlett.

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Table 1: Mean score and Results of paired t-test of Omaha System Outcome Ratings
N = 85

Note: ** Statistically significant difference between pre and post ratings, p≤ .05.

Table 2: Most Frequently Identified Omaha Problems, Interventions and Related Targets

Note: HTGC: Health Teaching, Guidance, and Counseling
          TP: Treatment & Procedure
         SUR: Surveillance

Authors’ Bios

PHYLLIS M. CONNOLLY PhD, APRN-BC, CNS,
Professor, School of Nursing
San Jose State University
1 Washington Square
San Jose, CA 95192-0057
www.sjsu.edu/nursing
408-924-3144 (O)
408-924-3135 (FAX)
CONNOLLYDR@SON. SJSU.EDU

Dr. Connolly is currently a full professor in the School of Nursing; Graduate Coordinator; Assistant Director of the School of Nursing; Coordinator for the Betty and Gordon Moore Funded Nurse Educator Option in the graduate program; Coordinator of the Psychiatric Nurse Managed Center; Chair for the Program Evaluation & Research Committee; Past Project Director for the FITNE Nightingale Tracker Project; a Past-President of the American Psychiatric Nurses Association, past President of the Alpha Gamma Chapter of Sigma Theta Tau, International, and, past Co-Chair of the California Alliance for the Mentally Ill AB 1278 Task Force on Families and Mental Illness.

Dr. Connolly's areas of expertise, publications, presentations, and research include serious and persistent mental illness, crisis intervention, psychosocial rehabilitation, web-based teaching; education, assertiveness training, total quality improvement, cultural diversity; collaboration, and organizational development. She initiated the use of the Omaha System within the Psychiatric Nurse Managed Center and is one of a few users of the Omaha System with persons with psychiatric disorders in the community. She was one of the recipients of a Learning Productivity award for Community Service Learning: A Collaborative Model for Professional Curricula and has received several San Jose State University awards for her collaboration work.

Dr. Connolly's 43 years in nursing include acute care in medical surgical nursing; community health; a private practice in psychiatric/mental health nursing; crisis intervention in the community; administration; teaching, and consulting.

Golden Gate University in San Francisco conferred her doctorate in public administration in 1987. Her clinical master’s degree in psychiatric nursing was awarded in 1981 from Rutgers University in New Jersey. She graduated Magna Cum Laude with a baccalaureate degree in humanities in 1974 from Georgian Court College in New Jersey. She received a diploma and an award for excellence in nursing in 1963 from Jersey City Medical Center in New Jersey.

Dr. Connolly maintains certification as a clinical specialist in adult psychiatric/mental health nursing by the American Nurses' Credentialing Center. She is a trained facilitator in the Mary Moller Simultaneous Consumer/Family Education Model and has conducted 12-week courses in collaboration with the School of Nursing’s Nurse Managed Center and a community mental health agency.

Chia-Ling Mao, Ph.D., R.N.
Associate Professor, School of Nursing
San Jose State University
One Washington Square
San Jose, CA. 95192-0057
www.sjsu.edu/nursing
(408)924-3152 (Office)
(408)924-3135 (FAX)
clmao@son.sjsu.edu

Dr. Chia-Ling Mao is an associate professor and Director of Nursing Research and Practice of School of Nursing at San Jose State University. Her doctorate and master degree in psychiatric nursing were awarded in 1985 and 1977 from Texas Woman’s University and University of Illinois at Chicago.  She is a certified Psychiatric Nurse by the American Nurses’ Credentialing Center.

Dr. Chia-Ling Mao started her teaching career in Taiwan and relocated to the San Francisco Bay area in 1995.  She has worked full time for San Jose State University, School of Nursing since August 2000.  She taught a variety of nursing courses in both undergraduate and graduate programs as well as presented community mental health related papers at regional, national, and international conferences.  Dr. Mao published many articles in peer reviewed journals and contributed to book chapters in psychiatric nursing and woman’s health.  Dr. Mao founded the first Mandarin speaking family support group for the mentally ill in collaboration with the National Alliance for the Mentally Ill in the Silicon Valley in 2001.  She mentors for advocacy and implementation of culturally competent care and facilitates cultural exchange internationally.

Marian K. Yoder Ed. D., RN
Professor, School of Nursing
San Jose State University
1 Washington Square
San Jose, CA 95192-00557
408-924-1324-0057
408 924-3135 (FAX)
myoder@son.sjsu.edu

Dr. Yoder is currently a full professor in the School of Nursing, the Coordinator of the six Nurse Managed Centers (NMC) operated by the School of Nursing, and Chairperson of the NMC Committee and the Omaha Research Task Force.  In the past she has served as the Case Management Curriculum Coordinator for the Building Competencies for Community-Based Practice HRSA Grant; the Clinical Coordinator for the Nursing Centers Without Walls: Primary Care on the Move (U S Health and Human  Services) Grant; the Satellite Coordinator for the Nurse Managed Centers: Impact on Cost and Quality (U S Health and Human  Services) Grant.  She has served as a health care provider, educator, and administrator in international projects in Kenya, Burundi, Saipan, Honduras, and Guatemala.

Dr. Yoder’s areas of expertise, publications, presentations, and research include Nurse Managed Centers, service-learning, multicultural education, international education, teaching ethnically diverse nursing students, community and home health care, and transcultural nursing.  She was a recipient of the San Jose State University award for research on College Teaching and Learning and was selected as a University Teacher Scholar.

Dr. Yoder’s experiences in nursing include providing care in acute medical-surgical nursing, intensive care, and community settings and teaching medical-surgical nursing, care of the adult, home health care, and community health nursing in vocational, diploma, community college, and university schools of nursing.  She has served on regional boards and state committees for the California Nurses Association, the American Nurses Association/ California and on professional boards for community and home health agencies.

Dr. Yoder earned a doctorate of  Higher, Adult and Professional Education at the University of Southern California with a specialty area of Administration; an MS in Nursing in the clinical area of community health nursing and functional area of teaching from San Jose State University. She received a BSN from Goshen College.

DARYL L. CANHAM, EdD, RN-BC
Associate Professor, School of Nursing
San Jose State Univeristy
1 Washington Square
San Jose, CA  95192-0057
www.sjsu.edu/nursing
408-924-1323 (Office)
408-924-3135 (FAX)
Canham@son.sjsu.edu

Dr. Canham is an Associate Professor in the School of Nursing; Coordinator of the School Nurse Credential/Clinical Nurse Specialist Program (graduate level); Faculty coordinator of the downtown Nurse Managed Center;  Co-coordinator of the California School Nurses Organization Coalition of School Nurse Educators (2004-2006); current treasurer of the Alpha Gamma Chapter of Sigma Theta Tau International; Co-chair of the California School Nurses Organization (CSNO) 2007 annual conference; Secretary of the Board of Directors of  Breathe California of the Bay Area; Member of the Editorial Board of the Journal of School Nursing.

Dr. Canham’s areas of expertise, publications, and research include utilization of the Omaha system in academic Nurse Managed Centers; measuring nursing care outcomes in the adult elder populations; delivering culturally competent care to diverse populations; community based care in pediatric settings; service learning; and collaborative partnerships.  She has played a leadership role in integrating nursing curricula and service learning.  She authors a bimonthly feature article for the Journal of School Nursing.

Dr. Canham’s 35 year nursing career includes ICU, School Nursing, Acute Pediatrics, Home Health, Coordinator of health programs for early childhood education, teaching, and consulting.

Dr. Canham received her doctorate in higher education from Nova Southeastern University, Fort Lauderdale, Florida in 1997.  Her Master’s degree was conferred in 1980 by the San Jose State University, School of Nursing, San Jose, California.  She graduated from the University of New Mexico, College of Nursing in 1971.

Dr. Canham maintains certification in community health nursing from the American Nurses Credentialing Center.  She holds a Preliminary Credential in School Nursing from the California Commission on Teacher Credentialing and the California Department of Education.