On the Cutting Edge Or Over the Edge? Implementing the Nightingale Tracker
By
Phyllis M. Connolly, PhD, RN, CS, My-Phuong T. Huynh, BSN, & Mary Jo Gorney-Moreno, PhD, RN

Abstract

Faculty and student involvement with  “point of care” technology increases teaching effectiveness and learning outcomes. The cutting edge technology of the Nightingale Tracker (NT) enables real time voice and data communication between students and their instructor. 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. The Omaha System incorporated into the NT, promotes a systematic approach to managing care and includes a rating scale for measuring outcomes.  Psychiatric nursing leadership in the use of technology is needed to increase collaboration among nursing and other disciplines for primary care. This article will describe the implementation of the NT into the community-based undergraduate psychiatric clinical at San Jose State University as one of FITNE’s  Seven Centers of Excellence.

Key words: Nightingale Tracker, Omaha System, FITNE

On the Cutting Edge Or Over the Edge? Implementing the Nightingale Tracker
By
Phyllis M. Connolly, PhD, RN, CS, My-Phuong T. Huynh, BSN, & Mary Jo Gorney-Moreno, PhD, RN 

Article

This article will describe the theoretical framework for change, the experience, process, outcomes, and evaluation of  implementing the Nightingale Tracker into the San Jose State University (SJSU) School of Nursing’s Psychiatric-Mental Health Nursing Practicum during the Fall 1998 semester. Recommendations for future users of the technology will be provided.

Background for the Project

            The Nightingale TrackerTM (NT) is an automated point of care (POC) information system developed by FITNE, Inc. (Elfrink & Martin, 1996.). The Tracker is used by students and instructors or preceptors to manage clinical communication. The Tracker enables real time voice and data communication between a student and the instructor or supervisor before, during or after the student-client visit. The Tracker facilitates the following five clinical education functions: (1) instructors’ computerized generation and electronic transfer of clinical assignments; (2) students’ computerized planning and development of automated yet individualized patient care plans using a nationally recognized and researched clinical vocabulary (the Omaha System); (3) instructors’ and students’ wireless voice and data messaging while the student is delivering patient care; (4) students’ computerized generation and electronic transfer of documentation data to their nursing instructors and those clinical agencies with compatible electronic client records;  and (5) students’ processing and instructors’ management of clinical summary data (Elfrink & Martin, 1996, p. 87).
The San Jose State University (SJSU) School of Nursing was very interested in serving as one of  FITNE’s Seven Centers for Excellence to showcase the Nightingale Tracker system, and successfully competed with forty-one other applicants to bring the technology on site. Having participated in FITNE’s clinical field testing in Spring 1997, the School of Nursing developed an early awareness of the Project’s needs. The School’s application to host the Project was strengthened by the earlier field testing with the technology; the use of a paper-based Omaha System in its Nurse Managed Centers (NMC); and a community based curriculum. San Jose State University School of Nursing Psychiatric Nurse Managed Center (NMC) had been using the paper version of the Omaha System (System) since 1994, and faculty had a high interest in the NT technology.  The NMC is one of only a few in the nation to use  the paper version of the System with a psychiatric population. Furthermore, the SJSU Institute for Teaching and Learning, implementing a California State University (CSU)-wide initiative, has been encouraging faculty to develop learning objectives and teaching strategies that “infuse technology into the learning and teaching processes to make them more effective, increase faculty and institutional collaboration and resource sharing, and enhance learner and faculty access to information resources and each other.” The Tracker Project allowed both nursing students and faculty and faculty, and students in other disciplines, to begin this process.

Psychiatric nursing leadership in the use of technology is needed to increase collaboration among nursing and other disciplines for primary care. Studies have demonstrated that there are many physical issues for persons with psychiatric disorders that are not currently being addressed by the medical primary care community. Easing the communication process should facilitate the treatment of these health issues. The results of studies indicated that, for persons with brain disorders, mortality rates are twice that of the general population, 50% have known medical disorders, and 35% have undiagnosed medical disorders (Jeste, Gladsjo Akiko,  Lindamer,  & Lacro, 1996). Furthermore, persons with schizophrenia may have increased risk of cardiovascular disorders, including myocardial infarction and coronary artery disease. Most importantly, one in five persons with a brain disorder has a medical problem that may be causing or exacerbating their psychiatric condition (Jeste et al.1996, p. 1362). In a study sponsored by the National Alliance for the Mentally Ill (NAMI), 33% of the 552 consumers of psychiatric services studied reported their physical health status as fair or poor (Uttaro & Mechanic, 1994). In primary care practices, anxiety disorders, depression and substance abuse are among the most frequently misdiagnosed disorders. Furthermore, the drive for cost-effective care demands relevant measurements of client outcomes--a priority and a particular challenge in the area of mental health.
The software in the Nightingale TrackerTM (NT) incorporates the Omaha System, a standardized reliable and valid method promoting a systematic approach to managing patient care, which includes a rating scale for measuring outcomes (Elfrink & Martin, 1996). The outcome measurements integrated into the Omaha System make it desirable for psychiatric-mental health nursing and meet a health care system need. Use of the Omaha System outcome measurements provides both individual and population data and is congruent with the Position Statement on Psychiatric-Mental Health Nurse Roles in Outcomes Evaluation and Management published by the American Psychiatric Nurses Association (1998), namely: to “provide PMH nurses with education on utilizing outcome evaluation measures in the context of an interdisciplinary team within a variety of patient care settings” and “promote the use of valid and reliable data for the measurement and evaluation of nursing–sensitive indicators within the provision of PMH services.”
One salient benefit for psychiatric nursing care is that NT not only includes the Omaha System’s complete assessment of the individual within four domains (environmental, psychosocial, physiological, and health related behaviors) but the NT’s software also includes a separate “head to toe” physical assessment component. This allows students to assess the whole person, which is critical to the health of persons with psychiatric disorders, clients whom these future nurses may encounter in their practice.
The Omaha System is also compatible with the documentation needs of other disciplines: in fact, the System is in use in SJSU’s Transdisciplinary Collaboration Project with the Communication Disorders faculty and students. Information technology helps nurses take better care of clients’ needs and allows nurses “to be leaders in automated health care information management”(Elfrink & Martin, 1996, p.89). The students involved in the NT Project will be better prepared to provide the needed services for an at-risk and underserved population.

Theoretical Framework

            Lewin’s (1951) field theory, specifically as it relates to planned change, served as the theoretical framework for the NT Project. According to Lewin’s concept of force field analysis of force within the life-space or environment, there are two opposing forces: one that produces change and one that tends to stop change. Lewin (1951) describes three phases of a social change: (a) dissatisfaction or unfreezing, (b) moving or conversion, and (c) stabilization or refreezing. According to Lewin’s theory, the driving forces are those that push toward a change position and the restraining forces are those that maintain the status quo. Therefore, in order to promote change, driving forces need to be increased and restraining forces decreased. By maximizing these two principles, as described below, the initiation and implementation of the NT Project was effective in addressing all three phases of change.

There were multiple driving forces which propelled this innovation. One of the strongest driving forces occurred during the unfreezing stage for this Project--the positive previous experience gained during the field testing of the NT, especially the positive student responses. Another driving force was faculty buy-in: since the faculty were already sophisticated users of the Omaha System, they understood the added-value a computer data base format brought to the curriculum. Additional driving forces included: (1) the ongoing use of the paper documentation of the Omaha System within the Nurse Managed Centers (NMC), (2) collection, analysis and a history of well-received presentation of Omaha System outcomes at national and international professional meetings, (3) inclusion of the Omaha System into the curriculum as part of a process course, (4) inclusion of Omaha data as part of the service definition of the School of Nursing (as one of its program outcomes), (5) the Semester 7 (identified for the NT first implementation) clinical course objective, “Utilizes information technology to improve care for psychiatric-mental health clients and at risk populations,” (6) a clinical performance objective of “utilizes World Wide Web to obtain information to improve client care,” (7) a School of Nursing program outcome, “employ nursing informatics at the basic practice level to improve health care delivery and outcome evaluation, and finally (8) the California State University System (CSU) goal which asserts that the “CSU should be known for using proven information technologies in ‘cutting edge’ ways to further its mission.” All of the above clearly served as driving forces, and increasing the identified driving forces facilitated and supported the changes needed for the NT Project.

            The restraining forces were also compelling. One initial restraining force was the FITNE Award of five Tracker devices for a clinical section which generally enrolled 10 students. Another restraining force was lack of experience with the technology of the clinical faculty member who planned to implement the NT with her clinical course. Unfunded time for preparation during the summer, as well as a lack of release time during the semester to carry out all the additional Project tasks, was a restraining force. Several infrastructure problems were restraining forces: these included an outdated faculty computer and printer as well as the lack of a required analog phone line in the faculty office. Additional restraining forces included: (1) finding and securing an adequate and secure room for the Server computer necessary to collect and process data, (2) lack of a printer for the Server, (3) training time for the students during the scheduled clinical hours, (4) incompatible phone lines in one of the clinical sites, (5) limited resources within the School of Nursing, the College, and the University, (6) outdated infrastructure for the NT technology, and lastly, (7) one student lived three hours away from the campus in another telephone area code, requiring her to incur the additional expense of a long distance call to participate in the Project from home) although she could do it for free from the campus or the agency). These all served as restraining forces. Clearly, in order to facilitate the changes needed to implement the NT, the restraining forces needed to be reduced or modified.

Preparation for Implementation

Train-the-Trainer

            The clinical faculty member, serving as Co-Project Director was responsible for the implementation of the NT. As part of the Award, she participated in the two-day training session provided by FITNE in Orlando, Florida during the Spring of 1998. The Information Technology Consultant in the School of Nursing who served as the Project technical support person also attended the training. Most of the technical support training sessions were separate from the nursing sessions.
The other Co-Project Director already had the necessary advanced technology knowledge and skills and had been the Project Director for the FITNE Tracker 1996 field test at SJSU. She was effective in negotiating with the School of Nursing and the University for additional resources and adaptations which were required in order to implement the Project. Additional College level and University information technology staff provided assistance and consultations as needed. Karen Martin, one of the developers of the Omaha System (Martin & Scheet, 1992), provided consultation on the Omaha during the training in Orlando and during the semester. Vicky Elfrink, the Project Development Manager from FITNE, provided the initial training in Orlando for nursing and remained a constant consultant, companion, problem solver, resource identifier and emotional supporter. Bruce Tong, the programmer of the information in the Tracker units from FITNE, provided consultation and support throughout the Project for all technical problems with the Trackers and the Server. The team was truly interdisciplinary and had many of the components of the “model team” needed for the new learning paradigm in universities. This “model team” was described by Barr and Tagg (1995) as “disciplinary experts, information technology experts, a graphic designer and an assessment professional” (p. 24).

            Upon returning from the training in Orlando, a Project timeline spreadsheet was developed indicating specific tasks and activities, areas of responsibility, target and  actual dates, comments, and outcomes. This project management spreadsheet served as both a record and a reference for team members and for the Director of Nursing. The timelines were reviewed frequently and during each team meeting. Meetings were set for the implementation team (the two faculty members and the technical support person), and monthly meetings were scheduled with the Director of Nursing and the Coordinator of the Nurse Managed Centers (she had participated in the field testing).
In preparation for the Orlando training, nursing participants were requested to write a case study and apply the Omaha System. Validity of the application of the Omaha System was provided by Karen Martin and the authors edited the cases. Subsequently the studies were placed on a server at the University of Florida and made available on the Internet (http://con.ufl.edu/omaha). The case study for a person with a psychiatric problem in the community (Connolly, 1998) became an integral part of the training at SJSU.

Pilot Training Session

In an effort to test out the Fall training session and to decrease some of the restraining forces, a four hour pilot training session was conducted during the summer. Nursing faculty, key information technology personnel, the Dean, our partners in the community, and a member from the Transdisciplinary Collaboration Project from Speech Pathology attended. The pilot training proved extremely beneficial and resulted in the engendering of knowledge, support and enthusiasm in faculty, staff, administrators and community members. This helped to expose the Project to more of the University and to provide another effort to garner more resources. The evaluations of the session were very positive.
This pilot training session proved a key milestone in moving the unfreezing stage of change. A senior student who had already completed the clinical in which the Tracker would be used and who was interested in participating as part of her senior clinical attended the training. This mentor student proved extremely useful as she had both experience at the clinical site, knew the clients, and was proficient with the Omaha System of documentation in its paper form. She kept the Tracker after the pilot training and during the summer learned the operating system and functionality of the Tracker through studying the manual and trial-and-error. Thus, she became a more advanced user and a mentor and was valuable in decreasing another restraining force. She demonstrated that utilizing peer mentors is a very effective teaching strategy for student learning. She wrote an extremely positive e-mail evaluating the pilot training which was forwarded to the Dean and may have influenced the Dean’s decision to allocate funds to purchase six more Trackers. The additional Trackers served to decrease a major restraining force.
SJSU’s Television Education Network (TEN) smart classroom was used to present the pilot training. This facilitated video-taping the training session, using the Elmo Projector (a visual presenter), PowerPoint, video player, and accessing the Internet, as well as an analog phone line for demonstrating the faxing capabilities of the Tracker. Videotaping the session allowed the team to review and evaluate the teaching strategies for effectiveness. As one of the motivators and rewards for nursing faculty and our community partners who were nurses, contact hours for nursing relicensure were obtained through the School of Nursing’s Continuing Education Program.
One restraining force, the lack of enough Trackers for the number of enrolled students, motivated the submission of a systemwide grant by the Project Directors for additional resources. In addition to Trackers, resources were sought for release time for the Project Directors in order to conduct necessary training to manage all of the additional responsibilities for data collection and on-going training (the grant was not funded). An application for a grant to the local Chapter of Sigma Theta Tau, Alpha Gamma, was submitted by the Project Directors. The application requested the purchase of a Tracker which could be designated the “faculty” Tracker and then utilized as the Trackers were implemented into various courses. Each Project Director received $200.00 to be used for the Project.

Implementation

Students were recruited utilizing the same method as for other sections of the course: that is, a description of the clinical and involvement in the Project was written and available on the bulletin board in the usual student information area. The two males and 6 females ranged in age from 22 to 30. All were full time and commuted, three were married, and three had children. The students were ethnically diverse and three were multilingual. Seven students were enrolled in a Nursing Practicum, Community Psychiatric Nursing in the Semester 7 level (students have 8 semesters to complete requirements for graduation), and one was enrolled in her senior Nursing Practicum on Advanced Nursing. The eight students received Trackers during the 3rd or 4th week of the semester based on availability.

Training of Subjects

            During the third week of the semester, the training session was conducted based on the successful summer pilot session (holding the training during the third week allowed faculty to orient the students to the course and introduce them into the clinical area during the first two weeks of the course). The TEN classroom was used and, again, the session was videotaped. This proved useful immediately as one student missed part of the meeting and viewed the tape later. One other variation included using a computer laboratory as part of the training session. This provided an even greater opportunity for students. Each student had his or her own computer and access to the Internet. They were able to access the FITNE site and view the case studies available at the various World Wide Web sites.

After obtaining consent forms from the students, the demographic survey (user characteristics) and Nightingale Tracker Impact Pre-Questionnaire (NTIQ) forms from FITNE were administered one week prior to the NT training session. Code numbers were assigned to both students and clients for the Project. The Project proposal was approved by the University’s Protection of Human Subjects Committee during the summer. Another NTIQ Post Teaching survey was administered immediately after the training, midway (5 weeks) during the use of the Trackers, and again at the end (10 weeks). In addition, the students completed a weekly log on how much time on the project was spent and any of their thoughts or concerns. These were collected weekly during the clinical supervision hour. All the data were sent to Vicky Elfrink, the primary researcher at FITNE. Tracker use was stopped one week before the actual semester ended and was evaluated.

The students were placed at two settings in the community: one was within walking distance of the campus and the other was approximately 30 minutes south of the campus.  Each student worked with one resident and completed his or her weekly documentation after demonstrating an understanding of the paper version of the  System and use of the System on the Tracker.  Although students met once a week, they were able to stay in touch with the faculty member through e-mail and fax during the week.  They also used the Tracker for their own personal use and to communicate with each other. Some actually used the calendar in the Tracker instead of some of their paper time management systems. Once students were able to connect to a phone either at home or at the clinical site, they were able to telephone any other place, and fax or e-mail the other students or the faculty member.

Infrastructure

An immediate challenge that we encountered at the southern site was an incompatible phone system.  The site had a digital system and the Tracker required an analog system.  It took us several weeks to diagnose the problem.  An agency representative did finally offer the use of the agency fax line and we will investigate a cell phone for the Spring semester.  Within the School of Nursing, the problem was accessing and printing the students’ e-mails on the faculty member’s computer.  This required installation of a special Ethernet line and Ethernet card which ultimately was still incompatible because of the Async Data Interface (ADI) box connected to the faculty member’s computer. The University’s infrastructure rewiring will be completed by May, 1999 and should resolve these issues.
Because of the current infrastructure, it was not possible to print out copies of students’ e-mails. Hard copies of the Tracker client records were obtained by faxing the records to the faculty member’s home fax. We did not use the University e-mail system to avoid conflicts in access and maintain confidentiality. Because each student had access to a free Internet account, we decided to use the  Server only as an Intranet, posting various Project related materials for the participants. Although our Server was “down” on several occasions, it still proved beneficial not to have the competition for the University’s e-mail resources.

In the CSU System, resources are allocated primarily through the Colleges. The University has approximately 20,000 full-time students, and the School of Nursing, with approximately 480 undergraduates, 150 graduate students, and 42 faculty,  competes for resources with others. Thus, a systemwide grant to fund aspects of the Project was submitted but ultimately not funded. During the Fall, we also submitted a proposal for a Champions Grant from the Institute for Teaching and Learning; however, it too was not funded for Spring 1999. We were invited to rewrite and resubmit for the implementation component of the Champions Grant for Fall 1999.
An upgraded computer and printer was necessary for the faculty member implementing the NT Project. Accepting faxes at the School of Nursing became an issue, primarily because of confidentiality issues. The clinical faculty person utilized her home resources to receive student information at her home fax. Additional resources obtained from the Sigma Theta Tau grant were used to purchase a keyboard and hardware for the Server.

How much time is needed for faculty and the technical support person? Far more than you anticipate. For the preparation and actual training of students, the co-Project Directors and technical support person added the tasks and time to their regular assignments. In addition, the faculty prepared and implemented the summer training session without compensation. However, most faculty expect to complete scholarly work during non academic times and the NT Project was considered as such.

The initial training day was 6 hours, and additional training was provided by approximately one hour sessions held for two more weeks at the end of the clinical day. After that, office hours for individual students were structured  from 11am until 12 noon each clinical day. Once they discussed the problem with the faculty member, students were given permission to leave the clinical area early and meet with the technical support person on campus. The need for those one to one meetings were less frequent after the fifth week. By the fifth week, we actually discovered that one of the Trackers was defective and it was finally replaced.

The technical support person estimated that he spent eight hours per week on the Project. That time included server problems, reconfiguring some of the Trackers, reinforcing training, and consulting with FITNE staff. A great deal of time was spent in problem solving the software and hardware problems which prevented printing hard copies of student e-mails. The ideal additional time for a faculty member who was responsible for training and implementation would be equivalent to 3 weighted teaching units (equal to a 3 unit course). Time is also needed between academic semesters to prepare materials for training sessions and problem solve issues which may be left over from the previous semester. It’s also important to continue building competencies in using the Tracker during semester breaks. Both Project Directors spent additional time in trying to identify and garner additional resources. Formal grants were submitted to three resources. Grant writing is a very time consuming yet necessary process. The Project definitely required much more faculty and staff time and challenged faculty and staff  technology skills.

Meeting the Challenges

Office Hours for Technical Support Person

Special office hours were set during practicum hours with the technical support person for problem solving individual problems.  After week five, there was far less need for the office hours. This was an important strategy because the technical support person was faced with multiple competing demands. This strategy will be utilized again in the Spring semester.

We had continuous support from all the staff at FITNE. We were able to participate in a “list-serve” so that we could learn from the problems reported by others.  In addition, Vicky Elfrink and Bruce Tong provided continuous and, in most cases, immediate help through e-mail, faxes, and phone on all the challenges and issues that arose. Considering the time differences between FITNE’s  midwest office and SJSU, the immediate feedback was an achievement. Most of our problems were not Tracker problems but were related to SJSU infrastructure problems which prevented maximizing use of the new technology.

Six criteria were used to evaluate the success of the NT Project based on the goals of the Project: (a) improvement of faculty – student communication, (b) providing an opportunity for students to manage patient care using computer technology, (c) establishing a network support system for students, (d) providing earlier feedback on care plans and Omaha ratings, (e) increasing teaching effectiveness, and (f) contributing to the body of knowledge. All six of the criteria were met.

            Students’ responses to the use of the Tracker varied. For most, they felt it was an asset and they were eager to be involved in the technology. Some comments included: “documenting is more enjoyable, it’s easier to go back and fix mistakes, [it’s] always legible.” Many liked the increased contact with the faculty member.  It was helpful to be able to send them messages as reminders, usually prior to their Wednesday clinical.  It also appeared that the students seemed to be doing better documentation using the Tracker than the students in a similar section using the paper version of the System. One comment from the student’s perspective supports this observation, “actually it is making me look more in detail at my patient.” This, of course, would be the area to do comparative research. A final comment from one student, “I will miss using such a great device that has made me feel competent in the new computerized world that health care is entering.”
            Students using the Trackers spent more time learning to use the NT software than the students using the pen-and-paper Omaha charting. However, the initial 6 hour training and subsequent training sessions were all conducted within the regular practicum time. They needed additional time to complete a weekly log and actually utilize the Tracker for client records. By week seven all students were reporting satisfaction in their weekly logs. At week nine one student wrote, “I think this a great way to access files instead of having to go thru [sic]so many papers to find out information.”
            Based on written evaluations with standardized questions, the students who participated in the NT Project reported the same level of satisfaction with the course as students enrolled in the same section and same clinical sites without the Tracker. Students were able to respond to questions about their client’s diagnosis and etiology, case management, and role of the family with the same degree of accuracy.

After the initial training session, each student in the class activated their own University Internet account. Prior to the training, only one of these seniors had activated their on-line free accounts with the university.  As part of their training we used the Web site to access case studies.  The psychiatric case study located at HYPERLINK http://con.ufl.edu/omaha/case19.htm  which had been developed as part of participation in the FITNE Project was used for the training. This helped to establish reliability and validity in the use of the Omaha System for the students. This was another unexpected positive outcome from the Project. The case also became part of the training for two additional sections of nursing students who were not involved with the NT Trackers and a new faculty member, and for the Transdisciplinary Collaboration Seminar. In fact, the additional cases available on the Web can now be used to teach the Omaha for some of the other Nurse Managed Centers students.

An outcome predicted by Batson and Bass (1996) “information technologies are providing faculty new venues of publication and professional collaboration, including electronic journals”(p.47), is evidenced with this article. The article, an outcome, was solicited for this on-line journal and includes the student peer mentor as a collaborator in the preparation. This is an example of collaboration on multiple levels. Publications and collaboration in research for faculty, students, and the University are a desirable outcome for the individuals as well as the University.

            The driving forces prevailed over the restraining forces and the change moved forward. The benefits and outcomes of the project facilitated the stabilization of the change. That is, they enhanced the driving forces and in some areas created additional driving forces. Moreover, some restraining forces have been decreased (eg., computer compatibility with the Server will be possible as soon as the new computer arrives). The generation of the Web-based case study and its use is an example of Batson and Bass’s (1996) claim that “the increased involvement of faculty in electronic environments is helping to breach the traditional boundary between scholarship and teaching” (p. 47), a definite stabilization factor for change. Approximately five faculty attended the Tracker Training, and each time that it is offered it is opened to our preceptors in the community, thus supporting stabilization of the change. As a result, one faculty who attended the training plans to include the use of the Web-based case studies for a learning activity in the Semester 7 Process course this Spring, The course, which is already televised, will offer a new and unique learning opportunity. Clearly, this is another example of stabilization of change.

            First and foremost, build a support network by identifying people involved with information technology in the university and let them know about the Project—build your team. There are many supports available and resources that can assist Project members. Increased visibility also increases the likelihood of garnering needed resources. Involve interested faculty and use incremental approaches--for example, offer Trackers to faculty during intersessions to help sensitize them to the technology. Second, organize materials for training sessions into packets which students can pick up with their other course materials. This also helps to reduce duplicating costs within your department. Third, use all forms of  teaching technology, videotape sessions and periodically reviewing them to improve teaching methods. Offer the videotapes to students who need to review or have missed a portion of the training. Utilize a learning environment which allows the use of computer, presentation software, video player, and accessing the Web. Fourth, obtain resources which enable the faculty member and technical support person some release time for the extra time involved in the Project. Purchase a keyboard, at least for faculty. Fifth, invite your community partners and provide contact hours for nursing relicensure as a reward for participants. Emphasize the experience to students and your community partners as active participants in research and cutting edge technology. And finally, remember that you and the students may feel as if you are not just on the “cutting edge” but are over the edge. This is to be expected and adds to the continued sense of excitement and effective collaboration that this Project offers.

Future plans include continuing to collect the research data for three years with FITNE, with additional courses utilizing and evaluating the technology over the next three years. This Spring, the psychiatric community settings will be used again for the Project. Students will be required to complete assignments earlier on the Tracker. A list of weekly performance objectives will be used: for example, by week two all students will be able to communicate effectively through the Tracker e-mail system. An NT Training packet has been developed and available for purchase in the student Print Shop. The course syllabus was revised and includes specific information and expectations related to the NT Project. Resources will be added to the Server that students could access through the Tracker.

An abstract has been submitted for the American Psychiatric Nurses Association Annual Meeting in Toronto in October 1999 and the Project will be presented during the International Council of Nurses in London this June. The technical support person plans to take a course in UNIX during the Spring. We will resubmit the proposal for the Champions Grant focusing on comparing the effectiveness of the technology. In  Fall 1999, the NT will be implemented into one section of an adult health care community experience, another stabilization strategy. We are already collaborating with the Speech Pathology faculty to connect the NT Project with another University funded project, “Community Service Learning: A Collaborative Model for Professional Curricula.” This project includes students and faculty from nursing, speech pathology, occupational therapy, therapeutic recreation, and social work.
Truly, the Nightingale Tracker Project has helped to change our paradigm from an instruction paradigm to a learning paradigm. We believe we have been designers of the “learning methods and environment” described by Barr & Tagg (1995, p. 17).

            The success of the Nightingale Tracker Project was made possible through the Award as one of the Seven Centers of Excellence by FITNE. The San Jose State University and the Alpha Gamma Chapter of Sigma Theta Tau International provided additional resources. The following SJSU staff: Bart Favero, Dave Kessler, and Deborah Young provided technical support along with the FITNE staff.
            A special acknowledgement is made to the students who were the pioneers in the use of this cutting edge technology as well as residents and staff from ALLIANCE for Community Care who supported us in this unique electronic communication system.

On the Cutting Edge Or Over the Edge? Implementing the Nightingale Tracker
By
Phyllis M. Connolly, PhD, RN, CS, My-Phuong T. Huynh, BSN, & Mary Jo Gorney-Moreno, PhD, RN

References

American Psychiatric Nurses Association (1998, August). Psychiatric – Mental health nurse roles in outcomes evaluation and management  (Position Statement). Washington, DC: Author.
Barr, R., & Tagg, J. (1995). From teaching to learning: A new paradigm for undergraduate education. Change, 27(6), 13 –25.
Batson, T., & Bass, R. (1996). Primacy of process: Teaching and learning in the computer age. Change, 28(2), 42 – 47.
Connolly, P. M. (1998). Omaha: Psychiatric home care case. [On–line], HYPERLINK http://con.ufl.edu/omaha/case19.htm.
Elfrink, V., & Martin, K. (1996). Educating for nursing practice: Point of care technology. Healthcare Information Management, 10(2), 81 – 89.
Felker, B., Yazel, J. , & Short, D. (1996). Mortality and medical comorbidity among psychiatric patients: A review. Psychiatric Services, 47, 1356 – 1363.
Jeste, D. V., Gladsjo Akiko, J., Lindamer, L., & Lacro, J. (1996). Medical comorbidity in schizophrenia. Schizophrenia Bulletin, 22, 413 – 430.
Lewin, K. (1951). Field theory in social science. New York: Harper & Brothers.
Martin, K., & Scheet, N. (1992). The Omaha system: Applications for community health nursing. Philadelphia: Saunders.
Uttaro, T., & Mechanic, D. (1994). The NAMI consumer survey analysis of unmet needs. Hospital and Community Psychiatry, 45, 372 –374.

On the Cutting Edge Or Over the Edge? Implementing the Nightingale Tracker
By
Phyllis M. Connolly, PhD, RN, CS, My-Phuong T. Huynh, BSN, & Mary Jo Gorney-Moreno, PhD, RN

Author Bios

PHYLLIS M. CONNOLLY PhD, RN, CS,
Professor, School of Nursing
San Jose State University
San Jose, CA 95192-0057
408-924-3144 (O)
408-924-3135 (FAX)

Dr. Connolly is currently a full professor in the School of Nursing, Director of the School of Nursing’s Institute for Research and Practice; Coordinator of the Psychiatric Nurse Managed Center; Coordinator for the Transdisciplinary Collaboration; Co-Project Director for the FITNE Nightingale Tracker Project; the Immediate Past-President of the American Psychiatric Nurses Association 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, and research include serious and persistent mental illness, crisis intervention, psychosocial rehabilitation, 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 the only user of the Nightingale Tracker 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.  She was nominated for Outstanding Professor from 1995 through 1996 and has received several San Jose State University awards for her collaboration work.

Dr. Connolly's 36 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.

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.

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.

My-Phuong T. Huynh

P.O. Box 51388
San Jose, CA  95151
408-787-8441
My105@hotmail.com

My spent her senior year of nursing school working in community psychiatric/mental health nursing, her area of interest. She prefers psychiatric mental health nursing over the traditional medical-surgical nursing because it gives her a chance to not only treat the patient’s physical illness, but also the psychosocial aspect of her patient. 

My’s leadership skills were shown through her organizing health promotion activities at the nurse managed center where she did her 120-hour independent preceptorship, and also serving as a mentor for semester 7 students who were going through their psychiatric clinical rotation. 

My was involved in the San Jose State University Transdisciplinary Seminar Project and FITNE’s Nightingale Tracker Project. The Transdisciplinary Seminar Project consisted of weekly meetings with other health fields (occupational therapy, speech therapy, and recreational therapy) to discuss client cases. This experience gave My an understanding of how the health team collaborated in order to provide the most complete health care services to the psychiatric client. The Nightingale Tracker Project is a change process of integrating the latest computerized communication and documentation tool into the nursing curriculum, a revolutionary concept of “using information technology at the point of care”. My was the only student in her semester involved in this new project.

Her goals for her nursing career include working in the community, preferably in psychiatric/mental health nursing, and continuing her education in order to become certified as a clinical nurse specialist.

EDUCATION

Institution                                                       Degree                                     Year
San Jose State University                                  BSN                                        1998
School of Nursing
San Jose, CA

Mary Jo Gorney-Moreno, Ph.D, R.N.

Biographical Information

            Dr. Gorney-Moreno is a  Professor in the School of Nursing at San Jose State University who served as an Alquist Center Faculty-in-Residence to provide support for faculty interested in the development of technology assisted instruction, Spring, 1998. Currently, Dr. Gorney-Moreno is Co-Project Director of a CLRIT funded project with faculty from SJSU, Sonoma State University, and CSU, Sacramento, working collaboratively to develop a Web-Based pharmacology simulation on pain management which was beta-tested by CSU campuses, Fall, 1998. She was co-awarded a Center of Excellence grant from Fuld Institute of Technology in Nursing Education(FITNE), Spring 1998 which designated the SJSU School of Nursing(SON) as one of seven Centers of Excellence in Community Healthcare and Technology. The SON serves as a showcase site for the Nightingale Tracker system. For this project co-directed by Dr. Mary Jo Gorney-Moreno, and Dr. Connolly, the SON was equipped with server hardware and software, 5 Nightingale Tracker devices and custom Tracker software, a full set of training materials, and free training for Dr. Phyllis Connolly and a support technician .
 
           Dr. Gorney-Moreno has authored and assisted in the production of a CD-ROM on Nursing Research published by  CV Mosby, St. Louis, MO, 1998. She co-authored a CD-ROM on Home Health Care in 1999 for Mosby, St. Louis. She has taught Nursing  Research on the Television Education Network for four semesters, in a synchronous video format offered to 5 off-campus sites. She was Research and Project Director for the FITNE Tracker™ beta test project, Spring, 1997, at the SJSU SON Nurse Managed Center in Los Gatos, CA.

            Dr. Gorney-Moreno has presented at Informatics Conferences nationally. She presented: Utilizing Hand-Held Computing Devices in Homecare Nursing, POC charting, and Decision support at The Forum for Hand-Held Computing in Healthcare ‘98, New Orleans, Louisiana, May 20-22, 1998. She co-presented., on “Integrating Information Technology in the Undergraduate Curriculum: Report of the Tracker Research Project,” Sigma Theta Tau, International, December 2, 1997, Indianapolis, Indiana. In addition, Gorney-Moreno co-presented on  “Strategies for Integrating Information Technology in the Undergraduate Curriculum,” at the FITNE Information Technology and Community Healthcare Conference, St. Louis, Missouri, July, 22, 1997.

Education

            Dr. Gorney-Moreno received her Ph.D. in Higher, Adult, and Continuing Education from the University of Michigan(U of M), 1985, and a Master’s Degree in Psychiatric/Mental Health Nursing from U of M, in 1975. She received her Bachelors in  Social Work from Michigan State University in 1971, and her nursing degree from St. Mary’s School of Nursing in 1968.