Patient problems and nurse interventions during acute care and discharge planning

The Application of the Omaha System in Community Rehabilitation Nursing for Patients With Stroke and Previous Falls

Objective

This study aimed to explore the use of the Omaha System in rehabilitation and nursing methods and the effects on patients within the community who had experienced stroke and previous falls.

Methods

This study enrolled 42 patients who had experienced stroke and previous falls and had returned to the community after being discharged from the Department of Neurology and Rehabilitation of the Affiliated Hospital of Nanchang University from January to July 2018. The patients were randomly divided into two groups: an experimental group (n = 21) and a control group (n = 21). Patients in the control group received routine community rehabilitation care, and patients in the experimental group received community rehabilitation care on the basis of the Omaha System. Intervention lasted for 1 year. The Omaha outcome score, the ability to perform activities of daily living (ADL) (measured via the Modified Barthel Index [MBI]), and the incidence of falls for each group were compared before and after the intervention.

Results

After 1 year of intervention, the Omaha outcome score and MBI of both groups were higher than before; the Omaha outcome score and MBI of the experimental group were higher than those of the control group; the differences were statistically significant (P < 0.05). No fall occurred in either of the two groups.

Conclusion

The Omaha System can comprehensively evaluate the health problems of patients, guide nursing intervention, and quantitatively evaluate the effect of nursing intervention; it is therefore worthy of promotion.

Nutrition interventions in patients with Crohn´s disease

Crohn's disease is a chronic non-specific inflammatory bowel disease of any part of the digestive tract. The seriousness of the disease requires a multi-disciplinary approach when providing patients with secondary and tertiary care. Patients also have specific problems from the nursing perspective that require intervention of nurses, e.g. in the area of nutrition. The role of a nurse in a specific community lies in supporting public health in the field of prevention, health education, group educational activities and care of the acutely or chronically ill. The regulation tool of nursing practice when providing community care is the documented form of nursing data expressed by means of expert terminology. The Omaha System is a standardised terminology for multi-disciplinary teams providing community care. The objective of the research is to draw attention to the possibility of using standardised terminology of the Omaha System when supporting public health in patients with Crohn's disease with nutrition problems. The research was divided into 3 stages: in the first stage we assessed the nutrition problem in 100 patients dispensarised in gastroenterology counselling centres using a form from the Omaha System. Out of these, identified 42 patients suffered from Crohn's disease and had problems with nutrition; in the second stage we chose interventions for nutrition from the Intervention Scheme of the Omaha System: their efficiency in patients was assessed by a nurse/nutritionist in the third stage of the research when the patients came to the gastroenterology counselling centre using Problem Rating Scale for Outcomes. When comparing the initial and final nutrition assessment with socio-demographic indicators we found a statistically significant difference (p = 0.000) between the status assessment where women scored a more remarkable advance than men when comparing the initial and the final assessment. With respect to age groups, education and jobs, no statistically significant differences were found (p >0.05). Nutrition interventions, according to the Omaha System, are linked to administering enteral and parenteral nutrition, monitoring of nutrition condition and education, management and consultancy during the diet that is individual and dependent on various factors.

Classifying Perinatal Advanced Practice Data With the Omaha System

This pilot study analyzed perinatal advanced practice registered nurse (APRN) diagnoses/client problems and interventions across sites using standardized terminology. APRN verbatim encounter logs from 8 patients in a previous study were coded by both the Omaha System and Current Procedural Terminology (CPT) codes. Previous outcomes were reduced preterm births, hospitalizations, and costs (Brooten et al., 2001). In 597 encounters (63% by telephone), 27 diagnoses and 8,077 interventions were recorded. Health Teaching, Guidance, and Counseling were 42%; Surveillance, 38%; Treatments and Procedures, 11%; and Case Management, 9%. Health Teaching, Guidance, and Counseling were most frequent in clinic (51%) and phone encounters (45%). Surveillance was 30% to 35% at each site. Treatments and Procedures occurred most frequently in home and clinic visits, whereas Case Management occurred most in clinic and phone visits. When coded with CPT, more than 80% of interventions were unlisted. Documentation using standardized terminology would facilitate the study of effective nursing interventions.

Describing pediatric hospital discharge planning care processes using the Omaha System

PURPOSE

Although discharge planning (DP) is recognized as a critical component of hospital care, national initiatives have focused on older adults, with limited focus on pediatric patients. We aimed to describe patient problems and targeted interventions as documented by social workers or DP nurses providing specialized DP services in a children's hospital.

METHODS

Text from 67 clinical notes for 28 patients was mapped to a standardized terminology (Omaha System). Data were deductively analyzed.

RESULTS

A total of 517 phrases were mapped. Eleven of the 42 Omaha System problems were identified. The most frequent problem was health care supervision (297/517; 57.4%). Three Omaha System intervention categories were used (teaching, guidance, and counseling; case management; and surveillance). Intervention targets are varied by role.

CONCLUSION

The findings provide a rich description of the nature of DP for complex pediatric patients and increase our understanding of the work of DP staff and the influence of the DP practice model.

Seeing the whole person: feasibility of using the Omaha System to describe strengths of older adults with chronic illness

A promising strategy for enhancing care and self-management of chronic illness is an integrative, whole-person approach that recognizes and values well-being. Assessment tools are needed that will enable health care professionals to perceive patients as whole persons, with strengths as well as problems. The purpose of this study was to examine the feasibility of using a standardized terminology (the Omaha System) to describe strengths of older adults with chronic illness. The Omaha System assessment currently consists of identifying signs/symptoms for 42 health concepts. Researchers mapped self-reported strengths phrases to Omaha System concepts using existing narratives of 32 older adults with 12-15 comorbid conditions. Results demonstrated the feasibility of describing strengths of patients with chronic illness. Exploratory analysis showed that there were 0-9 strengths per patient, with unique strengths profiles for 30 of 32 patients. Given that older adults with multiple chronic illnesses also have strengths that can be classified and quantified using the Omaha System, there is potential to use the Omaha System as a whole-person assessment tool that enables perception of both problems and strengths. Further research is needed to enhance the Omaha System to formally represent strengths-based as well as a problem-focused perspectives.

Identifying modifiable factors to improve quality for older adults in hospital: a scoping review

BACKGROUND

Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified.

DESIGN

Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology.

METHOD

We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria.

RESULTS

A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes.

CONCLUSION

The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care.

IMPLICATIONS FOR PRACTICE

Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.

Can home visits help reduce hospital readmissions? Randomized controlled trial

AIM

This paper is a report of a study to determine whether home visits can reduce hospital readmissions. Background. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive.

METHOD

A randomized controlled trial was carried out from 2003 to 2005 . The control group (n = 166) received routine care and the study group (n = 166) received home visits from community nurses within 30 days of hospital discharge. Data were collected at baseline before discharge and 30 days after discharge.

FINDINGS

Patients in the study group were statistically significantly more satisfied with their care. There were no statistically significant differences in other outcomes, including readmission rate, ADL score, self-perceived life satisfaction and self-perceived health. Regression analysis revealed that self-perceived life satisfaction, self-perceived health and disease category other than general symptoms were three statistically significant variables predicting hospital readmissions.

CONCLUSION

Preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well-being is a key variable that warrants attention in the planning and evaluation of postdischarge home care.

Care coordination for cognitively impaired older adults and their caregivers

Dementia and delirium, the most common causes of cognitive impairment (CI) among hospitalized older adults, are associated with higher mortality rates, increased morbidity and higher health care costs. A growing body of science suggests that these older adults and their caregivers are particularly vulnerable to systems of care that either do not recognize or meet their needs. The consequences can be devastating for these older adults and add to the burden of hospital staff and caregivers, especially during the transition from hospital to home. Unfortunately, little evidence exists to guide optimal care of this patient group. Available research findings suggest that hospitalized cognitively impaired elders may benefit from interventions aimed at improving care management of both CI and co-morbid conditions but the exact nature and intensity of interventions needed are not known. This article will explore the need for improved transitional care for this vulnerable population and their caregivers.

Utility of a Standardized Nursing Terminology to Evaluate Dosage and Tailoring of an HIV/AIDS Adherence Intervention

PURPOSE

To illustrate the utility of a standardized nursing terminology to calculate the dosage of the Client Adherence Profiling-Intervention Tailoring (CAP-IT) and to determine the extent to which a tailored intervention was delivered to 117 persons with HIV/AIDS who participated in the experimental arm of a randomized controlled trial (RCT).

METHODS

The intervention nurse assigned nursing diagnoses from the Home Health Care Classification (HHCC) based upon CAP scores. During the IT phase of CAP-IT, the nurse delivered and documented a tailored set of nursing interventions associated with the CAP and assigned nursing diagnoses. Hierarchical linear regression was used to evaluate the extent to which the number of interventions and intervention times were tailored to client needs.

RESULTS

Linear regression models that included CAP scores and nursing diagnoses as predictor variables explained 53.2% of the variance in total number of interventions and 58.9% of the variance in intervention time.

CONCLUSIONS

The use of the standardized nursing terminology enabled calculation of the intervention dose and documentation that a tailored intervention was delivered.

Global Case Management

This study applied a descriptive design to determine the usefulness of nursing diagnoses, on the basis of the Omaha System framework, in explaining utilization of primary health care services. Important findings include the identification of a medium number of problems for each client (M = 3.2), the broad range of problems, and an associated narrow number of interventions (M = 2.4 per client). The most frequently identified problems by domain were psychological (35.7%). Interventions were provided most frequently for diagnoses in the physiological domain with health teaching, guidance, and counselling of intervention category. The results of this study suggest that data related to nursing diagnoses are a valuable source of information when examining home health care nursing resource use.

Qualitative research contribution to a randomized clinical trial

Qualitative research may be combined fruitfully with intervention studies, but few examples provide detailed methodological strategies for doing so. In this article, we describe the qualitative component of a randomized clinical trial (RCT) of the PRO-SELF(c) Pain Control Program, an intervention that provides individualized education, coaching, and support for cancer pain management. We conducted three qualitative analyses of verbatim transcripts of "real-time" audiotaped intervention sessions. As a result, we were better able to ascertain the nature of the individualized coaching component of the intervention, patient and family caregiver use of selected intervention tools, and reasons the intervention did not work for some patients. Study results were used to increase the specificity with which the coaching portion of the intervention is described in the intervention protocol.

Peer support. An under-recognized resource in cardiac recovery

BACKGROUND

Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery.

AIMS

To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions.

METHODS

A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions.

RESULTS

Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery.

CONCLUSIONS

Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.

Community health service needs assessment in Korea using OMAHA Classification System

This study examined the appropriateness of OMAHA Classification System in identifying health service needs and relevant strategies for intervention by public health nurses working in community health centers in Seoul. The face-to-face interview using a questionnaire was used to assess individual and family health needs in the targeted district. Respondents were 4024 persons from 1449 households in one municipal district in Seoul, Korea. Based on OCS, 16 problems were identified including insufficient income and inadequate living space, ineffective communication with community resources, pain, and substance use. Health teaching, guidance and counseling, case management, treatment, and surveillance were identified as interventions for these problems. These results suggest that OCS is appropriate to implement in Korea to plan and organize better nursing interventions for community residents by public health nurses working in health centers.

Articulating the value-added dimension of NP care

Collecting standardized data to describe advanced nursing practice is imperative to define the value-added component of nurse practitioner (NP) care. This article describes NPs in a primary care setting who collected standardized nursing data using the Omaha System. Key findings include the prevalence of health teaching, guidance, and counseling and surveillance as frequent intervention strategies.

Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

OBJECTIVE

The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients >/= 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization.

DESIGN

A randomized clinical trial with repeated measures was used.

SAMPLE

A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients.

RESULTS

HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P <.05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P <.01) and lower reported stress (t = 3.77, P <.01) at 3 months after surgery was reported by HCI subjects.

CONCLUSIONS

Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.

A guide to assist nurse practitioners with standardized nursing language

The purpose of this project was to develop a guide to support use of the Omaha System in primary care. The Omaha System is a community practice-based standardized nursing language developed by the Visiting Nurses Association (VNA) of Omaha, NE. Nurse practitioners at a primary care faculty practice clinic began using the Omaha System to describe more completely the advanced nursing care provided to clients, beyond ICD-9 and CPT codes. After 9 months of data collection, key faculty members convened to analyze the data and discuss issues in coding and interpretation. To simplify use of the system and facilitate orientation of new faculty, this group devised a Primary Care Guide for the Omaha System. High-frequency problems and interventions were identified. Definitions of the intervention categories were reviewed, and targets appropriate for the primary care environment were recorded. The result was a concise, user-friendly guide to assist the primary care nurse practitioner in the use of standardized nursing language.

Advanced practice nursing in the care of frail older adults

Models of care for frail older adults have increasingly used advanced practice nurses (APNs) to achieve outcomes. Knowledge of the common APN functions and skills that contribute to the success of these models could better inform education and evidence-based practice and guide further research, but published investigations associated with models of gerontologic care neither describe fully these functions and skills nor link the activities of the APN with specific outcomes. Using examples primarily from the University of Pennsylvania School of Nursing, this paper identifies, describes, and analyzes common functions and skills of APNs in published gerontologic care models; examines the strength of the evidence for the effect of APNs on outcomes of care; and identifies areas for further study.

Home visits after hospitalization: enhancing baccalaureate nursing students' gerontologic clinical experience

This article describes posthospitalization visits by 83 nursing students to 57 older patients and their caregivers discharged from two large academic medical centers and one community hospital. Patient and caregiver interviews in the home focused on the areas of geriatric assessments of cognitive and functional status, patient and caregiver satisfaction with recent hospitalization, ongoing health management, patient teaching, and discharge planning.