Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

OBJECTIVES

To develop evidence-based standardized care plans (EB-SCP) for use internationally to improve home care practice and population health.

METHODS

A clinical-expert and scholarly method consisting of clinical experts recruitment, identification of health concerns, literature reviews, development of EB-SCPs using the Omaha System, a public comment period, revisions and consensus.

RESULTS

Clinical experts from Canada, the Netherlands, New Zealand, and the United States participated in the project, together with University of Minnesota School of Nursing graduate students and faculty researchers. Twelve Omaha System problems were selected by the participating agencies as a basic home care assessment that should be used for all elderly and disabled patients. Interventions based on the literature and clinical expertise were compiled into EB-SCPs, and reviewed by the group. The EB-SCPs were revised and posted on-line for public comment; revised again, then approved in a public meeting by the participants. The EB-SCPs are posted on-line for international dissemination.

CONCLUSIONS

Home care EB-SCPs were successfully developed and published on-line. They provide a shared standard for use in practice and future home care research. This process is an exemplar for development of evidence-based practice standards to be used for assessment and documentation to support global population health and research.

An empiric analysis of omaha system targets

Interface terminologies used in electronic health records must be re-evaluated and revised to reflect current health care practice and knowledge. To enable future revisions of the Omaha System Intervention Scheme, investigators evaluated formal semantic structure of target terms and concept duplication of problem and target terms. Using linguistic principles and qualitative analysis, five themes were found. A multidimensional formal semantic structure for the intervention target term was proposed. Concept duplication was examined for 16 problem-target matches. Clinical data enabled assessment of the validity of a proposed formal semantic structure and concept duplication. Recommendations are suggested for future development of the Omaha System Intervention Scheme.

Challenges and issues related to implementation of nursing vocabularies in computer-based systems

As key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated with implementing the vocabularies recognized by the American Nurses Association in several installations of commercially available clinical information systems. Although the focus of the article is on summarizing the challenges and issues, it is of note that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. The issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology.

Computerized charting--an essential tool for survival

Clinical documentation is becoming increasingly important, not only for patient care, but for satisfying payors' need for proof of efficient and cost-effective care. What factors are involved in a computerized documentation system and what should providers look for?

Children of battered women

Twenty children of physically abused women who were temporarily living in shelters were studied. These children, from 2 1/2 to 8 years of age showed significantly poorer cognitive, verbal, motor and quantitative abilities than would be expected in a normal population. They also demonstrated evidence of personality problems, with a concerning penchant for hostile-aggressive behavior. Hearing problems and articulation deficits were common. The children studied were from middle to lower-middle class families. The problems showed in this study group are felt to be an underestimate of the true prevalence of developmental and psychological problems in children of abused women. It is suggested that children are at a point of crisis just as admittedly few services available to abused women, there are even fewer services being provided to the children in such families. This is compounded by the relative unavailability of most recently assaulted women to attend to the emotional and developmental needs of their children. The need for health, developmental, and personality screening for children of abused women is highlighted, as well as the need for crisis intervention programs for such children. Groundwork has been laid through this research for more detailed clinical research to aid children of women who are physically abused. A greater appreciation of the problems encountered will facilitate appropriate interventions to optimize the growth and development of these children.