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.     

Decision Support to Promote Healthy Weights in Children

Using health information technology to facilitate decision support and consumer engagement is a major component of federal electronic health record meaningful use (MU) criteria. Health information technology has the potential to improve primary care and track outcomes in the persistent problem of childhood obesity. We describe a computerized decision support tool we developed to gather patient information, raise family awareness of risks, facilitate patient-centered counseling, and implement clinical quality measures for childhood obesity. It has bilingual capacity, can be used in community screening and pediatric primary care, and provides tailored patient education materials that promote patient engagement.     

A crosswalk between the Omaha System and guiding undergraduate public health nursing education documents

The Omaha System is the hallmark evidence‐based clinical information management system used in nursing education, research, and practice. Multiple education documents guide public health workforce preparation. This qualitative study identified similarities and gaps between the Omaha System and seven guiding documents commonly used by nurse educators. A crosswalk design was employed. The setting was virtually based using online technology. Recommendations are for public health nurse educators to update their teaching practices using evidence‐based approaches.     

Interpretation of Ecological Theory for Physical Activity with the Omaha System

Physical inactivity is a global health problem. Public health nurses (PHNs) have great potential to influence population health outcomes in this area. However, methods are needed to increase understanding of the problem and the impact PHNs may have on measuring and changing health behavior. One promising option is PHN documentation of client health data. However, literature examining how health behavior theories align with nursing documentation systems that use standardized terminology is sparse. The purpose of this article was to operationalize an ecological theory with the Omaha System standardized terminology using physical activity as an exemplar. The goal was to provide a method for using PHN clinical documentation to examine physical activity from a theoretical perspective in research and practice. We designed and used a three‐phase process informed by the literature to conceptually map the ecological model for health promotion and the Omaha System. The results of the mapping process reveal the ecological nature of the Omaha System and provide support for measuring and analyzing health‐related behavior problems from an ecological perspective with Omaha System data. This process could be replicated with other health‐related problems and standardized terminologies to guide theoretically based nursing care and research.     

Nominations for Excellence: Collegial Advocacy for Nurse Practitioners

This study examined physician nomination data submitted for Syntex Nurse Practitioner of the Year Awards for 1988, 1989, and 1990. The physicians identified nurse practitioner contributions to patient care, community service/outreach, and education and research. A content analysis of the text data yielded themes within four major domains that described outstanding nurse practitioners in mutual practice relationships with physicians. The domains were clinical expertise, holistic caring, patient-centered activism, and leadership. The findings in this study indicated that physicians value the contributions of nurse practitioners that enhance the quality and scope of health care for patients within a mutual practice.     

The transforming effect of handheld computers on nursing practice

Handheld computers have the power to transform nursing care. The roots of this power are the shift to decentralization of communication, electronic health records, and nurses' greater need for information at the point of care. This article discusses the effects of handheld resources, calculators, databases, electronic health records, and communication devices on nursing practice. The US government has articulated the necessity of implementing the use of handheld computers in healthcare. Nurse administrators need to encourage and promote the diffusion of this technology, which can reduce costs and improve care.     

Use of NIDSEC-compliant CIS in community-based nursing-directed prenatal care to determine support of Nursing Minimum Data Set objectives

If the Nursing Minimum Data Set elements, specifically the nursing care elements, are included in a clinical information system, nursing will be able to measure outcomes and contributions to both healthcare and nursing to build knowledge using clinical data. The purpose of the reported study was to determine whether a Nursing Information and Data Set Evaluation Center-compliant clinical information system using the Omaha System could support the Nursing Minimum Data Set goal to describe nursing care in a community health setting. The secondary data set analysis was conducted. The findings showed that although the clinical information system was compliant with the standard, used a recognized American Nurses Association nursing vocabulary, and supported the collection of the Nursing Minimum Data Set, the data were not sufficient to address the purposes of the Nursing Minimum Data Set. The implications for nursing research and clinical practice are outlined.     

Factors influencing health practitioners’ cognitive processing and decision-making style

ABSTRACT

Successful interventions, healthcare planning, and patient-centered care require explanation, justification, and collaboration through interprofessional clinical decision-making (CDM). Understanding health practitioners’ decision-making styles and influencing factors can enhance CDM capabilities. Health professionals and students (N = 229) completed an online survey on their decision-making styles, interprofessional education, interprofessional practice, discipline education, clinical experience, processing styles, personality, interpersonal motivational factors, and age. To assess the influence of task structure, participants answered CDM questions on a high- and a low-structured case study. Age demonstrated an effect on the level of clinical experience, while clinical experience also mediated the effect of age on rational processing styles. While personality results were mixed, consistent with previous findings, conscientiousness predicted rational processing style. Effects of interpersonal motivation on personality were also mixed, insofar as results indicated an association between conscientiousness and both experiential and rational processing styles. Interpersonal motivation also predicted rational processing styles. The complexity of CDM and factors influencing healthcare practitioners’ processing and decision-making styles was highlighted. To optimize CDM processes by addressing errors and biases, CDM, and practice complexity, healthcare practitioner education should include theory-driven CDM orientation frameworks.     

The Omaha System and quality measurement in academic nurse-managed centers: ten steps for implementation

Measuring and describing client problems, nursing interventions, and outcomes is a challenge in nursing care. This study reviews the literature about the use of the Omaha System and describes the steps used to introduce and implement the Omaha System as a documentation and outcome measurement system in academic nurse-managed centers. The goal of the article is to provide a guide for nurse educators to develop and implement a quality measurement system that can be used in clinical settings by undergraduate students. The Omaha System is a strategy to introduce and incorporate evidence-based practice in the undergraduate nursing clinical experience.     

Nursing standards to support the electronic health record

Quality and low cost health care that is free of medical mistakes requires continuity of person-centric healthcare information across the life span and healthcare settings. Interoperable clinical information systems that rely on the use of multiple standards to support health information exchange and, in particular, nurse sensitive data, information, and knowledge are key components to support high quality, safe care. A 2004 Executive Order called for a National Health Information Network and the widespread adoption of electronic health records (EHRs) by 2014. While there are numerous standards influencing the exchange of health data, the primary focus of this article is to synthesize the state-of-the-art in nursing standardized terminologies to support the development, exchange, and communication of nursing data. Research exemplars are described for information systems to support nursing practice using standardized terminologies and secondary use of standardized nursing data from EHRs for knowledge development.     

Getting on the same page: an interprofessional common reading program as foundation for patient-centered care

A primary goal of interprofessional education is to produce clinicians who practice collaboratively to provide patient-centered care. This exploratory study evaluated whether students’ attitudes about a literary account of an illness experience endured after a year of professional and clinical education and if students applied lessons learned from a common reading to the delivery of patient centered care. Six focus groups were completed with health professions students and five main themes emerged from the focus group data. Themes include: Seeing family members as stakeholders; Establishing common ground with peers and the larger reason for graduate school; Applying lessons to clinical practice that see the patient as a person; Experiencing an emotional connection with a story and its characters; and Taking alternative perspectives/stepping into the shoes of the patient. Study results are discussed in relation to the interprofessional education literature, with implications for educators and interprofessional curricula also presented. We conclude that a common reading program may provide an effective means for developing health professions students’ knowledge and attitudes in the tenets of patient-centered collaborative care. It has the potential to build community through shared intellectual experience, facilitating meaningful reflection and perspective-taking in interprofessional learners.     

HIT plants SEEDS in healthcare education

By incorporating a clinical information system in the education curriculum as a teaching platform, the University of Kansas School of Nursing teaches nurses and other health professional students how to assess, plan, document and manage care in an electronic medium that develops healthcare informatics competencies. The outcomes of this integrated technology curriculum brings hope for transforming health professional education for 21st century practice and graduating a workforce with the leadership and competencies for improving quality and safety in patient care. It results in IT savvy healthcare providers who will cross the quality chasm.     

Nursing Diagnoses and Home Care Nursing Utilization

Abstract The purpose of this study was to identify, from routinely collected health care record data, patient characteristics that describe home care clients' health care needs and explain variation in home health care utilization. Retrospective data were obtained from a total of 317 home health care patient records from one home health care agency. Outcome variables of care included number of visits and hours of care. Predictor variables included nursing diagnoses, medical diagnoses, and patient demographic variables. Nursing diagnoses were classified by the Omaha System. Nursing diagnoses explained a significant amount of variance over and above the demographic and medical diagnosis variables in both the number of nursing visits and hours of nursing care. 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.     

Nurses' perceptions of the impact of electronic health records on work and patient outcomes

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.     

Preparing Today's Nursing Students for Tomorrow's Career

Federal directives, nursing and nursing education associations, as well as accrediting bodies emphasize the importance of integrating health information technology and EHRs into nursing practice. Additionally, informatics is a required competency of baccalaureate nursing graduates. Nursing education's efforts to enhance students’ learning in the area of electronic documentation is at its peak. The goal of enabling nurses to make healthcare safer, more effective, efficient, patient-centered, timely and equitable can only be achieved if a variety of technologies are clearly integrated into nursing education. Therefore, some schools have developed educational innovations to incorporate academic EHRs. As the mental health setting is unique, extraordinary attention has to be provided during the education of electronic documentation. Nursing education efforts must focus on interventions that provide resources that enhance the participant's knowledge and skills related to electronic documentation in a variety of clinical settings. Additionally, implementing academic EHRs in clinical settings offers nursing educators an opportunity to note the benefits. The state of nursing education depends on the accessibility to utilize academic EHRs in the nursing curriculum within the clinical setting to effectively prepare students for real-word practice.     

Application of the Omaha System in acute care

Although effective as a standardized language for documentation in community and public health settings, the Omaha System has not been evaluated in acute care settings. The purpose of this study was to evaluate the utility of the Omaha System to code the terms used by nurses when documenting hospital care. The nursing documentation in 30 hospital records was content analyzed for signs and symptoms, patient problems, and nursing interventions, then coded into the categories of the Omaha System. Degree of match was evaluated using concept match scores, and utility was determined using empirical, operational, and pragmatic criteria. Study findings suggest several strengths (i.e., high reliability, coded 97% of the problems, easy to use) and some limitations (lack of mutual exclusivity among terms, lack of semantic clarity, the need for three new problems). This study has important implications in demonstrating the utility of the Omaha System for possible expansion into acute care to standardize communication between the hospital setting and home care.