A critical review of Omaha System use at the community level Karen A. Monsen, MS, RN Madeleine J. Kerr, PhD, RN Karen S. Martin, MS, RN Linda Olson Keller, MS, RN MNRS 4/3/2006

Purpose To determine the state of the science of using a standardized nursing classification, the Omaha System, to describe community level problems, interventions, and outcomes

Background In 2005, the second edition of the Omaha System was published that contained a community modifier Several exemplars using the community level modifier have since been developed and published related to diverse topics

Data Points in the Omaha System Omaha System Environmental (4) IncomeSanitationResidenceSafety Signs & Symptoms Category (4) Target (75) Client Specific Information Knowledge Behavior Status Modifiers Identity Individual Family Community Severity Actual Potential Promotion Psychosocial (12) Physiological (18) Health Related Behaviors (8)

Methods integrative descriptive review Criteria for assessment of these studies populations served problems addressed by domain interventions used by category reliability of data collection concurrent validity measures used outcomes measured internal and external controls implemented

Outcomes and Interventions in a Community- based Senior Health Clinic Populations served: Seniors in a high rise Problems addressed: Nutrition (HRB) Interventions used: Teaching, guidance, & counseling (1); Surveillance (4) Vance, E. A.; Fish, C. A. (2005). Poster presented at the Omaha System International Conference, Minneapolis, MN

Outcomes and Interventions in Health Promotion/Employee Health Populations served: Employees in a public health department Problems addressed: Circulation (Phys) Interventions used: Teaching, guidance, & counseling (1); Surveillance (4) Fish, C. A.; Vance, E. A. (2005). Poster presented at the Omaha System International Conference, Minneapolis, MN.

Using the Omaha System to Describe Community Level Depression and Suicide Interventions Populations served: Adolescents Problems addressed: Mental health (Psych) Interventions used: Case Management (3); Surveillance (4) Galligher, P. S., & Monsen, K. A. (2005). Poster presented at the Omaha System International Conference, Minneapolis, MN.

Maines Approach Modifier Community Problem Communicable/ Infectious Condition Populations served: TB Clinics Problems addressed: Communicable/Infectious Condition (Phys) Interventions used: Teaching, guidance, & counseling (1); Surveillance (4) Correll, P. (2005). Paper presented at the Omaha System International Conference, Minneapolis, MN.

West Nile Virus Outbreak: Reduce Disease Transmission in a Community Populations served: A Minnesota County Problems addressed: Communicable/Infectious Condition (Phys); Neighborhood/Workplace Safety (Env) Interventions used: Teaching, guidance, & counseling (1); Case management (3); Surveillance (4) Keller, L. O., MN Omaha System User Group (2005). Case study in Martin, K. S., Omaha System (2 nd ed). Elsevier: St. Louis.

Compliance checks: Strategies to decrease tobacco sales to teens in the community Populations served: Adolescents Problems addressed: Substance use (HRB) Interventions used: Teaching, guidance, & counseling (1); Surveillance (4) Galligher, P., Minnesota Omaha System Users Group (2005). Case study in Martin, K. S., Omaha System (2nd ed). Elsevier: St. Louis.

Garbage odors: Resolving a problem at a senior apartment building in the community Populations served: Seniors in a high rise Problems addressed: Sanitation (Env); Communication with community resources (Psych) Interventions used: Teaching, guidance, & counseling (1); Case management (3); Surveillance (4) Ottinger, B. (2005). Case study in Martin, K. S., Omaha System (2nd ed). Elsevier: St. Louis.

Influenza Outbreak: Reduce Disease Transmission in a Community Populations served: A Minnesota County Problems addressed: Communicable/Infectious Condition (Phys) Interventions used: Teaching, guidance, & counseling (1); Treatments & Procedures (2); Case Management (3); Surveillance (4) Keller, L. O., Minnesota Omaha System User Group (2005). Case study in

Results Eight community case studies and reports described diverse problems from all domains of the Omaha System Problem Classification Scheme; all intervention Categories, and reported Knowledge, Behavior, and Status outcomes.

Results, continued Data reliability was addressed in one practice setting for two of the case studies. KBS rating guides were created for inter-rater agreement purposes Concurrent validity was addressed in two studies. Blood pressure measurement Evaluation scores

Limitations difficulty reporting novel Omaha System outcome data to the uninitiated the usual limitations of observational descriptive studies

Implications The Omaha System has the capacity to describe community level problems, interventions, and outcomes (face validity). These case studies provide a beginning platform for research agendas related to use of standardized classifications for community level intervention and outcome research.