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Çalışmada, aile sağlığı merkezinden (ASM) hizmet alan bireylerde fiziksel aktivitenin Omaha Sistemi ile incelenmesi amaçlanmıştır. Bu kapsamda fiziksel aktivite ile ilişkili faktörler Omaha Sistemi Problem Değerlendirme Ölçeği (PDÖ), Omaha Sistemi Problem Sınıflama Listesi (PSL) ve Sağlığın Geliştirilmesi için Ekolojik Model kapsamında incelendi. Çalışma tanımlayıcı ilişki arayıcı tipte planlandı. Araştırmanın örneklemini 18 yaş ve üstü, fiziksel aktivite problemi olan 350 birey oluşturdu. Veriler Omaha Sistemi PDÖ ve PSL, Uluslararası Fiziksel Aktivite Ölçeği ve Sağlığın Geliştirilmesi için Ekolojik Model kapsamında belirlenen demografik verileri içeren Görüşme Formu ile toplandı. Çalışmada ASM'ye başvuran ve Omaha Sistemi PDÖ'ne göre inaktif olan bireylerin Fiziksel Aktivite bilgisi puan ortalaması 2,94±1,01 (min-maks:1-5), davranış puan ortalaması 1,95±0,9 (min-maks:1-3) ve durum puan ortalaması 1,91±0,9 (min-max:1-3). Bireylerde en sık görülen sağlık problemleri sırasıyla Fiziksel Aktivite (%100), Ağız Sağlığı (%61,2), Görme (%53,7) ve Beslenme (%52)'dir. Bireylerin Uluslararası Fiziksel Aktivite Ölçeği'ne göre %59'u inaktif ve %41'i minimal aktif olarak belirlenmiştir. Bireylerin oturma süreleri ortalamaları 354,09±192,77 dakikadır (medyan±Q3-Q1=300±240). Bireylerin çalışma durumu, yaş, eğitim düzeyi, gelir düzeyi, medeni durum ile Omaha Sistem problemlerinden görme, işitme, ağız sağlığı, deri, solunum, dolaşım, sindirim-hidrasyon, bağırsak fonksiyonu, sağlık bakım denetimi, konut ve yaşanılan mahalle/ iş yeri güvenliği fiziksel aktivite davranışı ile ilişkili bulunmuştur (p

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.

Objective Conduct and evaluate system-level evidence-based practice intervention for deep vein thrombosis (DVT) prevention. Design One group post-intervention survey evaluation. Setting A mother-baby unit in a tertiary hospital. Interventions/measurement Educating nurses, implementing an evidence-based deep vein thrombosis (DVT) prevention guideline in the mother-baby unit, and recommending policy changes. Outcomes were measured using Omaha System Knowledge, Behavior, and Status scales (1 = lowest–5 = highest) for nurse DVT knowledge and practice behavior, and implementation of policy recommendations. Results Twenty nurses (80%) completed the evaluation survey. The nurses reported that their knowledge increased significantly (3.70 vs. 4.40; p Conclusion Comprehensive evidence-based interventions resulted in practice and system change to prevent DVT. Nurses’ knowledge about DVT prevention increased and some nurses consistently assessed for DVT and applied compression boots. The facility supported the implementation of the guideline and implemented unit/facility policy changes.

SummaryVisualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period.Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 deidentified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis.The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed.We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes.Citation: Radhakrishnan K, Monsen KA, Bae S-H, Zhang W. Visual analytics for pattern discovery in home care: Clinical relevance for quality improvement.

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.

Objectives Public health nurse (PHN) perceptions of using standardized care plans to translate evidence-based guidelines into family home visiting practice have not been examined. The purpose of this study was to evaluate PHN experience and awareness of cognitive processes while using evidence-based care plans in family home visiting practice. Design This qualitative study used content analysis of PHN interviews. Sample A purposive sample of PHNs in a local public health agency who were experienced in the use of care plans in electronic documentation. Measures The qualitative study utilized content analysis methods. Semi-structured interviews examined their cognitive experience transitioning from usual practice care plans to evidence-based care plans. Interviews were transcribed and analyzed using a thematic analysis approach. Themes were developed and revised following several reviews of the transcripts. Results Four themes from PHN interviews revealed a complex dynamic process of knowledge management: (1) PHN thinking is separate from the care plan. (2) PHN thinking is supported by the care plan. (3) PHN thinking is stimulated by the care plan. (4) PHN documentation distress is minimized when the care plan matches PHN thinking. Conclusion While using the evidence-based FHV care plan, PHN cognitive processes were related to their own knowledge and expertise, their individual clients, and the entire client population or program. Evidence-based care plans supported and stimulated PHN thinking about evidence-based interventions and their application in practice. A good fit of the care plan knowledge schemata with a PHN's own knowledge schemata may decrease documentation distress. Further research is needed to evaluate the impact of using evidence-based care plans in other disciplines and settings.

Objective(s) Examine factors related to physical activity among rural women using Omaha System data. Design and Sample Mixed methods: quantitative analysis of de-identified clinical data and thematic analysis of public health nurse (PHN) focus group data. Rural women who received PHN services (N = 852) and purposively selected PHNs (N = 12). Measures Omaha System problems; signs/symptoms; knowledge, behavior, and status ratings; demographics. Results Physical activity behavior among rural women was inconsistently appropriate (M = 3.27). Age, body mass index, physiological, psychosocial, and environmental domain problems, and physical activity knowledge explained 33.2% of physical activity behavior variance. Almost all women for whom specific problems were documented had insufficient physical activity. This included physiological problems of cognition and pregnancy; psychosocial problems of abuse, caretaking/parenting, mental health, and interpersonal relationship; and environmental problems of neighborhood/workplace safety and income. Having problems in two or more domains was significantly associated with insufficient physical activity behavior (p

Omaha System data are text data that consist of standardized terminology and customized descriptions. The customized descriptions related to patient care reveal changes in a client's status over time. These data help public health nurses to understand the patient's progress and to plan future care. However, most electronic health records do not provide clinicians with efficient displays of stored text data. The purpose of this study is to develop point-of-care review screens for Omaha System data on an individual patient level and examine nurse perceptions of the usefulness of the displayed data in improving patient care. Individual patients' data were organized on a Web-based overview page to present all of the health problems that a client had and on detailed pages to present all records of Omaha System data regarding each health problem. Nurse survey results indicated the usefulness of at-a-glance displays of text data on patient care and nurses' decision making. The meaningful review of patient data using a health information system supports patient-data-driven, evidence-based practice and decision making.

Background Nursing documentation could improve the quality of nursing care by being an important source of information about patients’ needs and nursing interventions. Standardized terminologies (e.g. NANDA International and the Omaha System) are expected to enhance the accuracy of nursing documentation. However, it remains unclear whether nursing staff actually feel supported in providing nursing care by the use of electronic health records that include standardized terminologies. Objectives a. To explore which standardized terminologies are being used by nursing staff in electronic health records. b. To explore to what extent they feel supported by the use of electronic health records. c. To examine whether the extent to which nursing staff feel supported is associated with the standardized terminologies that they use in electronic health records. Design Cross-sectional survey design. Setting and participants A representative sample of 667 Dutch registered nurses and certified nursing assistants working with electronic health records. The respondents were working in hospitals, mental health care, home care or nursing homes. Methods A web-based questionnaire was used. Descriptive statistics were performed to explore which standardized terminologies were used by nursing staff, and to explore the extent to which nursing staff felt supported by the use of electronic health records. Multiple linear regression analyses examined the association between the extent of the perceived support provided by electronic health records and the use of specific standardized terminologies. Results Only half of the respondents used standardized terminologies in their electronic health records. In general, nursing staff felt most supported by the use of electronic health records in their nursing activities during the provision of care. Nursing staff were often not positive about whether the nursing information in the electronic health records was complete, relevant and accurate, and whether the electronic health records were user-friendly. No association was found between the extent to which nursing staff felt supported by the electronic health records and the use of specific standardized terminologies. Conclusions More user-friendly designs for electronic health records should be developed. The poor user-friendliness of electronic health records and the variety of ways in which software developers have integrated standardized terminologies might explain why these terminologies had less of an impact on the extent to which nursing staff felt supported by the use of electronic health records.

Aims The aim of the present paper was to establish and implement an integrated nursing management model for patients with newly-diagnosed type 2 diabetes mellitus (T2DM) based on the Omaha System and to explore its impact on blood glucose levels, quality of life, and diabetes knowledge in these patients. Methods A non-randomized concurrent controlled trial was designed and the study was conducted in a hospital on the east coast of China between September 2013 and November 2015. We screened for patients with newly-diagnosed T2DM in 12 clinics of 3 comprehensive hospitals. A total of 367 patients with newly-diagnosed T2DM were assigned into two groups. In the intervention group, patients received routine outpatient care plus integrated nursing management; in the control group, only routine outpatient care was given. Changes in blood glucose levels, quality of life, and diabetes knowledge in both groups before the intervention and 6 months after the intervention were observed and compared. Results At the 6 months, blood glucose levels, quality of life, and diabetes knowledge in the intervention group were significantly superior to those in the control group (all P Conclusions The integrated nursing management model was able to improve patients’ glucose levels, quality of life, and diabetes knowledge.

Visualization is a Big Data method for detecting and validating previously unknown and hidden patterns within large data sets. This study used visualization techniques to discover and test novel patterns in public health nurse (PHN)–client–risk–intervention–outcome relationships. To understand the mechanism underlying risk reduction among high risk mothers, data representing complex social interventions were visualized in a series of three steps, and analyzed with other important contextual factors using standard descriptive and inferential statistics. Overall, client risk decreased after clients received personally tailored PHN services. Clinically important and unique PHN–client–risk–intervention–outcome patterns were discovered through pattern detection using streamgraphs, heat maps, and parallel coordinates techniques. Statistical evaluation validated that PHN intervention tailoring leads to improved client outcomes. The study demonstrates the importance of exploring data to discover ways to improve care quality and client outcomes. Further research is needed to examine additional factors that may influence PHN–client–risk–intervention–outcome patterns, and to test these methods with other data sets.

Objectives The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. Design and sample A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. Measures An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. Results Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. Conclusions The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

Objective(s) The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions. Design and sample This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients. Measurements Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models). Results PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received. Conclusions Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions.

Identifying and measuring outcomes involves a number of conceptual and methodological problems. In order to measure an outcome, therefore, three elements are needed, namely: the pre-existing condition, the intervention and a measure of change in the condition. Records must be structured so that the three elements can be related, and the concepts must be expressed in a standardised language so like is compared with like. This involves a completely new way of documenting health visiting practice, but it is exactly what the Omaha system is designed to do. The health visitors overwhelmingly considered the Omaha system to be far better than their traditional record-keeping systems. The Omaha system is a structured problem-oriented documentation system that includes and relates the three elements of the 'problem', the intervention and change in the client's knowledge, behaviour or health status. Simple frequency distributions of the problems or issues discussed provide epidemiological data for needs assessment and service planning.

Advancements in healthcare systems include adoption of health information technology to ensure healthcare quality. Educators are challenged to determine strategies to integrate health information technology into nursing curricula for building a nursing workforce competent with electronic health records, standardized terminology, evidence-based practice, and evaluation. Nursing informatics, a growing specialty field, comprises health information technology relative to the profession of nursing. It is essential to integrate nursing informatics across nursing curricula to effectively position competent graduates in technology-laden healthcare environments. Nurse scholars developed and evaluated a nursing informatics case study assignment used in undergraduate level public health nursing courses. The assignment included an unfolding scenario followed by electronic health record charting using standardized terminology to guide the nursing process. The assignment was delivered either online or in class. Seventy-two undergraduate students completed the assignment and a posttest. Fifty-one students completed a satisfaction survey. Results indicated that students who completed the assignment online demonstrated a higher level of content mastery than those who completed the assignment in class. Content mastery was based on posttest results, which evaluated students' electronic health record charting for the nursing assessment, evidence-based interventions, and evaluations. This innovative approach may be valuable to educators in response to the National Academy of Sciences recommendations for healthcare education reform.

Background The growth and diversification of nursing theory, nursing terminology, and nursing data enable a convergence of theory- and data-driven discovery in the era of big data research. Existing datasets can be viewed through theoretical and terminology perspectives using visualization techniques in order to reveal new patterns and generate hypotheses. The Omaha System is a standardized terminology and metamodel that makes explicit the theoretical perspective of the nursing discipline and enables terminology–theory testing research. Objective The purpose of this paper is to illustrate the approach by exploring a large research dataset consisting of 95 variables (demographics, temperature measures, anthropometrics, and standardized instruments measuring quality of life and self-efficacy) from a theory-based perspective using the Omaha System. Aims were to (a) examine the Omaha System dataset to understand the sample at baseline relative to Omaha System problem terms and outcome measures, (b) examine relationships within the normalized Omaha System dataset at baseline in predicting adherence, and (c) examine relationships within the normalized Omaha System dataset at baseline in predicting incident venous ulcer. Methods Variables from a randomized clinical trial of a cryotherapy intervention for the prevention of venous ulcers were mapped onto Omaha System terms and measures to derive a theoretical framework for the terminology–theory testing study. The original dataset was recoded using the mapping to create an Omaha System dataset, which was then examined using visualization to generate hypotheses. The hypotheses were tested using standard inferential statistics. Logistic regression was used to predict adherence and incident venous ulcer. Results Findings revealed novel patterns in the psychosocial characteristics of the sample that were discovered to be drivers of both adherence (Mental health Behavior: OR = 1.28, 95% CI [1.02, 1.60]; AUC = .56) and incident venous ulcer (Mental health Behavior: OR = 0.65, 95% CI [0.45, 0.93]; Neuro-musculo-skeletal function Status: OR = 0.69, 95% CI [0.47, 1.00]; male: OR = 3.08, 95% CI [1.15, 8.24]; not married: OR = 2.70, 95% CI [1.00, 7.26]; AUC = .76). Discussion The Omaha System was employed as ontology, nursing theory, and terminology to bridge data and theory and may be considered a data-driven theorizing methodology. Novel findings suggest a relationship between psychosocial factors and incident venous ulcer outcomes. There is potential to employ this method in further research, which is needed to generate and test hypotheses from other datasets to extend scientific investigations from existing data.

Background: Nurses register data in electronic health records, which can use various terminology and coding systems. The net result is that information cannot be exchanged and reused properly, for example when a patient is transferred from one care setting to another. A nursing subset of patient problems was therefore developed in the Netherlands, based on comparable and exchangeable terms that are used throughout the healthcare sector and elsewhere (semantic interoperability).The purpose of the current research is to develop a mapping between the subset of patient problems and three classifications in order to improve the exchangeability of data. Those classifications are the Omaha System, NANDA International, and ICF (the International Classification of Functioning, Disability and Health).Method: Descriptive research using a unidirectional mapping strategy.Results: Some 30%-39% of the 119 SNOMED CT patient problems can be mapped one-to-one from the subset onto each separate classification. Between 6% and 8% have been mapped partially to a related term. This is considered to be a one-to-one mapping, although the meanings do not correspond fully. Additionally, 23%-51% of the patient problems could be mapped n-to-one, i.e. more specifically than the classification. Some loss of information will always occur in such exchanges. Between 1% and 4% of the patient problems from the subset are defined less specifically than the problems within the individual classifications. Finally, it turns out that 9%-32% of the terms from the subset of patient problems could not be mapped onto a classification, either because they did not occur in the classification or because they could not be mapped at a higher level.Conclusion: To promote the exchange of data, the subset of patient problems has been mapped onto three classifications. Loss of information occurs in most cases when the patient problems are transformed from the subset into a classification. This arises because the classifications are different in structure and in the degree of detail. Structural cooperation between suppliers, healthcare organisations and the experts involved is required in order to determine how the mapping should be used within the electronic health records, and whether it is usable in day-to-day practice.

The thesis deals with the use of Omaha system in lactation counselling. At present time the care of newborns realized through general practitioners is minimal. Therefore, the connection of community nursing related to shorter time of hospitalization of both mother and her newborn child is vital. Lactation counselling is closely connected to the obligatory documentation of provided care. Omaha system is considered as a suitable standardized terminology for community nursing. The thesis dealt with the analysis of Omaha system, lactation counselling, the issue of breastfeeding as a whole and the legislation related to nursing documentation in the theoretical part. The main aim of the research is the implementation of Omaha system in lactation counselling. Three main goals were set in the thesis. The first one was to map the differences between the care provided by lactation counsellors with and without medical qualification. The second goal was to describe the way of administration of breastfeeding mothers by the counsellors. The third goal was to elaborate and evaluate the documentation according to Omaha system in the field of lactation counselling provided by counselors with a qualification. To achieve the goals of this thesis quantitative-qualitative method of data collection was used. The method of questioning through a non-standardized questionnaire was selected for quantitative research. The qualitative part of the research was based on the use of semi-structured in-depth interview method. The third part of the research is represented by the content analysis of Omaha system. The qualitative part of the research was processed with open coding method. The research question was answered through the analysis of the interviews. The respondents in this research are represented by lactation counselors. The first research file is represented by counselors both with and without qualification. The second research file includes counselors with medical qualification only. The questionnaire research was realized through an electronic questionnaire. The interviews were conducted with six lactation counselors with a medical qualification. The questionnaire research shows differences in the counselling provided by the counselors with and without a qualification which supports H1. The official documentation for counselling is used by a few respondents and mainly by the ones with a qualification. The good thing is that most counselors record data about mothers and breastfeeding. Next, it seems that the unofficial documentation of counselors includes problems and solutions description. The results show that H2 has not been supported. However, it is good that almost half of the respondents are interested in using a standardized documentation for counselling. Next, the counselors with a qualification do not use standardized taxonomy of nursing problems. The results show that only two counselors with a qualification have a contract with an insurance company. Most of them do not cooperate with a podiatrist or gynecologist. The most troubling issues for them are lack of time and missing contracts with an insurance company. Most of them think that longer hospitalization of mothers does not have a better effect on the quality of breastfeeding. Moreover, the interviews with the counselors with a medical qualification show that the newly created documentation of Omaha system has been processed thoroughly and clearly. They consider it more time demanding, which could be a problem because of the lack of time caused by the financial situation of mothers or because of insurance companies. The output of tis thesis is a newly created documentation for lactation counselors and lactation centers based on Omaha system which allows a more effective way of providing lactation counselling.

Objectives: Nursing process guides the students in the diagnosing, planning, intervention and evaluation of patients/families, and it also gives a systematic point of view. The Omaha System is used as a nursing classification system in public health nursing course practice areas. It was conducted in order to examine the nursing diagnoses identified by the students according to the Omaha System. Methods: It was a retrospective, analytical research. Practice files of 51 students who took the public health nursing course created the sample. Results: According to the Omaha problem classification list (PCL), the students in the study identified a total of 412 problems. According to Omaha PCL, the students mostly used the area of health behavior, followed by the physiological, psychosocial and environmental areas respectively. It was determined that 73% of the students had sufficient skills to use the Omaha System and 26.8% of them were inadequate. Conclusion: It was observed that the nursing diagnoses identified by the students in line with the determined learning targets were sufficient.

Aim To test the effectiveness of discharge guidance based on the theoretical framework of the Omaha System on Mainland Chinese patients with angina without interventional treatment. Methods A randomized controlled trial was conducted on 150 Mainland Chinese patients with angina without interventional treatment between December, 2015 and September, 2016. The participants were randomly allocated to discharge guidance based on the Omaha System or usual care. The participants were assessed with the self-designed Problem Rating Survey Scale, including three dimensions and seven items. The Cronbach's alpha coefficient was 0.81. The 7-item-level content validity index was 0.80-1.00 and the scale-level content validity index was 0.94. Results The scores of the outcome measures differed significantly between the two groups at all three time points (admission day; 3 days before discharge; discharge day) and increased gradually. Improvements in knowledge, behavior , and the total score of the intervention group were significantly higher than those of the control group. An improvement in status did not differ significantly. Conclusion The Omaha System-based discharge guidance is effective at enhancing knowledge and behavior in patients from Mainland China with angina without interventional treatment.

Background Electronic health records (EHRs) provide many benefits related to the storage, deployment, and retrieval of large amounts of patient data. However, EHRs have not fully met the need to reuse data for decision making on follow-up care plans. Visualization offers new ways to present health data, especially in EHRs. Well-designed data visualization allows clinicians to communicate information efficiently and effectively, contributing to improved interpretation of clinical data and better patient care monitoring and decision making. Public health nurse (PHN) perceptions of Omaha System data visualization prototypes for use in EHRs have not been evaluated. Purpose To visualize PHN-generated Omaha System data and assess PHN perceptions regarding the visual validity, helpfulness, usefulness, and importance of the visualizations, including interactive functionality. Methods Time-oriented visualization for problems and outcomes and Matrix visualization for problems and interventions were developed using PHN-generated Omaha System data to help PHNs consume data and plan care at the point of care. Eleven PHNs evaluated prototype visualizations. Results Overall PHNs response to visualizations was positive, and feedback for improvement was provided. Conclusion This study demonstrated the potential for using visualization techniques within EHRs to summarize Omaha System patient data for clinicians. Further research is needed to improve and refine these visualizations and assess the potential to incorporate visualizations within clinical EHRs.

OBJECTIVE(S): A public health nurse (PHN) in the Midwestern United States (U.S.) led a collaborative system-level intervention to translate the Institute of Clinical Systems Improvement (ICSI) Adult Obesity Guideline into interprofessional practice. This study 1) evaluated the extent of guideline translation across organizations and 2) assessed the Omaha System as a method for translating system-level interventions and measuring outcomes. DESIGN AND SAMPLE: This retrospective, mixed methods study was conducted with a purposeful sample of one administrator (n=10) and two to three clinicians (n=29) from each organization (n=10). MEASUREMENTS: Measures: Omaha System Problem Rating Scale for Outcomes Knowledge, Behavior, and Status (KBS). Procedures and analysis: KBS ratings gathered from semi-structured interviews and Omaha System documentation were analyzed using standard descriptive and inferential statistics and triangulated findings with participant quotes. RESULTS: KBS ratings and participant quotes revealed intervention effectiveness in creating sustained system-level changes. Self-reported and observed KBS ratings demonstrated improvement across organizations. There was moderate to substantial agreement regarding benchmark attainment within organizations. On average, self-reported improvement exceeded observer improvement. CONCLUSIONS: System-level PHN practice facilitator interventions successfully translated clinical obesity guidelines into interprofessional use in health care organizations. The Omaha System Problem Rating Scale for Outcomes reliably measured system-level outcomes.

A conceptualization of the research or evaluation as described in Chapters. 2 and 3 provides the basis for operationalizing the PIO MM for intervention effectiveness research, quality improvement activities, and program evaluation. This operationalization requires measures, data, and software. In this chapter, checklists for obtaining new or existing data for operationalizing PIO MM are provided for two situations, new data that will be collected prospectively, and reusing existing data. Nursing’s robust standardized terminologies are described, with emphasis on the Omaha System as an exemplar for all terminologies. Use of large datasets is described, and their unique contribution to the examination of interventions and outcomes is discussed.

The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients.Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes.This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined.Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p0.001).This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.

Global efforts are underway to develop, implement and test health care transition (HCT) models of care. Most studies have focused on the transfer of care models. In contrast, the nurse-led interdisciplinary HCT model, Movin' On Up, provides comprehensive HCT services beginning in early adolescence. A retrospective analysis was conducted of data extracted from HCT records of 146 adolescents and emerging adults with spina bifida (with a mean age of 13.91 years) who were provided services in the Movin' On Up HCT program. Data were categorized based on the Health Care Transition Research Consortium HCT model and the Omaha System framework and as to type of direct HCT services provided by the HCT Specialist and nurse-led interdisciplinary team conferences conducted. Findings revealed that the scope of services provided represented the scope of comprehensive needs beyond those associated with the transfer of care.

Aim This study examined nurses’ work, comparing nursing interventions and locations across three units in a United States hospital using Omaha System standardized terminology as the organizing framework. Background The differences in nurses’ acute-care work across unit types are not well understood. Prior investigators have used time–motion methodologies; few have compared differences across units, nor used standardized terminology. Methods Nurse-observers recorded locations and interventions of nurses on three acute-care units using hand-held devices and web-based TimeCaT™ software. Nursing interventions were mapped to Omaha System terms. Unit-differences were analysed. Results Nurses changed locations approximately every 2 min, and averaged approximately one intervention/minute. Unit differences were found in both the interventions performed and the locations. Most interventions were case-management related, demonstrating the nurses’ patient management/coordination role. Conclusions Unit differences in nursing interventions and location were found among three unit types. Omaha System terminology, as well as the observational method used, were found to be feasible and practical. Implications for Nursing Management Nursing work varies by unit, yet managers have not been armed with empirical data with which to make more informed decisions about nurses’ work priorities, clinical outcomes, patient satisfaction, staff satisfaction and cost. The results from this study will help them to do so.

Structured health care data has played a critical role in improving quality of care and achieving better patient outcomes. Despite increased use of terminology standards within the electronic health records (EHRs), there is a need to map multi-institutional data that represent patient observations to develop standardized information models. The purpose of this study was to conduct an empirical evaluation of the potential for international health system data interoperability with the Wanda Horta theory using the Omaha System ontology. The 2 frameworks were mapped and validated by a panel of experts. The results showed that the majority (80.95%) of the Wanda Horta theory concepts were mapped at a high level of agreement. Such mappings show that the information models have the potential to facilitate and enhance communication and improve practices between organizations internationally.

Background and Purpose: It is critical to accurately represent strengths interventions to improve data and enable intervention effectiveness research from a strengths perspective. However, it is challenging to understand strengths interventions from the multiple perspectives of computerized knowledge representation, evidence-based practice guidelines, and practice-based evidence narratives. Intervention phrases abstracted from nurse care coordinator practice narratives described strengths interventions with community-dwelling elders. This project aims were to (a) compare nurse care coordinator use of evidence-based interventions as described in the two guidelines (what to do and how to do it), (b) analyze nurse care coordinator intervention tailoring (individualized care), and (c) evaluate the usefulness of the Omaha System for comparison of narrative phrases to evidence-based guidelines. Methods: Phrases from expert nurse care coordinators were mapped to the Omaha System for comparison with the guidelines interventions and were analyzed using descriptive statistics. Venn diagrams were used to visually depict intervention overlap between the guidelines and the phrases. Results: Empirical evaluation of 66 intervention phrases mapped to 14 problems using 3 category terms and 19 target terms showed alignment between guidelines and the phrases, with the most overlap across two guidelines and the phrases in categories, and the most diversity in care descriptions. Conclusion: These findings demonstrate the value in having both standardized guidelines and expert clinicians who see the whole person and can synthesize and apply guidelines in tailored ways. There is potential to create a feedback loop between practice-based evidence and evidence-based practice by expanding this approach to use of practice-generated Omaha System data as practice-based evidence. Further research is needed to refine and advance the use of these methods with additional practices and guidelines.

Current situation: Standardized terminology of the Omaha system brings new opportunities for nurses providing community care. Objectives: Four objectives have been defined for this study: to implement the Omaha system in the nursing documentation for the purpose of verification of nursing care in community practice - to characterize the problems of patients with gastrointestinal diseases as per the Problem Classification Scheme - to map the links between problems and interventions as per the Intervention Scheme - to evaluate the problem results using the Problem Rating Scale for Outcomes of the Omaha system. Methodology: The research method used was based on the study by Kathryn H. Bowles (2000) addressing problems of patients and nurse interventions. The quantitative research method was implemented by inquiry using nursing documentation with the Omaha system implemented. The data acquired was tested using the software tools SPSS 22.0 and MS Excel. Research set: It consisted of 103 patients with gastrointestinal diseases. The inquiry was carried out by contact persons - nurses of the gastroenterology department. Results: Patients with gastrointestinal diseases suffering from a wide range of problems corresponding to given character of diseases, which predominantly occur in the Physiological Domain and Health-Related Behavior Domain. In terms of mapping of links between problems and interventions, the results have proven a high usability of the objectives defined in the Intervention Scheme in community practice. The interventions were mostly determined in the categories Treatments and Procedures and Surveillance. Statistical differences have been confirmed in the documentation of interventions in individual categories for patient problems as well as for the selection of interventions in individual categories with respect to the type of given gastrointestinal disease. The study results have proven a significant improvement of knowledge, behaviour and status for individual problems, which is shown in comparison of final values with the initial values of problem results. The implementation of the selected interventions as per the Intervention Scheme resulted in a reduction or elimination of ? of problems. Conclusions: The results of the research inquiry clearly show that the Omaha system is an appropriate tool for documentation of all stages of the nursing process in the community care. Implementation of the functional documentation in community practice requires the Czech version of the Omaha system and electronic form of the documentation, which are absent at present.

Objective: The aim of this study was to detect the needs of individuals receiving home healthcare and to create guidance data for initiatives to be planned for this purpose by demonstrating the availability of the Omaha system in determining the care needs of these people. Background: Home care services are generally provided to promote and protect an individual's wellbeing or to restore his/her to health either by health professionals or by family members in the person's own home or the place where he/she lives. Design. Eighty-seven people receiving home healthcare services from BayA±ndA±r State Hospital affiliated with Izmir Province Association of Public Hospitals South General Secretariat in their home environment between January 2015 and April 2015 comprised the population and sample of this descriptive and cross-sectional Study and methods: The sample of the research field of home care services unit formed individuals (N=87). A total of 50 patients were included in the study. The data collection tools used in the study were the 5-item sociodemographic characteristics questionnaire and OMAHA problem classification scheme (PCS). Results: According to the OMAHA PCS, 29 problems were identified. The problems identified, 49% were in the physiological domain, 28.8% in the health-related behaviors domain, 15.4% in the psychosocial domain and 6.8% in the environmental domain. With the nursing diagnoses, 2326 actual symptoms-signs were determined. Conclusion: It was determined that the OMAHA PCS could be used to identify healthcare needs of people receiving home care services.

Rigor in clinical knowledge representation is necessary foundation for meaningful interoperability, exchange and reuse of electronic health record (EHR) data. It is critical for clinicians to understand principles and implications of using clinical standards for knowledge representation within EHRs. Purpose: To educate clinicians and students about knowledge representation and to evaluate their success of applying the manual lookups method for assigning Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) concept identifiers using formally mapped concepts from the Omaha System interface terminology. Methods: Clinicians who were students in a doctoral nursing program conducted 21 lookups for Omaha System terms in publicly available SNOMED CT browsers. Lookups were deemed successful if results matched exactly with the corresponding code from the January 2013 SNOMED CT-Omaha System terminology cross-map. Results: Of the 21 manual lookups attempted, 12 (57.1%) were successful. Errors were due to semantic gaps, differences in granularity and synonymy or partial term matching. Conclusions: Achieving rigor in clinical knowledge representation across settings, vendors and health systems is a globally recognized challenge. Cross-maps have potential to improve rigor in SNOMED CT encoding of clinical data. Further research is needed to evaluate outcomes of using of terminology cross-maps to encode clinical terms with SNOMED CT concept identifiers based on interface terminologies.

Objectives To evaluate variability in health literacy outcomes due to home visiting (HV) program components including PHN, Intervention, and Client. Design and Sample A comparative, correlational study evaluated PHN home visiting program data that included PHNs (N = 16); Interventions (N = 21,634); and Clients (N = 141). Client age ranged from 14 to 46 (median = 21, mean = 22.8, SD = 6.65). Clients were predominately White (75.9%), not married (84.4%), and female (99.3%). PHNS documented care using electronic health records (EHR) and the Omaha System. Measures The outcome of interest was health literacy benchmark attainment (adequate knowledge) operationalized by Omaha System Problem Rating Scale for Outcomes Knowledge scores averaged across problems. Intervention Program of individually tailored, evidence-based HV interventions provided by PHNs. Results There were 233 different interventions for 22 problems. Knowledge benchmark was attained by 16.3% of clients. Four factors explained variance in reaching the knowledge benchmark: Client (51%), Problem (17%), Intervention (16%), and PHN (16%). Conclusions The PHN and intervention tailoring are actionable components of HV programs that explain variability in health literacy outcomes. Further research should examine effects of training on PHN relationship skills and intervention tailoring to optimize outcomes of evidence-based PHN HV programs, and to evaluate whether improving health literacy may subsequently improve client problems.

Cyberbullying is a global phenomenon. The experiences of bullied children are the same across cultures and languages, and psychiatric nursing interventions are known to be effective. It is critical to widely disseminate effective interventions to identify and address cyberbullying. Therefore, evidence-based care plans addressing cyberbullying at the individual and community levels were developed using the Omaha System, a terminology that is used internationally to guide and document care. This article presents a case study in which an evidence-based intervention was used to help a bullied child arrive at a solution, and demonstrates the use of the Omaha System to document evidence-based cyberbullying interventions with individuals and communities. [ Journal of Psychosocial Nursing and Mental Health Services, 52 (3), 34–41.]

Background The Omaha System (OS) is one of the oldest of the American Nurses Association recognized standardized terminologies describing and measuring the impact of healthcare services. This systematic review presents the state of science on the use of the OS in practice, research, and education. Aims (1) To identify, describe and evaluate the publications on the OS between 2004 and 2011, (2) to identify major trends in the use of the OS in research, practice, and education, and (3) to suggest areas for future research. Methods Systematic search in the largest online healthcare databases (PUBMED, CINAHL, Scopus, PsycINFO, Ovid) from 2004 to 2011. Methodological quality of the reviewed research studies was evaluated. Results 56 publications on the OS were identified and analyzed. The methodological quality of the reviewed research studies was relatively high. Over time, publications' focus shifted from describing clients' problems toward outcomes research. There was an increasing application of advanced statistical methods and a significant portion of authors focused on classification and interoperability research. There was an increasing body of international literature on the OS. Little research focused on the theoretical aspects of the OS, the effective use of the OS in education, or cultural adaptations of the OS outside the USA. Conclusions The OS has a high potential to provide meaningful and high quality information about complex healthcare services. Further research on the OS should focus on its applicability in healthcare education, theoretical underpinnings and international validity. Researchers analyzing the OS data should address how they attempted to mitigate the effects of missing data in analyzing their results and clearly present the limitations of their studies.

This article analyzes the application of Omaha system in perioperative continuation nursing and discharge follow-up of patients undergoing total hip arthroplasty in China, and combine the Omaha system with mobile medical to design a mobile management platform APP suitable for patients with total hip arthroplasty, and strengthen professional training for nurses, with the cooperation of multi-disciplinary teams, will be widely applied and promoted in clinical, in order to better manage and improve the nursing outcomes of patients with total hip arthroplasty and enhance the quality of life of patients.

Preparing nursing students to achieve informatics competencies is essential in today's information-intensive healthcare delivery systems. This study aimed to provide hands-on informatics experience to nursing students and to identify the frequency and type of home care clients' health problems, nursing interventions, and outcomes using a standardized nursing terminology, the Omaha System. Data were collected by 159 nursing students on home visits to 598 clients, who received 8657 interventions from students and faculty for 2267 problems, in addition to the services provided by the home care centers. Skin, neuromusculoskelatal function, personal care, nutrition, and urinary function were the most common problems. The most common intervention category was teaching, guidance, and counseling (47%), followed by treatments and procedures (22%), surveillance (22%), and case management (9%). Outcomes evaluation showed significant improvement in 97.5% of the identified problems. Students gained informatics experience in the use of a standardized nursing language in electronic health records, data management, and use of nursing data at the basic practice level. This study demonstrated that the Omaha System was a useful data collection tool for evaluating problems, interventions, and outcomes in home care and a positive teaching and learning tool for baccalaureate nursing education.

Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports (n=127), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems.

Objective To examine the associations between social and behavioral determinants of health (SBDH), health disparities, and the outcomes of women who received public health nurse home visits for pregnancy and parenting support. Design Observational exploratory data analysis and comparative outcome evaluation. Setting An extant dataset from women served in a Midwestern U.S. state, including demographics and Omaha System problems, signs/symptoms, interventions, and outcome assessments. Participants Women ( N = 4,263) with an average age of 23.6 years ( SD = 6.1); 21.4% were married, and 39.1% were White. Methods An evaluation dataset was constructed that included all women of childbearing age, their demographics, and outcome assessments. A summative SBDH Index based on Institute of Medicine-recommended instruments was computed based on sign/symptom data. Visualizations were developed using Microsoft Excel, and outcome significance statistics were computed using SPSS version 22 and SAS version 9.4. Results Outcome evaluation showed positive, significant changes from baseline after public health nurse intervention. Visualization showed variable concentrations of problem-specific signs/symptoms by SBDH Index subgroups. There were between-group differences in overall outcome attainment across SBDH Index subgroups. Compared with White women, minority women had greater improvement; however, despite these gains overall minority final ratings were lower. Conclusion An informatics approach showed that SBDH are important factors for understanding a comprehensive and holistic view of health and health care outcomes. There is potential to use large datasets to further explore intervention effectiveness and progress toward health equity related to SBDH.

Background Coronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China. Objectives To examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease. Design Randomized controlled trial. Methods The Omaha system and Pender's health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n=100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n=99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014. Results Compared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t =5.762, P =0.000; diastolic blood pressure, t =4.250, P =0.000; fasting blood glucose, t =2.249, P =0.027; total cholesterol, t =4.362, P =0.000; triglyceride, t =3.147, P =0.002; low density lipoprotein cholesterol, t =2.399, P =0.018; and body mass index, t =3.166, P =0.002), higher knowledge scores for coronary artery disease (total knowledge score, t =−7.099, P =0.000), better physical health status ( t =−2.503, P =0.014) and mental health status ( t =−2.950, P =0.004). Conclusions This study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender's health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.

Background\ud \ud In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice®, Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions’ impact on quality, safety and patient outcomes in published research is relatively unknown.\ud \ud Purpose\ud \ud This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice® as a case study.\ud \ud Methods\ud \ud A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice® were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature.\ud \ud Results\ud \ud Since 2006, 38 studies have been published on the International Classification for Nursing Practice®. The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice.\ud \ud Conclusions\ud \ud Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care.

Home healthcare clinicians can benefit from the use of interprofessional standardized terminologies to more efficiently document and assess patient problems, describe and present clinician interventions, and measure the outcomes of care. The Omaha System is a research-based, comprehensive standardized terminology that can enable users to describe and measure the impact of nursing and healthcare services on patient care and outcomes. In this article, we (1) describe effective strategies for teaching the Omaha System to home healthcare agency staff, and (2) illustrate those strategies' effectiveness by presenting an example from an Omaha System Basic Workshop conducted in 2015. The 12 participants included home healthcare nursing administrators and clinicians, software developers from several companies, nursing educators, and nursing researchers. The role-playing and unfolding case studies that we report here represent teaching strategies that can provide opportunities for home healthcare users to practice using the Omaha System. Quantitative evaluation consisted of comparing the participants' pretest and posttest scores on the survey. Qualitative evaluation involved analyzing participants' feedback and comments on a form distributed at the end of the workshop. Participants found the workshop beneficial in improving their understanding of the Omaha System and its application to their practice.

Background: A whole-person representation captures not only patient problems but also patient strengths. To better understand and inform practice of person-centered care and documentation using a whole-person representation, a critical review of literature was conducted of the current state of patient problems and strengths documentation in electronic health records. Methods: The informatics model of Data, Information, Knowledge and Wisdom is employed to develop this critical review. Two scientific databases were used to conduct a systematic search: CINAHL and Ovid Medline with the following search terms: strength*, problem*, whole person, wellbeing or well-being, electronic health record*, personal health record*, EHR*, and PHR*. 602 articles were returned. All articles were screened through review of titles, abstracts, or full texts. 24 articles were selected for this review. Results: Four themes have emerged from this critical review. They are individual or cross-institutional use of problem-oriented EHRs, extension of problem-based EHRs with other integration, patient-centered integration of the problem-oriented EHR build, and construction of a whole-person representation to include strengths in the EHR documentation. The vast majority of articles focus on problem-based diagnoses and practices. Early reports of strengths documentation were found using a standardized interface terminology and ontology, the Omaha System. Results of two studies demonstrated the feasibility of using the Omaha System for whole-person documentation to capture perception of both problems and strengths. Conclusion: Clinical information in EHRs is typically structured by problem-based diagnoses; however, there is emerging documentation of formalized strengths attributes using the Omaha System, which may promote a holistic approach to clinical practice and documentation using a person-centered, strength-based ontology.

In this chapter we focus on the ICT implementation and relevant factors enhancing a Pragmatic Will with ICT at Buurtzorg. ICT starts with supporting the primary process at Buurtzorg aiming to serve the clients’ needs from a holistic focus. How the principles of Buurtzorg are integrated and simplified through ICT facilities will be explained. Another aspect of the Pragmatic Will is the process of implementation and the argumentations behind the decisions to implement ICT. The implementation of ICT at Buurtzorg seemed to be a step by step creativity process that comprises of the following three elements: frugal attitude, smart simplification, and its effectual way of designing the ICT solutions.

Evidence-based clinical guidelines are being developed to bridge the gap between research and practice with the goals of improving health care quality and population health. However, disseminating, implementing, and ensuring ongoing use of clinical guidelines in practice settings is challenging. The purpose of this study was to demonstrate the feasibility of encoding evidence-based clinical guidelines using the Omaha System. Clinical documentation with Omaha System-encoded guidelines generates individualized, meaningful data suitable for program evaluation and health care quality research. The use of encoded guidelines within the electronic health record has potential to reinforce use of guidelines, and thus improve health care quality and population health. Research using Omaha System data generated by clinicians has potential to discover new knowledge related to guideline use and effectiveness.