The Omaha Model – Case Study (Nursing)

by Heide Cygan, DNP, RN

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    00:01 Okay, now back to our case study.

    00:03 Now, before we get into this, what I'm going to ask you to do is to get a pen and paper and get ready to take some notes.

    00:10 I'm going to walk you through the full case study.

    00:12 And so while I'm doing that, jot down things that you think are important.

    00:17 When we get to the end, then what we'll do is apply the Omaha system to put together a comprehensive plan for Bloom County.

    00:25 So as a reminder, Bloom County has a population of about 120,000 people.

    00:30 The residents are the client in this case study because they just experienced their first confirmed case of influenza this season.

    00:37 Unfortunately, the person who is infected was also employed as a clerk at a local store in a shopping mall.

    00:44 That person continued to work even though they were feeling ill and possibly exposed many people.

    00:51 The Bloom County Health Department jumped into action.

    00:54 They started offering 24 hour a day immunization clinics.

    00:58 There are numerous people, including friends, family members and-co workers of the confirmed case who started to experience some mild symptoms, a fever and a cough.

    01:08 Now it wasn't possible to know if they were experiencing early stages of influenza and needed to be quarantined, or if they're experienced some other milder illness.

    01:19 The Health Department's public health nurses conducted an aggressive media campaign.

    01:23 Of course in collaboration with others local healthcare facilities, stores, churches, and other community groups.

    01:29 The campaign included information about disease prevention, treatments, how to obtain the vaccine, as well as warnings about the limitations of the vaccine and the need to reduce contact with others.

    01:41 But new issues started to arise.

    01:43 Many residents were unwilling to follow voluntary quarantine recommendations, especially because it was the holiday season.

    01:50 Despite a public plea to schedule appointments with the health care providers for specific symptoms, many residents continue to visit the local emergency department.

    01:59 The health department worked around the clock.

    02:02 They conducted contact investigation for documented influenza cases and attempted to quarantine exposed family members.

    02:08 They worked with the state health department to disseminate accurate and timely public information.

    02:13 By the time the influenza outbreak had ended, the county experienced more than 200 cases and 31 deaths.

    02:22 Based on the case study, let's use the Omaha system to create a comprehensive problem solving model to improve the health outcomes for Bloom County.

    02:30 Now, I hope you have your notes ready.

    02:33 Starting first with the problem identification scheme.

    02:36 The first step here is to select the domain.

    02:39 And there are four domains: Environmental, physiological, psychological, and health behaviors.

    02:46 So based on what we know from the case study, which domain would you pick? Now remember, we're dealing with influenza here.

    02:54 So I would pick physiological.

    02:57 The next step in the problem identification scheme is to select one of 42 problems.

    03:03 Now you see here we have the 42 problems.

    03:06 What I'm going to ask you to do is pause the video for just a second, and pick the problem that you think best fits the case study.

    03:21 Wonderful.

    03:22 We've selected communicable or infectious condition as our problem.

    03:26 The next step in the problem identification scheme, is to select our modifiers.

    03:31 Now, is this an actual problem or a potential problem? Well, based on the fact that we've had over 200 cases already, I would call this an actual problem.

    03:42 And what level are we working at here? Is this an individual level? A family level? Or community level? Again, based on the case study, I would definitely say this is a community level problem.

    03:54 Now the fourth and final step in the problem identification scheme, is to determine signs and symptoms.

    04:01 What signs and symptoms have you used in order to select the problem, to select the modifiers, to select the domain.

    04:09 Maybe it's fever, positive lab results, inadequate immunity, and respiratory symptoms.

    04:16 That is the first step and using the Omaha system.

    04:19 We've completed the problem identification scheme.

    04:23 Okay, now moving on to the second construct in the system, the intervention scheme.

    04:28 Now remember, and the intervention scheme there are four categories of intervention, health teaching, guidance and counseling, interventions and procedures, case management, and finally, surveillance.

    04:41 So take a second and think about, which one of those categories you'd like to focus on? I say let's focus on the health teaching, guidance, and counseling.

    04:51 Now, the next step is determining the target of your intervention.

    04:56 So the target of that health teaching.

    04:58 Now, there's 75 different targets.

    05:01 You'll see just a few of them here on the screen, Go ahead and select the one that you think is the biggest priority for Bloom County.

    05:15 For the target, let's focus on infection precautions.

    05:19 Now the third step in the intervention scheme is to use client's specific data to determine the specific areas that you want to focus on for your intervention.

    05:29 So remember, we're focusing on health teaching regarding infection precautions.

    05:34 What type of health teaching and guidance is needed here? It could be guidance around effective measures to stop the transmission of influenza.

    05:42 Like additional education about immunizations, hand hygiene, quarantine measures.

    05:50 Okay, now, here we are with our third and final construct of the system.

    05:55 This is the problem rating scale.

    05:57 And remember, this is just like a grading rubric.

    06:00 So let's start first with knowledge and assess Bloom County.

    06:04 Now remember, knowledge is how much the community knows.

    06:07 And what we know is that the health department has conducted a large scale educational campaign throughout the community.

    06:15 They've put up billboards, they put up flyers telling people about how to protect themselves against influenza.

    06:21 So based on that, let's say that for right now, Bloom County has some basic knowledge.

    06:26 Let's score them as a three.

    06:29 Moving on to the next level here behavior.

    06:32 Now remember, behavior is different than knowledge just because people know about how to protect themselves, doesn't mean they're actually doing it.

    06:40 So here we want to focus on the behaviors that we are seeing.

    06:43 What are our observations? We know that people are still going into gatherings.

    06:48 It's the holiday season.

    06:50 So even though they might know that they should stay home, they're still going out.

    06:54 So based on that, let's score Bloom County as a two, rarely appropriate behavior.

    07:01 And then finally, we want to look at status.

    07:03 Again, this is the severity of the symptoms.

    07:06 We're seeing an increased number of cases and we've already seen 31 deaths.

    07:11 So for this, I would say we're still seeing extreme signs and symptoms.

    07:15 So we've used our grading rubric to score Bloom County at baseline.

    07:20 So based on our grading rubric, Bloom County has scored a six.

    07:25 Now, the cool thing about this is is that after you conduct your intervention, you can score them again so that you can look for trends over time.

    07:33 And hopefully we see this number increasing.

    07:36 We want to see superior knowledge, consistently appropriate behavior, and no signs or symptoms.

    About the Lecture

    The lecture The Omaha Model – Case Study (Nursing) by Heide Cygan, DNP, RN is from the course Public Health Nursing Models and Theories (release in progress).

    Included Quiz Questions

    1. Physiological
    2. Environmental
    3. Psychosocial
    4. Health-related behaviors
    1. Communicable/infectious condition
    2. Oral health
    3. Skin
    4. Caretaking/parenting
    1. Infection precautions
    2. Behavior modification
    3. Anatomy/physiology
    4. Respiratory care

    Author of lecture The Omaha Model – Case Study (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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