The Omaha Model (Nursing)

00:01 Today we're going to talk about the Omaha system.

00:04 Now, I recognize that this is a very complex system.

00:07 a complex model to understand.

00:09 And I always find the best way to understand complex models is to see them in action.

00:14 So let's move together through a case study that will show you how to use the Omaha system and apply it to community level public health problem.

00:24 Bloom County.

00:25 Bloom County has a population of 120,000 people.

00:29 It's a metropolitan county in Minnesota.

00:32 The residents became the client of this case study when they experienced the first confirmed case of influenza during the winter holiday season.

00:40 Unfortunately, the person was employed as a clerk at a store located in a large regional shopping mall.

00:46 They continued to keep working while feeling ill during the busy holiday season, and exposed many people.

00:53 Sadly, the clerk died five days later.

00:57 Okay, now let's take it in depth look at the Omaha system and then we'll come back to the case study at the end and work through it together.

01:06 This system was developed out of the Omaha Visiting Nurses Association with the intent to increase the effectiveness and efficiency of nursing practice within the agency.

01:15 It was designed to operationalize the nursing process and provide an easy to understand quantifiable guide for use in a variety of public health nursing settings.

01:25 It includes information from several health professions.

01:29 The Omaha system is a conceptual model that's grounded in the fact that public health nursing is a dynamic and iterative process that's based on the client nurse relationship and guided by critical thinking and quality improvement.

01:42 It's based on the nursing process and provides an easy to use guide to public health nursing.

01:49 Now this is the full Omaha system.

01:52 The client who can be an individual, a family or a community is at the very center of the system, signifying that the care delivered through the model is a client centered approach and requires collaboration between the nurse and the client.

02:07 The system is based on a six step problem solving process.

02:12 The six step process starts with collecting and assessing data, stating the problem, identifying a problem reading, planning an actual interventions, identifying interim and dismissal problem ratings, and finally evaluating problem outcomes.

02:30 We'll move through the six steps of the problem solving process through three model constructs.

02:37 But first, on the very outside of the model, we see that the client and the six steps are all encircled by the practitioner-client relationship.

02:47 This signifies the importance of that relationship and public health nursing practice.

02:53 Beyond the problem solving process, there are three constructs for this model.

02:58 The problem classification scheme, the intervention scheme, and the problem rating scale for outcomes.

03:04 Let's take some time to look at each of these constructs individually.

03:09 Starting first with the problem classification scheme.

03:12 The problem-classification scheme is a holistic, comprehensive method for identifying health related concerns.

03:19 It provides a method for standardized assessment of individuals, families, and communities.

03:24 It gives us a common language.

03:27 Now, it can be a little complex to work through.

03:30 So let's do it together.

03:32 At the very top of the problem classification scheme are four domains.

03:37 Those four domains are environmental, physiological, psychological, and health related behaviors.

03:45 The first thing you do is select one of those four domains.

03:48 Based on what you know about the problem, where does it lie? Which domain does it fit best within? Once you've determined the domain, then you move down to the second level of classification.

04:00 And that's where we see specific client problems.

04:03 And for this system, there are 42 specific client problems that you can choose from.

04:09 Once you've selected one of those 42 problems, then you move down to the third level of classification.

04:15 Here there are two modifiers.

04:18 The first is to determine is this an actual problem? Or is it a potential problem? The second set of modifiers is based on the level.

04:27 Is this an individual level problem? A family level problem? Or a community level problem? Once you've worked through those three levels, the fourth level is determining signs and symptoms.

04:40 So specific signs and symptoms that support your identification of the previous three levels.

04:49 The second construct of the model is the intervention scheme.

04:52 So let's take a look at that one in detail.

04:56 The intervention scheme provides a framework for documenting plans and nursing interventions in four different areas.

05:02 The first is health teaching guidance and counseling.

05:06 The second treatments and procedures, The third case management.

05:11 And then finally, the fourth surveillance.

05:14 Now, when you're using the intervention scheme, the first thing you do is select which of those four categories you want to work within.

05:21 Once you've determined that the next level is picking your specific target.

05:26 So if you're going to do health teaching, what are you going to target? And within the intervention scheme, this system actually provides you with 75 specific targets that are already populated for you.

05:37 So all you have to do is just pick one.

05:41 Next, it's important to understand how the client's specific data will help shape your intervention.

05:47 So based on health teaching, based on a target, what do you know about the client? Whether that's an individual, a family, or community that you need to consider when you're planning your intervention.

06:01 So as an example, if a public health nurse selects, again, health teaching guidance and counseling as the first level here, he can then select a target for these efforts, it may be teaching about behavior modification.

06:16 And then based on what he knows about the client, he can use client specific assessment data to determine exactly which behaviors he'll focus on during his teaching.

06:27 So here we are on the third and final construct of this system.

06:31 This is the problem rating scale.

06:34 So here it is the problem rating scale on one slide.

06:38 Now, I know it looks complicated, but just bear with me, what I want you to do is to think about this as a rubric, maybe a grading rubric that one of your nursing faculty would use to grade a paper you've written.

06:50 So on the first line, what we're doing is assessing a client's knowledge.

06:55 So really, what do they know? If they have no knowledge, we give them a score of one.

07:01 If they have superior knowledge, we give them a score of five.

07:05 Moving down to the next slide, what we're doing is assessing behavior.

07:09 So what behaviors is the client exhibiting? A one means that they are not exhibiting any appropriate behaviors.

07:18 A five means that they are consistently displaying appropriate behaviors.

07:23 And then finally, we have status.

07:25 What we're assessing here is the severity of signs and symptoms.

07:28 So a one would be extreme signs and symptoms, and a five would be no signs or symptoms.

07:34 So again, just think about this as a simple grading rubric.