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Aim The purpose of this retrospective, correlational pilot study was to explore the relationship between historical weekly weather data including temperature, dew point, humidity, barometric pressure, visibility, and cloud cover compared to weekly influenza-like illness reports over a four year period. Background Climate and weather-related conditions may affect the viral activity and transmission of influenza, although this relationship has not been widely studied in nursing. Some research suggests that there are causal links between cold temperatures, low indoor humidity, minimal sun exposure, and influenza outbreaks. Additionally, rapid weather variability in a warming climate can increase influenza epidemic risk. Methods Data from a local public health district were extracted and used to correlate with weekly weather averages for the area. Results Findings showed that current influenza reports are significantly associated with temperature and visibility, both lagged two weeks. Conclusions Though more research is needed, nurses must understand, recognize, and act upon weather and climate factors that affect the health of populations. With a greater understanding of the relationship between weather and influenza-like illness, nurses and other healthcare providers can potentially work to respond to and mitigate the consequences of weather-related illness as well as anticipate and prepare for increased flu burden. Furthermore, nurses can remain engaged in climate protective initiatives and policy development at their local community and/or organizational levels to underscore and advocate for the needs of populations and groups they serve.

During a pandemic, basic public health precautions must be taken across settings and populations. However, confinement conditions change what can be done in correctional settings. Correctional nursing (CN) care, like all nursing care, needs to be named and encoded to be recognized and used to generate data that will advance the discipline and maintain standards of care. The Omaha System is a standardized interprofessional terminology that has been used since 1992 to guide and document care. In 2019, a collaboration between the newly formed American Correctional Nurses Association and the Omaha System Community of Practice began a joint effort with other stakeholders aimed at encoding evidence-based pandemic response interventions used in CN. The resulting guidelines are included and illustrated with examples from CN practice.

The use of complementary and integrative health therapy strategies for a wide variety of health conditions is increasing and is rapidly becoming mainstream. However, little is known about how or if complementary and integrative health therapies are represented in the EHR. Standardized terminologies provide an organizing structure for health information that enable EHR representation and support shareable and comparable data; which may contribute to increased understanding of which therapies are being used for whom and for what purposes. Use of standardized terminologies is recommended for interoperable clinical data to support sharable, comparable data to enable the use of complementary and integrative health therapies and to enable research on outcomes. In this study, complementary and integrative health therapy terms were extracted from multiple sources and organized using the National Center for Complementary and Integrative Health and former National Center for Complementary and Alternative Medicine classification structures. A total of 1209 complementary and integrative health therapy terms were extracted. After removing duplicates, the final term list was generated via expert consensus. The final list included 578 terms, and these terms were mapped to Systemized Nomenclature of Medicine Clinical Terms. Of the 578, approximately half (48.1%) were found within Systemized Nomenclature of Medicine Clinical Terms. Levels of specificity of terms differed between National Center for Complementary and Integrative Health and National Center for Complementary and Alternative Medicine classification structures and Systemized Nomenclature of Medicine Clinical Terms. Future studies should focus on the terms not mapped to Systemized Nomenclature of Medicine Clinical Terms (51.9%), to formally submit terms for inclusion in Systemized Nomenclature of Medicine Clinical Terms, toward leveraging the data generated by use of these terms to determine associations among treatments and outcomes.

OBJECTIVE To examine associations of data-driven intervention approaches (IAs) with the outcomes of adolescent or adult Latina mothers with or without the Mental health problem. DESIGN AND SAMPLE Retrospective observational study using public health nurse (PHN)-generated data for 676 Latina mothers aged 14-52. MEASURES Mothers' age, having the Mental health problem, number of problems and interventions, and Knowledge, Behavior, and Status scores using the Omaha System. Mother-specific percentages of interventions to the total number received were calculated. Visualizations and statistical tests were used to analyze the association of IAs relating mothers' characteristics, problems, interventions, and outcomes. RESULTS Four IAs were discovered. Sample characteristics differed significantly among IAs by age and having the Mental health problems. There was a small effect of age on outcomes (

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

Background End-of-life care (EOLC) relieves the suffering of millions of people around the globe each year. A growing body of hospice care research has led to the creation of several evidence-based clinical guidelines for EOLC. As evidence for the effectiveness of timely EOLC swells, so does the increased need for efficient information exchange between disciplines and across the care continuum. Aims The purpose of this study was to investigate the feasibility of using the Omaha System as a framework for encoding interoperable evidence-based EOL interventions with specified temporality for use across disciplines and settings. Methods Four evidence-based clinical guidelines and one current set of hospice standing orders were encoded using the Omaha System Problem Classification Scheme and Intervention Scheme, as well as Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT). The resulting encoded guideline was entered on a Microsoft Excel spreadsheet and made available for public use on the Omaha System Guidelines website. Results The resulting EOLC guideline consisted of 153 interventions that may enable patients and their surrogates, clinicians, and ancillary providers to communicate interventions in a universally comprehensible way. Linking Evidence to Action Evidence-based interventions from diverse disciplines involved in EOLC are described within this guideline using the Omaha System. Because the Omaha System and clinical guidelines are maintained in the public domain, encoding interventions is achievable by anyone with access to the Internet and basic Excel skills. Using the guideline as a documentation template customized for unique patient needs, clinicians can quantify and track patient care across the care continuum to ensure timely evidence-based interventions. Conclusions Clinical guidelines coded in the Omaha System can support the use of multidisciplinary evidence-based interventions to improve quality of EOLC across settings and professions.

The objective of this quality evaluation was to evaluate the changes in public health nursing (PHN) interventions after the implementation of an evidence-based family home visiting (EB-FHV) guideline encoded using the Omaha System. Design and sample This quality improvement evaluation was conducted using a secondary dataset of 27,910 PHN family home visiting interventions from visits to 129 adult clients enrolled in EB-FHV programs in a Midwestern PHN agency. The interventions were documented 12 months before and 14 months after EB-FHV Guideline implementation. The EB-FHV consisted of 94 PHN interventions for 10 Omaha System problems, with electronic health record (EHR) data generated by PHNs during routine clinical documentation. Standard descriptive and inferential statistics were employed in the analysis. Measures The Omaha System was used to compare PHN practice before and after the guideline implementation. Results Documentation patterns revealed that PHNs tailored interventions while also shifting toward the use of the EB-FHV guideline interventions. Ten EB-FHV problems accounted for 96.3% of interventions documented before and 98.5% of interventions documented after implementation. The proportion of interventions before and after EB-FHV by problem differed significantly for all problems except Substance use. Fewer interventions were provided after EB-FHV for the primary problems of Pregnancy and Postpartum, with a shift to more interventions for Caretaking/parenting. Conclusion The PHN documentation after guideline implementation demonstrated adherence to the EB-FHV guideline, while tailoring the evidence-based interventions differentially by problem. Further research is needed to extend this quality improvement approach to other guidelines and populations.

We used a standardized terminology to describe patient problems and the nursing care provided in a pilot study of a transitional palliative care intervention with patients and caregivers. Narrative phrases of a nurse's documentation were mapped to the Omaha System (problem, intervention, and target)

Objectives Nurse coaching is an important strategy for improving the health of populations. Effective interventions for nurse coaching (NC) practice, fair value outcome measurements, and standardization of terms have yet to be determined. As healthcare systems adopt electronic medical records and as nurse coaching practice evolves, it is important to capture and identify NC interventions. The long-term goal is to improve patient-centered practice by using standardized interface terminology and to examine the feasibility of using the Omaha System to represent NC practice. The three aims were to evaluate content validity of NC case studies, test accuracy of NC graduates identifying Omaha System terms for NC interventions, and explore the feasibility of analyzing NC case study data. Design This survey research evaluated NC case studies that were developed for this study by the first author and mapped to Omaha System intervention terms. Sample Surveys were emailed to 400 graduates of two nurse coach education programs. Nurse Coaches self-reported little to no experience using standardized terminologies for documentation. Measures The Omaha System was used to describe the interventions found in the NC case studies. Results Across the three case studies, 95.7% of NCs agreed that the case studies were realistic, and 89.3% agreed that they would use similar interventions; NCs identified Omaha System interventions for the case studies accurately 84.3% of the time, and feasibility of analyzing NC practice data was demonstrated through use of case study data in aggregate. Conclusion The Omaha System has potential for use as a NC documentation tool and should be considered for development of a standardized, evidence-based guideline for NC practice.

During prelicensure education, nursing students engage in cognitive learning and skills development. Content regarding the essence of nursing, caring, may be embedded within didactic course work; however, there is no theoretical framework describing ways to improve or increase caring among nursing students. We describe the we can be more caring theory as caring science potential, give examples from a cultural immersion–service learning experience, and suggest that service learning and cultural immersion, followed by guided periods of reflection, may help nursing students to know and become more caring—more fully themselves as nurses. Further research is needed to validate this theory in other contexts, programs, and cultures.

General health status is a holistic concept that includes not just diseases, but also life expectancy, activities, and health status. However, there is a gap in understanding how recipient general health status impact survival post liver transplantation. We aimed to evaluate the impact of general health status on survival after liver transplantation, while adjusting for severity of their comorbidities and demographics. This was a retrospective cohort study of 344 adults 18 years or older that underwent liver transplantation from 01/01/2008 through 12/31/2014. Predictors were general health status, comorbidities, and demographics. A severity score was built for health status and for each of the comorbidities by body system. The outcome was all-cause mortality after transplantation. Cox proportional hazard models and Kaplan – Meier analysis were used. From 344 patients, 82 died at the end of follow-up time (mean = 609 days), and 262 were alive (mean = 1523 days). General health status score controlled for comorbidities and demographics was statistically significant for mortality (HR = 2.20, p-value < 0.001). Comorbidities represented by severity scores for the circulatory system (HR = 1.89, p-value < 0.001), endocrine system (HR = 2.22, p-value < 0.01), and musculoskeletal system (HR = 2.04, p-value < 0.05) were also statistically significant. Survival analysis showed statistically significant differences between different categories of general health status. This study was the first to use pre-transplant recipient general health status as a single weighed metric to predict survival post-transplant; thus, providing new evidence to evaluate risk of mortality that is individualized for each patient.

Objective: Liver transplantation is a costly and risky procedure, representing 25 050 procedures worldwide in 2013, with 6729 procedures performed in the United States in 2014. Considering the scarcity of organs and uncertainty regarding prognosis, limited studies address the variety of risk factors before transplantation that might contribute to predicting patient’s survival and therefore developing better models that address a holistic view of transplant patients. This critical review aimed to identify predictors of liver transplant patient survival included in large-scale studies and assess the gap in risk factors from a holistic approach using the Wellbeing Model and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data Source: Search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PubMed from the 1980s to July 2014. Study Selection: Original longitudinal large-scale studies, of 500 or more subjects, published in English, Spanish, or Portuguese, which described predictors of patient survival after deceased donor liver transplantation. Data Extraction: Predictors were extracted from 26 studies that met the inclusion criteria. Data Synthesis: Each article was reviewed and predictors were categorized using a holistic framework, the Wellbeing Model (health, community, environment, relationship, purpose, and security dimensions). Conclusions: The majority (69.7%) of the predictors represented the Wellbeing Model Health dimension. There were no predictors representing the Wellbeing Dimensions for purpose and relationship nor emotional, mental, and spiritual health. This review showed that there is rigorously conducted research of predictors of liver transplant survival; however, the reported significant results were inconsistent across studies, and further research is needed to examine liver transplantation from a whole-person perspective.

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.

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.

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.

This systematic literature review explores the role of school nurses n helping children being bullied in three countries, Norway, Scotland and the United States (US). Comparisons were made of the way school nurses were trained and employed to better understand how this reflects their roles and responsibilities within the context of bullying among school children. Different systems used to support children affected by bullying were explored and examples of good practice shared. The challenges faced by school nurses due to their limited numbers compared to pupils they support was a common phenomenon in all three countries. This in itself challenges school nurses to explore more creative ways of working to ensure that the needs of school children are being met. Recommendations were made on possible cross-cultural research that can explore existing best practice creating a community of learning. This systematic literature review could provide a starting point for futurecollaborations in this field.

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

Objective To explore the quality of life (QOL) and related factors in early postnatal women. Design A descriptive, cross-sectional study. Setting Liwonde, Malawi. Participants Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018. Measurements The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL. Results The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain. Conclusion and implications for practice The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

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.

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.

Background Liver transplants account for a high number of procedures with major investments from all stakeholders involved; however, limited studies address liver transplant population heterogeneity pretransplant predictive of posttransplant survival. Objective The aim of the study was to identify novel and meaningful patient clusters predictive of mortality that explains the heterogeneity of liver transplant population, taking a holistic approach. Methods A retrospective cohort study of 344 adult patients who underwent liver transplantation between 2008 through 2014. Predictors were summarized severity scores for comorbidities and other suboptimal health states grouped into 11 body systems, the primary reason for transplantation, demographics/environmental factors, and Model for End Liver Disease score. Logistic regression was used to compute the severity scores, hierarchical clustering with weighted Euclidean distance for clustering, Lasso-penalized regression for characterizing the clusters, and Kaplan–Meier analysis to compare survival across the clusters. Results Cluster 1 included patients with more severe circulatory problems. Cluster 2 represented older patients with more severe primary disease, whereas Cluster 3 contained healthiest patients. Clusters 4 and 5 represented patients with musculoskeletal (e.g., pain) and endocrine problems (e.g., malnutrition), respectively. There was a statistically significant difference for mortality between clusters ( p < .001). Conclusions This study developed a novel methodology to address heterogeneous and high-dimensional liver transplant population characteristics in a single study predictive of survival. A holistic approach for data modeling and additional psychosocial risk factors has the potential to address holistically nursing challenges on liver transplant care and research

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.

Team-based healthcare delivery models, which emphasize care coordination, patient engagement, and utilization of health information technology, are emerging. To achieve these models, expertise in interprofessional education, collaborative practice across professions, and informatics is essential. This case study from informatics programs in the Academic Health Center (AHC) at the University of Minnesota and the Office of Health Information Technology (OHIT) at the Minnesota Department of Health presents an academic-practice partnership, which focuses on both interprofessionalism and informatics. Outcomes include the Minnesota Framework for Interprofessional Biomedical Health Informatics, comprising collaborative curriculum development, teaching and research, practicums to promote competencies, service to advance biomedical health informatics, and collaborative environments to facilitate a learning health system. Details on these Framework categories are presented. Partnership success is due to interprofessional connections created with emphasis on informatics and to committed leadership across partners. A limitation of this collaboration is the need for formal agreements outlining resources and roles, which are vital for sustainability. This partnership addresses a recommendation on the future of interprofessionalism: that both education and practice sectors be attuned to each other's expectations and evolving trends. Success strategies and lessons learned from collaborations, such as that of the AHC-OHIT that promote both interprofessionalism and informatics, need to be shared.

Countries around the world are facing very similar healthcare issues: the quality and cost of care, poor outcomes, lack of access to care, lack of transparency of information, and a growing dissatisfaction among both patients and caregivers. In the United States, healthcare constitutes 15.7% of the gross national product compared to 9.7% in the Netherlands, 8.9% in Norway, and 7.5% in Ireland. According to a report recently released by the World Economic Forum,1 with no reforms underway that would affect the fundamental drivers of healthcare expenditures, some estimate that by 2040 total expenditures could grow by another 50% to 100%. Increases in expenditures are often not commensurate with health outcomes, as illustrated by the United States, which spends more money on health-care than any other country in the Western world and has health outcomes near the bottom of the Western world. In the United States, even after the passage of the Affordable Care Act, it is estimated that 30 million people will not be able to afford care. The topic of “healthcare reform” is a pressing issue for most countries as it is becoming more apparent that required investments in healthcare adversely impact the ability to invest in education, infrastructure, social welfare, and a host of other priorities. The healthcare workforce itself is also a dominant issue. While the reasons for this are complex and differ around the world, in many countries, there is a growing dissatisfaction and disillusionment with practice. Most often when healthcare professionals retire early or leave the profession, it is not due to dissatisfaction with caring for people. Rather, it is dissatisfaction with bureaucratic systems that need to be contended with in order to deliver care. Within nursing, major drivers of dissatisfaction include loss of autonomy, frustration with bureaucracy, and adverse working conditions. Dissatisfaction contributes to workforce shortages. The reform agenda around heathcare often focuses on the financing of healthcare and the coordination of care, given that care is highly fragmented, which leads to errors, poor quality, and poor outcomes. Ironically, both of these strategies strive to give access to health-care systems that are inherently flawed, are not patient-centered, emphasize the treatment of disease over prevention, and are oriented more toward the provision of provider-delivered goods and services rather than empowering people to better manage their own health and wellbeing. Healthcare is an excellent example of a social problem that is complex and “wicked” and not amenable to easy, predictable solutions. “Wicked” problems, as defined by Conklin,2 are difficult or impossible to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize. Solving wicked problems requires innovation, novel solutions, and a systems approach. Innovations that radically and fundamentally change the what, how, and why of healthcare delivery are scarce and desperately needed. The fundamental root of many issues in healthcare is the failure to focus on the primary process of delivering care to patients. The focus is on the wrong issues. Instead of focusing on sustaining bureaucracy, new ways are needed to focus attention on humanity and the relationships between people who promote and optimize health.

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.

Background: For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. Objective: The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. Methods: A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Results: Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer’s household, number of visits to providers outside the consumer’s insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. Conclusions: This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable 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.

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.

Objective The purpose of the study was to investigate the perceptions of administrators and clinicians regarding a public health facilitated collaborative supporting the translation into practice of the Institute for Clinical Systems Improvement (ICSI) Adult Obesity Guideline. Design and Sample This qualitative study was conducted with 10 health care organizations participating in a voluntary, interprofessional obesity management collaborative. A purposive sample of 39 participants included two to three clinicians and an administrator from each organization. Interview analysis focused on how the intervention affected participants and their practices. Results Four themes described participant experiences of obesity guideline translation: (1) a shift from powerlessness to positive motivation, (2) heightened awareness coupled with improved capacity to respond, (3) personal ownership and use of creativity, and (4) a sense of the importance of increased interprofessional collaboration. Conclusions The investigation of interprofessional perspectives illuminates the feelings and perceptions of clinician and administrator participants regarding obesity practice guideline translation. These themes suggest that positive motivation, improved capacity, personal creative ownership, and interprofessional collaboration may be conducive to successful evidence-based obesity guideline implementation. Further research is needed to evaluate these findings relative to translating the ICSI obesity guideline and other guidelines into practice in diverse clinical settings.

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.]

This study aimed to assess the attitudes of health professionals towards electronic health records (EHRs) in primary health care settings in Turkey.A survey was administered to 754 health professionals working in Family Health Centres (FHCs) in seven districts in Istanbul, Turkey. The survey was developed based on extensive literature review, and consisted of 33 statements rated on a five-point Likert-scale.A total of 325 completed questionnaires were received, representing a 43% response rate, with 97% of respondents being satisfied with the EHR system in the FHCs. There were significant differences between health professional groups (physicians and nurses/midwives) in their perceptions of EHRs decreasing paper-based records, data security in EHRs, and costs of EHRs (p 0.05). Narrative responses indicated ongoing needs in software development, further support of nursing documentation and training.Overall positive attitudes towards EHRs among primary care health professionals in Turkey suggest strong acceptance and use. Recommendations based on the findings include EHR technology refinements, improved clinical documentation using standardized terminologies, and health professional-informed EHR training.

Providers in all settings are increasingly aware of the need to focus on transitional care needs and services across healthcare settings to improve quality of life, maintain optimal health, and prevent unnecessary hospitalizations. Home care is an essential piece of the transitional care puzzle, especially in providing services to support older adults with chronic comorbid conditions to remain at home safely with optimal health and psychosocial well-being. Home care is essential in bridging the gap from acute hospital care to home; however, little is known about the needs of older adults after discharge from home care. Our study investigated the perceptions of older adults with chronic health conditions after discharge from home care regarding their daily activities and healthcare needs and identified how these needs were met.

Postoperative nausea and vomiting (PONV) remains a common postoperative complication that causes patient discomfort and increases health care costs. Clinicians use the American Society of PeriAnesthesia Nurses (ASPAN) guideline to help prevent and treat PONV. However, the lack of standardized terminology in the electronic health record (EHR) and the lack of clinical decision support tools make it difficult for clinicians to document guideline implementation and to determine the effects of nursing care on PONV. To address this, we created a concept map of the Perioperative Nursing Data Set (PNDS) that illustrates the relationship between elements of this standardized nursing terminology and the ASPAN guideline, using the Systematized Nomenclature of Medicine-Clinical Terms multidisciplinary terminology to fill any gaps. This mapping results in a standardized dataset specific to PONV for use in an EHR, which links nursing care to nursing diagnoses, interventions, and outcomes. The mapping and documentation in the EHR also allows standardized data collection for research, evaluation, and benchmarking, which makes perioperative nursing care of patients who are at risk for or experiencing PONV measureable and visible. Distributing this information to perioperative and perianesthesia nursing personnel, in addition to implementing risk assessment tools for PONV and clinical support alerts in electronic documentation systems, will help support implementation of the PONV clinical practice guideline in the EHR.

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: 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.

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.

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health.

SummaryBackground: There is a critical need to reduce hospitalizations for Medicare patients and electronic health record (EHR) home care data provide new opportunities to evaluate risk of hospitalization for patients.Objectives: The objectives of this study were to 1) develop a measure to predict risk of hospitalization among home care patients, the Hospitalization Risk Score (HRS), and 2) compare it with an existing severity of illness measure, the Charlson Index of Comorbidity (CIC).Methods: A convenience sample of clinical data from 14 home care agencies’ EHRs, representing 1,643 home care patient episodes was used for the study. The development of the HRS was based on review of the literature, and expert panel evaluation to construct the HRS. Descriptive statistics and generalized linear models were used for comparative analysis; areas under curve (AUC) values were compared for receiver operating curves (ROC), and cut points predicting hospitalization were evaluated.Results: The HRS for this sample ranged from 0 to 5.6, with a median of 1.25. The CIC for this sample ranged from 0 to 9 and with a median of 0. Nearly three fourths of the sample was hospitalized at an HRS of 2, and a CIC of 1. AUC values for ROC were 0.63 for HRS and 0.59 for the CIC. The ROC curves were significantly different (t = -7.59, p Conclusions: This preliminary study demonstrates the potential value of the HRS using Omaha System EHR data. There was a statistically significant difference for predicting hospitalization of home care patients with the HRS versus the CIC; however the AUC values for both were low. Continued research is needed to further refine the HRS, determine whether it is more sensitive for particular subgroups of patients, and combine it with additional risk factors in understanding rehospitalization.Citation: Monsen KA, Swanberg HL, Oancea SC, Westra BL. Exploring the value of clinical data standards to predict hospitalization of home care patients. Appl Clin Inf 2012; 3: 419–436http://dx.doi.org/10.4338/ACI-2012-05-RA-0016

Objectives: Benchmark client outcomes across public health nursing (PHN) agencies using Omaha System knowledge, behavior, and status ratings as benchmarking metrics. Design and Sample: A descriptive, comparative study of benchmark attainment for a retrospective cohort of PHN clients (low-income, high-risk parents, primarily mothers) from 6 counties. Measures: Omaha System Problem Rating Scale for Outcomes data for selected problems. Benchmark measures were defined as a rating of 4 on a scale from 1 (lowest) to 5 (highest). Intervention: Family home visiting services to low-income, high-risk parents. Results: The highest percentage of benchmark attainment was for the Postpartum problem (knowledge, 76.2%; behavior, 94.0%; status, 96.6%), and the lowest was for the Interpersonal relationship problem (knowledge, 21.7%; behavior, 69.0%; status, 40.7%). All counties showed significant increases in client knowledge benchmark attainment, and 4 of 6 counties showed significant increases from baseline in behavior and status benchmark attainment. Significant differences were found between counties in client characteristics and benchmark attainment for knowledge, behavior, and status outcomes. Conclusions: There were consistent patterns in benchmark attainment and outcome improvement across counties and family home visiting studies. Benchmarking appears to be useful for comparison of population health status and home visiting program outcomes.

Background The purpose of this study was to evaluate outcomes of public health nurse home visiting for mothers with intellectual disabilities (ID) and a comparison group. Methods The study was a secondary analysis of existing de-identified family home visiting data. It used a two-group comparative, 1:3 match design. Sixty-eight clients were in the study (n = 17 for mothers with ID and n = 51 for mothers without ID). Client characteristics and problem prevalence were compared using standard descriptive and inferential statistics. Mixed model methods were used for the analysis of outcomes, accounting for baseline scores, time of services and matched cases. Results Mothers with and without ID showed statistically significant improvement following family home visiting services. For both groups, discharge scores were consistently higher than the corresponding admission scores, with a mean increase of 0.37 (range = 0.05–0.90). Mothers without ID attained higher outcomes than mothers with ID. Seven of 21 outcomes significantly improved for mothers with ID, and 10 of 21 for the comparison group. The percentage of mothers with ID attaining the benchmark of 4 ranged from 13.3% to 90.4% and for the comparison group ranged from 30% to 95.7%. Public health nurses addressed 15 environmental, psychosocial, physiological and behavioural problems for both groups. Conclusion Family home visiting appears to be effective in assisting parents with ID to have improved outcomes in many domains. These results provide an opportunity for service providers, home visiting nurses and public health agencies to understand the unique needs of mothers with ID.

Structured clinical data generated using standardized terminologies such as the Omaha System are available for evaluating healthcare quality and patient outcomes. New intervention management grouping approaches are needed to deal with large, complex clinical intervention data sets. We evaluated 56 intervention groups derived using four data management approaches with a data set of 165,700 interventions from 14 home care agencies to determine which approaches and interventions predicted hospitalizations among frail (n = 386) and non-frail (n = 1,364) elders. Hospitalization predictors differed for frail and non-frail elders. Low frequencies in some intervention groups were positively associated with hospitalization outcomes, suggesting that there may be a mismatch between the level of care that is needed and the level of care that is provided. © 2011 Wiley Periodicals, Inc. Res Nurs Health

Objectives: To use structured clinical data from public health nurse (PHN) documentation to describe client risk, to describe family home visiting interventions, including tailoring, and to assess the associations between client risk and intervention tailoring. Design and Sample: Retrospective cohort design. A cohort of 486 family home visiting clients who received at least 3 visits from PHNs in a local Midwest public health agency (2000–2005). Measures: Omaha System variables documenting assessments, interventions, and outcomes. A risk index was created to identify low- and high-risk clients. Descriptive and inferential methods were used to describe interventions, and to assess intervention tailoring between groups. Intervention: Routine PHN family home visiting practice. Results: The risk index meaningfully discriminated between groups. PHNs provided more visits and interventions to clients in the high-risk group, with variations in problem, category, and target by group, demonstrating that PHNs tailored interventions to address specific client needs. Conclusions: Standardized terminologies and structured clinical data are useful tools to support PHN practice, and may be useful to advance health care quality research, program evaluation, policy development, and population health outcomes.

Meaningful use has become ubiquitous in the vocabulary of health information technology. It suggests that better healthcare does not result from the adoption of technology and electronic health records, but by increasing interoperability and informing clinical decisions at the point of care. Although the initial application of meaningful use was limited to eligible professionals and hospitals, it incorporates complex processes and workflow that involve all nurses, other healthcare practitioners, and settings. The healthcare community will become more integrated, and interdisciplinary practitioners will provide enhanced patient-centered care if electronic health records adopt the priorities of meaningful use. Standardized terminologies are a necessary component of such electronic health records. The Omaha System is an exemplar of a standardized terminology that enables meaningful use of clinical data to support and improve patient-centered clinical practice, education, and research. It is user-friendly, generates data that can be shared with patients and their families, and enables healthcare providers to analyze and exchange patient-centered coded data. Use of the Omaha System is increasing steadily in diverse practice, education, and research settings nationally and internationally.

Summary Background: Public health nurse (PHN) home visiting programs have been widely employed to improve life course trajectories for high risk mothers. Home visiting programs are often lengthy, during which PHNs simultaneously address multiple problems using diverse interventions over several client encounters. To manage PHN caseloads it is critical to understand the trajectory of client improvement and the optimal duration or services. PHN documentation data enable intervention trajectory research for specific client problems. A new metric called problem stabilization is proposed for evaluating interim improvement during PHN home visiting. Problem stabilization is an intervention pattern for a client problem that is characterized by co-occurring actions (i.e. teaching, guidance, and counseling; treatments and procedures; case management; and/or surveillance) during a client encounter; followed by surveillance actions only for that problem during a subsequent client encounter. The purpose of the study was to investigate problem stabilization during home visiting services for high risk mothers. Methods: A retrospective cohort was created using family home visiting intervention documentation data from a local Midwest public health agency over a six year period (2000–2005). The data set consisted of Omaha System interventions for 720 high risk mothers. Analysis was conducted using descriptive statistics and Kaplan Meier curves. Results: On average 30.1% of the time, client problems stabilized before discharge. Stabilization patterns differed by problem. Time to stabilization was longest for Caretaking/parenting and Ante-partum/postpartum problems, and shortest for Residence and Mental health problems. Conclusions: Problem stabilization, a proposed intermediate outcome of PHN home visiting care, appears to be meaningful in describing client response to PHN intervention. This metric is an example of meaningful use of structured clinical electronic health record data for program evaluation and clinical decision support.