Between 1975 and 1993, staff of the Visiting Nurse Association of Omaha (NE) collaborated with staff from 7 diverse community-focused field test sites, consultants, and advisory committee members to conduct 4 federally funded research projects. The projects were designed to develop and refine the Omaha System, and to establish its reliability, validity, and usability. The Omaha System is based on actual client data generated by practicing clinicians; an inductive approach was used with each project. The first three projects were Division of Nursing, USDHHS contracts and the fourth was a National Institute of Nursing Research RO-1 grant. Funding during the 13 years of research approximated $1.4 million. Because of this funding, the Omaha System exists in the public domain.
The Omaha System is useful for describing and quantifying the practice of nurses and other health care professionals. It is designed to organize pertinent data about clients' problems, the activities health care professionals provide, and clients' progress over time. The model can be used both when a clinician provides care to one client and when aggregate data are generated during multiple client-clinician encounters.
The Omaha System is a structured and complete approach to practice, documentation, and information management and is designed for use by clinicians, administrators, researchers, faculty, and students. Use of the System minimizes redundancy in the client record and limits documentation time. The architecture of the Omaha System is flexible and allows for additions or revisions consistent with established taxonomic rules and a research environment. Each part of the Omaha System is organized from general to specific and includes:
The number and diversity of Omaha based studies conducted by health care providers is increasing. Numerous faculty as well as masters and doctoral students have used the Omaha System for research projects and have extended the body of knowledge. Research has expanded to include acute care settings. Several studies have demonstrated the ability to describe resource utilization patterns, severity or case-mix variables using the data elements of the Omaha System.
The Omaha System supports clinical standards of practice, therefore it is being used in many settings to fulfill regulatory and quality assurance requirements. The most recent survey of Omaha System users was published in 1992. Nearly 250 user sites were identified; each site employed from one to 600 staff members for a total of 4,000 users. The number of users has increased markedly since that survey was published. Another survey is being planned for late in 1997.
The Omaha System is being used in home care, public health, outpatient, case management, school, hospital, and other practice settings. As health care system integration and the shift to community-focused care continues, the Omaha System is being used across increasingly diverse settings. Changes in health care delivery have also stimulated college of nursing faculty to revise their curricula. The first undergraduate-graduate program to change their curriculum to one based on the Omaha System will do so in the fall of 1997. In addition to users in the USA, the Omaha System is being used internationally. It has been translated into Danish, Dutch, Chinese, Japanese, Swedish, and other languages. Additional known Omaha System users reside in Canada and Australia.
Several software developers have integrated the vocabulary and codes of the Omaha System into commercially available software. At present, at least 7 companies are producing software which is available to home care agencies, public health departments, nursing centers, and colleges of nursing. The Omaha System can serve as a stand-alone clinical documentation system or can be integrated into a management information system along with personnel, financial, equipment, and staffing modules.
The Omaha System is being used to explain the world of community health nursing to new employees, as a system of cues to improve the quality of practice of experienced staff, and as a framework for quality improvement and information management. The Omaha System provides valid and reliable data for conversion to information about the health care of individual patients that can be aggregated to produce knowledge on how to best meet the needs of groups of patients.
The Omaha System is recognized by the American Nurses Association as one of the four vocabularies to be considered for use by nurses. The Omaha System is similar yet different than the other 3 vocabularies. The Omaha System's Problem Classification Scheme shares similarities with NANDA's nursing diagnoses. The Intervention Scheme shares similarities with the Nursing Interventions Classification and the Home Health Care Classification. The other three recognized vocabularies do not have a formalized outcome measurement component. ANA has initiated a report card project in the acute care setting to develop quality indicators and methods of evaluating care. A committee has just been appointed to launch a similar community-focused program in 1997. The Omaha System categories will be discussed and considered as a source of quality indicators.
The Omaha System is included in the National Library of Medicine's Metathesaurus and is recognized for inclusion in the Unified Medical Language System.
It has been incorporated into the ICN's International Classification of Nursing Practice. The ICNP combines vocabularies pertinent to nurses.
The interdisciplinary nature of the Omaha System enables nurses, physicians and allied health professionals to use the Omaha System in conjunction with other standardized coding systems such as the ICD-9-CM and CPT codes.
As a taxonomy which exists in the public domain, the Omaha System is available to those who wish to use it in print and electronic formats. Many chapters and articles are available about the Omaha System. The most comprehensive publications are two books published in 1992 by WB Saunders, Philadelphia: The Omaha System: Applications for Community Health Nursing and The Omaha System: A Pocket Guide for Community Health Nursing. The pocket guide contains a users' guide. The Japanese version of the Omaha System pocket guide will be available in 1997. A textbook for students is now being written.
FITNE, Inc., formerly the Fuld Institute for Technology in Nursing Education, has produced two videotapes for purchase by service providers or faculty to facilitate initial and ongoing reliable use of the Omaha System.
Various speakers offer sessions.
An organization is being formed by Karen Martin.
Omaha System revisions and updates will be included in the activities of the users' group.
| Karen S. Martin, RN, MSN, FAAN Health Care Consultant Martin Associates 2115 S. 130th St. Omaha, NE 68144 Phone: 1-402-333-1962 Fax: 1-402-333-2091 |
Kathryn H. Bowles, RN, PhD Research Associate University of Pennsylvania, School of Nursing 1435 Wynnemoor Way Ft. Washington, PA 19034 Phone: 1-215-628-2056 Fax: 1-215-628-2056 |