NURS 6051 Week 7 Standardized Terminology Argument Example

Adopting the Omaha System in a Home Health Agency: An Argument for Standardized Terminology That Can Show Whether Visits Change Anything

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College of Nursing, Walden University

NURS 6051: Transforming Nursing and Healthcare Through Technology

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Month Day, Year

Adopting the Omaha System in a Home Health Agency: An Argument for Standardized Terminology That Can Show Whether Visits Change Anything

The Agency's Notes and the Thesis

The agency in this paper is a composite: a nonprofit home health agency with about 40 nurses serving a mixed urban and rural county. Its nurses document each visit in a narrative note within the electronic record, supplemented by the assessment items Medicare requires at admission and discharge. The narratives are careful and often rich; experienced nurses describe what they saw, what they taught, and how the patient responded. But because each nurse describes the same problem in her own words, the agency cannot count anything across patients. It cannot say how many patients with heart failure improved their understanding of their medications, or whether its teaching visits change behavior, without reading thousands of notes.

This paper argues that adopting the Omaha System as the agency's standardized terminology would let it show, for the first time, whether its visits change anything for the problems nurses address. The argument does not claim that narrative has no value; it claims that narrative alone cannot be aggregated, and that the agency's future depends partly on being able to demonstrate outcomes.

The Omaha System in Plain Words

The Omaha System was developed for community and home health nursing and has three linked parts (Martin, 2005). The Problem Classification Scheme is a list of 42 health-related problems organized into four domains: environmental, psychosocial, physiological, and health-related behaviors. Each problem can be described further by whom it affects, whether it is actual or potential, and by specific signs and symptoms. The Intervention Scheme describes what the nurse does in four categories, teaching, guidance, and counseling; treatments and procedures; case management; and surveillance, each paired with a target, such as medication actions or signs and symptoms. The Problem Rating Scale for Outcomes rates each problem on three five-point scales: knowledge, what the person understands; behavior, what the person does; and status, the condition itself.

The Omaha System is among the terminologies the American Nurses Association recognizes for nursing practice, and the association's position is that recognized terminologies should be built into electronic health records so that nursing care can be captured, shared, and analyzed (American Nurses Association [ANA], 2018). The system has been used and studied widely in home and community settings, including in research linking interventions to outcome ratings (Topaz et al., 2014). The agency would not be adopting an experimental tool; it would be joining a large group of organizations already using a common language.

The Same Visit, Two Ways

Consider a composite patient, Mrs. W., 78, discharged home after a hospitalization for heart failure. On the first home visit the nurse writes a narrative: "Pt states she takes her 'water pill' most days but skips it when she has to go out. Ankles swollen, 2+ pitting. Short of breath walking to kitchen. Reviewed purpose of furosemide and importance of daily weights; pt verbalized understanding. Scale in bathroom but pt not using. Will reinforce next visit."

The same visit coded in the Omaha System reads: Problem, Circulation (physiological domain), individual, actual; signs and symptoms, edema and dyspnea on exertion. Second problem, Medication regimen (health-related behaviors domain), individual, actual; sign, does not follow recommended dosage. Interventions: teaching, guidance, and counseling, target medication action and side effects; teaching, guidance, and counseling, target signs and symptoms, physical (daily weights); surveillance, target signs and symptoms, physical. Ratings for Medication regimen: knowledge 2, behavior 2, status 3. Ratings for Circulation: knowledge 2, behavior 3, status 2.

The narrative is more vivid, and nothing in the coded version replaces the nurse's judgment. But only the coded version can be counted. If the same problems are rated again at discharge, the agency can see whether knowledge, behavior, and status moved, and it can do that for every heart failure patient it serves, not just Mrs. W.

The Time Objection, Conceded in Part

The strongest objection is that coding takes time away from patients. Nurses already spend a large share of their day documenting, and adding a coded layer to a narrative note could lengthen visits or push charting into evenings. This objection is partly right. Learning the terminology takes training time, and during the first months coding will be slower than writing.

Two responses limit the cost. First, the coded elements can replace parts of the narrative rather than duplicate them: problem lists, interventions, and ratings can be selected from structured pick lists, with free text reserved for what the codes cannot capture. Agencies that have adopted the system report that documentation becomes faster once nurses are familiar with it, although that depends on how the record is configured (Topaz et al., 2014). Second, the agency can phase adoption, starting with one high-volume problem such as circulation for heart failure patients, so that nurses learn a small part of the system well before expanding. The objection is a reason to implement carefully, not a reason to keep data that cannot be counted.

Questions a Year of Coded Data Could Answer

After a year of coded documentation, the agency could ask questions it cannot answer now. Do knowledge ratings for medication regimen among heart failure patients rise between admission and discharge, and by how much? Does improvement in knowledge translate into improvement in behavior, or do patients understand their medications without taking them differently? Which interventions are most often delivered to patients whose status improves, compared with those whose status does not? Do outcomes differ between urban and rural patients, or between patients who receive more surveillance visits and those who receive fewer? These are stated as questions, not promised results. The data might show that the agency's teaching changes knowledge but not behavior, which would be uncomfortable and useful. Either way, the agency would be able to answer from its own records instead of from impression. Those answers would also strengthen the agency's position with payers and referral partners, who increasingly ask home health agencies to show results rather than describe services.

References

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions [Position statement]. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/

Martin, K. S. (2005). The Omaha System: A key to practice, documentation, and information management (Reprinted 2nd ed.). Health Connections Press.

Topaz, M., Golfenshtein, N., & Bowles, K. H. (2014). The Omaha System: A systematic review of the recent literature. Journal of the American Medical Informatics Association, 21(1), 163-170. https://doi.org/10.1136/amiajnl-2012-001491