Integrating Use of the Omaha System Into Continuing Care Clinical Processes
Application of the OMAHA System in the education of nursing students: A systematic review and narrative synthesis
Abstract
Aim
The aim of this systematic review was to synthesize evidence on the application of the Omaha System in the education of nursing students and to provide advice for educators to apply the Omaha System to practice and research effectively and meaningfully.
Background
It is a necessary part of nursing education to provide students with informatics experience. The Omaha System is a standardized nursing terminology designed to enhance practice, documentation, and information management.
Design
A systematic review and narrative synthesis.
Methods
Studies from eight databases (PubMed, Web of Science , Embase, CINAHL, PsycINFO, China Biology Medicine disc, CNKI, Wanfang Data) were systematically retrieved. Twenty-three articles were found and synthesized.
Results
Existing studies showed that the Omaha System was mainly applied in student community practice as a tool for guiding practice and collecting information, and the practice data were used by educators to analyse the outcomes of nursing education. Recently, the Omaha System was introduced into the classroom environment and achieved positive results in terms of teaching. Students' feedback on the use of the Omaha System was generally positive.
Conclusions
The Omaha System can be an active teaching and learning tool for nursing education, and further research is needed to explore and realize its potential in the field of education.
Introduction
Documentation is an important part of nursing activities. As the use of electronic health records (EHRs) expands globally, the practice of capturing nurses' work in electronic formats is increasing (Kruse et al., 2018). Standardized terms are an important part of electronic health records. Nurses use these terms to describe, record and quantify their daily practice in a consistent way, which is essential for information exchange, the discovery of practice-based knowledge, and the evaluation of nursing quality (Macieira et al., 2019). The Omaha System is a research-based standardized classification system for nursing practice that is one of the seven standardized nursing terminologies recognized by the American Nurses Association (Mccormick et al., 1994), which consists of terms and codes from generic to specific and is freely available. The Omaha System originated with the Visiting Nurse Association (VNA) of Omaha in the 1970s. After 40 years of development, it has been translated into a dozen languages and is widely used in practice, education and research by various healthcare practitioners from both developed and developing countries (Topaz et al., 2014).
The Omaha System is hierarchical, multidimensional, and computer-compatible and consists of three interrelated components: the Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes. The Problem Classification Scheme provides a method for identifying patient problems and then making a diagnosis. The Problem Classification Scheme consists of forty-two client problems or areas of concern, which are categorized under one of the following four domains: environmental, psychosocial, physiological, and health-related behaviours. There are two sets of problem modifiers: health promotion, potential, and actual; and individual, family, and community. Groups of signs and symptoms are designed to further describe actual problems. The Intervention Scheme provides a way to classify the nursing activities provided to clients into four categories: health teaching, guidance, and counselling; treatments and procedures; case management; and surveillance. More specific interventions are described by using 75 targets (e.g., "skin care" or "support group"). The Problem Rating Scale for Outcomes consists of three five-point Likert-type scales to evaluate the client's knowledge, behaviour, and status related to an identified problem at regular or predictable times (Martin, 2005).
Among the educational objectives, it has become increasingly important to develop students' decision-making skills, evidence-based nursing, and informatics ability to use standardized terminology (Stalter et al., 2019). The AACN (American Association of College of Nursing), 2008, AACN (American Association of College of Nursing), 2011 argues that graduates of bachelor's and master's nursing programmes should be able to use standardized terminologies in a care environment to reflect nursing care outcomes. An increasing number of educators realize the importance of providing students with informatics experience in classroom, laboratory and clinical settings (Choi and De Martinis, 2013). The function of the Omaha System may respond to these educational needs, with its emphasis on professional practice, decision-making skills, standardized documentation, information management and communication (Martin, 2005), which reflects the great potential of its application in nursing curriculum reform.
Nursing educators from many countries have actively applied the Omaha System to education. In the 1980s, faculty began to introduce students to the Omaha System, mainly in community health courses. Since then, the scope of use has expanded to many schools' nursing programmes internationally and includes diploma, associate's, bachelor's, master's and doctoral programmes (Martin et al., 2011). In 1998, the Fuld Institute for Technology in Nursing Education (FITNE) released the Nightingale Tracker (NT), which was a point-of-care information processing unit adopting an automated Omaha System software program incorporated into a handheld computer, the DataRover 840 (Elfrink et al., 1999). The NT supported the automated patient record and the e-mail process through a client-server architecture, which was designed to facilitate the supervision of students by establishing synchronous communications between the faculty and students at remote sites and to collect, store, retrieve, and aggregate patient data efficiently for instructional purposes. It was reported that the NT was introduced in more than 50 schools in the United States and New Zealand, mainly for home visit programmes in community health courses (Martin et al., 2011). In addition, to provide nursing students with community clinical practice sites, many schools established primary care nurse-managed centres (Martin et al., 2011). These academic service institutions were scattered in the community public residential areas where students provided health promotion and disease prevention services for individuals and families with health-related problems. Educators chose the Omaha System to standardize practice, documentation, and information management and established a repository for integrating clinical, financial and statistical data (Thompson et al., 2012).
This paper summarized the application of the Omaha System in the education of nursing students. Compared with other standardized terminologies, the Omaha System is characterized by its three components that can be used to record a complete nursing process, clear and concise structure, and community-based development. Therefore it has been widely studied and used in nursing education. Although the previous reviews of the Omaha System mentioned its application in education (Martin et al., 2011, Topaz et al., 2014), there is no systematic and comprehensive review of its use in the field of education. In addition, the reviewed literature has been published for more than 10 years, and there are a lack of specific descriptions of the research results. The ever-changing medical environment puts forward new challenges for nurses. Determining how to develop the informatics ability of nursing students to use standardized terms is a common task for educators. More emerging evidence needs to be integrated to determine the ways in which standardized terminology has been meaningfully applied in nursing education. Therefore, the purpose of this paper was to (1) systematically review publications about the application of the Omaha System for nursing students; (2) describe how the Omaha System is applied with students in the field of education and its effect; and (3) provide suggestions for educators to apply the Omaha System in practice and research effectively and meaningfully.
Section snippets
Methods
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement (Moher et al., 2009) to answer the following questions: how is the Omaha System applied with nursing students and what is the effect of its application?
Findings
Twenty-three articles meeting the inclusion criteria were screened, and the selection process is shown in Fig. 1.
Table 1 summarizes the characteristics of the studies. All 23 articles were published between 1990 and 2019, and two of them were from the same study. The studies were conducted in a number of countries. There were 12 studies in the United States, four in Turkey, three in China, and one in Canada. One study was conducted jointly in the United States and Turkey, and one was a
Discussion
This review described how the Omaha System was applied with nursing students and what its effects was, aiming to provide information and suggestions for educators to conduct relevant research. Existing studies suggested that the Omaha System was mainly used to guide and record students' community practice activities, and it was also introduced into classroom settings recently to develop students' nursing competence. Students' feedback on the use of the Omaha System was generally positive.
Limitations
Some of the selected studies were not designed to answer our questions, so they thus gave us indirect answers. Direct comparison of the studies' quality was limited due to the inconsistent study methodologies they used. The common limitations were small sample size and lack of randomization. In addition, when students used the Omaha System to rate clients, there may be deviations in the ratings related to beliefs or unconscious desires. For qualitative studies, the common data source was
Conclusion
With constant changes in the medical environment, an increasing number of educators have realized the importance of developing the informatics ability of nursing students to use standardized terms. However, the role of the Omaha System in education goes beyond that. This paper systematically reviewed publications about the application of the Omaha System with nursing students. Existing studies showed that the Omaha System is an active teaching and learning tool for nursing education that can
Ethical approval details
Not applicable.
Funding
This work was supported by the Graduate Teaching Reform Project of Jilin University, China (Grant Number: 2021JGY37).
Declarations of interest
None.
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