Discovering Associations Among Older Adults' Characteristics and Planned Nursing Interventions Using Electronic Health Record Data.

BACKGROUND AND PURPOSE: Little is known about how nursing assessments of strengths and signs/symptoms inform intervention planning in assisted living communities. The purpose of this study was to discover associations among older adults' characteristics and their planned nursing interventions. METHODS: This study employed a data-driven method, latent class analysis, using existing electronic health record data from a senior living community in the Midwest. A convenience sample comprised de-identified data of well-being assessments and care plans for 243 residents. Latent class analysis, descriptive, and inferential statistics were used to group the sample, summarize strengths and problems attributes, nursing interventions, and Knowledge, Behavior, and Status scores, and detect differences. RESULTS: Three groups presented based on patterns of strengths and signs/symptoms combined with problem concepts: Living Well (n = 95) had more strengths and fewer signs/symptoms; Lower Strengths (n = 99) had fewer strengths and more signs/symptoms; and Resilient Survivors (n = 49) had more strengths and more signs/symptoms. Some associations were found among group characteristics and planned interventions. Living Well had the lowest average number of planned interventions per resident (Mean = 2.7; standard deviation [SD] = 1.7) followed by Lower Strengths (Mean = 3.8; SD = 2.6) and Resilient Survivors (Mean = 4.1; SD = 3.4). IMPLICATIONS FOR PRACTICE: This study offers new knowledge in the use of a strengths-based ontology to facilitate a nursing discourse that leverages use of older adults' strengths to address their problems and support their living a healthier life. It also offers the potential to complement the problem-based infrastructure in clinical practice and documentation.

Feasibility of describing community strengths relative to Omaha system concepts.

OBJECTIVES: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. DESIGN AND SAMPLE: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. RESULTS: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. CONCLUSIONS: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

A strengths-based data capture model: mining data-driven and person-centered health assets.

With health care policy directives advancing value-based care, risk assessments and management have permeated health care discourse. The conventional problem-based infrastructure defines what data are employed to build this discourse and how it unfolds. Such a health care model tends to bias data for risk assessment and risk management toward problems and does not capture data about health assets or strengths. The purpose of this article is to explore and illustrate the incorporation of a strengths-based data capture model into risk assessment and management by harnessing data-driven and person-centered health assets using the Omaha System. This strengths-based data capture model encourages and enables use of whole-person data including strengths at the individual level and, in aggregate, at the population level. When aggregated, such data may be used for the development of strengths-based population health metrics that will promote evaluation of data-driven and person-centered care, outcomes, and value.

Historical review of efforts to reduce noise-induced hearing loss in the United States.

BACKGROUND: Noise-induced hearing loss is a centuries-old problem that is still prevalent in the United States and worldwide. AIM: To describe highlights in the development of hearing loss prevention in the U.S. from World War II to the present. METHODS: Literature review. RESULTS: Approaches to occupational noise-induced hearing loss prevention in the United States over the past seven decades are described using a hierarchy of controls framework and an interdisciplinary perspective. Historical timelines and developmental milestones related to occupational noise-induced hearing loss prevention are summarized as a life course. DISCUSSION: Lessons are drawn for other countries in their hearing conservation efforts. CONCLUSION: Future developments building on the hearing loss prevention work of the past 70 years can prevent the problem of occupational NIHL in the 21st century. Am. J. Ind. Med. 60:569-577, 2017. © 2017 Wiley Periodicals, Inc.

Geo-spatial Informatics in International Public Health Nursing Education.

This poster describes results of an undergraduate nursing informatics experience. Students applied geo-spatial methods to community assessments in two urban regions of New Zealand and the United States. Students used the Omaha System standardized language to code their observations during a brief community assessment activity and entered their data into a mapping program developed in Esri ArcGIS Online, a geographic information system. Results will be displayed in tables and maps to allow comparison among the communities. The next generation of nurses can employ geo-spatial informatics methods to contribute to innovative community assessment, planning and policy development.

Wearable Technology Surveillance Data for the Personal Health Record Using the Omaha System: Noise Exposure, Cardiovascular and Stress Biomarkers.

This poster describes a method to prepare noise and health data from wearable technology for standardized representation in the electronic personal health record thus enabling individuals to identify noise-related health risks. Using a case study approach, the authors demonstrate transformation of data to the Omaha System standardized terminology in order to depict the data graphically in a personal health record.

Feasibility of Describing Wellbeing and Strengths at the Community Level Utilizing the Omaha System.

Capturing strengths at the community level offers an emergent perspective to a strength-based approach for population health. The Omaha System standardized terminology has been found feasible to describe individual strengths in patient care planning. This study depicts results of using the Omaha System to capture strengths at the community level. Descriptive statistics and visualization were used to examine patterns of strengths and signs/symptoms by Omaha System Problem concept based on the secondary data analysis from 118 student-generated community assessments. Results suggest that it is feasible to use the Omaha System as a method classifying strengths and problems at the community level. The relationship between strengths and signs/symptoms is consistent with the pattern observed at the individual-level. Utilizing a strength-based model may provide robust information about community strengths leading to new approaches to population health management in support of community wellbeing.

Feasibility of Using the Omaha System for Community-level Observations.

OBJECTIVES: The purpose of this study was to determine the feasibility of using a standardized language, the Omaha System, to capture community-level observations to facilitate population assessment and electronic information exchange. The objectives were: (1) to evaluate the feasibility of using the Omaha System at the community level to reflect community observations and (2) to describe preliminary results of community observations across international settings. DESIGN AND SAMPLE: Descriptive. A dataset of 284 windshield surveys (community observations) completed by nursing students in five countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: The Omaha System Problem Classification Scheme provided standardized terms for assessment of communities in an online checklist of 11 problems and their respective signs/symptoms. RESULTS: Feasibility was demonstrated: students were able to describe community observations using standardized terminology from the Omaha System. Preliminary results describe variations in community signs and symptoms by location. CONCLUSIONS: The Omaha System appears to be a useful tool for community-level observations and a promising strategy for electronic exchange of population health assessments.

Lifelong occupational exposures and hearing loss among elderly Latino Americans aged 65-75 years.

OBJECTIVE: The purpose of this study is to determine the relationship between occupational exposures and hearing among elderly Latino Americans. DESIGN: A descriptive, correlational design used for this secondary analysis with the data from the Sacramento Area Latino Study of Aging (SALSA). STUDY SAMPLE: A total of 547 older adults were included. RESULTS: A majority of participants (58%) reported occupational exposures to loud noise and/or ototoxic chemicals. About 65% and over 90% showed hearing loss at low and high frequencies, respectively. Participants with occupational exposure to loud noise and/or ototoxic chemicals were, significantly, two times more likely to have hearing loss at high frequencies compared to those without exposure (OR = 2.29; 95% CI: 1.17 = 4.51, p = .016), after controlling for other risk factors of hearing loss such as age, gender, household income, current smoking, and diabetes. However, lifelong occupational exposure was not significantly associated with hearing loss at low frequencies (OR = 1.43; 95% CI: 0.94 = 2.18, p = .094). CONCLUSION: Lifelong occupational exposure to loud noise and/or ototoxic chemicals was significantly associated with hearing loss among elderly Latino Americans. Healthy work life through protection from harmful auditory effects of occupational exposures to noise and chemicals will have a positive impact on better hearing in later life.

Stages of change in hearing-protection behavior, cognition, and hearing status.

OBJECTIVE: To determine stages of hearing-protection behavioral change and their relationships with cognitions and hearing status. METHOD: A cross-sectional study of 769 construction workers who completed a survey and audiometric tests. RESULTS: The majority of participants (over 64%) were in the preparation stage. Participants in the action/maintenance stage demonstrated significantly greater benefits, self-efficacy, and interpersonal influence; fewer barriers; and better hearing. This is the first study that shows significantly better health outcome, hearing ability, as the stage progresses. CONCLUSION: Study demonstrates preliminary validity of the stages of change with hearing-protection behavior. Future hearing-protection intervention should integrate the stages of change to increase effectiveness.

Firefighter hearing health: an informatics approach to screening, measurement, and research.

OBJECTIVE: The purpose of this study was to evaluate the use of a standardized interface terminology, the Omaha System, with respect to noise-induced hearing loss (NIHL). DESIGN: A descriptive, correlational design was employed for this secondary analysis with the data from an ongoing hearing protection intervention study. STUDY SAMPLE: A total of 346 firefighters were included. RESULTS: First, an evidence-based standardized care plan (EB-SCP) for hearing screening was developed and validated by clinical experts. Second, occupational health records were used to compute Omaha System Knowledge, Behavior, and Status outcomes. Third, research data were mapped to Omaha System rating scales. For Knowledge, the mean score was close to 'adequate' (3.7). For Behavior, the mean score was close to 'rarely appropriate' (2.2). For Status, the mean score was close to 'minimal sign/symptom' (4.4). Significant positive relationships were found between Knowledge and Behavior (Spearman's rho =.13, p =.01), and between Behavior and hearing Status (Spearman's rho =.12, p =.02). CONCLUSIONS: Findings support the validity of the new Knowledge, Behavior, and hearing Status. Informatics methods such as the standardized NIHL EB-SCP and outcome data sets will create opportunities for clinical decision support and data exchange across various health care settings, thus supporting population-based hearing health assessments and outcomes.

Feasibility of encoding the Institute for Clinical Systems Improvement Depression Guideline using the Omaha System.

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.

Benchmark attainment by maternal and child health clients across public health nursing agencies.

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.

Prevalence of hearing loss and accuracy of self-report among factory workers.

Noise represents one of the most common occupational health hazards. A Healthy People 2020 objective aims to reduce hearing loss in the noise-exposed public. The purpose of this study was to describe and compare perceived and measured hearing, and to determine the prevalence of hearing loss among a group of factory workers. Data collected as part of an intervention study promoting hearing protector use among workers at an automotive factory in the Midwest were used. Plant employees (n=2691) provided information regarding their perceived hearing ability, work role, and other demographics. The relationships among audiograms, a single-item measure of perceived hearing ability, and demographic data were explored using chi-square, McNemar's test, Mann-Whitney U-test, sensitivity, and specificity. The prevalence of hearing loss among noise-exposed factory workers was 42% (where hearing loss was defined as >25 dB loss at the OSHA-recommended frequencies of 2, 3, and 4 kHz in either ear). However, 76% of workers reported their hearing ability as excellent or good. The difference in perceived hearing ability was significant at each tested frequency between those with and without measured hearing loss. Self-reported hearing ability was poorly related to results of audiometry. Although this group of workers was employed in a regulated environment and served by a hearing conservation program, hearing loss was highly prevalent. These findings, together with national prevalence estimates, support the need for evaluation of hearing conservation programs and increased attention to the national goal of reducing adult hearing loss.

Public health nurses tailor interventions for families at risk.

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.

Linking home care interventions and hospitalization outcomes for frail and non-frail elderly patients.

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.

Informing standard development and understanding user needs with omaha system signs and symptoms text entries in community-based care settings.

The Omaha System is one of the most widely used standards for documentation in community-based settings. While researchers have focused upon this extensible classification scheme to understand and summarize structured data, few studies have analyzed the use of associated text. Two years of client records were accessed from two diverse sites utilizing the Omaha System 2005 revision: a skilled homecare, hospice, and palliative care program and a maternal child health home visiting program. Each problem allows users to enter text data for "other" signs and symptoms (S&S). Problems with the most frequent use of Other S&S were analyzed by a group of content experts to categorize associated text and inform future standard refinements. Text entries for Other S&S frequently contained duplicate entries, multiple concepts, medical diagnoses, interventions, or comments. A number of potential new and modified S&S were identified. Text entries for Other S&S appear valuable for informing future standard development.

Data management for intervention effectiveness research: comparing deductive and inductive approaches.

Management approaches are needed to prepare intervention data sets for research. We identified four management approaches and applied them to Omaha System intervention data from 15 home care agencies (621,385 interventions provided to 2,862 patients). Classifying intervention data created differing numbers of distinct groups for deductive approaches labeled as action category (four groups), theoretical (5), and clinical expert consensus (23). One inductive, data-driven approach generated 150 groups of interventions, of which 24 were meaningful and unique. Interventions in deductive groups were mutually exclusive, and approaches mapped readily according to intervention action terms. The novel, overlapping, inductive groups consisted of diverse actions for multiple problems. The four management approaches created meaningful intervention groups to be employed in future outcomes evaluation studies.