Multitasking during Medication Management in a Nursing Home: A Time Motion Study.

BACKGROUND: Multitasking, defined as performing two or more interventions simultaneously, increases the cognitive burden of clinicians. This may, in turn, lead to higher risk of medication and procedural errors. Time motion study (TMS) data for nurses in nursing homes revealed an extensive amount of multitasking while managing medications. Further investigation of multitasked nursing interventions will provide a foundation for optimizing medication management workflows. OBJECTIVES: Using a continuous observational TMS method, this study aimed to describe pairs of multitasked nursing interventions associated with medication management interventions, including preparing and administering medications, assessing medication effects, instructing on medications, and documenting medication administration. METHODS: An external nurse observer used 57 predefined Omaha System nursing interventions embedded within TimeCaT (version 3.9), TMS data recording software to collect observation data in a single nursing home. A total of 120 hours of time-stamped observation data from nine nurses were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. RESULTS: The majority (74%) of medication management interventions were multitasked, resulting in 2,003 pairs of multitasked interventions. Of the 57 Omaha System nursing interventions, 35 were involved in these multitasking pairs. When nurses multitasked, the average duration of medication preparation was longer (non-multitasked: 81 seconds; multitasked: 162 seconds, p < 0.05), while the average duration of medication administration record documentation was shorter (non-multitasked: 93 seconds; multitasked: 66 seconds, p < 0.05). CONCLUSION: The findings reveal the complexity of medication management in nursing homes with numerous and diverse multitasking pairs. Findings provide a platform for in-depth study of medication management multitasking in the clinical context, and inform future efforts to create clinical and informatics solutions to optimize medication management workflow. This method may be also applied to examine medication management and multitasking in other clinical settings.

Applied Informatics Innovation Within a Childhood Blood Lead Poisoning Prevention Program Resulted in Improved Data Management and Demonstrated Client Outcomes.

This poster presentation describes innovative use of the Omaha System, a standardized terminology, into public health nurses' (PHNs) workflow and electronic records within a local health department's Childhood Lead Poisoning Prevention Program. The Omaha System facilitated the tracking of evidence-based interventions and client outcomes, showing a significant improvement in record completeness (from 33% pre-implementation to 84% post-implementation) and client outcomes in health care supervision, growth and development, and nutrition. Outcome data analysis revealed improvement across all post-implementation records from initial assessments to interim assessments for Health care supervision (p<.001), Growth and development (p<.001), and Nutrition (p = .025). This achievement has given program leaders and employees the ability to clearly present their services and results to policymakers, facilitating better assessment of the program's effectiveness. The successful implementation illustrates its potential applicability to other public health projects and areas.

Comparison of Weighting Methods to Understand Improved Outcomes Attributable to Public Health Nursing Interventions.

BACKGROUND: The complex work of public health nurses (PHNs) specifically related to mental health assessment, intervention, and outcomes makes it difficult to quantify and evaluate the improvement in client outcomes attributable to their interventions. OBJECTIVES: We examined heterogeneity across parents of infants served by PHNs receiving different interventions, compared the ability of traditional propensity scoring methods versus energy-balancing weight (EBW) techniques to adjust for the complex and stark differences in baseline characteristics among those receiving different interventions, and evaluated the causal effects of the quantity and variety of PHN interventions on client health and social outcomes. METHODS: This retrospective study of 4,109 clients used existing Omaha System data generated during the routine documentation of PHN home visit data. We estimated the effects of intervention by computing and comparing weighted averages of the outcomes within the different treatment groups using two weighting methods: (a) inverse probability of treatment (propensity score) weighting and (b) EBWs. RESULTS: Clients served by PHNs differed in baseline characteristics with clients with more signs/symptoms. Both weighting methods reduced heterogeneity in the sample. EBWs were more effective than inverse probability of treatment weighting in adjusting for multifaceted confounding and resulted in close balance of 105 baseline characteristics. Weighting the sample changed outcome patterns, especially when using EBWs. Clients who received more PHN interventions and a wider variety of them had improved knowledge, behavior, and status outcomes with no plateau over time, whereas the unweighted sample showed plateaus in outcomes over the course of home-visiting services. DISCUSSION: Causal analysis of PHN-generated data demonstrated PHN intervention effectiveness for clients with mental health signs/symptoms. EBWs are a promising tool for evaluating the true causal effect of PHN home-visiting interventions.

Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba.

OBJECTIVE: To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies. PROCESS: Experts led a day-and-a-half virtual update on nursing's sustained and rigorous efforts to develop and use valid, reliable, and computable standardized nursing terminologies over the past 5 decades. Over the course of the workshop, policymakers, industry leaders, and scholars discussed the successful use of standardized nursing terminologies, the potential for expanded use of these vetted tools to advance healthcare, and future needs and opportunities. In this article, we elaborate on this vision and key recommendations for continued and expanded adoption and use of standardized nursing terminologies across settings and systems with the goal of generating new knowledge that improves health. CONCLUSION: Much of the promise that the original creators of standardized nursing terminologies envisioned has been achieved. Secondary analysis of clinical data using these terminologies has repeatedly demonstrated the value of nursing and nursing's data. With increased and widespread adoption, these achievements can be replicated across settings and systems.

Critical consciousness of public health nurses: A descriptive, comparative survey.

BACKGROUND: Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing. OBJECTIVE: Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality. DESIGN AND SAMPLE: A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%). MEASURE: The study employed the Short Critical Consciousness Scales' subscales: Critical Reflection, Critical Motivation, and Critical Action. RESULTS: PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001). CONCLUSIONS: High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.

FHIR-up! Advancing knowledge from clinical data through application of standardized nursing terminologies within HL7® FHIR®.

Health Level 7®'s (HL7) Fast Healthcare Interoperability Resources® (FHIR®) is leading new efforts to make data available to healthcare clinicians, administrators, and leaders. Standardized nursing terminologies were developed to enable nursing's voice and perspective to be visible within the healthcare data ecosystem. The use of these SNTs has been shown to improve care quality and outcomes, and to provide data for knowledge discovery. The role of SNTs in describing assessments and interventions and measuring outcomes is unique in health care, and synergistic with the purpose and goals of FHIR. FHIR acknowledges nursing as a discipline of interest and yet the use of SNTs within the FHIR ecosystem is rare. The purpose of this article is to describe FHIR, SNTs, and the potential for synergy in the use of SNTs with FHIR. Toward improving understanding how FHIR works to transport and store knowledge and how SNTs work to convey meaning, we provide a framework and examples of SNTs and their coding for use within FHIR solutions. Finally, we offer recommendations for the next steps to advance FHIR-SNT collaboration. Such collaboration will advance both nursing specifically and health care in general, and most importantly, improve population health.

Indigenous Model to Support Nursing Student Success, Cultural Identity and Workforce Diversity.

BACKGROUND: Indigenous nurses are underrepresented in the nursing workforce. Important strategies have been developed to increase the diversity of the future nursing workforce; however, unique cultural needs of Indigenous students must be addressed to provide holistic support while maintaining and strengthening cultural identity. METHOD: The Niganawenimaanaanig (We Take Care of Them) Indigenous Nursing Education Model was developed based on the Medicine Wheel and previous diverse nursing education models. This model supports the cultural, social, academic, and financial needs of Indigenous nursing students throughout recruitment, enrollment, retention, graduation, and licensure and specifies eight essential resources necessary for success. RESULTS: Lessons learned from implementing the Niganawenimaanaanig Model are shared. CONCLUSION: The Niganawenimaanaanig Model may be employed in nursing schools to guide educators and universities in promoting the success of Indigenous nursing students. [J Nurs Educ. 2023;62(9):523-527.].

Using data visualization to characterize whole-person health of public health nurses.

OBJECTIVE: To characterize patterns in whole-person health of public health nurses (PHNs). DESIGN AND SAMPLE: Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%). MEASUREMENTS: Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains. RESULTS: PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53). CONCLUSIONS: PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.

Advantages and disadvantages of using theory-based versus data-driven models with social and behavioral determinants of health data.

OBJECTIVE: Theory-based research of social and behavioral determinants of health (SBDH) found SBDH-related patterns in interventions and outcomes for pregnant/birthing people. The objectives of this study were to replicate the theory-based SBDH study with a new sample, and to compare these findings to a data-driven SBDH study. MATERIALS AND METHODS: Using deidentified public health nurse-generated Omaha System data, 2 SBDH indices were computed separately to create groups based on SBDH (0-5+ signs/symptoms). The data-driven SBDH index used multiple linear regression with backward elimination to identify SBDH factors. Changes in Knowledge, Behavior, and Status (KBS) outcomes, numbers of interventions, and adjusted R-squared statistics were computed for both models. RESULTS: There were 4109 clients ages 13-40 years. Outcome patterns aligned with the original research: KBS increased from admission to discharge with Knowledge improving the most; discharge KBS decreased as SBDH increased; and interventions increased as SBDH increased. Slopes of the data-driven model were steeper, showing clearer KBS trends for data-driven SBDH groups. The theory-based model adjusted R-squared was 0.54 (SE = 0.38) versus 0.61 (SE = 0.35) for the data-driven model with an entirely different set of SBDH factors. CONCLUSIONS: The theory-based approach provided a framework to identity patterns and relationships and may be applied consistently across studies and populations. In contrast, the data-driven approach can provide insights based on novel patterns for a given dataset and reveal insights and relationships not predicted by existing theories. Data-driven methods may be an advantage if there is sufficiently comprehensive SBDH data upon which to create the data-driven models.

Synthesis of Long COVID Symptoms: An Evidence-Based Standardized Mapping Study With the Omaha System.

Background: In COVID-19 survivors, symptom burden is a significant and multifaceted personal and societal challenge. The Omaha system is a standardized terminology used by researchers and clinicians for documentation and analysis of meaningful data for whole-person health. Given the urgent need for a standardized symptom checklist specific to the long COVID population, the purpose of the present study was to identify long COVID symptoms from the published literature (native symptoms) and map those to the Omaha system signs/symptoms terms. Methods: The long COVID symptoms identified from 13 literatures were mapped to the Omaha system signs/symptoms, using an expert consensus approach. The criteria for mapping were that the long COVID signs/symptoms had to contain either a one-to-one match (exact meaning of the native terms and the signs/symptoms) or a partial match (similar but not exact meaning). Results: The synthesis of the 217 native symptoms of long COVID and mapping analysis to the Omaha problems and signs/symptoms level resulted in a combined, deduplicated, and standardized list of 74 signs/symptoms for 23 problems. Of these, 72 (97.3%) of native signs/symptoms were a full match at the problem level, and 67 (90.5%) of native signs/symptoms were a full or partial match at the sign/symptoms level. Conclusions: The present study is the first step in identifying a standardized evidence-based symptom checklist for long COVID patients. This checklist may be used in practice and research for assessment, tracking, and intervention planning as well as longitudinal analysis of symptom resolution and intervention effectiveness.

Using Omaha System data to explore relationships between client outcomes, phenotypes, and targeted home intervention approaches: an exemplar examining practice effectiveness for older women with circulation problems.

BACKGROUND: Improved health among older women remains elusive and may be linked to limited knowledge of and interventions targeted to population subgroups. Use of structured community nurse home visit data exploring relationships between client outcomes, phenotypes, and targeted intervention approaches may reveal new understandings of practice effectiveness. MATERIALS AND METHODS: Omaha System data of 2363 women 65 years and older with circulation problems receiving at least 2 community nurse home visits were accessed. Previously identified phenotypes (Poor circulation; Irregular heart rate; and Limited symptoms), 7 intervention approaches (High-Surveillance; High-Teaching/Guidance/Counseling; Balanced-All; Balanced-Surveillance-Teaching/Guidance/Counseling; Low-Teaching/Guidance/Counseling-Balanced Other; Low-Surveillance-Mostly-Teaching/Guidance/Couseling-TreatmentProcedure-CaseManagement; and Mostly-TreatementProcedure+CaseManagement), and client knowledge, behavior, and status outcomes were used. Client-linked intervention approach counts, proportional use per phenotypes, and associations with client outcome scores were descriptively analyzed. Associations between intervention approach proportional use by phenotype and outcome scores were analyzed using parallel coordinate graph methodology for intervention approach effectiveness. RESULTS: Percent use of intervention approach differed significantly by phenotype. The 2 most widely employed intervention approaches were characterized by either a high use of surveillance interventions or a balanced use of all intervention categories (surveillance, teaching/guidance/counseling, treatment-procedure, case-management). Mean outcome discharge and change scores significantly differed by intervention approach. Proportionally deployed intervention approach patterns by phenotype were associated with outcome small effects improvement. DISCUSSIONS AND CONCLUSIONS: The Omaha System taxonomy supported the management and exploration of large multidimensional community nursing data of older women with circulation problems. This study offers a new way to examine intervention effectiveness using phenotype- and targeted intervention approach-informed structured data.

Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system.

BACKGROUND: Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. METHODS: An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. RESULTS: Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. CONCLUSIONS: Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.

Prioritizing nutrition interventions for low-income clients receiving public health nurses' home visiting services: a latent class analysis study of Omaha System data.

OBJECTIVE: This study aimed to identify phenotypes of nutritional needs of home-visited clients with low income, and compare overall changes in knowledge, behavior, and status of nutritional needs before and after home visits by identified phenotypes. MATERIALS AND METHODS: Omaha System data collected by public health nurses from 2013 to 2018 were used in this secondary data analysis study. A total of 900 low-income clients were included in the analysis. Latent class analysis (LCA) was used to identify phenotypes of nutrition symptoms or signs. Score changes in knowledge, behavior, and status were compared by phenotype. RESULTS: The five subgroups included Unbalanced Diet, Overweight, Underweight, Hyperglycemia with Adherence, and Hyperglycemia without Adherence. Only the Unbalanced Diet and Underweight groups showed an increase in knowledge. No other changes in behavior and status were observed in any of the phenotypes. DISCUSSION AND CONCLUSIONS: This LCA using standardized Omaha System Public Health Nursing data allowed us to identify phenotypes of nutritional needs among home-visited clients with low income and prioritize nutrition areas that public health nurses may focus on as part of public health nursing interventions. The sub-optimal changes in knowledge, behavior, and status suggest a need to re-examine the intervention details by phenotype and develop strategies to tailor public health nursing interventions to effectively meet the diverse nutritional needs of home-visited clients.

Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis.

Objective: Bone marrow suppression is the most common side effect of chemotherapy that may lead to discontinuation for treatment pertaining to patients during the therapy course. Acupuncture may relieve bone marrow suppression with regulation hematopoietic function during chemotherapy. The purpose of this study is to evaluate the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression and determine the effects of acupuncture on bone marrow function. Design: PubMed, Embase, Cochrane Library, Medline OVID, CINAHL Plus, Web of Science, and Chinese articles in the Airiti Library and China National Knowledge Infrastructure databases were searched up to February 2023. Publications in both English and Chinese were eligible for inclusion without any limitations on the publication date. Only randomized controlled trials investigating the impact of acupuncture on chemotherapy-induced bone marrow suppression were considered. In addition, a trial sequential analysis was performed to assess the adequacy of the current sample size. Results: A total of 25 studies met the inclusion criteria. Acupuncture was found to increase the levels of hematopoietic cytokine granulocyte colony-stimulating factor (G-CSF) (Hedges' g = 0.79, p < 0.001), as well as stimulate the production of white blood cells (Hedges' g = 0.69, p < 0.001), red blood cells (Hedges' g = 0.37, p = 0.01), neutrophils (Hedges' g = 0.66, p < 0.001), absolute neutrophil count (Hedges' g = 0.89, p = 0.01), hemoglobin (Hb) (Hedges' g = 0.37, p = 0.02), platelets (Hedges' g = 0.50, p < 0.001), and natural killer (NK) cells (Hedges' g = 1.30, p = 0.02). Further, the levels of platelets and NK cells were observed to increase cumulatively over time. Conclusions: Acupuncture may improve chemotherapy-induced bone marrow suppression due to increasing levels of the hematopoietic cytokine, G-CSF and further relieving chemotherapy-induced bone marrow suppression. PROSPERO Registration: This review was registered with PROSPERO (International Prospective Register of Systematic Reviews: CRD42020185813).

Comparison of SIREN social needs screening tools and Simplified Omaha System Terms: informing an informatics approach to social determinants of health assessments.

OBJECTIVE: Numerous studies indicate that the social determinants of health (SDOH), conditions in which people work, play, and learn, account for 30%-55% of health outcomes. Many healthcare and social service organizations seek ways to collect, integrate, and address the SDOH. Informatics solutions such as standardized nursing terminologies may facilitate such goals. In this study, we compared one standardized nursing terminology, the Omaha System, in its consumer-facing form, Simplified Omaha System Terms (SOST), to social needs screening tools identified by the Social Interventions Research and Evaluation Network (SIREN). MATERIALS AND METHODS: Using standard mapping techniques, we mapped 286 items from 15 SDOH screening tools to 335 SOST challenges. The SOST assessment includes 42 concepts across 4 domains. We analyzed the mapping using descriptive statistics and data visualization techniques. RESULTS: Of the 286 social needs screening tools items, 282 (98.7%) mapped 429 times to 102 (30.7%) of the 335 SOST challenges from 26 concepts in all domains, most frequently from Income, Home, and Abuse. No single SIREN tool assessed all SDOH items. The 4 items not mapped were related to financial abuse and perceived quality of life. DISCUSSION: SOST taxonomically and comprehensively collects SDOH data compared to SIREN tools. This demonstrates the importance of implementing standardized terminologies to reduce ambiguity and ensure the shared meaning of data. CONCLUSIONS: SOST could be used in clinical informatics solutions for interoperability and health information exchange, including SDOH. Further research is needed to examine consumer perspectives regarding SOST assessment compared to other social needs screening tools.

Clinical Judgment and Informatics: Encoding Simulations Using the Omaha System.

BACKGROUND: Clinical judgment is a critical nursing competency. Unfolding case study is a pedagogy used to develop clinical judgment. The Omaha System is an accepted taxonomy for standardizing nursing documentation. METHOD: An unfolding case study was developed from a simulation scenario by encoding 33 nursing interventions with the Omaha System, then developed multiple true-false response items which were sent electronically in survey format to prelicensure baccalaureate nursing students. Differences between identified essential and distractor interventions were evaluated. RESULTS: Participants (n = 101) identified correct interventions (M = 74.6%, standard deviation [SD] = 12%). A paired t-test indicated the percentage of correctly identified essential interventions (M = 78%, SD = 18.7%) was significantly higher than distractor interventions (M = 67%, SD = 18%). DISCUSSION: Nursing students can identify appropriate interventions using the Omaha System, demonstrating potential to extend highly effective and low-cost learning experiences using unfolding case study and multiple true-false response items. [J Nurs Educ. 2023;62(4):237-239.].

Algorithm development to improve intervention effectiveness for parents with mental health signs and symptoms.

OBJECTIVES: In this study we aimed to describe and compare groups formed by a rules-based algorithm to prospectively identify clients at risk of poor outcomes in order to guide tailored public health nursing (PHN) intervention approaches. DESIGN: Data-driven methods using standardized Omaha System PHN documentation. SAMPLE: Clients ages 13-40 who received PHN home visiting services for both the Caretaking/parenting and Mental health problems (N = 4109). MEASUREMENT: We applied a theory-based algorithm consisting of six rules using existing Omaha System data. We examined the groups formed by the algorithm using standard descriptive, inferential statistics, and Latent Class Analysis. RESULTS: Clients (N = 4109) were 25.1 (SD = 5.9) years old and had an average of 7.3 (SD = 3.2) problems, 250 (SD = 319) total interventions, and 32 (SD = 44) Mental health interventions. Overall outcomes improved after PHN interventions (p < .001 for all) and having more Mental health signs/symptoms was negatively associated with outcome scores (p < .001 for all). CONCLUSIONS: This algorithm may be helpful in identifying high-risk clients during a baseline assessment who may benefit from more intensive mental health interventions. Findings show there is value using the Omaha System for PHN documentation and algorithm clinical decision support development. Future research should focus on algorithm implementation in PHN clinical practice.