She is Emily, who has just started working as a home visiting nurse, an occupation which she had always wanted to become. It has been one year since she became a home visiting nurse. Although she feels that it is a worthwhile job being a home visiting nurse, she has daily concerns.
I have understood that it is important to proceed nursing with holistic approach to patient's life in home visiting nursing. But I have concerns whether I'm overlooking something and also worried whether my nursing care is actually helping the patients. Hi, Emily. You look worried.
A speaking book? Who are you? I am Omaha Man. I think I can help.
I can support your holistic approach with Omaha System. This is very useful when describing the flow from assessments, planning, care practicing to evaluation. And it guides you to the nursing of your ideal.
Omaha System is a tool for describing the nursing process from planning, care practicing, to evaluation. It is named from Omaha City in the United States, where the system is developed by the Home Visiting Nursing Association. This is used in home visiting nursing not only in the U.S., but throughout the world.
For example, in the Netherlands, Caring plan using Omaha's system is covered by national insurance, which means the system is publicly recognized. Wow, it is a world-famous tool, but a system sounds difficult to me. I'm not so sure if I can understand. It is explained with the terms which can easily be understood, even by those who are not healthcare workers.
Using the examples, let's look at the flow, starting from the planning. Patient A 93-year-old female. She used to be a teacher in an elementary school.
Very bright person. She liked to go to karaoke with her neighbors after retirement. She lives with her son in his 60s, after her husband passed away 10 years ago.
From half a year ago, she started to tumble more often, and was diagnosed with progressing supranuclear paralysis. It gradually became difficult for her to go see a doctor, so the hospital introduced community support center. So she started using home visiting nursing and medical service. There was a bed sore in the sacral area at the beginning.
Although her dementia symptom is progressing, she is able to communicate, if short. Her son told us, she wants to stay at home, so I want to do as much as possible to meet her will. But I have never tried home care, so I have no idea what to do.
With this example, let's look at how to plan, practice care, and evaluate with Omaha System. Let's start with analyzing nursing problems. There are 40 nursing problems in Omaha System, each categorized under items such as environmental domain, psychosocial domain, health-related behaviors domain.
So that home visiting nurses can understand the patients from various angles. In this case, when focusing on the bed sore, we are directed to look at the background behind the problem bed sore. First, her son is not used to caretaking.
Second, the environment of her house, living conditions like nutrition and cleanliness. So nursing problems can not only be about skin, but also have to be understood with relation to the backgrounds such as caretaking, personal care, and nutrition. We are able to think not only the problems but also the backgrounds surrounding the life of the patients in relation to the problems. There is no one correct answer so we need to pick the problems depending on the relations and prioritization of problems.
This time we shall choose skin after specifying the problem, let's assess the condition of patient A before practicing the care. In Omaha's system, use score from three dimensions, knowledge, behavior, status, to see the changes before and after practicing the care. For example, the score of the knowledge is one because her son does not have any knowledge of the bed sore. The score of the behavior is one because Neither herself nor her son deterred the bedsore, nor changed the position for the bedsore prevention. The score of the status is 2, because although there is no...
A sign of infection, it is a stage 2 bed sore. We can assess the problem not only by the visible status of the patients, but also by the behavior and by the knowledge. This is important as this educates the family towards less dependence on the medical care and supports the family towards more independence, which is exactly what we're aiming for.
After the assessment, you are supposed to select Intervention, Nursing Plan. There are four kinds of intervention in Omaha's system. Surveillance, treatments and procedures, teaching, guidance, and counseling, and case management. Case management, which is the main feature of Omaha's system, as all the staff members from multidisciplinary can discuss using the same material to arrange the patient's holistic care, including nursing. We can record the consultations with doctors and social workers as a part of important nursing care.
In this case, these kinds of care can be like the following. Surveillance. Observing affected part. Treatments and procedures. How to care wound.
Teaching, guidance, and counseling. Advice for her son for caregiving. Case management.
Consultation with doctors. Now the nursing plan for skin is completed. After practicing care based on the nursing plan, You are supposed to evaluate knowledge, behavior, and status with scores to see the improvements.
We can see how and which part of knowledge, behavior, and status has improved. Wow, this reflects whether my care was helpful or not. Now it is easier for you to plan what kind of care is needed for this patient.
Omaha's system is a tool to describe the process, guide you to the holistic approach, evaluate the effectiveness of the care, and share the nursing process. A process which nurses normally carry out but have only done with a singular angle. This is why Miss Karen, the developer of the system, says that it is important for nurses to think more holistically. The features of Omaha's system are, one, covers all angles of uniting life and medical care necessary for home visiting nursing.
Two, Easy to see the improvements of the patients and their family. Three, understanding the effectiveness of CARES. More profound discussion about CARE will be possible, as all the staff members from Multidisciplinary can discuss using the same material.
It visualizes what we usually do in this easily comprehensible way. Caring quality will surely remarkably improve. I should start thinking about using Omaha System.