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.

Disseminating Strengths-Oriented Best Practices in Diabetes Care Utilizing a Standardized Language within a Global Community.

Diabetes is a manageable chronic condition that contributes significantly to the global health burden of diseases and mandates a global collective effort to create an effective solution. This paper describes a community diabetes care pathway built upon a Strengths-Oriented Global Health Informatics Framework and an interdisciplinary standardized terminology, the Omaha System, along with a related translational process to disseminate best practices in diabetes care in China. This project demonstrates a novel strengths-oriented collaborative approach to disseminate best practices of diabetes management in global health communities and offers a potential to bring person-centered coordinated care to multi-levels of engagement that generate actionable and measurable results. Such collaboration opens a continued dialogue in the discourse for constructing global health informatics principles and practice to reduce the burden of diseases around the world.

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.

Exploring Older Adults' Strengths, Problems, and Wellbeing Using De-identified Electronic Health Record Data.

As new data sources including individuals' strengths emerge in electronic health records, such data provide whole-person oriented information to generate integrated knowledge for person-centered practice. The purpose of this study is to describe older adults' strengths and problems within a wellbeing context documented by the Omaha System. The Wellbeing Model is employed as a conceptual framework for wellbeing and is operationalized by the Omaha System Problem Classification Scheme. This study has a retrospective, descriptive design using de-identified EHR data of wellbeing assessments including problems, strengths, and signs/symptoms for a convenience sample of 440 assisted-living residents in a Midwest metropolitan area. Descriptive statistics and data visualization were used to summarize and display strength and signs/symptom attributes within wellbeing contexts. The study reveals cutting-edge knowledge regarding older adults' strengths and wellbeing, and creates a platform for further research use of a strength-based ontology in clinical practice and electronic system of documentation.

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.

A comparison of mental state examination documentation by junior clinicians in electronic health records before and after the introduction of a semi-structured assessment template (OPCRIT+).

OBJECTIVES: The mental state examination (MSE) provides crucial information for healthcare professionals in the assessment and treatment of psychiatric patients as well as potentially providing valuable data for mental health researchers accessing electronic health records (EHRs). We wished to establish if improvements could be achieved in the documenting of MSEs by junior doctors within a large United Kingdom mental health trust following the introduction of an EHR based semi-structured MSE assessment template (OPCRIT+). METHODS: First, three consultant psychiatrists using a modified version of the Physician Documentation Quality Instrument-9 (PDQI-9) blindly rated fifty MSEs written using OPCRIT+ and fifty normal MSEs written with no template. Second, we conducted an audit to compare the frequency with which individual components of the MSE were documented in the normal MSEs compared with the OPCRIT+MSEs. RESULTS: PDQI-9 ratings indicated that the OPCRIT+MSEs were more 'Thorough', 'Organized', 'Useful' and 'Comprehensible' as well as being of an overall higher quality than the normal MSEs. The audit identified that the normal MSEs contained fewer mentions of the individual components of 'Thought content', 'Anxiety' and 'Cognition & Insight'. CONCLUSIONS: These results indicate that a semi-structured assessment template significantly improves the quality of MSE recording by junior doctors within EHRs. Future work should focus on whether such improvements translate into better patient outcomes and have the ability to improve the quality of information available on EHRs to researchers.

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.