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Describing The System: Components and Terms

The Omaha System consists of three components - the Problem Classification Scheme, Intervention Scheme, and Problem Rating Scale for Outcomes - which provide a structured way to collect and organize client data, identify problems, plan interventions, and evaluate outcomes. The system conceptualizes the client assessment and care process as circular and interactive. An example application shows how the system can be used to assess and address environmental and cognitive problems for a client named Ander and their family. Safety issues in the home environment and Ander's declining cognition are identified as high priority problems. Teaching and surveillance interventions are planned and initial ratings of knowledge, behavior, and problem status are provided.

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272 views

Describing The System: Components and Terms

The Omaha System consists of three components - the Problem Classification Scheme, Intervention Scheme, and Problem Rating Scale for Outcomes - which provide a structured way to collect and organize client data, identify problems, plan interventions, and evaluate outcomes. The system conceptualizes the client assessment and care process as circular and interactive. An example application shows how the system can be used to assess and address environmental and cognitive problems for a client named Ander and their family. Safety issues in the home environment and Ander's declining cognition are identified as high priority problems. Teaching and surveillance interventions are planned and initial ratings of knowledge, behavior, and problem status are provided.

Uploaded by

imnas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Describing the System: Components and Terms

The Omaha System consists of three components: the Problem Classification Scheme, the Intervention
Scheme, and the Problem Rating Scale for Outcomes (see “Omaha System Overview” on page 45).
The components offer users a relational, reliable, and valid structure and set of terms that can link
clinical data to demographic, financial, administrative, and staffing data.
A model of the system (shown above) reflects the circular, interactive nature of the process from data
collection, critical thinking, and clinical decision making through to evaluation and quality
improvement. This process occurs within the dynamics of the practitioner-client relationship. The
center of the model identifies the pivotal position of the individual, family, and community and the
partnership with multidisciplinary practitioners.
The Problem Classification Scheme is equivalent to the leading two wedges of the model’s circle,
“collect and assess data” and “state problem.” The scheme is a comprehensive, orderly, nonexhaustive,
mutually exclusive taxonomy designed to identify diverse health-related concerns. Its simple and
concrete terms are used to organize assessment at four levels, flowing from general to specific.
The Intervention Scheme is equivalent to the wedge “plan and intervene.” It has a hierarchical structure
similar to that of the Problem Classification Scheme. Its three levels of actions or activities flow from
general to specific and are used to describe care plans and services provided by multidisciplinary health
professionals.
The Problem Rating Scale for Outcomes is equivalent to three wedges: “identify admission problem
rating,” “identify interim/dismissal problem rating,” and “evaluate problem outcome.” It measures the
entire range of severity for the concepts of knowledge, behavior, and status. Each subscale provides a
continuum for examining problem-specific ratings for individuals, families, or communities at regular
or predictable times.
Application of the Omaha System
DOMAIN: ENVIRONMENTAL
Problem: Residence (high priority problem)
Problem Classification Scheme
Modifiers: Family and Actual
Signs/Symptoms of Actual:
 Inadequate/obstructed exits/entries
 Unsafe mats/throw rugs
 Structural barrier
Intervention Scheme
Category: Teaching, Guidance, and Counseling
Targets and Client-specific Information:
 Safety (develop plan to remove throw rugs, clutter, toys; add rail; improve lighting)
Category: Surveillance
Targets and Client-specific Information:
 Safety (completed safety checklist and noted needed modifications)
Problem Rating Scale for Outcomes
Knowledge: 2—minimal knowledge (family now concerned about increasing falls, need to
increase safety)
Behavior: 2—rarely appropriate behavior (family did not modify environment/residence for 6
months)
Status: 3—moderate signs and symptoms (moderate clutter, throw rugs, toys, poor lighting)
DOMAIN: PHYSIOLOGICAL
Problem: Vision (low priority problem: provide interventions and rate problem if Ander or family want
additional services for legal blindness; current needs may be met with Residence and Cognition
interventions)
Problem Classification Scheme
Modifiers: Individual and Actual
Signs/Symptoms of Actual:
 Difficulty seeing small print/calibrations
 Difficulty seeing distant objects
 Difficulty seeing close objects
 Absent/abnormal response to visual stimuli
Problem: Cognition (high priority problem)
Problem Classification Scheme
Modifiers: Individual and Actual
Signs/Symptoms of Actual:
 Diminished judgment
 Disoriented to time/place/person
 Limited recall of recent events
 Limited reasoning/abstract thinking ability
Intervention Scheme
Category: Teaching, Guidance, and Counseling
Targets and Client-specific Information:
 Day care/respite (an option for Ander while the family was gone)
 Medical/dental care (needs evaluation especially for mental status)
 Safety (needs supervision while family was gone)
 Stimulation (needs activities with the family and during the day)
Category: Surveillance
Targets and Client-specific Information:
 Signs/symptoms—mental/emotional (cognitive changes)
 Signs/symptoms—physical (vital signs, weight, general health)
Problem Rating Scale for Outcomes
Knowledge (Family): 3—basic knowledge (family concerned about cognitive changes)
Behavior (Family): 3—inconsistently appropriate behavior (family requested home visit,
beginning to consider alternatives to current situation)
Status: 3—moderate signs and symptoms (Ander oriented to person/place but not to time/date;
difficulty with short-term memory; dressed appropriately; reasonable discussion)

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