 Omaha
 Public
System – Documentation System
Health Wheel – Intervention Model
 Began
in 1975 by Visiting Nurse Association of
Omaha, Nebraska
 Rigorous
development and research studies
funded by U.S federal Division of Nursing
between 1975-1986
 Nurses
 Physical,
speech, language, and occupational
therapists
 Social workers
 Dieticians
 Recreational therapists
 Home
health care
 Public health agencies
 School health services
 Nurse managed centers
 Hospital-based and managed care case
managers
 Educators and students
 Acute care and rehabilitation hospital staff
 Computer software vendors
 English
 Slovene
 Danish
 Spanish
 Dutch
 Turkish
 Japanese
 German
 Chinese
 Estonian
 Swedish
 Thai
 Korean
 Care
for individuals, families, and community
of all ages, geographic locations, medical
diagnoses, socio-economic ranges, spiritual
beliefs, ethnicity, and cultural values
 Problem
classification – client assessment
 Intervention
 Problem
scheme – care plans and services
Rating Scale for Outcomes – client
change and evaluation
 Environmental
Domain – material resources
and physical surroundings both inside and
outside living area, neighborhood, and
broader community
 Psychological
Domain – Patterns of behavior,
emotions, communication, relationships, and
development
 Physiological
Domain – functions and
processes that maintain life
 Health-Related
Behavior Domain – patterns of
activity that maintain or promote wellness,
promote recovery, and decrease risk of
disease
 Teaching,
Guidance, and Counseling
 Treatments
 Case
and Procedures
Management
 Surveillance
 Long,





diverse list ranging from:
Anger management to
Infection precautions to
Nursing care to
Substance use cessation to
Transportation
 Knowledge
– ability of client to remember
and interpret information

1(no knowledge)
5 (superior knowledge)
 Behavior
– observable responses, actions, or
activities fitting occasion or purpose

1 (no appropriate)
5 (consistently appropriate)
 Status
– condition of client in relation to
objective and subjective defining
characteristics

1 (extreme signs/symptoms) 5(No signs
symptoms)
 Measurement
at admission and closing of
case and other times as needed
 Can
measure individual or population change
 Tamika,
19 years old, comes to the public
health agency because she doesn’t have
enough food. She works part-time, no home -moves from friend to friend, is probably 7
months pregnant with a 1st child. Sick with
nausea and vomiting for first 5 months. No
health care; smokes about ½ pack each day.
Says smoking no problem – others smoke and
their babies are fine.
 Income

Intervention Scheme





(high priority)
Teach about community resources
Case management – referral to resources
Knowledge – 2
Behavior – 2
Status -- 1
 Pregnancy






( high priority)
Teaching – A/P, dietary, fetal development,
medical/dental care
Case Management – referral to prenatal provider
Surveillance– make sure she follows through to a
prenatal provider
Knowledge – 2
Behavior – 2
Status -- 2
 Substance





Use (high priority)
Teaching – effects of smoking on Tamika and the
fetus
Surveillance – changes in use of cigarettes
Knowledge – 1
Behavior – 1
Status -- 2
 Recognized
by many standards for electronic
records such as LOINC, SNOMED, Health Level
7
 Congruent
with reference terminology for
International Organization for
Standardization
 Mapped
to International Classification of
Nursing Practice
 www.omahasystem.org/
 Karen
Martin, RN, MSN, FAAN
martinks@tconl.com
1990s Health Reform
Public Health for the 21st Century
National satellite programs
 Norway
 Iceland
 Kazakhstan
 Uzbekistan
 Kyrgyzstan
 Mexico
 Japan
 Namibia
 Ireland
 Information
 Linda

Olson Keller, DNP, RN, FAAN
olson173@umn.edu
 Thank
you for your attention