The Omaha System: Solving the Clinical Data-Information Puzzle

Case Studies Introduction

Case studies are a valuable strategy to increase accurate and consistent use of the Omaha System. This Web site includes 8 case studies (stories and answers) developed by expert users representing practice, education, and research. The case studies present a rich and diverse set of realistic but fictitious clients (individuals, families, and communities) who received equally diverse services from multidisciplinary practitioners in various settings.

Additional case studies are available. The 2005 Omaha System book includes 18 case studies; it includes more details about how to use case studies than this Web site. Other publications listed on the References section include case studies. CHAMP Software, Inc. produced two videotapes that include two case studies. As you become more familiar with the Omaha System, you may want to develop new case studies that reflect your local clients and practice. Consider replicating characteristics of the case studies in this Web site including length, focus, and degree of difficulty.

Use the following guidelines:

After you have become familiar with the Omaha System, use a combination of lectures, discussion, workshops, role plays, videotapes, and publications to introduce it to practitioners, managers, educators, students, and others.
Use case studies as the next step in the introduction process. Recognize that PRACTICE and accurate feedback are the keys to successful Omaha System use.
Consider that the case study stories already occurred, and identify answers to reflect care that was actually provided rather than developing a care plan. The time required increases and agreement decreases dramatically if a story is used to develop a care plan.
Use case studies to check interrater reliability among practitioners, students, and others who previously learned to use the Omaha System. Positive feed back is essential for developing skills.
Use case studies to promote discussion about holistic practice; expectations about practitioners' and clients' responsibilities; ethical issues; similarities and differences between the Omaha System and other standardized vocabularies, and generation of data to enhance practice, documentation, and information management.
Use case studies with manual forms or automated versions of the Omaha System to understand how to complete the required information. Note: The format used in these case studies does not represent any manual form or software; the case studies are intended to be form neutral.

The case studies in this Web site have two sections:

a. INFORMATION OBTAINED DURING A VISIT/ENCOUNTER or PROJECT/INCIDENT: The stories include referral details, data that practitioners or students obtained during the time reflected in the case study, and clues for identification of Omaha System problems, interventions, and ratings. Use critical thinking skills to identify data that are pertinent in the stories and then identify correct answers.

b. APPLICATION OF THE OMAHA SYSTEM: The "best answers" for the case studies include the Problem Classification Scheme (domains, problems, modifiers, signs/symptoms, risk factors, and details), Intervention Scheme (categories, targets, and client-specific information), and Problem Rating Scale for Outcomes (numeric ratings for Knowledge, Behavior, and Status). Brief comments, usually placed within parentheses, clarify selected answers, including ratings. Often these or similar brief comments are included in client records as free text or narrative generated by practitioners. The answers that are presented have been judged by experts to be accurate and pertinent, and should be considered the standard. However, answers are always viewed thorugh the lens of each unique practice setting, and are meant to be discussed, challenged, and changed if appropriate. Refer to stories for data to support and explain your choices, and make certain you have the opportunity to discuss your opinions.

When reading the answers, remember some basic assumptions. Because "more is not necessarily better", the goal is to list pertinent answers one time, and not duplicate answers unnecessarily. Although there should be a high level of agreement among those who complete case study exercises, it will not reach 100%. For example, it is more important to have agreement at the level of the problem than at the level of signs and symptoms. The answers are not intended to replicate the exact text practitioners or students would document following a visit or encounter.

You will need to do more preparation if your goal is to teach others about the Omaha System and your initial exposure is occurring as you read this Web site and the case studies. Read other Omaha System publications, view videotapes, practice making decisions with case studies, discuss your conclusions with colleagues, and attend workshops.

If you are interested in developing a case study for inclusion on the Web site, please contact Karen Martin.

Case Studies

The 8 case studies presented represent the following client scenarios: