Three decades of Omaha System research: Providing the map to discover new directions

The Omaha System is a research-based, comprehensive, standardized ANA recognized terminology designed to enhance practice, research, and information management. It consists of the Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes. When used together, the components provide a way to directly link client needs and strengths with specific interventions and outcomes of care. A computerized search of the research literature used CINAHL, MEDLINE, and Dissertation Abstracts databases for the years 1982-2003 on the keyword, Omaha System. All English language articles describing completed Omaha System research were reviewed. A table of evidence was developed that included authors, sample, setting, purpose, design, and findings. Nursing studies predominated. Sample sizes ranged from 10 to over 1,500 subjects. Most samples were less than 100 and took place in public health or home care settings. Fifty unique studies were organized into eight categories that: 1) described client outcomes, 2) described clinical practice, 3) described client outcomes, 4) explained health care utilization, 5) advanced classification research, 6) involved students, 7) reported on the Community Nurse Organization project, and 8) were completed but not yet published. The most common research design was descriptive. Recommendations for “new Omaha System roads” resulted from the critique and included: expand use and testing to diverse settings and populations, conduct international comparison studies to address how well the System captures cultural diversity, determine the effect on care coordination and continuity, and design more rigorous randomized controlled experiments that demonstrate the value of electronic, standardized client records.