Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

Abstract

The objective of this quality evaluation was to evaluate the changes in public health nursing (PHN) interventions after the implementation of an evidence-based family home visiting (eB-fHV) guideline encoded using the Omaha System. Design and sample: This quality improvement evaluation was conducted using a secondary dataset of 27,910 PHN family home visiting interventions from visits to 129 adult clients enrolled in eB-fHV programs in a Midwestern PHN agency. The interventions were documented 12 months before and 14 months after eB-fHV Guideline implementation. The eB-fHV consisted of 94 PHN interventions for 10 Omaha System problems, with electronic health record (eHr) data generated by PHNs during routine clinical documentation. Standard descriptive and inferential statistics were employed in the analysis. Measures: The Omaha System was used to compare PHN practice before and after the guideline implementation. Results: Documentation patterns revealed that PHNs tailored interventions while also shifting toward the use of the eB-fHV guideline interventions. Ten eB-fHV problems accounted for 96.3% of interventions documented before and 98.5% of interventions documented after implementation. The proportion of interventions before and after eB-fHV by problem differed significantly for all problems except Substance use. fewer interventions were provided after eB-fHV for the primary problems of Pregnancy and Postpartum, with a shift to more interventions for caretaking/parenting. Conclusion: The PHN documentation demonstrated an adherence to the eB-fHV guideline, while tailoring the evidence-based interventions differentially by problem. further research is needed to extend this quality improvement approach to other guidelines and populations.

Discovering Associations Among Older Adults' Characteristics and Planned Nursing Interventions Using Electronic Health Record Data

“…There was no difference in Surveillance interventions. Such a finding aligns with research in other populations and settings that nurses actively monitor the health and safety of individuals under their care (Harding, Galano, Martin, Huntington, & Schellenbach, 2007; LeCroy & Davis, 2016; Monsen, Swenson, et al, 2017).…”

“…The finding of between-group differences in intervention categories suggests that nursing assessments of strengths and signs/symptoms are associated with the planning of interventions. This first known study to demonstrate intervention tailoring in assisted living aligns with the literature on intervention tailoring in other populations and settings (Martin, 2005; Monsen & Martin, 2002; Monsen et al, 2011; Monsen, Swenson, et al, 2017). Teaching, Guidance, and Counseling is used to delineate nursing activities designed to provide information, encourage action and responsibility for self-care and coping, and assist the individual and family to make decisions and solve problems (Martin, 2005).…”

“…The group that had more signs/symptoms of Physiological and Health-related Behaviors problems had a higher average number of planned interventions. Further investigation is needed to explore whether these problems may require more nursing interventions as suggested in research that nurses adjust their care plans according to the older adults’ needs (Monsen, Swenson, et al, 2017). Such a finding also suggests that Physiological and Health-related Behaviors signs/symptoms do not necessarily negatively affect strengths in other domains.…”

“…Standardizing terminology supports nurses to establish care plans from bland statements of intent to unambiguous, prescriptive, and coded actions (Moore & Stonham, 2010). Research also demonstrates that nurses tailor evidence-based interventions differentially by problems based on quality evaluation of nursing care and interventions (Monsen, Swenson, Klotzbach, Mathiason, & Johnson, 2017). Studies also suggest that public health nurses document routine and tailored interventions in EHRs using the Omaha System (Martin, 2005; Monsen & Martin, 2002; Monsen, Radosevich, Kerr, & Fulkerson, 2011).…”

Understanding tailored PHN interventions and outcomes of Latina mothers

“…Alternatively, it may reflect different program protocols within the public health department. Further studies should account for program documentation to help understand the reasons for differential problem proportions across IAs (Monsen, Swenson, Klotzbach, Mathiason, & Johnson, ).…”