Monsen Karen A, Vanderboom Catherine E, Olson Kirstie S, Larson Mary E, Holland Diane E
Res Theory Nurs Pract. 2017 Feb 1;31(1):39-55. doi: 10.1891/1541-6577.31.1.39.
It is critical to accurately represent strengths interventions to improve data and enable intervention effectiveness research from a strengths perspective. However, it is challenging to understand strengths interventions from the multiple perspectives of computerized knowledge representation, evidence-based practice guidelines, and practice-based evidence narratives. Intervention phrases abstracted from nurse care coordinator practice narratives described strengths interventions with community-dwelling elders. This project aims were to (a) compare nurse care coordinator use of evidence-based interventions as described in the two guidelines (what to do and how to do it), (b) analyze nurse care coordinator intervention tailoring (individualized care), and (c) evaluate the usefulness of the Omaha System for comparison of narrative phrases to evidence-based guidelines.
Phrases from expert nurse care coordinators were mapped to the Omaha System for comparison with the guidelines interventions and were analyzed using descriptive statistics. Venn diagrams were used to visually depict intervention overlap between the guidelines and the phrases.
Empirical evaluation of 66 intervention phrases mapped to 14 problems using 3 category terms and 19 target terms showed alignment between guidelines and the phrases, with the most overlap across two guidelines and the phrases in categories, and the most diversity in care descriptions.
These findings demonstrate the value in having both standardized guidelines and expert clinicians who see the whole person and can synthesize and apply guidelines in tailored ways. There is potential to create a feedback loop between practice-based evidence and evidence-based practice by expanding this approach to use of practice-generated Omaha System data as practice-based evidence. Further research is needed to refine and advance the use of these methods with additional practices and guidelines.
准确呈现优势干预措施对于改善数据并从优势视角开展干预效果研究至关重要。然而，从计算机化知识表示、循证实践指南和基于实践的证据叙述等多个角度理解优势干预措施具有挑战性。从护士护理协调员实践叙述中提取的干预短语描述了针对社区居住老年人的优势干预措施。本项目旨在：（a）比较护士护理协调员对两项指南中所述循证干预措施的使用情况（做什么以及如何做）；（b）分析护士护理协调员的干预调整（个性化护理）；（c）评估奥马哈系统在将叙述性短语与循证指南进行比较方面的实用性。
将专家护士护理协调员的短语映射到奥马哈系统，以便与指南干预措施进行比较，并使用描述性统计进行分析。维恩图用于直观描述指南与短语之间的干预重叠情况。
对使用3个类别术语和19个目标术语映射到14个问题的66个干预短语进行实证评估，结果表明指南与短语之间具有一致性，其中两项指南与短语在类别上的重叠最多，而护理描述的多样性最大。
这些发现证明了既有标准化指南又有能全面看待患者并能以定制方式综合应用指南的专家临床医生的价值。通过将这种方法扩展到使用实践生成的奥马哈系统数据作为基于实践的证据，有可能在基于实践的证据和循证实践之间创建一个反馈循环。需要进一步研究以完善和推进这些方法在更多实践和指南中的应用。
