Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Res Theory Nurs Pract. 2022 Nov 4;36(4):395-421. doi: 10.1891/RTNP-2021-0112.
Demands on long-term services and supports for older adults are growing, although geriatric workforce shortages have persisted for decades. Methods to define and quantify practice of licensed nurses in nursing homes are needed for work optimization within limited nurse resources available in nursing homes. This study aimed to refine and validate observable nursing interventions for nursing homes, using the Omaha System. Based on the existing corpus of Omaha System interventions for acute care nursing, this multi-phase, multi-method study included a mapping procedure of interviews from licensed nurses in nursing homes, the evaluation of content validity and coding of the interventions using a survey, and inter-observer reliability assessment using TimeCaT. This study validated 57 observable interventions for nursing homes. Of the previously identified acute care nursing interventions, eight interventions were deemed out of scope. One additional intervention was identified. Refined intervention definitions were related to procedures common in acute care settings such as tracheal intubations/extubations and nasogastric tube insertion that were not performed in nursing homes. Expert agreement for content validity and coding of the interventions was high (S-CVI = 0.97), and inter-observer reliability levels (Cohen's κ value >0.4; proportion agreement >60%) were acceptable for all case studies. The validated observable Omaha System nursing interventions for nursing home practice have potential for use in future studies of nursing home practice to understand evidence-based practice, and gaps in care provided. The methodology may be extended to define observable interventions for other roles and settings.
对老年人的长期服务和支持的需求在不断增长，尽管老年医学劳动力短缺问题已经持续了几十年。需要采用奥马哈系统来定义和量化养老院注册护士的实践活动，以便在养老院有限的护士资源内实现工作优化。本研究旨在使用奥马哈系统来优化和验证养老院的可观察护理干预措施。 基于现有的急性护理护理奥马哈系统干预措施，本多阶段、多方法研究包括对养老院注册护士进行访谈的映射程序、使用调查评估内容有效性和干预措施编码，以及使用 TimeCat 评估观察者间可靠性。 本研究验证了 57 项可观察的养老院干预措施。在之前确定的急性护理护理干预措施中，有八项干预措施被认为超出了范围。还确定了一项额外的干预措施。改进后的干预措施定义与急性护理环境中常见的程序相关，例如气管插管/拔管和鼻胃管插入，而这些程序在养老院中并不进行。干预措施的内容有效性和编码的专家一致性很高（S-CVI = 0.97），并且所有病例研究的观察者间可靠性水平（Cohen's κ 值> 0.4；协议比例> 60%）均可接受。 验证后的奥马哈系统可观察性护理干预措施在未来的养老院护理实践研究中具有潜力，可用于了解循证实践和护理提供方面的差距。该方法可扩展到定义其他角色和环境的可观察干预措施。
