00:01
Okay, now back to our case study.
00:03
Now, before we get into this,
what I'm going to ask you to do
is to get a pen and paper and
get ready to take some notes.
00:10
I'm going to walk you through
the full case study.
00:12
And so while I'm doing that,
jot down things that
you think are important.
00:17
When we get to the end,
then what we'll do is apply
the Omaha system
to put together a comprehensive
plan for Bloom County.
00:25
So as a reminder,
Bloom County has a population
of about 120,000 people.
00:30
The residents are the client
in this case study
because they just experienced their
first confirmed case of influenza
this season.
00:37
Unfortunately,
the person who is infected
was also employed as a clerk at
a local store in a shopping mall.
00:44
That person continued to work
even though they were feeling ill
and possibly exposed many people.
00:51
The Bloom County Health
Department jumped into action.
00:54
They started offering 24 hour
a day immunization clinics.
00:58
There are numerous people,
including friends, family members
and-co workers of the confirmed case
who started to experience
some mild symptoms,
a fever and a cough.
01:08
Now it wasn't possible to
know if they were experiencing
early stages of influenza
and needed to be quarantined,
or if they're experienced
some other milder illness.
01:19
The Health Department's
public health nurses
conducted an aggressive
media campaign.
01:23
Of course in
collaboration with others
local healthcare facilities,
stores, churches,
and other community groups.
01:29
The campaign included information
about disease prevention,
treatments,
how to obtain the vaccine,
as well as warnings
about the limitations of the vaccine
and the need to reduce
contact with others.
01:41
But new issues started to arise.
01:43
Many residents
were unwilling to follow
voluntary quarantine
recommendations,
especially because it
was the holiday season.
01:50
Despite a public plea
to schedule appointments
with the health care providers
for specific symptoms,
many residents continue to visit
the local emergency department.
01:59
The health department
worked around the clock.
02:02
They conducted contact investigation
for documented influenza cases
and attempted to quarantine
exposed family members.
02:08
They worked with the
state health department
to disseminate accurate and
timely public information.
02:13
By the time the influenza
outbreak had ended,
the county experienced
more than 200 cases and 31 deaths.
02:22
Based on the case study,
let's use the Omaha
system to create
a comprehensive
problem solving model
to improve the health
outcomes for Bloom County.
02:30
Now, I hope you have
your notes ready.
02:33
Starting first with the
problem identification scheme.
02:36
The first step here
is to select the domain.
02:39
And there are four domains:
Environmental, physiological,
psychological, and health behaviors.
02:46
So based on what we know
from the case study,
which domain would you pick?
Now remember,
we're dealing with influenza here.
02:54
So I would pick physiological.
02:57
The next step in the problem
identification scheme
is to select one of 42 problems.
03:03
Now you see here
we have the 42 problems.
03:06
What I'm going to ask you to do
is pause the video
for just a second,
and pick the problem that you think
best fits the case study.
03:21
Wonderful.
03:22
We've selected communicable or
infectious condition as our problem.
03:26
The next step in the problem
identification scheme,
is to select our modifiers.
03:31
Now, is this an actual problem
or a potential problem?
Well, based on the fact that
we've had over 200 cases already,
I would call this
an actual problem.
03:42
And what level are
we working at here?
Is this an individual level?
A family level?
Or community level?
Again, based on the case study,
I would definitely say
this is a community level problem.
03:54
Now the fourth and final step in
the problem identification scheme,
is to determine signs and symptoms.
04:01
What signs and
symptoms have you used
in order to select the problem,
to select the modifiers,
to select the domain.
04:09
Maybe it's fever,
positive lab results,
inadequate immunity,
and respiratory symptoms.
04:16
That is the first step and
using the Omaha system.
04:19
We've completed the problem
identification scheme.
04:23
Okay, now moving on to the
second construct in the system,
the intervention scheme.
04:28
Now remember,
and the intervention scheme
there are four categories
of intervention,
health teaching,
guidance and counseling,
interventions and procedures,
case management,
and finally, surveillance.
04:41
So take a second and think about,
which one of those categories
you'd like to focus on?
I say let's focus on the health
teaching, guidance, and counseling.
04:51
Now, the next step is determining
the target of your intervention.
04:56
So the target of that
health teaching.
04:58
Now, there's 75 different targets.
05:01
You'll see just a few of
them here on the screen,
Go ahead and select
the one that you think
is the biggest priority
for Bloom County.
05:15
For the target, let's focus
on infection precautions.
05:19
Now the third step in
the intervention scheme
is to use client's specific data
to determine the specific areas
that you want to focus on
for your intervention.
05:29
So remember,
we're focusing on health teaching
regarding infection precautions.
05:34
What type of health teaching
and guidance is needed here?
It could be guidance
around effective measures
to stop the transmission
of influenza.
05:42
Like additional education
about immunizations,
hand hygiene,
quarantine measures.
05:50
Okay, now, here we are
with our third and final construct
of the system.
05:55
This is the problem rating scale.
05:57
And remember,
this is just like a grading rubric.
06:00
So let's start first with
knowledge and assess Bloom County.
06:04
Now remember, knowledge is
how much the community knows.
06:07
And what we know is that the
health department has conducted
a large scale educational
campaign throughout the community.
06:15
They've put up billboards,
they put up flyers
telling people about how to protect
themselves against influenza.
06:21
So based on that,
let's say that for right now,
Bloom County has some
basic knowledge.
06:26
Let's score them as a three.
06:29
Moving on to the next
level here behavior.
06:32
Now remember, behavior is
different than knowledge
just because people know about
how to protect themselves,
doesn't mean
they're actually doing it.
06:40
So here we want to focus on the
behaviors that we are seeing.
06:43
What are our observations?
We know that people are
still going into gatherings.
06:48
It's the holiday season.
06:50
So even though they might know
that they should stay home,
they're still going out.
06:54
So based on that,
let's score Bloom County as a two,
rarely appropriate behavior.
07:01
And then finally,
we want to look at status.
07:03
Again, this is the
severity of the symptoms.
07:06
We're seeing an
increased number of cases
and we've already seen 31 deaths.
07:11
So for this,
I would say we're still seeing
extreme signs and symptoms.
07:15
So we've used our grading rubric
to score Bloom County at baseline.
07:20
So based on our grading rubric,
Bloom County has scored a six.
07:25
Now, the cool thing about this is
is that after you conduct
your intervention,
you can score them again
so that you can look
for trends over time.
07:33
And hopefully we see
this number increasing.
07:36
We want to see superior knowledge,
consistently appropriate behavior,
and no signs or symptoms.