Nursing Terminology System Comparison In the world of nursing, there are different terminologies and systems that are used to communicate information. This helps providers to have clearly defined standards which enhances coordination and communication. However, there are contrasting systems that emphasize different areas. Two of the most notable include: Omaha and CCC approaches. To fully understand their effects requires comparing the two and discussing why there is a need of codification data in EHRs with real world examples. Together, these different elements will illustrate how each one is achieving specific objectives that are designed for a variety of healthcare environments. (Schwirian, 2013)

The Omaha Approach

The Omaha system is designed to track and monitor the patient from the moment they are admitted to the time they are discharged from the hospital. It can be utilized by nurses from different skill levels, background and other healthcare professionals inside the organization. The Omaha is approach is divided into a total of three different areas. The most notable include: a problem classification scheme, intervention and a problem rating scale for outcomes. The problem classification scheme is concentrating on four domains, two sets of problem modifiers and clusters of problem specific signs and symptoms. The intervention scheme is developing, planning and recording actions taken to identify client related problems. It has four categories and 75 unique targets and client specific information. The problem rating system is composed of a three five points techniques that mirror the Likert scale for capturing the process of the patient. This is accomplished by carefully examining their knowledge, behavior and status. (Schwirian, 2013)

These objectives are achieved by using a circular solution which is carefully examining a number of factors in conjunction with each other. The most notable include: to collect / assess data, state the problem, identify admission problem ratings, plan / intervene, identify interim / dismissal problem ratings and evaluating the problem outcomes. These areas are important, as they are focused on creating a patient centered model that is circular in nature. The center is emphasizing the importance of the individual, family and community in conjunction with healthcare professionals from a variety of disciplines. (Martin, 2005)

According to Barrera (2003), this is used to improve communication and collaboration with him saying, "Nursing classification systems enable practitioners to describe their contributions to client care. The results of this study indicated an improvement in the outcome ratings, using the Omaha System, as a result of nursing interventions for 47 clients with chronic mental illness receiving services in three academic nurse-managed centers. The Omaha System was found to be a valid and reliable nursing documentation tool for outcome and quality of care measurement for clients with mental illness." (Barrera, 2003) This is illustrating that the Omaha system is identifying the need for codifying EHRs, the data and information inside them. Once this occurs, is the point healthcare professionals can objectively track what is happening and determine the long-term impacts on everyone.

The CCC Approach

The Critical Care Classification system (CCC) is designed to follow and provide a unique coding structure at all points when patients are entering and leaving healthcare facilities. These objectives are achieved by concentrating on a number of different areas in conjunction with each other. The most notable include: nursing diagnosis, interventions and outcomes. Nursing diagnosis is when a judgment is made about the patient's response to actual, clinical or potential health conditions. This is used as the basis for creating a plan to improve the expected outcomes based upon experience and education. Interventions are when specific actions are taken to achieve the desired diagnosis. During this phase, patient services are started by orders from the doctor and then they are reviewed via the admitting nurse. They will decide if the treatment protocol is taking into account the expected outcomes, goals and history of the individual. Outcomes are using 528 concepts to determine if the patient has improved, stabilized or deteriorated. This is designed to represent the goals of the patient and decide if they were successful in achieving them over the long-term. (Saba, 2014)

To achieve these objectives there is a focus on several different concepts throughout the process. The most notable include:

If it is using discrete automatic level concepts utilizing qualifiers to improve and expand key concepts.

The data that is collected once can be used again to improve aggregation

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There must be specifically designed EHRs and information technology systems for processing the data.

Everything must be tested and applied to a variety of healthcare settings.

It must conform and utilize predetermined criteria to achieve these larger objectives.

There must be coded standards and frameworks for electronic data documentation, analysis and retrieval.

This helps to improve collaboration and coordination throughout the process. (Saba, 2014)
To support these larger objectives there is a concentration on 176 diagnosis (60 major / 116 subcategories), 804 interventions (77 major and 124 subcategories) and 21 core components. This is designed to provide a better understanding of the patient's psychological, behavioral and functional needs. To achieve these standards there is a focus on a number of key concepts to include:

Activity

Bowel/Gastric

Cardiac

Cognitive/Neuro

Coping

Fluid Volume

Health Behavior

Medication

Metabolic

Nutritional

Physical Regulation

Role Relationship

Safety

Self-Care

Self-Concept

Sensory

Skin Integrity

Tissue Perfusion

Urinary Elimination

Life Cycle (Saba, 2014)

According to Moss (2011), this helps to reduce costs and it increases efficiency within the organization with her saying, "The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96)." This is showing how the CCC model is effective in reducing costs, improving collaboration and dealing with the challenges impacting a modern day healthcare environment.

Omaha vs. CCC

The Omaha system is more focused on delivering EHRs using a holistic and collaborative process. It is designed to utilize technology to generate, store and retrieve data among different staff members involving a number of steps. The most notable include: a problem classification scheme, intervention and a problem rating scale for outcomes. These objectives are achieved by using a circular solution which is carefully examining a number of factors in conjunction with each other. The most notable include: to collect / assess data, state the problem, identify admission problem ratings, plan / intervene, identify interim / dismissal problem ratings and evaluating the problem outcomes. The center is emphasizing the importance of the individual, family and community in conjunction with healthcare professionals from a variety of disciplines. (Martin, 2005)

The CCC system is emphasizing a unique coding structure at all points when patients are entering and being discharged at healthcare facilities. These objectives are achieved by concentrating on a number of different areas in conjunction with each other. The most notable include: nursing diagnosis, interventions and outcomes. This is designed to represent the goals of the patient and decide if they were successful in achieving them over the long-term. The differences between the two are the CCC model does not emphasize a holistic approach. Instead, it is more rigid in comparison with the Omaha model. (Saba, 2014)

As a result, there is a need for the codification of EHRs. This is because they streamline care and reduce the possibility of errors. For example, in a study that was conducted by Rutherford (2008). It was determined that the use of the Omaha or CCC system would improve the quality of care. This is from nurses having streamlined procedures for communicating with other staff members. In any kind of healthcare setting, these issues are critical as they allow them to diagnose and treat a variety of conditions more effectively. When this happens, patients are more satisfied with the care and the staff is able to identify the best solutions. During the study, they examined different community hospitals and found that this is the key for improving the impacts of EHRs. The codification procedures can be…