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ISSN: 2167-7182
Journal of Gerontology & Geriatric Research
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Application of the Omaha System in the Determination of Healthcare Needs of Individuals Receiving Home Healthcare

Betül Aktaş*, Medine Yilmaz, Nazife Kaplan and Banu Çankiri

Sanko University, Gaziantep, Turkey

*Corresponding Author:
Betül Aktaş
Sanko University, Gazimuhtar Paşa Boulevard
No: 36, 27090 Şehitkamil, Gaziantep, Turkey
Tel: 05055250335
E-mail: [email protected]

Received Date: November 28, 2016; Accepted Date: December 20, 2016; Published Date: December 23, 2016

Citation: Aktas B, Yilmaz M, Kaplan N, Çankiri B (2016) Application of the Omaha System in the Determination of Healthcare Needs of Individuals Receiving Home Healthcare. J Gerontol Geriatr Res 6:379. doi:10.4172/2167-7182.1000379

Copyright: © 2016 Aktas B, et al. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: The aim of this study was to detect the needs of individuals receiving home healthcare and to create guidance data for initiatives to be planned for this purpose by demonstrating the availability of the Omaha system in determining the care needs of these people.

Background: Home care services are generally provided to promote and protect an individual's wellbeing or to restore his/her to health either by health professionals or by family members in the person's own home or the place where he/she lives. Design. Eighty-seven people receiving home healthcare services from Bayındır State Hospital affiliated with Izmir Province Association of Public Hospitals South General Secretariat in their home environment between January 2015 and April 2015 comprised the population and sample of this descriptive and cross-sectional

Study and methods: The sample of the research field of home care services unit formed individuals (N=87). A total of 50 patients were included in the study. The data collection tools used in the study were the 5-item sociodemographic characteristics questionnaire and OMAHA problem classification scheme (PCS).

Results: According to the OMAHA PCS, 29 problems were identified. The problems identified, 49% were in the physiological domain, 28.8% in the health-related behaviors domain, 15.4% in the psychosocial domain and 6.8% in the environmental domain. With the nursing diagnoses, 2326 actual symptoms-signs were determined.

Conclusion: It was determined that the OMAHA PCS could be used to identify healthcare needs of people receiving home care services.

Keywords

Home health care; The Omaha System; Healthcare needs

Introduction

In our age, aging and increases in aging-associated chronic diseases and disabilities have started to create a lot of pressure on social policies. Because this increase, along with the increased average life span, has led to rise in need for care, to increases in costs of health care beyond estimations, and thus to the development of alternative systems [1].

A person’s needs, and socio-cultural values and preferences affect their decision to receive long-term care services either at home or in an institution. Home healthcare services can be provided for people who need healthcare due to factors such as chronic diseases, severe mental illnesses, developmental disabilities, and old age if they want to, as an alternative to institutional healthcare [2].

Home health care is a care model that includes psychosocial, physiological, and medical support services offered to elderly persons, convalescents, people with disabilities and/or people with chronic diseases in their own environment. Home health care aims to help those people to adapt to social life and to integrate them into society so that they can lead a happy and peaceful life. It also aims to ease the burden on family members, particularly women, who provide care for those people [3].

Home care services are generally provided to promote and protect an individual’s wellbeing or to restore his/her to health either by health professionals or by family members in the person’s own home or the place where he/she lives.

These services also aim to protect the person’s quality of life and social prestige considering his/her needs in a wide range of health and social services. Therefore, home healthcare services are in general defined as services which take the place of institutional care and reduce the need for and length of stay in institutions [1].

Long-term care needs of a person constantly change in the flow of his/her life, and are affected by the environment and changes in the physical, mental, cognitive, and/or functional capacities of that person. While most people lose some of their functional capacities, they can regain others. Therefore, it is often difficult to determine the type and duration of healthcare need of a person [2].

Nursing classification systems are used to classify and label patientrelated problems that nurses deal with, interventions to solve these problems and these interventions’ contribution to patient outcomes [4]. The Omaha System, one of the nursing classification systems, is based on “problem-solving approaches in the nursing process”, and it combines and analyzes individual-focused basic information [5].

This system classifies the health needs of individuals and makes the provision of healthcare and focusing on the problem easier. The Problem Rating Scale which assesses an individual's health in the process of problem solution in the same way ensures the continuity of health monitoring of the individual [5-8].

The system which was first used for the community-based home care was later used in health areas such as public health, school health and occupational health [6,9-11]. In Turkey, there are several area studies in which the Omaha System problem classification scheme is used either alone or together with the rating scale.

Among these studies are “effects of the use of the Omaha system in the development of women's health on the lifestyle and quality of life [12]”, “determination of nursing practices, and the healthcare needs of the elderly living in nursing homes [10,13]”, “determination of elementary school students’ health problems [9]”, “assessment of occupational health nursing interventions with the Omaha nursing interventions scheme [5]”, “the use of the Omaha system in occupational health nursing practices, advantages of nurses’ using a common language in the assessment of health problems, diagnosis and interventions [14]”, “application-based use of the Omaha System in the family nursing training [15]”, “the use of the Omaha System to identify of health problems, health applications and results in the provision of home healthcare [16]”, and “the use of the Omaha system in the nursing care of children with acute care needs [17]”.

This present study is expected to contribute to the provision of home care services as well.

Aim: The aim of the present study is to diagnose the needs of individuals receiving home healthcare with a standard method by demonstrating the availability of the Omaha system in determining health care needs of those individuals, and to create guidance for attempts to be planned in this area.

Methods

Design and sampling

Eighty-seven people receiving home healthcare services from Bay?nd?r State Hospital affiliated with Izmir Province Association of Public Hospitals South General Secretariat in their home environment between January 2015 and April 2015 comprised the population and sample of this descriptive and cross-sectional study.

During the study, of these 87 people, 22 who lost their lives and 5 who were referred to other hospitals were excluded from the study. In addition, 10 people who lived in mountain villages were also excluded from the study because it was difficult to access them. Therefore, the study data were collected from the remaining 50 people who volunteered to participate in the study and who were contacted (participation rate: 57.5%).

Inclusion criteria: Receiving home healthcare services, being registered with a home healthcare unit, volunteering to participate in the study and living in an accessible area.

Exclusion criteria: Not being registered with a home healthcare unit, not volunteering to participate in the study, villages who cannot be reached by public transport.

Data collection

The study data were collected from the participants in the home environment between January 2015 and April 2015 by the researchers through one-to-one interviews using the observation method.

In the study, the sociodemographic characteristics questionnaire and OMAHA problem classification scheme were used as data collection tools.

Sociodemographic characteristics questionnaire: The questionnaire developed by the researchers includes five items questioning the participants’ socio-demographic characteristics (age, gender, education, place of residence, people lived together at home, etc.).

OMAHA problem classification scheme: The problem classification scheme (PCS) was used to collect data on individuals' health assessment.

The OMAHA system developed by the North America Visiting Nurses Association (VNA) is the oldest classification system used since 1975 and enables nurses to implement and keep the records. The OMAHA system was adapted to Turkish by Erdogan, and it was proven that it was a valid and reliable tool for the Turkish society and could be used in public health nursing education. The model was considered as a guiding tool indicating the value of the nursing process in practice [7].

The PCS is the section in which nursing diagnoses are classified. The scheme holistically diagnoses health problems of an individual in four domains (environmental, psychological, physiological, and healthrelated behaviors) [6,9,10,18].

Ethical considerations

The permission to conduct the study was received from the ethics committee (dated and numbered 18/12/2014, 277). Prospective participants receiving home healthcare services and their families were informed about the study and told that the participation was voluntary. Then their consent was obtained.

Data analysis

Statistical analysis of the data was conducted using the SPSS 20.0 statistical software package. For the evaluation of the data, percentages and means were used.

Results

Analysis of the socio-demographic characteristics of the participants demonstrated that of them, 74% were in the 65 and over age group, 62% were female, 76% were illiterate, 46% lived in a village, 54% lived in a town, 44% lived with their children, and 24% lived with their spouse (Table 1).

Socio-Demographic Characteristics Number %
Gender
Female 31 62
Male 19 38
Age
17-19 years 3 6
47-64 years 10 20
65 years and over 37 74
Education
Illiterate 38 76
Primary school graduate 9 18
Secondary school graduate 3 6
Place of residence
Village 23 46
Town 27 54
Households
Alone 3 6
Spouse 12 24
Spouse and children 5 10
Children 22 44
Relatives 2 4
Mother and/or father 6 12
Total 50 100

Table 1: Distribution of socio-demographic characteristics of the participants.

In the study, the participants were determined to have 2326 (46.5 per person) symptoms, signs, deficiencies, insufficiencies related to 29 problems included in the four diagnosis domains designated in the OMAHA Problem Classification Scheme (Figure 1).

gerontology-geriatric-research-OMAHA-problem

Figure 1: Distribution of individuals in terms of the four domains of the OMAHA problem classification scheme (N=2326).

In the present study, the participants’ symptoms, signs, deficiencies, insufficiencies related to the four diagnosis domains designated in the OMAHA Problem Classification Scheme were evaluated. These symptoms, signs, deficiencies, insufficiencies are as follows:

Environmental domain

In this domain, 159 insufficiencies related to 3 problems (housing, sanitation, income) were identified.

The housing-related problem comprised 87 (54.7%) insufficiencies. Of these insufficiencies, 29.9% were associated with the inadequate heating and cooling system, 27.6% with the untidy living area and 24.1% with the structurally weak housing. The sanitation-related problem comprised 56 (35.2%) insufficiencies. Of these insufficiencies, 41.2% were due to the dirty living area, and 30.4% due to bed smelling of the living area. The income-related problem included 16 (10.1%) insufficiencies, all of which resulted from low-income levels or lack of income (Table 3).

Problem Insufficiency Number %
Income Low/none 16 100
Total 16 10.1
Sanitation Dirty living area 23 41.2
Storage and disposal of food 4 7.1
Bed smelling of the living area 17 30.4
Insufficient fresh water 4 7.1
Laundry 4 7.1
Mold 4 7.1
Total 56 35.2
Housing Structurally weak housing 21 24.1
Inadequate heating and cooling system 26 29.9
Steep/unsafe stairs 3 3.4
Narrow and inadequate entrance to the building 8 9.2
Untidy living area 24 27.6
Crowded/inadequate living area 5 5.7
Total 87 54.7
Environmental domain total 159 100

Table 3: Problems and insufficiencies related to the environmental domain according to the OMAHA problem classification scheme.

Physiological domain

In this domain, 1140 impairments related to 10 problems were identified. The hearing-related problem included 36 (3.1%) impairments all of which were related to difficulties in hearing normal speaking voices.

Of the problems identified, 49% were in the physiological domain, 28.8% in the health-related behaviors domain, 15.4% in the psychosocial domain and 6.8% in the environmental domain (Table 2).

Problem Classification Domain Nursing diagnoses The number of the problems identified The percentage of the problems identified
Environmental Domain Income 16 0.68
Sanitation 56 2.41
Housing 87 3.74
Total 159 6.83
  Psychosocial Domain Utilization of community resources 20 0.86
Social interactions 37 1.59
Interpersonal relationships 62 2.67
Mental health 121 5.20
Caregiving/parenting 87 3.74
Neglect 31 1.33
Total 358 15.4
  Physiological Domain Hearing 36 1.55
Vision 73 3.14
Speech and language 34 1.46
Oral health 67 2.88
Cognitive status 133 5.72
Pain 76 3.27
Consciousness 27 1.16
Skin 144 6.19
Neuro-musculo-skeletal function 231 9.93
Respiratory function 82 3.53
Circulatory function 64 2.75
Digestion and hydration 72 3.10
Intestine 59 2.54
Urinary function 42 1.81
Total 1140 49.0
  Health Behaviors-Related Domain Self-feeding and nutrition 103 4.43
Sleep 70 3.00
Physical activity 38 1.63
Personal care 377 16.21
Medication 81 3.48
Total 669 28.8
General total 2326 100

Table 2: Distribution of Nursing Diagnoses of the Participants in Terms of Problem Classification Domains.

There were 73 (6.4%) impairments related to vision. Of these impairments, 54.8% were associated with having trouble reading small font size texts, and 38.4% with having difficulty seeing distant objects.The number of speech and language impairments was 34 (2.9%). Of them, 61.7% were related to improper pronunciation and incomprehensibility, and 38.2% to inability to speak. Of the impairments regarding the 67 (5.9%) oral health problems, 32.8% were related to the loss of teeth, 25.4% to ill-fitting dentures or dentures with missing teeth, 20.9% to tooth decays and 20.9% to injured, swollen or bleeding gums. There were 133 (11.7%) impairments related to the cognitive status problem. Of these impairments, 30.8% were related to inadequacy in the calculation and counting skills, and 29.3% to decreased reasoning ability. Of the impairments regarding the 76 (6.7%) pain problems, 42.1% were related to grimace, 30.3% to pale appearance/sweating. Regarding consciousness, 27 (2.4%) impairments were identified. While stupor constituted 37% of the impairments, lethargy constituted 48.1% of them. The number of impairments related to the skin problem was 144 (12.6%). While 22.9% of the impairments were associated with dry skin, 20.8% were associated with pressure sores. There were 231 (20.3%) impairments regarding the neuro-musculo-skeletal functions. Of these impairments, 20.3% were associated with a decrease in muscle strength and 19.5% were associated with difficulty in walking/moving.

The number of impairments associated with breathing (respiratory system) was 82 (7.2%). Whereas 40.2% of them were related to abnormal breathing, 20.7% were related to coughing. Of the impairments regarding the 64 (5.6%) circulatory system problems, 45.3% were identified as discoloration of the skin/cyanosis and 37.5% were identified as edema. Seventy-two (6.3%) impairments regarding the digestion and hydration were identified. Of the impairments, 41.7% were related to anorexia. Of the 59 (5.2%) intestinal functionrelated impairments, 69.5% were associated with fecal incontinence, and of the 42 (3.7%) urinary function-related impairments, all were associated with urinary incontinence (Table 4).

Problem Impairment Number %
Hearing Difficulty in hearing normal speaking voices 36 100
Total 36 3.1
Vision Having trouble reading small font size texts 40 54.8
Having difficulty seeing distant objects 28 38.4
Others 5 6.8
Total 73 6.4
Speech and Limited ability to speak or produce 13 38.2
Language sound/inability to speak    
Improper pronunciation, and incomprehensibility 21 61.7
Total 34 2.9
Oral Health Deformity in the teeth, broken/missing teeth 22 32.8
Tooth decays 14 20.9
Injured, swollen or bleeding gums 14 20.9
Ill-fitting dentures or dentures with missing teeth 17 25.4
Total 67 5.9
Cognitive Status Decreased reasoning ability 39 29.3
Deterioration in orientation to time/person/place 19 14.3
Inability to recall recent events 8 6.0
Inability to recall the events from the distant past 9 6.7
Inadequacy in the calculation and counting skills 41 30.8
Lack of concentration 11 8.3
Uncontrolled movements 6 4.5
Total 133 11.7
Pain Attempts to protect the aching part 21 27.6
Grimace 32 42.1
  Pale appearance/sweating 23 30.3
Total 76 6.7
Consciousness Lethargy 10 37.0
Stupor 13 48.1
Unresponsiveness to stimuli 4 14.8
Total 27 2.4
Skin Lesion/pressure sore 30 20.8
Rash 18 12.5
Dry skin 33 22.9
Inflammation 13 9.0
Itching 18 12.5
Bruise 21 14.6
Excessive growth of nails/nail hypertrophy 11 7.6
Total 144 12.6
Neuro-Musculo-Skeletal Functions Decrease in muscle strength 47 20.3
Decreased coordination 36 15.6
Decrease in muscle tone 35 15.2
Reduction in sensation 13 5.6
Balance disorder 13 5.6
Difficulty in walking/moving 45 19.5
Transfer difficulty 38 16.5
Fractures 4 1.7
Total 231 20.3
Respiration Abnormal breathing types 33 40.2
Inability to breathe independently 6 7.3
Coughing 17 20.7
Voice breathing 15 18.3
Abnormal breathing sounds 11 13.4
Total 82 7.2
Circulation Edema 24 37.5
Discoloration of the skin/cyanosis 29 45.3
Abnormal blood pressure measurements 11 17.2
Total 64 5.6
Digestion and Hydration Difficulty in chewing/swallowing/indigestion 25 3.7
Anorexia 30 41.7
Cracked lips/dry mouth 17 23.6
Total 72 6.3
Intestinal Function Abnormal stool consistency/frequent 18 30.5
defecation 41 69.5
Total Fecal incontinence 59 5.2
Urinary Function Urinary incontinence 42 100
Total 42 3.7
General Total for the Physiological Domain 1140 100

Table 4: Problems and insufficiencies related to the physiological domain according to the OMAHA problem classification scheme.

Physiological domain

In this domain, 358 inabilities related to 10 problems were identified.

Twenty (5.6%) inabilities regarding the utilization of community resources were identified. Of them, 35% were related to inability to know options/processes on how to utilize services. Of the 37 (10.3%) inabilities regarding the social interactions, all were associated with establishing social interaction. There were 62 (17.3%) inabilities regarding interpersonal relations. While 54.8% of these inabilities were related to the shortage of shared activities, 25.8% were related to establishing interpersonal relationships. The number of the inabilities regarding the mental health was 121 (33.8%). Of them, 22.3% were sadness/despair/decreases in self-esteem, 22.3% were worries/ undefined fears. The number of inabilities identified within the framework of caregiving/parenting was 87 (24.3%). Of them, 52.9% were associated with difficulty in taking responsibility/dissatisfaction, and 47.1% with difficulty in providing physical care/safety. Regarding neglect, 31 (8.7%) inabilities were determined. Of them, 64.5% were associated with the lack of physical care (Table 5).

Problem Insufficiencies Number %
Utilization of Community Resources Inability to know options/processes on how to utilize services 7 35
Inability to know the tasks and roles of service providers 5 25
Inability to access services 4 20
Inadequate communication tools/failure to use of communication tools 4 20
Total 20 5.6
Social Interactions Lack of social interaction 37 100
Total 37 10.3
Interpersonal Relations Difficulty in establishing and maintaining interpersonal relationships 9 14.5
Shortage of shared activities 34 54.8
Lack of interpersonal communication 16 25.8
skills Prolonged, unresolved tensions 3 4.8
Total 62 17.3
Mental Health Sadness/despair/decreases in self-esteem 27 22.3
Concern (worries)/undefined fears 27 22.3
Loss of interest in self-care and maintenance of daily activities 23 19.0
Blunting of emotions 9 7.4
Restless/agitated/aggressive 23 19.0
Difficulty in anger management 5 4.1
Hallucinations/illusions 3 2.5
Stating the desire to commit suicide/homicide 4 3.3
Total 121 33.8
Caregiving/Parenting   Difficulty in providing physical care/safety 41 47.1
Difficulty in taking responsibility, dissatisfaction 46 52.9
Total 87 24.3
Neglect Lack of physical care 20 64.5
Lack of emotional care/support 11 35.5
Total 31 8.7
General Total for the Psychosocial Domain 358 100

Table 5: Problems and insufficiencies related to the psychosocial domain according to the OMAHA Problem Classification Scheme.

Health behavior domain

In this domain, 669 insufficiencies related to 5 problems were identified. Regarding self-feeding and nutrition, 103 (15.4%) insufficiencies were determined. Of them, 40.8% were malnutritionassociated insufficiencies. Of the 70 (10.5%) insufficiencies related to sleep and rest patterns, 45.7% were associated with frequent night waking. Of the 377 (56.4%) insufficiencies related to personal care, 12.5% were associated with forgetting/not willing/not being able to do personal care activities, 11.7% with the cleaning/washing of the clothes, 11.9% with not being able to have a bath, 11.7% with not being able to clean himself/herself after going to the toilet and 11.9% with having difficulty in wearing lower body clothing. Of the 81 (12.1%) insufficiencies related to the management of drug administration, 56.8% were associated with failure to take medication without aid and 23.5% with non-compliance with the recommended dose/treatment program (Table 6).

Problem Insufficiencies Number %
Self-Feeding and Nutrition       Overweight (BMI score of 25 and above) 21 20.4
Underweight (BMI score of 18.5 and below) 4 3.9
Daily calorie/fluid intake lower than the standard 19 18.4
Malnutrition 42 40.8
Inability to maintain the proposed nutrition program 3 2.9
Inability to buy and prepare food 14 13.6
Total 103 15.4
Sleep and RestPattern Sleep and rest patterns causing discomfort to family members 20 28.6
Frequent night waking 32 45.7
Insomnia 18 25.7
Total 70 10.5
Physical Activity Sedentary lifestyle 38 100
Total 38 5.7
Personal Care Inability to clean and wash clothing 44 11.7
Inability to have a bath 45 11.9
Difficulty in cleaning himself/herself after going to the toilet 44 11.7
Difficulty in wearing lower body clothing 45 11.9
Difficulty in wearing upper body clothing 38 10.1
Bad body odor 29 7.7
Difficulty in washing and combing hair 42 11.1
Difficulty in performing oral care/tooth brushing/flossing 43 11.4
Forgetting/not willing/not being able to do personal care activities 47 12.5
Total 377 56.4
Management of Medication   Non-compliance with the recommended dose/treatment program 19 23.5
Inadequate management of medication 16 19.8
Failure to take medication without aid 46 56.8
Total 81 12.1
General total for the health-related problems domain 669 100

Table 6: Problems and insufficiencies related to the health-related problems domain according to the OMAHA Problem Classification Scheme.

Discussion

In this present study, health problems of individuals receiving home healthcare were determined through one-to-one interviews using the observation method at the participants’ homes. During the interviews, the OMAHA Problem Classification Scheme was used.

Of the participants, 74% were in the 65 and over age group. As in the present study, the majority of individuals participating in several other studies were elderly people [16,19-22]. This situation reveals the necessity of home healthcare services for the elderly in Turkey where the average life expectancy is increasing with each passing day.

Problems among the participants were identified based on four domains of the OMAHA Problem Classification Scheme. Of the problems identified, 49% were in the physiological domain, 28.8% in the health-related behaviors domain, 15.4% in the psychosocial domain and 6.8% in the environmental domain. As the identified problems demonstrate, the OMAHA Problem Classification Scheme ensures the provision of a holistic diagnostic approach which covers all the components of health. This result shows that the Omaha system is an appropriate tool in performing individual, family and communityoriented nursing diagnoses from a holistic perspective.

\Most of the insufficiencies determined among the participants were related to the physiological domain. In a study conducted with the elderly [13], of the nursing diagnoses, most were related to the physiological domain, followed by health-related behaviors, psychosocial and environmental domains. In another study conducted on the home healthcare by Erdogan et al., the most common problems were determined in the physiological domain (63%), followed by health-related behaviors domain (16.8%), environmental domain (10.3%) and psychosocial domain (9.9%) [16].

Similar to the findings of this present study, Westra et al. determined that patients receiving home healthcare experienced problems mostly in the physiological and health-related behaviors domains. The problems were mostly associated with the neuromusculo- skeletal function, skin, pain, medication management and circulatory system [23].

In this present study, the distribution of the identified problems regarding the physiological domain was as follows: neuro-musculoskeletal function (20.3%), skin (12.6%) and cognition (11.7%). Because most the participants in the study sample were in the 65 and above age group, and because intra- and extra-cellular changes occurring with aging lead to the development of physiological problems and dysfunction, noticeable changes occur in the body structure and image. The study findings indicate that the impairments detected in the participants were due to physiological changes. Similar to the results of this study, in Erdogan et al.’s study, the most common problems were related to the physiological domain. The problems were related to skin, neuro-musculo-skeletal system, and urinary function in 92%, 47% and 18% of the participants respectively [16).

In Olgun et al. study investigating the health status of the elderly, the results of the physical examinations revealed that of the participants, 72.1% had muscle weakness/walking problems, 42% had skin problems such as paleness, rash and cold skin, 41% had gastrointestinal complaints such as pain, nausea, constipation, 61.8% had respiratory problems such as cough, phlegm and respiratory difficulties, 59.4% had neurological problems such as fatigue, headache and dizziness, 47.6% had genitourinary problems such as frequent and painful urination and urinary incontinence, and 65.6% cardiovascular system problems such as edema, nocturia and fatigue [24].

The health-related behaviors domain was the domain in which the second highest number of problems was identified with the OMAHA Problem Classification Scheme. In the health-related behaviors domain, impairments were most frequently observed in personal care (56.4%), self-feeding and nutrition (15.4%), medication management (12.1%), sleep and rest (10.5%) and physical activity (5.7%). The problems identified in the present study are similar to problems identified in several other studies conducted with individuals receiving home healthcare services [16,20,21,25]. The most common problems identified by Erdogan et al. in the health-related behaviors domain were related to personal care, and self-feeding and nutrition [16]. Similarly, in Önder et al. study investigating individuals receiving home healthcare services, of the participants, 90.4% were not able to take a bath without assistance, 82.7% were not able to dress without assistance, and only 34.6% were able take medication unassisted [20]. In Hisar and Erdo?du’s study of the patients receiving home healthcare services, 74.5% were not able to carry out personal care, and 14.9% were not able to feed orally [21]. Akdemir et al. determined that a great majority of bedridden patients (94.7%) did not receive sufficient hygienic care, and that they were not knowledgeable enough about nutrition, hygiene, and medicines they took [25]. Because home healthcare has a wide range of services such as provision of assistance for personal care, personal hygiene, dressing, having a bath, preparing meals, feeding and patient education, it could contribute to the fulfillment of the needs of individuals if problems are well defined with a multidisciplinary team approach and if healthcare is planned accurately [26,27].

In the present study, according to the OMAHA PCS, the most common insufficiencies identified in the environmental domain were housing (54.7%), sanitation (35.2%) and income (10.1%). In their study in which they used the OMAHA PCS for the identification of problems, Erdogan et al. determined that the problems were related to sanitation, income, housing, and environmental safety. In many studies evaluating patients receiving home healthcare, problems related to the patient’s environmental conditions have not been addressed. The use of the OMAHA PCS in the diagnoses of patients at home eliminates these limitations and enables health workers to evaluate patients together with their environment. The regulation published in 2011 focusing on nursing specialties addresses home healthcare nurses’ roles regarding the environmental domain. The OMAHA PCS can be considered as an important tool in the fulfillment of these roles.

In the present study, according to the OMAHA PCS, the most common problems identified in the psychosocial domain were mental health (33.8%), caregiving/parenting (24.3%), interpersonal relationships (17.3%), lack of social interaction (10.3%), neglect (8.7%) and utilization of community resources (5.6%). In their study determined that 78.9% of the bedridden patients receiving home healthcare had psychosocial problems and that 63.2% of them were unable to communicate verbally [25].

Erdogan et al. determined that the problems identified in the psychosocial domain were mental health, neglect, interpersonal relationships, sadness, social relations and utilization of community resources [16]. Because the OMAHA Problem Classification Scheme, evaluate individuals receiving home healthcare together with the environment they are in, it facilitates the identification of health problems arising due to aging and disease process.

Limitations

Findings of this study are limited by the small sample size of 50 patients. There are limited sources about OMAHA Assessment System in home care patients, so discussion was restricted. Reliability in the use of Omaha System problems and signs/symptoms at the community level was also a limitation of this study. A limitation of the study's descriptive results is the nature of preliminary data. The data of this research will constitute data for a so-called interference initiative.

Conclusions

The results of the evaluation conducted to determine the health problems of individuals receiving home healthcare services revealed that the problems they had most were in the physiological domain followed by the problems in the health-related behaviors, psychosocial and environmental domains. The results also revealed that the OMAHA PCS evaluates healthcare needs of individuals receiving home healthcare services considering all the components of health, and facilitates the identification of health problems of an individual by offering opportunities to evaluate the individual together with his/her family and environment.

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