Minnesota Wheel—The Public Health Interventions Model
The Minnesota Department of Health, Division of Community Health Services, Public Health Nursing Section, devised a model that depicts public health interventions and applications for public health practice. In the form of a wheel, the model presents 17 different interventions within three levels of public health practice: population-based community-focused practice, systems-focused practice, and individual-focused practice.
The “Minnesota Wheel” (Public Health Nursing Section, Minnesota Department of Health, 2001) is depicted in Figure 14–3.
FIGURE 14–3 The Minnesota Wheel. (Source: Minnesota Department of Health, Division of Community Health Services, Public Health Nursing Section.)
The intervention wheel was first proposed in 1998 (Keller, Strohschein, Lia-Hoagberg,
& Schaffer, 1998) as a practice model for population-based public health nursing. It presents public health nursing as a specialty practice within the field of nursing (Public Health Nursing Section, Minnesota Department of Health, 2001). It can be applied in a variety of venues including public health practice, nursing education, and management.
Keller and colleagues emphasized that the “use of the Wheel has empowered nurses to explain in a better way how their practice contributes to the improvement of population health” (Keller, Strohschein, Lia-Hoagberg, & Schaffer, 2004, p. 454). The wheel is useful for public health nurses because it visually depicts the comprehensive list of interventions
nurses must consider in the scope of practice. Schaffer, Anderson, and Rising (2015) described how school nurses using the interventions presented within the model in their day-to-day work. Including nurses who were not even aware of the model, school nurses identified screening, referrals, and case management as the interventions they most commonly implement (Schaffer et al., 2015). This example shows how well the model describes and guides community health nursing interventions.
Public Health Nursing Practice Model
The Los Angeles County Public Health Nursing Practice Model (LAC PHN Practice Model) was developed in response to an identified need for a model that could blend public health nursing practice and the principles of public health, which could be applicable to both the generalist nurse and nurses working in specific programs (Smith & Bazini-Barakat, 2003). Public health nurses at the Los Angeles County Department of Health Services (LAC-DHS) created the model, with input from the California Conference of Local Health Department Nursing Directors (CCLHNDN) Southern Region and other public health nurse leaders. The LAC PHN Practice Model (Public Health Nursing, Los Angeles County Department of Health Services [PHN, LAC-DHS], 2013) integrates foundational nursing and public health guiding documents including the Public Health Nursing Standards of Practice, the 10 Essential Public Health Services, the 12 Leading Health Indicators from Healthy People 2020, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a “conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines” (Smith & Bazini-Barakat, 2003, p. 42). It establishes that public health nursing is population based and was created to “describe the building blocks of PHN practice and to delineate their relationship to each other” (PHN, LAC-DHS, 2013, para. 1).
FIGURE 14–4 Public Health Nursing Practice Model. (Used with permission from the Los Angeles County Department of Public Health, Public Health Nursing. Retrieved from
As described by Smith and Bazini-Barakat (2003) and Public Health Nursing (PHN, LAC-DHS, 2013), the principles of population-based practice are included in the LAC PHN Practice Model. Public health nurses integrate assessment, policy development, and assurance into their work. The three levels of population-based practice—individuals and families, community, and systems—are addressed, with the nursing process applied throughout the model. The 17 interventions, as first presented in the Minnesota Public Health Nursing Model described above, are also incorporated into the LAC PHN Practice Model. The LAC PHN Practice Model promotes the concepts of an interdisciplinary public health team working together, with an emphasis on primary prevention. It also recognizes the importance of active participation of the individual, family, and community (PHN, LAC-DHS, 2013; Smith & Bazini-Barakat, 2003). See Figure 14–4 for a depiction of the LAC PHN Model.
Omaha System
The Omaha System is a multidisciplinary standardized interface that incorporates documentation of nursing assessment and interventions (Thompson, Monsen, Wanamaker, Augustyniak, & Thompson, 2012). It was developed and refined during four research projects conducted between 1975 and 1992 with the Omaha Visiting Nursing Association.
It was designed to increase the effectiveness and efficiency of nursing practice in the agency (Bowles & Naylor, 1996; Martin, Leak, & Aden, 1992). The system is now finding increasing utility in facilitating EBP, documentation, and information management, all of which are critical to contemporary public health care systems. It is a comprehensive system, including the following components (Martin, 2005):
Problem classification scheme that offers nurses a holistic, comprehensive method for identifying clients’ health-related concerns. It includes domains, problems, modifiers, and signs/symptoms. Problems can be identified at the individual, family, or community level.
Intervention scheme that provides a framework for documenting plans and interventions in the client record in the areas of health teaching, guidance, and counseling; treatments and procedures; case management; and surveillance.
Problem rating scale for outcomes that consists of a Likert-type scale that is a systematic and recurring method used to document the progress of clients in the record and in case conferences during their time of service in the agency. It is used in conjunction with any problem in the Problem Classification Scheme. Central to problem rating is quantifying outcomes in three dimensions: knowledge (what the client knows), behavior (what the client does), and status (how the client is).
The Omaha System is based on universal principles of nursing practice. The model was judged to be consistent with the Nightingale model of environmental health (Zurakowski, 2005). Citing some variations in language use, Griffin and Landers (2014) found that Orem’s model of self-care was also consistent with the premises of the Omaha System. The Omaha System Model of the Problem-Solving Process (Fig. 14–5) shows the interrelationship between the practitioner and the client in addressing health problems. The model guides the nurse through the six steps in the process: (1) collecting and assessing data, (2) stating the problem, (3) identifying the problem rating on admission, (4) planning and actual interventions, (5) identification of interim or dismissal problem rating, and, finally, (6) evaluating the problem outcome. The model is applicable to individuals, families, and communities and provides a mechanism to evaluate both individual and group change over time. With ongoing pressure for public health program funding, outcome data is vital and can be achieved through the application of the Omaha System.
FIGURE 14–5 Omaha System Model of the Problem-Solving Process. (From Martin, K.
S. (2005). The Omaha System: A key to practice, documentation, and information management (2nd ed.). Omaha, NE: Health Connections Press, with permission.)
Research regarding the contribution of the Omaha System to program evaluation has included. This model was used by Thompson et al. (2012) to assess the outcome of public health nurse interventions provided through a nurse-managed wellness center. In a practice- related approach, health promotion lifestyle profiles and quality of life in Turkish women were explored using the Omaha System (Erci, 2012). The findings of this study demonstrated that application of system interventions improved measurements of self- actualization, health responsibility, interpersonal support, and stress management.
Thompson et al. (2012) utilized the Omaha System to gather data regarding the effectiveness of a nurse-managed wellness center. Students documented their interventions in the system that allowed the researchers to access and analyze the data. The results
indicated that the nurse-managed center saw improved outcomes, justifying the value and effectiveness of the work being done there (Thompson et al., 2012). These are but a few of the examples of research adding to the body of knowledge regarding the role of the Omaha System in affecting individual and group change and providing a reliable measure of programmatic effectiveness.