Puzzle Pieces The Omaha System: Solving the Clinical Data-Information Puzzle
Case Studies
  1: Emma B.
  2: Janice A.
  3: Influenza
  4: Francis R.
  5: Bill T.
  6: John C.
  7: Julie B.
  8: Tamika J.
  9: Joe G.
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Influenza Outbreak: Reduce Disease Transmission in a Community

Linda Olson Keller, RN, DNP, FAAN
Clinical Associate Professor
University of Minnesota School of Nursing
Minneapolis, Minnesota
Minnesota Omaha System Users Group

Information Obtained during a Project/Incident:

Bloom County, population 120,000, is a metropolitan county in Minnesota. The residents became the client of this case study when they experienced the first confirmed influenza case during the winter holiday season. Unfortunately, the person was employed as a clerk at a store located in a large regional shopping mall, continued to work while feeling ill during the busy holiday season, and exposed many people. The clerk died five days after becoming ill.

Residents began to panic. Although the health department quickly exhausted their supply of vaccine, the U.S. Centers for Disease Control and Prevention sent enough doses for all county residents the following week. The Bloom County Health Department then offered 24-hour/day immunization clinics. Many of the clinics were inundated with worried residents and security became a concern. In addition, there were numerous people including friends, family members, and co-workers of confirmed cases who experienced mild symptoms of fever and cough. It was not possible to know if they were experiencing the early stages of influenza and needed to be quarantined to protect others, or a milder illness.

The health department's health educators, public health nurses, and other staff conducted an aggressive media campaign with the help of the state health department and local pharmacists, physicians, health care facilities, stores, churches, and other community groups. In addition to providing information about disease prevention and treatment and how to obtain vaccine, the campaign included warnings about the limitations of the vaccine and the need to reduce contact with others. Many residents were unwilling to follow a voluntary quarantine especially because it was the holiday season; few events were cancelled or postponed and event attendance decreased minimally. Despite a public plea to schedule appointments with health care providers for specific symptoms, many residents continued to visit local emergency departments.

Health department staff conducted contact investigations for documented influenza cases and attempted to quarantine exposed family members. Staff members worked with the state health department to disseminate accurate and timely public information and quell the rising panic of the public. By the time the influenza outbreak ended, the county experienced more than 200 cases and 31 deaths.

Application of the Omaha System:

Domain: Physiological

Problem: Communicable/infectious condition (high priority)

Problem Classification Scheme
Modifiers: Community and Actual
Signs/Symptoms of Actual:
  • infection
  • fever
  • positive screening/culture/laboratory results
  • inadequate supplies/equipment/policies to prevent transmission
  • does not follow infection control regimen
  • inadequate immunity
Intervention Scheme
Category: Teaching, Guidance, and Counseling
Targets and Client-specific Information:
  • anatomy/physiology (transmission)
  • communication (distributed information about the disease, how to obtain anti-viral medication/its limitations; attempted to reduce public panic)
  • education (sessions about reducing risk of transmission)
  • infection precautions (effective preventive measures and actions including voluntary quarantine and visits to usual health care providers)
  • medical/dental care (appropriate/adequate use-medical home versus emergency room)
Category: Treatments and Procedures
Targets and Client-specific Information:
  • medication administration (anti-viral medication for those who were ill)
Category: Case Management
Targets and Client-specific Information:
  • communication (health department organized media campaign supported by many individuals and groups)
  • infection precautions (enforced quarantine for exposed residents)
Category: Surveillance
Targets and Client-specific Information:
  • infection precautions (conducted contact investigation, monitored adherence, tracked reports of cases and deaths)
Problem Rating Scale for Outcomes
Knowledge: 2-minimal knowledge (most residents were aware of outbreak, those who were ill knew they needed to receive the anti-viral medication-not aware of other precautions; some were overly concerned)
Behavior: 3-inconsistently appropriate behavior (most residents who were ill received anti-viral medication; many would not restrict their activities/follow voluntary quarantine)
Status: 2-severe signs/symptoms (extensive influenza infection with many cases and deaths, monitored statistics)