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Using Omaha System Documentation to Understand Physical Activity Among Rural Women Jeanette Melissa Olsen University of Wisconsin-Milwaukee

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Using Omaha System Documentation to Understand Physical Activity Among Rural Women Jeanette Melissa Olsen University of Wisconsin-Milwaukee University of Wisconsin Milwaukee UWM Digital Commons Theses and Dissertations May 2015 Using Omaha System Documentation to Understand Physical Activity Among Rural Women Jeanette Melissa Olsen University of Wisconsin-Milwaukee Follow this and additional works at: https://dc.uwm.edu/etd Part of the Databases and Information Systems Commons, Nursing Commons, and the Public Health Commons Recommended Citation Olsen, Jeanette Melissa, "Using Omaha System Documentation to Understand Physical Activity Among Rural Women" (2015). Theses and Dissertations. 906. https://dc.uwm.edu/etd/906 This Dissertation is brought to you for free and open access by UWM Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of UWM Digital Commons. For more information, please contact [email protected]. USING OMAHA SYSTEM DOCUMENTATION TO UNDERSTAND PHYSICAL ACTIVITY AMONG RURAL WOMEN By Jeanette Olsen A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing at The University of Wisconsin-Milwaukee May 2015 ABSTRACT USING OMAHA SYSTEM DOCUMENTATION TO UNDERSTAND PHYSICAL ACTIVITY AMONG RURAL WOMEN by Jeanette Olsen The University of Wisconsin-Milwaukee, 2015 Under the Supervision of Professor Mary Jo Baisch Rural women are more inactive and have different barriers to physical activity than those who live in more urban settings, yet few studies have specifically examined physical activity and associated factors in this population. Clinical data documented with standardized terminology by nurses caring for rural women may provide an opportunity to generate evidence that informs and improves nursing care. However, the knowledge to be gained and utility of nurses’ clinical documentation in regard to physical activity have not been explored. Accordingly, the purpose of this study was to increase understanding of physical activity and associated factors among rural women by analyzing clinical data documented by local health department (LHD) nurses using the Omaha System standardized terminology. The study was guided by the ecological model for health promotion. A two-phase, retrospective, mixed-methods design was used. Phase One involved quantitative secondary analysis of a de-identified dataset derived from a convenience sample of women who received care from LHD nurses in a rural, Minnesota county (N=852). Measures included demographic data, baseline Physical activity Knowledge, Behavior, and Status (KBS) ratings, Physical activity signs/symptoms, and ii ecological factors operationalized with the Omaha System Problem Classification Scheme and Problem Rating Scale for Outcomes. Results revealed rural women had more than adequate Knowledge (M=3.41), inconsistent Behavior (M=3.27), and minimal to moderate signs/symptoms (M=3.56) for Physical activity. Hierarchical regressions indicated ecological factors influenced Physical activity Behavior; however, age, BMI, and Physical activity Knowledge had more impact. Phase Two involved a focus group session with a purposive sample of LHD nurses (N=12) in the study setting. A semi- structured interview guide was used to elicit their perspectives about the quantitative findings. Three themes emerged with qualitative thematic analysis: (a) knowledge is good, behavior is the issue; (b) clients may be more complex than what is captured; and (c) assessment and coding are impacted by professional judgment, time constraints, and priorities. The outcomes of this study provide support for measuring and analyzing physical activity from an ecological perspective with clinical information documented by nurses using the Omaha System. The results indicate Physical activity Behavior among rural, female, LHD clients in the Midwest is inconsistent and influenced by demographic factors of age, BMI, Physical activity Knowledge, and environmental factors. However, LHD nurses perceive Physical activity Behavior remains an issue, despite more than adequate Physical activity Knowledge. In addition, nurses reported that documented data may not have fully captured client complexity due to nursing time constraints and client priorities. Future studies are needed with attention to these assessment and coding challenges. Providing nurses with ongoing education on KBS rating and information regarding potential research applications of client clinical data may help address these challenges and strengthen future research in this area. iii ©Copyright by Jeanette M. Olsen 2015 All Rights Reserved iv DEDICATION This dissertation is dedicated to my husband. It is your support, encouragement, and selflessness that made it possible for me to pursue this goal. I am grateful. v TABLE OF CONTENTS CHAPTER 1.0…………………………………………………………………………….1 Introduction ..................................................................................................................1 Structure to Dissertation .....................................................................................2 Background……………………………………………………………………….......3 The Omaha System ............................................................................................ 6 Study Design and Methods ...........................................................................................8 Theoretical Framework ................................................................................................9 Purpose of the Study ...................................................................................................10 Significance of Study .................................................................................................10 Definition of Concepts ...............................................................................................13 Physical Activity .............................................................................................. 14 Intrapersonal Factors ........................................................................................ 15 Interpersonal Factors ........................................................................................ 16 Commmunity Factors ....................................................................................... 17 Standardized Terminology ............................................................................... 18 Rural Area ........................................................................................................ 18 Chapter Summary .......................................................................................................19 References ..................................................................................................................24 CHAPTER 2.0 REVIEW OF LITERATURE AND THEORETICAL FRAMEWORK ..30 Chapter Introduction ...................................................................................................30 Section 2.1 Review of Literature on Physical Activity among Rural Women ...........30 Methods and Findings ...................................................................................... 31 Physical Environment Factors ................................................................... 32 Socio-economic Factors ............................................................................ 33 Personal Factors ........................................................................................ 36 Synthesis of Findings and Recommendations for Future Research ................. 39 Section 2.2 Theoretical Framework ...........................................................................44 Theoretical Models ........................................................................................... 44 Social Cognitive Theory ........................................................................... 44 Transtheoretical Model of Health Behavior Change ................................ 45 Theory of Planned Behavior ..................................................................... 47 Health Promotion Model ........................................................................... 48 Self Determination Theory ........................................................................ 49 Ecological Model for Health Promotion ................................................... 51 Section 2.3 - Manuscript One “An Integrative Review of Literature on the Determinants of Physical Activity among Rural Women” ...............................57 Section 2.4 - Manuscript Two “The Omaha System: An Ecological Approach to Physical Activity Nursing Care and Research" ..............................................102 Chapter Summary .....................................................................................................136 References ................................................................................................................138 vi CHAPTER 3.0 METHODOLOGY .................................................................................147 Chapter Introduction .................................................................................................147 Section 3.1 Phase I Methodology .............................................................................147 Research Questions and Hypotheses ..............................................................148 Protection of Human Subjects ........................................................................148 Setting and Sample .........................................................................................149 Inclusion and Exclusion
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