Nurses’ lifestyle behaviours,health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study

Background

Nurses have an increased risk for non-communicable diseases (NCDs), along with a high prevalence of obesity, poor eating habits and insufficient physical activity. The aim of this study was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa.

Methods

Participants were purposively sampled (n?=?103), and included management personnel (n?=?9), night shift (n?=?57) and day-shift nurses (n?=?36). Twelve focus groups (FGDs) were conducted with nursing staff to obtain insight into nurses’ health concerns, lifestyle behaviours and worksite health promotion programmes (WHPPs). Seven key informant interviews (KII) were conducted with management personnel, to gain their perspective on health promotion in the worksite. Thematic analysis was used to analyse the data with the assistance of Atlas.ti Qualitative Data Analysis Software.

Results

Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. Being overweight was perceived to have a negative impact on work performance. All nurses identified backache and exposure to tuberculosis (TB) as occupation-related health concerns, and both management and nurses frequently reported a stressful working environment. Nurses frequently mentioned lack of time to prepare healthy meals due to long working hours and being overtired from work. The hospital environment was perceived to have a negative influence on the nurses’ lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling services, an online employee wellness programme offered by the Department of Health and wellness days in which clinical measures, such as blood glucose were measured. Nurses identified a preference for WHPPs that provided access to fitness facilities or support groups.

Conclusions

Public hospitals are a stressful work environment and shift work places an additional strain on nurses. The risk of NCDs and exposure to infectious disease remains a concern in this working population. Our findings highlight the need for WHPPs that support nurses in managing stress and transforming the work environment to facilitate healthy lifestyles.

     

Disability and access to health care – a community based descriptive study

Abstract

Purpose: The World Disability Report highlighted the need for adequate access to health and medical rehabilitation services for those with disability. Participants in a large community based survey in a low-income area were asked questions relating to their use of health related services. Method: Using random, cluster sampling a representative sample of 1083 households in a deprived area of Cape Town were approached and 152 people with disability were interviewed. Results: Those with disability were more likely to be male (χ²?=?4.24, p?=?0.03) and unemployed (χ²?=?66.89, p?>?0.001) compared to those without disability. The percentages reporting unmet needs were respectively: 54% for home-based care; 34.5% for assistive devices, 28.9% for medical rehabilitation services; and 2.5% for health services. Those over 65 years of age were less likely to have had the medical rehabilitation that they required (χ²?=?8.00, p?=?0.018). There were fewer respondents with sensory and language disorders but these groups reported proportionately more unmet needs. The main problems with accessing services included inadequate finances (71%) and transport problems (72%). Conclusion: It is recommended that all efforts be expended to extend appropriate rehabilitation services, including home based-care and appliances to those identified as having disability, particularly to those older than 65 years. In addition, the services need to be affordable and accessible in terms of suitable transport, particularly in the light of the high unemployment rate and the large number of respondents with mobility problems.

• Implications for Rehabilitation

• People with disability may be the most in need of additional health related care and the least able to access it.

• Transport and financial considerations were found to limit the ability to access appropriate care.

• Rehabilitation and health services need to reach out through home-based care and appropriate forms of rehabilitation delivery to ensure that those who are most in need of care, such as the elderly and those with more neglected forms of disability, are provided with the services that they require.

     

Implementing multimodal pain rehabilitation in primary care – a health care professional perspective

Purpose: To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare.

Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care.

Results: The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program – a process, and good teamwork – not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching.

Conclusions: To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients.

• Implications for rehabilitation

• Much can be gained from conducting multimodal pain rehabilitation in primary care.

• Front line managers and those at other organizational levels must prioritize and create appropriate conditions to facilitate multimodal pain rehabilitation in primary care.

• Creation of an effective multimodal rehabilitation team requires that each team member takes responsibility, drops the focus on individual rehabilitation, seek member consensus about the content of the rehabilitation, and confer equal worth to each team member.

• The process of creating a program can be facilitated, especially at the beginning, if the team is supported by speciality pain clinics or more experienced teams.

     

Nurses’ perception of missed nursing care in a Western Australian teaching hospital: A cross-sectional study

BackgroundMissed nursing care (MNC) has gained increasing emphasis in nursing literature because of its association with nurse and patient outcomes in healthcare settings. While missed care has been widely studied, little evidence is available on the types and frequency of missed care, reasons for its occurrence, and predictors of missed care in Western Australia.AimsTo determine nurses’ perceptions of the types of MNC, reasons for missed care and to identify factors predicting missed care occurrence in Western Australian acute care settings.MethodsA cross-sectional study in medical and surgical wards was performed. The nurse MISSCARE survey tool was used to capture self-reported types and reasons for missed care and level of nurse job satisfaction from a sample of 204 nurses working in 16 acute care wards. Data analyses were carried out in International Business Machines Corperation located in Armonk, New York United States (IBM SPSS Statistics) (v 29).FindingsThe most common perceived missed activities included ambulation (87%), patient teaching (79%), interdisciplinary conference attendance (78%), mouth care (78%), intake and output (77%), and patient turning (75%). Labour resources ranked highest for reasons for missed care followed by material resources and communication. Significant relationships were observed between missed care and job satisfaction, role satisfaction, and teamwork.DiscussionWorking overtime, job dissatisfaction, inadequate staffing, and heavy admissions and discharges were related to increased likelihood for missed care occurrence.ConclusionAlthough further studies examining the link between MNC and staffing methodologies are needed, this study provides evidence on nurse-reported missed care and the impact of missed care in Western Australia.     

Nurses’ lived experiences of professional autonomy in Iran

ObjectivesNurses' autonomy is a complex and multi-dimensional concept that has often been overlooked. Although many studies have addressed patients' autonomy, there has been no assessment of nurses' experience of professional autonomy. The present study aimed to assess nurses’ lived experiences of professional autonomy in Shiraz, Iran.MethodsThe present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018. The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The experiences of the participants were assessed through 14 in-depth semi-structured interviews. The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.ResultsBased on the analysis of the interviews, 4 themes, 11 categories, and 13 sub-categories were extracted. The themes were: Advocacy for patients and nurses, independence in the workplace, Involvement in professional decision-making, and Professional accountability.ConclusionDue to the intense interaction between nurses and patients, a better quality of care will be achieved if the professional autonomy of nurses is ensured. Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.     

School Nurses’ perspectives on the role of the school nurse in health education and health promotion in England: a qualitative study

Background

The role of the school nurse is complex with many possible elements identified by previous research. The aim of this study is to understand perceptions of the role of the school nurse in order to support school nurses in the delivery of health education.

Methods

The study used an inductive, qualitative research design involving semi-structured interviews and focus groups. Participants were recruited from four NHS trusts across England and final sample size was thirty one school nurses. Three focus groups and two interviews took place in person, and three interviews were over the phone. Data was thematically analysed.

Results

School nurses described six main themes. Four themes directly related to the school nurse role: the main roles of a school nurse, school nurses' role in health education, prioritisation of workload and activities, and community work. A further two other themes related to the delivery of health education: the school nursing system and educational resources.

Conclusions

The role of the school nurse in England is very diverse and the school nurse role in health education is primarily to advise and support schools, rather than to directly deliver education. The study identified that tailored public health educational resources are needed to support school nurses.

     

General practitioners’ views on leadership roles and challenges in primary health care: a qualitative study

Objective: To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care.

Design: We conducted focus groups (FGs) with 17 GPs.

Setting: Norwegian primary health care.

Subjects: 17 GPs who attended a 5 d course on leadership in primary health care.

Results: Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement.

Conclusions: GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance.

• KEY POINTS

• Little is known about doctors’ experiences and views about leadership in general practice and primary health care. Our study suggests that:

• There is a lack of preparation and formal training for the leadership role.

• GPs experience tensions between the clinical and leadership role.

• GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care.

     

Continuing professional education: Motivations and experiences of health and social care professional’s part-time study in higher education. A qualitative literature review

ObjectivesTo understand the motivations and experiences of health and social care professionals undertaking part-time, accredited, continuing professional education in higher education.DesignA review following systematic principles.Data sourcesSystematic searches for literature published between January 2000 and December 2015 using the databases: SCOPUS, Web of Science, Medline, PsychINFO, Social Policy and Practice and CINAHL.Review methodsStudies were included if they were published in the English language and were qualitative in design, focussing on the motivations and experiences of staff engaged in part-time, accredited, higher education study. Three reviewers appraised the quality of the selected studies.ResultsThirteen qualitative studies were identified for the review. Motivating factors for staff to engage in part-time, accredited, continuing professional development study included: personal and professional drivers, influence of workplace/management and funding and availability. Key themes in relation to how staff experienced study included: the demands of adjusting to the academic requirements of higher education study; the experience of juggling competing demands of study, work and family; and the presence or absence of support for part-time study in the personal and professional arenas.ConclusionsHealth and social care professionals experience a number of challenges when engaging in part-time, continuing professional education in higher education institutions. A significant challenge is the juggling of competing demands of study, work and family, and this may have a negative impact on learning. Research is needed to inform how higher education can address the specific learning needs of this population and develop pedagogic approaches that are both responsive to need and support of effective learning.