Sedentary Behavior: Considerations for the Nurse Practitioner

Recent development in sedentary behavior research has resulted in heightened awareness of this health behavior across the health care provider community, including nursing practitioners (NPs). Sedentary behavior, independent of physical activity, poses negative health implications across a person’s lifespan. Although there is no consensus regarding clinical recommendations for sedentary behavior, NPs must consider sedentary behavior as a significant health risk in their patient populations. Existing research assessment tools may be adapted for use in the clinical setting. Proper assessment by the NP can lead to identifying patients at risk for sedentary behavior, with recommendations to sit less and move more.     

Registered nurses' beliefs of the benefits of exercise, their exercise behaviour and their patient teaching regarding exercise

Recommendations by experts have been in place for > 10 years encouraging every adult to participate in ≥ 30 min of daily moderate-intensity physical activity. Despite extensive research supporting the value of physical activity, only about one-third of all adults meet physical activity recommendations. Using Pender's Health Promotion Theory as the framework, this study was focused on the relationships between nurses' beliefs regarding the benefits of exercise, their exercise behaviour and their recommendation of exercise for health promotion or as part of a treatment plan. Results showed positive correlations between exercise benefits, physical activity and recommendation of exercise to patients. Nurses who believe in health promotion and embrace healthy behaviours are more likely to be positive role models and teach healthy behaviours to their patients. Recommendations for practice and future research are included.     

Perceptions of mental health nurses and patients about health promotion in mental health care: a literature review

The aim of this review was to examine the perceptions of patients with mental disorders and mental health nurses of health promotion targeting physical activity and eating habits in mental health care. An electronic search strategy was conducted. Furthermore, references were searched by hand-searching the reference lists of the retrieved articles from the electronic databases. The literature on perceptions of health promotion and lifestyle interventions in mental health care principally consist of qualitative studies using interviews and focus groups. Positive perceptions of both mental health nurses and patients towards health promotion targeting physical activity and eating habits in mental health care were identified. Contrary, several barriers for integrating healthy lifestyles into the daily life of patients were described. Patients usually want to learn more about healthy lifestyles, but see the ability to change their physical health as beyond their control. In this sense, support from mental health nurses is considered as important. Despite the awareness of the importance of health promotion in mental health care, it appears that visions and attitudes towards the potential of health promotion are in need of change.     

Atrial Fibrillation: Focus on Anticoagulant Pharmacotherapy

The use of anticoagulant medication is important for stroke prevention, but it has many risks, including bleeding. Nurse practitioners (NPs) should be knowledgeable and informed of these medications as they manage their patients. Aspirin, warfarin, dabigatran, rivaroxaban, and apixaban are discussed in this review to inform NPs of their profiles and to help NPs appropriately select and prescribe these medications.     

Promotion of Cardiovascular Health in Children by Nurse Practitioners and Physicians in Family Practice

The purpose of this study was to describe cardiovascular (CV) health promotion practices of nurse practitioners (NPs) and physicians (MDs). Clinical practice was described for three age groups of children both with and without parental premature heart disease. Differences in clinical practice by type of provider and by age and risk level of the child were examined. A 42-question survey was mailed to all family NPs in North Carolina and to MDs randomly selected from the roster of the North Carolina Academy of Family Physicians; 94 responded. A high level of blood pressure measurement for all children and counseling regarding smoking for 13 to 19 year olds was found among all participants. Fewer health promotion activities were reported for other risk factors for the oldest group and for the younger children in general. Health promotion practices increased with the age of the child. Nurse practitioners had significantly higher total CV health promotion scores than did MDs, regardless of the age or risk level of the child. An increase in counseling about prudent diet and increased physical activity is needed for all children, regardless of risk level. In addition, there should be an increase in CV health promotion activities with younger children.     

Walking for health: a nurse-managed activity

One researcher has noted that forced inactivity leads to changes that are similar to those associated with the aging process, possibly indicating that some of the effects of aging may be due to inactivity rather than an intrinsic biologic process. The benefits of regular physical activity include improved cardiopulmonary function, lowered blood pressure, increased bone mineral content, increased muscle strength and joint flexibility, and improved psychological well-being. Walking is an excellent activity for seniors because it is a low impact sport, making the potential for injury low. A multi-faceted walking program managed by nurses can provide health promotion activities such as screenings, educational programs, weight-reduction classes, and health consultation. The sponsoring hospital, mall, and most importantly the walkers benefit from participation in such a program.     

Facilitating Successful Aging: Encouraging Older Adults to Be Physically Active

Participation in regular physical activity has the potential to change the way we age. Evidence indicates that engaging in regular physical activity can provide dramatic physical, mental, and social benefits to older adults and decrease overall any-cause mortality. For older adults, the focus changes, and beside the promotion of health, maintenance of independent living becomes paramount. Nurse practitioners (NPs) must counsel older adults on the benefits of physical activity. The Stages of Change theory can be used to encourage older adults to change sedentary behavior and become more active.     

Caught in the middle: experiences of tobacco-dependent nurse practitioners

PURPOSE: To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke. DATA SOURCES: Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews. CONCLUSIONS: Participants' responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction. IMPLICATIONS FOR PRACTICE: All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobacco-dependent patients but providers as well.     

Health Beliefs and Experiences of a Health Promotion Intervention Among Psychiatric Patients With Substance Use: An Interview Study

We aimed to explore beliefs about physical health from the perspective of patients with concurrent mental illness and substance use and to explore how a health promotion intervention influenced their personal agency for changing health-related behaviour. Our findings were that patients' beliefs were focused on their present day state of health and that patients had strategies to normalize their health and health-related behaviour. Health promotion to this group of patients should be tailored to fit their particular beliefs. Health measurements were experienced as providing tangible insight into their health and appeared to prevent patients from minimizing physical health problems.     

The Exercise Prescription: A Tool to Improve Physical Activity

The current epidemic of sedentary behavior is a serious public health issue that requires the attention of the medical community. Although the benefits of physical activity are well established, research indicates that Americans are not heeding the message, and new strategies are warranted to bring about change in this arena. The health care community can and should play a key role in this movement. Patients respect their physicians as credible sources of information and look to them for health-related guidance. Unfortunately, many physicians are not talking to their patients about physical activity and are missing a unique opportunity to raise awareness about its benefits. Exercise needs to be discussed as a serious form of treatment, similar to medication, and should be thoughtfully prescribed to every patient. Physicians need to be familiar with the level of exercise necessary to achieve health benefits as defined by the Physical Activity Guidelines for Americans. Furthermore, they should be competent in their ability to identify a patient's level of risk for starting or increasing exercise and provide guidance on the frequency, intensity, time, and type of activity necessary to safely elicit maximal health benefits. These basic competencies can be easily understood by physicians and incorporated into their practices. Resources have been established to help support physicians in this process. Physiatrists are uniquely positioned to lead the effort for change in this area because they are well-established proponents of exercise and are trained to prescribe therapeutic exercise to address the complex medical issues of their patients. This skill-set should be used for every patient in an effort to reduce the widespread prevalence of the “chronic disease” physical inactivity.     

Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists

Both New Zealand and Sweden have health and disability policies that promote recreational exercise within society for people with disability. Despite these policies, levels of physical activity by people with disability in these countries are low. Physiotherapists are equipped to assist people with disabling conditions into physical activity. This qualitative study explored the perspectives and experiences of physiotherapists in New Zealand and Sweden toward promoting physically active recreation for adults with chronic neurological conditions. Nine physiotherapists who worked with adults with neurological disability in a range of long-term rehabilitation and community (home) health services were interviewed and the data analysed for themes. The physiotherapists described innovative and resourceful expertise to assist patients to be physically active. However, they perceived a lack of support for their work from within the health system and a lack of knowledge of disability issues within the recreational arena, both of which they perceived hindered their promotion of physical activity for people with neurological disability. Physiotherapists feel unable to fully support health and disability policies for the promotion of physically active recreation for people with neurological conditions, because of perceived constraints from within the recreational arena and their own health systems. If these constraints were addressed, then physiotherapists could be better agents to promote physical activity for people with neurological conditions.     

Perceptions of older Latino adults regarding physical fitness, physical activity, and exercise

Healthy People 2000 has identified the importance of physical activity for healthy aging, but little is known about what motivates older individuals, older Latino adults, in particular, to be physically active. The purpose of this research was to examine the perceptions of older Latino adults toward physical fitness, physical activity, and exercise. This study used a qualitative focus group design. The sample of Latino adults age 60 and older resided in Northeast Massachusetts and was recruited from community settings which serve older Latino adults. Three focus groups, consisting of four to eight individuals in each group, were conducted and audiotaped. Data analysis used a combination of open, axial, and selective coding procedures. Focus group participants viewed physical fitness as being able to do anything; the mind and body working together; and feeling "light," being healthy. Support was viewed as a motivator of physical activity and exercise and included community resources, group support, cultural unity, and health provider assistance Barriers of fear and a feeling of inappropriateness were identified by focus group participants. Although the study was exploratory and the sample size small, it provides useful cultural knowledge and information for community health and gerontological nurses. Knowledge about older Latino adults' perceptions of motivators and barriers to physical activity and exercise is a necessary first step for nurses to prescribe activities that will help improve functional independence and quality of life. Nurses can serve as links for older Latino adults in accessing community resources. Sociocultural factors that influence Latino adult perceptions must be assessed if health promotion program planning is to be tailored to meet individual and group needs.     

Promoting healthy ageing: the importance of lifestyle

The UK has a rapidly ageing population with increased healthcare needs. While the population can, on the whole, look forward to longer years of good health, many people will be living with one or more chronic conditions. However, modifiable lifestyle, such as a healthy diet and physical activity, can encourage healthy ageing and improve the quality of life of older people. Nurses are ideally placed to provide advice on nutrition and physical activity to older people in an effort to reduce the burden of age-related disease. This is likely to require new ways of working, with nurses being trained to recognise opportunities for health promotion with older patients, as well as how to plan for and conduct health promotion so that it becomes integral to practice.     

Managing Metabolic Syndrome: Focus on Physical Activity

Metabolic syndrome is a target for intervention to prevent cardiovascular disease and diabetes. The prevalence of metabolic syndrome is increasing, and the adverse health outcomes and economic consequences are substantial. Physical activity is the single most effective strategy to reduce cardiometabolic risk. The individual benefits of physical activity are maximized by adherence and long-term maintenance, although this is often difficult to achieve. Nurse practitioners (NPs) play a key role in promoting physical activity as first-line therapy. NPs must be aware of the current evidence supporting various approaches for physical activity adherence and maintenance over time to achieve the desired outcomes.     

Promoting cognitive health and vitality: a review of clinical implications

To maintain cognitive health and vitality, multidimensional cognitive structures must be developed and preserved. With a focus on patient education and health promotion, nurses in general, and geriatric nurses in particular, can proactively address concerns and fears that their patients have about dementia-related illnesses through strategies geared at promoting cognitive health and sustaining abilities. A clinical review of the research literature on the topic of cognitive health revealed the transdisciplinary nature of research on this topic. Effective strategies identified for promoting cognitive health and vitality are categorized as follows: prevention and management of chronic conditions, nutrition, physical activity, mental activity, and social engagement. Current research findings on the promotion of cognitive health and vitality are explored, and research-based implications for geriatric nursing practice are discussed.     

Do nurses’ personal health behaviours impact on their health promotion practice? A systematic review

BackgroundThere is a growing expectation in national and international policy and from professional bodies that nurses be role models for healthy behaviours, the rationale being that there is a relationship between nurses’ personal health and the adoption of healthier behaviours by patients. This may be from patients being motivated by, and modelling, the visible healthy lifestyle of the nurse or that nurses are more willing to promote the health of their patients by offering public health or health promotion advice and referring the patient to support services.MethodsAn integrated systematic review was conducted to determine if nurses’ personal health behaviour impacted on (1) their health promotion practices, and (2) patient responses to a health promotion message. Medline, CINAHL, SCOPUS, and PsycINFO databases were searched. A narrative synthesis was conducted.Results31 studies were included in the review. No consistent associations were noted between nurses’ weight, alcohol use, or physical activity level and their health promotion practice, although smoking appeared to negatively impact on the likelihood of discussing and engaging in cessation counselling. Nurses who reported confidence and skills around health promotion practice were more likely to raise lifestyle issues with patients, irrespective of their own personal health behaviours. The two studies included in the review that examined patient responses noted that the perceived credibility of a public health message was not enhanced by being delivered by a nurse who reported adopting healthy behaviours.ConclusionsAlthough it is assumed that nurses’ personal health behaviour influences their health promotion practice, there is little evidence to support this. The assertion in health care policy that nurses should be role models for healthy behaviours assumes a causal relationship between their health behaviours and the patient response and adoption of public health messages that is not borne out by the research evidence.     

Promoting Physical Activity and Exercise in Patients With Asthma and Chronic Obstructive Pulmonary Disease

Chronic lower respiratory diseases, including asthma and chronic obstructive pulmonary disease, are a significant public health burden owing to their high incidence and prevalence. Nurse practitioners in primary care routinely see patients with these diagnoses. Although inhaled pharmacotherapy is the mainstay of treatment for individuals with these diseases, providing an overall approach to health and wellness, which includes physical activity and exercise, is imperative in optimizing patient outcomes. The purpose of this article is to provide nurse practitioners in primary care with foundational information regarding the promotion of physical activity and exercise for patients with asthma and chronic obstructive pulmonary disease.