Lifestyle risk communication by general practice nurses: An integrative literature review

Background

The growth of the general practice nursing workforce, has created opportunities to enhance activities aimed at lifestyle change to optimise health and reduce risk. While health status and risk levels are amenable to behaviour change, a number of complex interrelated factors influence the general practice nurses’ (GPN) role, often resulting in the underutilisation of nurses. This can limit their capacity to respond to patients’ needs, including communication regarding lifestyle risk factors and their chronic health conditions. Understanding GPNs’ views on lifestyle risk communication and factors influencing this can inform improvement in chronic disease management and effectiveness of lifestyle risk communication by GPNs.

Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic

Aim

To investigate organizational commitment among Chinese nurses and analyze factors influencing organizational commitment during COVID-19.

Background

Organizational commitment is the most important link between nurses and the organization because it is effective in work retention and the motivation of nurses, especially when addressing the COVID-19 crisis. However, there has been no empirical study conducted to predict organizational commitment in the field of nursing by combining work values with professional practice environments.

Methods

A cross-sectional predictive study was done with 362 nurses recruited from two tertiary hospitals in China. The Organizational Commitment Questionnaire, the Work Values Scale, and the Practice Environment Scale of the Nursing Work Index were used to collect data. Two factors related to the organizational commitment of nurses were investigated by using binary logistic regression analyses.

Results

Increased work values and a professional practice environment were associated with an increased likelihood of higher organizational commitment.

Discussion

The COVID-19 crisis became the utmost challenge to global healthcare systems and professional organizational commitment. Nurses’ organizational commitment was directly influenced by the professional practice environment and work values, especially intrinsic work values, in which the spirit of collectivism was consequential.

Conclusion and implications for the field of nursing and health policy

Study results provide information for global hospital administrators to promote these organizational commitment predictive factors, including work values and a professional practice environment in nursing practice. This helped foster a stronger organizational commitment among nurses to reduce nurse resource flow during COVID-19.     

Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting

Aims and objectives

To explore and explain how nurses minimise risk in the perioperative setting.

Background

Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting.

Design

Classic grounded theory.

Methods

Ethical approval was granted for all aspects of the study. Thirty‐seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data.

Results

Participants’ main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting.

Conclusion

Understanding the strategies of anticipatory vigilance extends and provides an in‐depth explanation of how nurses’ behaviour ensures that risk is minimised in a complex high‐risk perioperative setting. This is the first theory situated in the perioperative area for nurses.

Relevance to clinical practice

This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting.     

Effects of a lifestyle counselling intervention on adherence to lifestyle changes 7 years after stroke – A quasi-experimental study

Background

Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling.

Aim

To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA.

Methods

Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017–2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups.

Results

Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group.

Conclusions

The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle.

Relevance to clinical practice

The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.     

Violence risk–assessment screening tools for acute care mental health settings: Literature review

Background

Violence is a large concern for mental health professionals: 90% of physicians and nurses working in mental health areas have been subject to violence from patients. Approximately 80% of violent acts from patients are directed toward nurses.

Using the lens of enablement to explore patients’ experiences of Nurse Practitioner care in the Primary Health Care setting

Background

Patient enablement is a patient-centred concept reflecting a patient’s ability to cope, understand and manage their own health. It can be used as a measure of the quality of care and has been linked with improved patient outcomes. While there have been studies into patient enablement following consultations with General Practitioners (GPs) and practice nurses, Nurse Practitioners’ (NPs) role in enabling patients remains unexplored.

The educational and practice tensions in preparing pre-registration nurses to become future health promoters: a small scale explorative study

Over the past three decades health policy within the United Kingdom (UK) has consistently acknowledged the potential for nurses to contribute to the health of individuals and communities. The educational curricular of pre and post registration nursing programmes has responded to such health policies by placing greater emphasis on the role of the nurse in health promotion and ill health prevention.

Aim

This paper explores how pre-registration student nurses in one university experience the impact of these factors on their preparation for practice.

Design

This small scale explorative study used a convenience sample of second year pre-registration student nurses (n = 100) studying at one university. Data were collected via four focus groups, and from student evaluations of practice placement experiences and self-reported learning outcomes relating to health promotion practice.

Findings

The findings suggest a dichotomy between what is espoused in the underpinning theory of the curriculum and what the student nurses actually experience in practice. It highlights some of the difficulties that student nurses have in effecting the professional and policy objectives and argues if nurses are to turn health promotion rhetoric into reality then health promotion practice needs to be more effectively actualised.     

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

Background  

Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied.     

A systematic review of the effectiveness of advanced practice nurses in long‐term care

Aim

To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long‐term care residential settings.

Background

Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.

Design

Quantitative systematic review.

Data sources

Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.

Review methods

Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

Results

Four prospective studies conducted in the USA and reported in 15 papers were included. Long‐term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.

Conclusion

Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long‐term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.     

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.

     

Cardiovascular risk factor screening satisfaction in the Heart of New Ulm Project

Objective

Community-based cardiovascular disease (CVD) risk factor screening programs have been used successfully in rural health improvement initiatives. However, little is known about what consumers like or dislike about them, which is a barrier to the design of future process improvements. The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction.

Design

This study utilized a cross-sectional survey design.

Setting

Data was collected as part of the broader Heart of New Ulm Project, which is a community-based CVD prevention demonstration project based in rural Minnesota.

Participants

There were 126 randomly invited individuals from the CVD risk factor screenings, with 118 individuals who agreed to participate and had complete data available for analyses.

Methods

A multivariate logistic regression analysis was used to examine the association between demographics, lifestyle, and biometric risk factors and screening satisfaction.

Results

Twenty percent of respondents indicated some level of dissatisfaction with the screening process. Satisfied participants were more likely to be female (OR=4.15), not have an optimal lifestyle (OR=3.47), and have an intention to improve their lifestyle habits (OR=3.26). Age, education, and CVD risk level were not significant predictors in the final model.

Conclusion

Satisfaction was high in this screening program, with healthy males being least satisfied with their experience. This has implications for the design of future intervention efforts, as they may require specific programmatic features and more specialized, targeted marketing strategies to attract a broad spectrum of participants likely to benefit.     

Perceiving need for lifestyle counseling: findings from Finnish individuals at high risk of type 2 diabetes

OBJECTIVE

To investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention.

RESEARCH DESIGN AND METHODS

Baseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project.

RESULTS

In total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women.

CONCLUSIONS

It will be vital to find additional means to support lifestyle change.Most individuals at high risk of type 2 diabetes intend to and attempt to change their lifestyle (1–3). In previous studies, however, only 16% of high-risk individuals were motivated to enroll in an intervention program (4), whereas 46% agreed to participate in lifestyle intervention (5). Hence, our research questions were:

1. What proportion of individuals perceive the need for lifestyle counseling (LC)?
2. What are the predictors of perceived LC need?
3. Is there an association between perceived LC need and i) agreement to participate in supervised intervention, ii) agreement on a self-initiated lifestyle change, and iii) refusal to participate in the intervention?
4. Among those agreeing to participate in supervised intervention, is there an association between perceived LC need and actual attendance/nonattendance in the intervention?

     

Nurses' perceptions of health beliefs and impact on teaching and practice: a Q‐sort study

Aim

To understand Chinese nurses’ perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence‐based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses.

Background

Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence.

Methods

Q‐method design using q‐sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China.

Findings

Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) ‘the importance of evidence’, and (3) beliefs rooted in culture.

Discussion

Influence on nurses’ health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours.

Conclusions

Education for nurses in practice needs to acknowledge that individual practitioners’ beliefs strongly influence health teaching for patients and families. In order to implement evidenced‐based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs.

Implications for nursing policy and health policy

Education policy needs to consider that culture and societal pressures affect nurses’ health beliefs and practice. Critical thinking, reflective and evidence‐based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available.     

Practice nursing in Australia: A review of education and career pathways

Background  

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia.