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.

     

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.     

Healthy eating and physical activity among new graduate nurses: A qualitative study of barriers and enablers during their first year of clinical practice

BackgroundNew graduate nurses entering the workforce experience numerous barriers to maintaining a healthy lifestyle including shift work, the high cost of healthy foods at the workplace and high levels of exhaustion which reduce motivation to participate in regular physical activity. Research has documented unhealthy lifestyles among nurses across the profession. However, few studies focus on graduates' experiences during their transition into their careers.AimTo investigate the barriers and enablers to healthy eating and participation in physical activity for new graduate nurses during their first year of clinical practice, and to explore attitudes to participation in workplace health promotion programs.MethodsSemi-structured interviews informed by the socioecological model were conducted with 24 new graduate nurses and analysed using thematic analysis.FindingsFour key themes emerged as barriers to healthy eating and physical activity: time, shift work, work environment, and work culture. Participants indicated a high interest in workplace health promotion programs.DiscussionLimited time and shift work impact on the eating and physical activity behaviours of new graduate nurses which leads to unhealthy snacking to maintain energy, as does high levels of exhaustion, reduced motivation to eat healthy foods, and decreased participation in physical activity. The work culture and environment also influence eating behaviours. Inadequate breaks lead to consumption of foods that are quick to eat but often low in nutrients.ConclusionNew graduate nurses experience the same difficulties in maintaining healthy lifestyles as more experienced nurses. Understanding the barriers which influence their dietary and physical activity behaviours can help inform strategies to improve the health of nurses at a critical time when they enter the nursing workforce.     

What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study

The health and lifestyles of student nurses has been widely explored internationally finding relatively high levels of smoking, low levels of physical activity and unhealthy diets. Not only does this have implications for productivity, personal health and the ability to do the demanding job of nursing, but unhealthy behaviours are also associated with a reluctance to undertake health promotion in their roles. Stress, time constraints and the irregular routine of nurse training were cited as barriers to a healthy lifestyle.Three types of accessible interventions were piloted to encourage the adoption of healthier lifestyles by student nurses: an educational session on having ‘healthy conversations’ with patients, an accelerometer to record steps, and an online personal wellness tracker. There was low take up of the offers designed to motivate behaviour change but students did welcome the educational input on how to have a ‘healthy conversation’ with a patient.This project highlights the need to incorporate programmes that addresses student nurses' health behaviours within nurse education, and at salient time points (e.g. induction or just before going on placement) over the course of study.     

Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

Disordered eating and job stress among nurses

Aim  The purpose of this study was to examine disordered eating behaviours among nurses in the state of Ohio.
Background  Individuals involved in disordered eating tend to report more frequent and higher levels of perceived stress than their counterparts. As nurses regularly perform stressful roles and responsibilities within a high-stress environment, this group may be at elevated risk of disordered eating.
Method  A 65-item survey was mailed to a random sample of 1000 nurses in the state of Ohio.
Results  A total of 435 nurses (47%) returned completed surveys. Most (93%) were registered nurses (RNs) and 87% were over 31 years old. Results indicated that disordered eating differed significantly based on perceived job stress and perceived body satisfaction. Nurses with high levels of perceived job stress and low levels of body satisfaction had higher disordered eating involvement.
Conclusions  Nurses reporting high levels of job stress are at increased risk of disordered eating behaviours. Recommendations for future research are offered.
Implications for nursing management  Employee wellness programmes should be developed that educate and support nurses to make healthy lifestyle choices.     

Lifestyles and Health-Related Outcomes of U.S. Hospital Nurses: A Systematic Review

Background

Nurses’ modifiable lifestyles have important health-related consequences.

Clinical Supervision and the Well-Being of the Psychiatric Nurse

Recent mental health care policy has addressed the need for health care professionals to consider the physical health of consumers. Mental health nurses are particularly well-placed for this role. To provide mental health nurses with practical information, this narrative review summarises evidence from recent research on the physical health of individuals with Serious Mental Illness (SMI). In those with SMI, the international prevalence of obesity, the metabolic syndrome, diabetes mellitus, symptoms of cardiovascular disease, and respiratory disease all exceed that of the general population by at least two times, and HIV prevalence may be increased by as much as eight times. This increased prevalence of chronic disease may be largely responsible for an increased risk of death of up to five times, resulting in as much as 30 years of potential life lost. Of particular concern, the recent evidence suggests that for physical health and increased mortality, the gap between individuals with SMI and the general population is worsening. Unhealthy lifestyle behaviours undoubtedly play a role in the development of poor physical health and chronic disease, and the present review indicates that low physical activity, poor diet, smoking, alcohol and substance abuse, and risky sexual behaviour are common in individuals with SMI. This narrative review demonstrates that the prevalence of poor physical health and health behaviours in people with SMI far exceed that observed in the general population, and reinforces the urgent need for mental health nurses to address physical health concerns in patients.     

The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness

Recent mental health care policy has addressed the need for health care professionals to consider the physical health of consumers. Mental health nurses are particularly well-placed for this role. To provide mental health nurses with practical information, this narrative review summarises evidence from recent research on the physical health of individuals with Serious Mental Illness (SMI). In those with SMI, the international prevalence of obesity, the metabolic syndrome, diabetes mellitus, symptoms of cardiovascular disease, and respiratory disease all exceed that of the general population by at least two times, and HIV prevalence may be increased by as much as eight times. This increased prevalence of chronic disease may be largely responsible for an increased risk of death of up to five times, resulting in as much as 30 years of potential life lost. Of particular concern, the recent evidence suggests that for physical health and increased mortality, the gap between individuals with SMI and the general population is worsening. Unhealthy lifestyle behaviours undoubtedly play a role in the development of poor physical health and chronic disease, and the present review indicates that low physical activity, poor diet, smoking, alcohol and substance abuse, and risky sexual behaviour are common in individuals with SMI. This narrative review demonstrates that the prevalence of poor physical health and health behaviours in people with SMI far exceed that observed in the general population, and reinforces the urgent need for mental health nurses to address physical health concerns in patients.     

Audit of health promotion practice within a UK hospital: results of a pilot study

Introduction and aim There is clear evidence that modifiable risk factors – smoking, alcohol misuse, poor diet, lack of exercise and obesity – are detrimental to health. UK public health policy now requires hospitals to have in‐place health promotion programmes to empower patients to swap risky for healthy behaviours. This audit aimed to determine a baseline level of health promotion practice for modifiable risk factors in a UK hospital. Method Case notes from two hundred and fifty hospitalized adult patients (excluding all terminally ill patients), discharged alive between January and June 2004, were audited for evidence of screening for risk factors (smoking, alcohol, diet, exercise and obesity) and the provision of health promotion to change these risk behaviours. Results The majority of inpatients were asked about smoking (88%) and alcohol consumption (74%), but few were screened for obesity (18%) or asked about their normal diet (5%) and physical activity (3%). Health promotion was delivered to a third of smokers and over half of inpatients reporting misuse of alcohol. Healthy diets, exercise and weight management were rarely discussed. Only three inpatients were screened for all risk factors. Conclusion This study indicates that the majority of hospital inpatients were screened for smoking and alcohol use, but improvements need to be made in the delivery of health promotion for smoking cessation and sensible drinking. It is clear that inpatients’ are not routinely screened for diet, exercise and weight status, nor delivered health promotion for the management of these risk behaviours.     

Health‐promoting lifestyle behaviours in pregnant women in Turkey

This study aims to describe the health‐promoting lifestyle behaviours of pregnant women. The study was carried out with pregnant women who applied to the polyclinics in different maternity and children hospitals located in Adana, Turkey, between 1 March and 30 May 2009. The data collection tools used in the study were (i) a questionnaire that was used to collect sociodemographic data from the participants and (ii) the Health Promoting Lifestyle Profile II (HPLP II). The results obtained from the study showed that total HPLP II scores were moderate; the highest scores were obtained on the spiritual growth dimension and the lowest scores on the physical activity dimension. Pregnant women with older age, those with a higher educational level, those with a better socioeconomic status and those living in a nuclear family were found to be more likely to have health‐promoting lifestyles. Health promotion and healthy lifestyle need to be an integral part of health services provided for pregnant women. Midwives and nurses have prominent roles in encouraging pregnant women to engage in health‐promoting behaviours.     

Physical activity among South Asian Indian immigrants: an integrative review

ABSTRACT Objective(s): The aim of this research review was to portray the correlates of lifestyle physical activity (PA) behavior of healthy South Asian Indian (SAI) immigrants comprehensively by identifying, synthesizing, and critically analyzing the existing research literature. Design and Sample: An integrative review methodology was used. The sample included 11 cross‐sectional and 4 qualitative studies. Measures: The physical activity framework for SAI immigrants guided the development of data collection tools that included study measures of PA and background (current health, acculturation, discrimination, social support, environmental) and intrapersonal (motivation) correlates of PA. Results: Regardless of the PA measure used, all studies reported low PA levels in at least 40% of the participants. The correlates of PA most often studied were sociodemographic variables, current health, and acculturation; female sex; poorer health; and less time since immigration. Few studies focused on social support, environmental factors, or included dynamic motivational factors. Conclusions: Increased knowledge of the factors that impact lifestyle PA is needed so that public health nurses can develop targeted interventions to increase the lifestyle PA of SAI immigrants at risk for cardiovascular disease, diabetes, and central obesity.     

The relationship between lifestyle, working environment, socio-demographic factors and expulsion from the labour market due to disability pension among nurses

Background:  Denmark is facing a shortage of nurses and this trend is anticipated to worsen within the next decades. The major reason for this shortage is that only very few nurses remain employed until the general retirement age. Every year several nurses are expelled from the labour market prematurely which causes a problem not only for the disabled nurses but also because it can affect the morale and productivity among the remaining personnel while new staff members are hired and trained.
Aim:  The aim of the study was to analyse the relationship between lifestyle, working environment, socio-demographic factors and disability pension (DP) among nurses.
Methods:  The study was based on 12 028 nurses above the age of 44 who in 1993 completed a questionnaire. The survey information was combined with longitudinal data from a register compiled by Statistics Denmark. The follow-up period was from 1993 to 2002.
Results:  Nurses with relatively low gross incomes were more likely to become disability pensioners compared to nurses with high incomes (hazard ratio, HR 1.33 and HR 2.17). Also, nurses who were singles had a higher probability of entering DP (HR 1.63). Nurses who worked fixed evening or night shifts had higher risks of DP than nurses who worked daytime exclusively (HR 1.51 and HR 1.45). Smoking, obesity and having a sedentary lifestyle were also risk indicators for DP (HR 1.42, HR 1.63 and HR 1.50). Furthermore, low influence and high physical demands at work increased the probability of entering DP (HR 1.39 and HR 1.22).
Conclusion:  DP among nurses is influenced by a number of factors. Nurses who have poor working environments and/or unhealthy lifestyles have higher risks of becoming disability pensioners. Also, nurses who are singles and/or have low gross incomes have higher probability of entering DP.     

Maternal Perspectives on Lifestyle Habits That Put Children of Mexican Descent at Risk for Obesity

PURPOSE.  This article presents the views that mothers of Mexican descent have related to lifestyle habits that put children at risk for obesity.
DESIGN AND METHOD.  A qualitative, naturalistic design using ethnographic interviews was selected for this study. Informational redundancy was reached with 9 mothers of Mexican descent. Spradley's Developmental Research Sequence guided data collection and analysis.
RESULTS.  Participants held views that were congruent with the American Academy of Pediatrics' recommendations.
PRACTICE IMPLICATIONS.  Findings provide nurses with knowledge on how mothers of Mexican descent view appropriate nutrition, discipline in feeding, and the place of physical activity and television in young preschool children's lives.     

Physical health promotion for young people at ultra‐high risk for psychosis: An application of the COM‐B model and behaviour‐change wheel

People with psychotic illnesses, such as schizophrenia, have high rates of unhealthy lifestyle factors, such as smoking and physical inactivity. Young people who seek help for mental health care, particularly those at high risk for psychosis, often also display high rates of these unhealthy behaviours. Although healthy living interventions have been applied to people with established psychosis, no attempt has been made to offer them to young people at risk for developing psychosis, despite potential benefits to mental and physical health. We propose that the COM‐B model (consisting of capability, opportunity and motivation) and behaviour‐change wheel might be an appropriate framework that mental health nurses and other health professionals could apply. Using a systematic and theoretically‐based approach to intervention development could result in effective methods of health promotion in this group. Further training and development for mental health nurses could encourage a greater integration of mental and physical health care.