Promoting physical activity in primary care settings: health visitors' and practice nurses' views and experiences

AIM: This paper reports a study investigating health visitors' and practice nurses' attitudes, beliefs and practice associated with routinely advising patients about physical activity. BACKGROUND: There is worldwide concern about increasing rates of obesity and decreasing population levels of physical activity, and it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities. In recent years, the public health role of primary care-based nurses in the United Kingdom has been considerably expanded to include playing a key role in improving the health of their local practice populations. A systematic literature search revealed that very few studies investigating nurses' views and experiences of this type work have been published. The limited amount of research that has been conducted is generally small-scale and primarily concerned with general medical practitioners' practice and attitudes, and not those of nurses. METHODS: A questionnaire survey (n = 630) and 20 in-depth interviews were conducted with health visitors and practice nurses in four health regions in Scotland between March and April 2004. The response rate was 63% overall. RESULTS: Ninety per cent (n = 149) of health visitors and 88% (n = 186) of practice nurses said that they were very likely or likely to recommend all apparently healthy adult patients to take moderate exercise. Health visitors were more likely to discuss psychological benefits than practice nurses. However, only 9% (n = 15) of practice nurses and 11% (n = 15) of health visitors correctly described the current recommendations - an accumulation of 30 minutes of moderate physical activity five times a week. Interview data suggested that most nurses gave physical activity advice based on their beliefs about the patient's willingness to change and their impressions of the patient's presenting condition, underlying physical condition and life circumstances. No measure of underlying physical fitness was used. There was a lack of agreement between the questionnaire and interview data associated with levels of physical activity advising. CONCLUSION: There were high levels of enthusiasm for physical activity promotion amongst health visitors and practice nurses. However, nursing leaders and opinion-makers should challenge practitioners' current beliefs and assumptions about physical activity promotion in the general population.     

An exploratory survey into primary care nurses and dementia care

This article introduces findings from the first phase of a randomized controlled trial of educational interventions in primary care. The focus of the article is the knowledge, attitudes and confidence of primary care nursing staff to the diagnosis and ongoing management of dementia. A total 78 nurses with a mean age of 46.4 years and a mean time since qualification of 23.0 years were recruited in 36 practices in central Scotland and in London. Disciplines represented by this sample were predominantly district nurses, health visitors, practice nurses and community staff nurses. Each practitioner was administered an extensive self-completion questionnaire before the educational interventions were introduced to measure baseline knowledge, confidence and perceived difficulties in dementia care management and attitudes. Results from the quiz indicate lower levels of knowledge about epidemiology and diagnosis, but slightly higher levels about management strategies. Self-reported ratings of confidence were also low and were directly related to ratings of difficulty in identifying dementia and dealing with coexisting behavioural and mental health problems. Lower scores on all domains were recorded for practice nurses than for district nurses or health visitors.     

Health care professionals' attitudes about obesity: An integrative review

Stigma and discrimination against obese people are common and related to individual attitudes about obesity. Despite a robust field of study on attitudes related to obesity, no integrative review of health providers' beliefs exist. Fifteen studies (1990–2007) on various health care providers are examined along with practice implications. Analysis indicates that attitudes toward overweight patients, although primarily still negative, have improved over time. Findings indicate that care dispensed to obese patients is not as likely to be affected by health care providers' attitudes as in the past. Implications include the need for additional research, awareness education, and practice guidelines.     

Aboriginal nurses' beliefs,attitudes, and values about sexuality in Taiwan

The potential of risky sexual behaviors and adolescent unplanned pregnancy has become a primary issue in the health care system for aborigines in eastern Taiwan. Using aboriginal nurses to provide information on sexual behaviors may have potential in promoting healthy sexual practices among aborigines. The purposes of this study were to explore Taiwanese aboriginal nurses beliefs. attitudes, and values about sexuality. Several health centers in eastern Taiwan were randomly selected to recruit participants in the year 2000. A self-report questionnaire was administered to 206 female nurses (mean age = 28.4, SD = 7.4) who worked in various clinical units. The results revealed that aboriginal nurses hold moderately positive beliefs, attitudes, and values about sexuality. The conflict between aboriginal nurses' belief and value systems about sexuality was clear. A conflict between aboriginal nurses' value systems and patients behaviors also existed. Strategies to help aboriginal nurses to be more aware of their beliefs, attitudes, and values about sexuality should be an essential issue in the practice and education of nurses.     

Registered nurses’ knowledge,attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review

AimThe aim of this study was to describe, evaluate and synthesise the literature on registered nurses’ knowledge, attitudes and beliefs towards end-of-life care in adult non-specialist palliative care settings.BackgroundLittle is known about the knowledge, attitudes and beliefs of Registered Nurses working in non-specialist palliative care settings about end-of-life care.DesignA mixed-methods systematic review and narrative synthesis was conducted (PROSPERO Registration No: CRD4202148114). Five databases (Medline, CINAHL, PubMed, PsycINFO and Web of Science) were searched from inception to August 2020. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsNineteen studies met the inclusion criteria. Registered nurses in non-specialist palliative care settings demonstrated good knowledge of pain symptoms and management and positive attitudes towards caring for dying patients and their families. Knowledge deficits were identified in the psychosocial and spiritual aspects of end-of-life care and registered nurses reported negative attitudes towards communication about death. Only five of the included studies explored registered nurses’ beliefs towards end-of-life care.ConclusionsThere is a need to enhance palliative care education in clinical practice settings and in undergraduate programs to improve registered nurses’ knowledge, attitudes and beliefs about end-of-life care. Future studies that use reliable and validated methods to measure registered nurses’ beliefs about end-of-life care should be conducted.Tweetable abstractRNs in non-specialist palliative care settings want more education on pain management & greater knowledge on communicating about death/dying.     

Primary care nurses' attitudes, beliefs and own body size in relation to obesity management

AIM: This paper is a report of a study to explore primary care nurses' attitudes, beliefs and perceptions of own body size in relation to giving advice about obesity. BACKGROUND: Primary care nurses have a key role in the management of obesity. Their responses to the stigma of obesity and the effects of their own body size in this context have not been investigated. METHODS: A purposive sample of 15 primary care nurses of markedly different body size were interviewed in a qualitative study undertaken in 2006 in the north of England. FINDINGS: Participants were aware of obesity stigma and this, among other factors, contributed to perceptions of obesity as being a sensitive issue to discuss. Communication tactics were employed in managing the sensitivity, with emphasis placed on maintaining good rapport. Participants took care to avoid stereotypes in presenting their beliefs about obesity, which were complex and in some respects ambivalent. They were conscious of their own body size in interactions with patients. A slim build appeared to amplify sensitivities surrounding obesity and add concerns about appearing to lack empathy or authentic experience. Those with a large body size made a virtue of their perceived greater empathy and experience, but had concerns about being poor role models. Self-disclosure techniques oriented to demonstrating personal understanding and rapport were employed to manage impressions made by body size. CONCLUSION: It is important to consider the effects of own body size in educating nurses, and further research should investigate its effects on patient outcomes.     

Vision, permission and action: a bottom up perspective on the management of public health nursing

AIM: To explore the opportunities and obstacles that impinge on attempts to advance public health nursing, paying particular attention to the role of, and implications for, nursing management. BACKGROUND: Nurses are to have a central role in the government's drive to re-invigorate the United Kingdom public health agenda. This paper explores the perceptions and support needs of the primary and community nurses, health visitors and midwives charged with meeting that goal. METHOD: Focus group interviews were conducted separately with health visitors, school nurses, district nurses, community midwives and practice nurses from the a single health authority area in Yorkshire. Eight group interviews were conducted involving 31 practitioners in total. All interviews were audio recorded and transcribed in full. Data were analysed using the framework approach. FINDINGS: Workload, resource and time pressures limit the ability of community and primary care nurses to deliver public health work. Furthermore, nurses feel that the leadership required to guide service delivery and optimize deployment of under utilized public health skills at local level is missing, and that public health activity lacks legitimacy. CONCLUSION: If the new public health agenda is to be delivered, nursing managers will have to be clear about what is meant by public health work and decide whether it is to remain a peripheral concern or core activity. Having made that decision they must communicate it to practitioners on the ground through word and deed--that is, by identifying capacity, restructuring workloads and re-prioritizing activity.     

The role of primary care nurses in the review of stable epilepsy

AIM: To assess the feasibility of primary care nurses reviewing patients with 'stable' epilepsy. Sample Practice nurses, health visitors, and district nurses drawn from all GP practices in Cheshire West Primary Care Trust. METHOD: Questionnaires were distributed to nursing staff about the management of patients considered to be stable but who require an annual review. RESULTS: Regarding their suitability for the work, there was a significant positive response from practice nurses and district nurses but less so from health visitors, while district nurses and health visitors did not feel they had the spare capacity for the work. CONCLUSION: Inclusion of epilepsy as a quality indicator in the new GP contract means practices are likely to ask primary care nurses to take a role in managing patients with stable epilepsy. From this study there is evidence of some interest in taking this work on but there are issues around capacity, manpower, and funding.     

Nurses' attitudes towards adult patients who are obese: literature review

AIMS: This paper presents a review of all empirical studies focusing on nurses' attitudes towards adult overweight or obese patients, with the aim of clarifying the dimensions and patterns of these attitudes and the methods by which they have been studied. BACKGROUND: Obesity has become a common condition and a major public health concern, but it is often associated with negative attitudes and discrimination. Nurses play a key role in providing support and care to patients who are obese. METHODS: Electronic searches were carried out on seven databases from inception to December 2004, along with hand-searching of references in relevant studies. The search terms were built around obesity (and related terms), nursing (and its branches) and attitudes (and related terms). Eleven studies met the inclusion criteria. Data were extracted and summarized in tabular form and analysed in relation to the aims of this review during January 2005. FINDINGS: There is relatively little research about nurses' attitudes towards obese patients, and the studies reviewed mostly have weaknesses of sampling and measurement. However, they do consistently suggest that a proportion of nurses have negative attitudes and beliefs, reflecting wider stereotypes within Western cultures. There is also a hint of a more complex mix of attitudes among nurses, some of which may counter the consequences of negative attitudes, but these have not been adequately investigated. A number of variables that influence attitudes of nurses can be identified, including age, gender, experience and the weight/body mass index of the nurse. CONCLUSION: Further research (both qualitative and quantitative) is needed with more rigorous sampling and, where appropriate, more consistency of measurement. A shift in focus towards the sets of attitudes (positive as well as negative) and behaviours that influence health service quality and outcomes for obese persons would be useful.     

What blocks health visitors from taking on a leadership role?

Current government documents in the United Kingdom call for all nurses to take on a greater leadership role. This paper critically considers some of the management factors that block one group of specialist nurses (health visitors) from fulfilling their leadership role. Health visitors have a key role to play in meeting the public health targets of local primary care trusts, known as local health improvement plans. But to take on a greater public health role, health visitors need to move away from working independently within separate general practitioner surgeries and to work in teams which share the vision and goals of the primary care trusts. The paper explores different styles of management that promote transformational leadership and relate to practice. It is suggested that use of the Servant-Leader model of management should encourage the empowerment of staff, and through empowerment health visitors should be able to instigate change and become more innovative in their practice. Persistent recruitment and retention problems have resulted in little time being available to focus on the effectiveness of services. The future management of health visitors will be to primarily run the service while supporting staff in accessing and influencing those in power.     

District nurses’ self-reported clinical activities,beliefs about and attitudes towards obesity management

AimTo describe district nurses’ self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables.BackgroundObesity is increasing worldwide and primary care could play a central role in the management.MethodsQuestionnaire data were collected from 247 nurses in 33 centres.ResultsThe most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities.ConclusionManagers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.     

Weight management: a survey of current practice in secondary care NHS settings in 2004

OBJECTIVE: To determine the current practices in relation to weight management currently provided for overweight/obese patients attending different secondary care outpatient clinics. METHODS: Postal questionnaire sent to 100 consultant clinicians working in a range of specialist areas in three NHS Trust areas in Scotland, between January and March 2004. RESULTS: Overall response rate was 55%. Only 9% (five) of clinicians reported having a protocol in place for the management of patients who were overweight or obese. Lack of expertise and inaccessibility to expertise were cited frequently as reasons for having no protocol in place. Fifty-one per cent felt that weight management (including obesity treatment) should be undertaken by a specialist service either run by general practitioners (GPs), or by clinicians in a secondary care setting. Around a third of all those surveyed reported willingness to incorporate obesity management within their own routine specialty practice. CONCLUSION: Clinicians acknowledged the adverse health effects of obesity within their specialist area, but felt unskilled and under-resourced to provide effective management. Effective prevention and management are required to challenge the obesity epidemic and will require the involvement of both primary and secondary care NHS settings. It is encouraging that a third of respondents felt prepared to incorporate obesity and weight management within their routine specialist practice.     

Touching their lives: North Western Mental Health's approach to practice development in aged mental health

The ongoing development of mental health practice is an important issue for consumers, carers, and clinicians. This paper outlines a practice development project undertaken by North Western Mental Health. The aim of the project was to assist nurses and direct care staff working in a residential facility to provide individualized, sensitive, therapeutic, and responsive care for long-term clients with severe mental illness. A clinical nurse educator was engaged to help facilitate changes to both attitudes and practices in a specialist environment catering to those with psychiatric, cognitive, and physical health concerns. The project identified institutionalized routines and practices that were entrenched within the setting and, with support and guidance from a clinical nurse educator, encouraged enhancement of clients' experience and choice. Nurses' clinical reasoning skills were also extended through this process. The project encouraged all staff to develop and maintain an awareness of residents' experience of receiving care in a potentially disempowering environment. In particular, nurses were challenged to consider how nursing, realized to its full potential, can touch the lives of residents and families.     

The UKCC's Scope of Professional Practice--some implications for health care delivery

AIMS: The research reported here is part of a larger study commissioned by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) to analyse and understand the impact of the Scope of Professional Practice (Scope) on the practice of nursing, midwifery and health visiting. The data in this paper relate to attitudes about, and perceptions of Scope among a variety of stakeholders. BACKGROUND: This research provided a valuable opportunity to explore the essence of Scope and the ways in which it can enable nurses, midwives and health visitors to adapt to growing or changing health care needs. The findings contribute to this debate, by drawing on the knowledge and experience of the key groups involved in the change process. METHOD: The study utilized several approaches, tailored to meet the requirements of each phase. In this (the final) phase a structured questionnaire was sent to different groups of stakeholders. FINDINGS AND CONCLUSIONS: The stakeholders displayed considerable interest in the development of innovative systems for delivering nursing and midwifery care, provided that the necessary safeguards and support were in place. Scope was seen as a valuable way of optimizing the skills and contribution of nurses, midwives and health visitors.     

Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey

Abstract

Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists’ beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n?=?65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n?=?53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n?=?13 [20%]) or through professional development (n?=?7 [11%]). Most physiotherapists (n?=?55 [84.6%]) provided physical activity advice for weight management, but a minority (n?=?27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0–38.9, p?=?0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists’ management of obesity.     

Health promotion training needs analysis: an integral role for clinical nurses in Lanarkshire,Scotland*

Training needs analysis is considered essential to professional and organizational development, for continuing education and for incorporation into professional practice. Increasingly, nurses are encouraged to develop their health promotion role. Despite this there has been relatively little research in Scotland into the health promotion role of the hospital nurse. This study describes the results of a health promotion training needs analysis undertaken on qualified, hospital-based nurses in Lanarkshire, Scotland. Information on the nurses' current health promotion practices, their attitudes and beliefs, their views on role development and priorities for further training were collated, analysed and discussed within the framework of the Health Action Model. This model was originally designed to assist understanding of the gap that exists between an individual intention to act and the eventual health action. However, in this study the ways in which ‘cognitive factors’ (knowledge and beliefs) and ‘motivational factors’ (considering values, attitudes and drives) and pressures from social norms and significant others assisted in the understanding of the nurse's orientation to, and beliefs about, health promotion practice. Fifty-seven per cent of nurses in the study considered health promotion activities to be emerging in clinical care and 4% considered them to be advanced. The interest respondents have in role development and the further integration of health promotion activities into nursing practice was explored by ascertaining the nurses' attitudes and beliefs about their own health promotion role. Of 107 respondents, a majority 72 (67%) agreed health promotion interventions to be an important function of the nurse with 29 (27%) strongly agreeing (n=107). Sixty per cent stated they would be interested in developing their role and 30% were very strongly interested. Recommendations are therefore made for future planning and development strategies for the health promotion role of hospital nurses.     

Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme?

RATIONALE: The concept of evidence-based practice (EBP) encourages health care professionals to provide the most effective health care, and to be accountable for the interventions they provide. Little work has been undertaken to examine how practically allied health professionals' encompass EBP and how they perceptive and understand the concept of EBP. The use of opinion leaders to disseminate new evidence into practice, and thereby encourage the behaviour of health care professionals has been proposed. AIMS: The aims of this study were to investigate physiotherapists' attitudes towards EBP and to examine change in their attitudes following an education package, which utilized local opinion leaders. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work to two groups. The intervention group received an evidence-based programme on aspects of EBP including literature searching and critical appraisal. The attention control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' attitudes towards EBP were measured at baseline (before randomization) and at 3 and 6 months follow-up. RESULTS: Physiotherapists reported that they primarily relied on 'courses' and 'in-service training' for informing their clinical practice. Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so. However, many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas. In terms of clinical practice, literature, journals and research were ascribed low priority throughout. Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up. CONCLUSIONS: In this study, physiotherapists appeared to be in favour of the idea of EBP, yet they remained reluctant to change their practice. Opinion leaders were not easily identifiable by physiotherapists, suggesting that this method alone may not be an effective method of changing attitudes in clinical practice. The process of changing attitudes in the clinical environment is a complex issue worthy of further research.     

Literature review of nursing practice in managing obesity in primary care: developments in the UK

Aims and objectives. To review empirical studies reporting primary care nursing practice in relation to obesity management for adults in the UK; to place these in the context of policy and professional developments. Background. Obesity is recognized as a public health problem in many parts of the world. The UK has a well‐developed system of primary care nursing with experience of initiatives to tackle obesity. Methods. Searches of electronic databases supplemented by hand‐searching of identified leads and key journals. Data extracted and analysed following methods for an integrative literature review. Findings. Eleven empirical studies were reviewed. Obesity management developed as part of the role of general practice nurses after 1990. Nurses’ role has been mainly in providing one‐to‐one support to within surgery or clinic consultations; and to a lesser extent group based support sessions. The interventions could be characterized as general oral advice about nutrition and lifestyle. There was no evidence of positive outcomes for patients from these interventions. In some contexts, oral advice extended to calorie deficit diets and more developed referral options about physical activity. Two studies examined outcomes of practice following attempts to implement evidence‐based protocols. The evidence of outcomes from these is mixed. At best, perhaps 10% of patients entering a nurse led support programme may achieve a clinically significant weight loss. Conclusions. There is potential in primary care nursing to help patients manage obesity but caution is needed. Despite practice developments in the UK the outcomes for patients remain unclear. Relevance to clinical practice. It is important to follow a structured programme in supporting patients with weight loss within an holistic assessment of their needs.