Job stress and work schedules in relation to nurse obesity

Nurses' work environment and health promotion in relation to psychological distress symptoms, and sleep disturbance: A structural equation modeling approach

BACKGROUND

The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health.

OBJECTIVE

This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling.

DESIGN

This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods.

METHODS

A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (n = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health.

RESULTS

Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (β = 1.47, p < 0.001), sleep disturbance (β = 1.22, p < 0.01), and decreased overall health (β = -1.36, p < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (β = 1.61, p < 0.001), sleep disturbance (β = 1.31, p < 0.01), and lower overall health (β = -1.51, p < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and physical health promotion had restorative effects in relation to decreasing the impact of distress and sleep disturbance while increasing overall health.

CONCLUSIONS

Our results highlight the need to improve the work environment by decreasing the nurses' workload and using health promotion behaviors to mitigate nurses' psychological distress. Future studies should focus on exploring distress in the context of non-pandemic work conditions and finding ways to promote coping behaviors in nurses. In addition, healthcare organizations should develop policies and strategies to incentivize nurses' participation in health promotion behaviors to promote their well-being and ultimately stabilize the nursing workforce.

Relationship between health and productivity management and health-related attributes in Japanese medical institutions: an ecological study

Objective

To clarify the relationship between the implementation of health and productivity management (H&PM) and staff health-related attributes in Japanese hospitals.

Method

This study selected 2,000 hospitals from the FY2021 Bed Function Report data and conducted a questionnaire survey from November to December 2023. The questionnaire enquired about the H&PM implementation status, which was the explanatory variable; and health-related attributes, which was the objective variable. The implementation status of the four items and the presence or absence of Excellent H&PM Corporation certification were used to divide the hospitals into three groups: certification, implementation, and non-implementation groups. Logistic regression analysis was conducted with H&PM implementation status and health-related attributes as the variables.

Results

Data from 221 hospitals were analyzed. There were 25 hospitals in the certification group, 68 in the implementation group, and 128 in the non-implementation group. Logistic regression used average monthly physician overtime as the outcome, with non-implementation hospitals as the reference. Results showed significant positive associations for the implementation and certification groups. Clear written policies on H&PM promotion and full-time occupational health staff were also significantly associated. However, health issue understanding, plan formulation, and management training were not linked to physician overtime. Other health-related attributes were also unrelated to H&PM implementation status.

Conclusion

Hospitals engaging in H&PM may provide an appropriate working environment for physicians.

Exploring the relationship between family care, organizational support, and resilience on the professional quality of life among emergency nurses: A cross-sectional study

BACKGROUND

The professional quality of life (ProQOL), encompassing emotional, physical, and psychological well-being, is profoundly influenced by the unique nursing experiences of emergency nurses. Understanding and effectively enhancing their professional well-being are of paramount importance. This study aimed to explore the relationship between family care, organizational support, and resilience with the ProQOL among emergency nurses.

METHODS

This cross-sectional study, conducted between May 1 and June 1, 2023, involved 118 emergency nurses from Hunan Provincial Brain Hospital. Demographic and work-related information were collected. ProQOL, family care, organizational support and resilience were assessed using validated scales. Statistical analysis was conducted to examine the associations between these variables.

RESULTS

Significant differences were observed in the two dimensions of ProQOL (compassion satisfaction and burnout) among emergency nurses with different age, marital status, technical titles, work experience and night shift frequency (P < 0.05). Furthermore, both organizational support and resilience demonstrated a significant positive correlation with compassion satisfaction, while exhibiting a significant negative correlation with burnout (P < 0.05). Additionally, the third dimension of ProQOL (secondary trauma stress) was significantly negatively correlated with resilience (P < 0.05).

CONCLUSION

This study elucidates the pivotal role of organizational support and resilience in influencing the professional quality of life among emergency nurses, highlighting the specific needs of younger and less-experienced practitioners. Our findings lay the groundwork for targeted interventions aimed at enhancing the occupational well-being and job satisfaction of nursing staff.

Effect of Mandatory and Voluntary Overtime Hours on Stress Among 9-1-1 Telecommunicators

BACKGROUND

9-1-1 telecommunicators are frequently exposed to indirect traumatic events that impact their mental and physical health and are often required to work overtime with rotating shifts. Previous studies reported various harmful effects of overtime on the health and well-being of workers, such as musculoskeletal injuries, burnout, low job satisfaction, fatigue, and intent to leave. However, there is limited research on the impact of overtime hours on 9-1-1 telecommunicators' stress symptoms, especially mandatory overtime hours. This study aimed to examine the relationship between overtime hours-mandatory and voluntary-and the level of stress symptoms among 9-1-1 telecommunicators.

METHODS

We used secondary data from the surveys of the "Multi-tasking to hyper-tasking: Investigating the impact of Next Generation 9-1-1" study for analysis. Linear mixed-effects regression was applied to examine the association of overtime hours with the stress level.

RESULTS

Of the 403 participants, 47.6% reported that they were required to work mandatory overtime, and the mean mandatory overtime was 7.51 (SD = 12.78) hours in the past month. 58.3% reported working voluntary overtime, and the mean voluntary overtime was 11.63 (SD = 17.48) hours. This study found that mandatory overtime hours were associated with an increase in self-reported stress symptoms (β = 0.30, p = .002), whereas no significant association was found between voluntary overtime and the level of stress symptoms (β = -0.01, p = .885).

CONCLUSION/APPLICATION TO PRACTICE

Study results highlight the importance of reducing mandatory overtime in call centers as one possible strategy for reducing stress levels among this critical workforce.

Work-Related Health Conditions Among American Nurses: A Scoping Review

Background

Working in the nursing profession is hazardous, and nurses report poor health. Risk factors associated with poor health outcomes have been documented. However, the extent of literature exploring the prevalence of health conditions among American nurses that may be attributable to their work has not been examined.

Method

A scoping review following the Joanna Briggs Institute recommendations was conducted of peer-reviewed quantitative studies to answer the question: What are health conditions experienced by American nurses that may be attributable to their work as nurses?

Results

Thirty articles met the inclusion criteria. Due to the methods used in many articles, studies of the prevalence of health conditions among the nursing population were lacking. Health conditions studied broke into six categories: (a) work-related injuries and hazards; (b) unhealthy lifestyles; (c) mental health conditions; (d) burnout; (e) fatigue, sleep, and migraines; and (f) reproductive health. The role of work in the health conditions studied varied from an immediate impact on health (e.g., a needlestick or injury) to a cumulative impact (e.g., scheduling or workplace demands). Within the work demands, the physical environment; physical, emotional, and cognitive demands of work; and shiftwork were all frequently identified as antecedents that could be further explored and addressed to improve nurse health.

Conclusions

Healthcare systems should seek to address the hazards and exposures that may be linked to health conditions in the nursing workforce. Understanding and mitigating the impact of the pandemic and nursing work on the workforce's health is crucial to the solvency of the workforce. Occupational health practitioners should assess for workplace hazards and exposures.

Shoulder Pain and Disability Scores and the Factors Influencing Them among Orthopedic Surgeons Working in the Kingdom of Saudi Arabia: A Cross-Sectional Study

(1) Background: Musculoskeletal pain is common among orthopedic surgeons. Their common musculoskeletal issues include shoulder pain and disability. Many associated factors could lead to this pain and disability; by identifying these, we can prevent orthopedic surgeons' pain and improve their functional capacity. (2) Methods: This study aimed to gather quantitative data regarding the shoulder pain and disability experienced by orthopedic surgeons. It also aimed to explore the potential correlations between demographic characteristics and work-related factors and their pain and disability. This study interviewed 150 orthopedic surgeons working in the Kingdom of Saudi Arabia, asking questions on the Shoulder Pain and Disability Index (SPADI) scale and about their demographic characteristics. (3) Results: All interviewed orthopedic surgeons were male, married, and nonsmokers. Their SPADI pain subsection score was 25.24%, their SPADI disability subsection score was 21.25%, and their total SPADI score was 22.79%. Among the examined demographic characteristics, total SPADI scores have a significant positive correlation with body weight (Spearman's ρ = 0.432; p < 0.05) and body mass index (BMI; ρ = 0.349; p < 0.05). (4) Conclusions: Our findings indicate that all orthopedic surgeons generally suffer from moderate shoulder pain and disability. Body weight and body mass index are important factors that may influence shoulder pain and disability among orthopedic surgeons.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses

BACKGROUND

Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery.

OBJECTIVE

To investigate the global prevalence of overweight and obesity among nurses.

DESIGN

Systematic review with meta-analysis.

SETTING

29 different countries across the WHO-classified geographical region.

PARTICIPANTS

Nurses.

METHODS

Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic.

RESULTS

Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators.

CONCLUSIONS

This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as this is a systematic review.

REGISTRATION

PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785.

TWEETABLE ABSTRACT

High prevalence of overweight and obesity among nurses worldwide.

Optimizing Forecasted Activity Notifications with Reinforcement Learning

In this paper, we propose the notification optimization method by providing multiple alternative times as a reminder for a forecasted activity with and without probabilistic considerations for the activity that needs to be completed and needs notification. It is important to consider various factors when sending notifications to people after obtaining the results of the forecasted activity. We should not send notifications only when we have forecasted results because future daily activities are unpredictable. Therefore, it is important to strike a balance between providing useful reminders and avoiding excessive interruptions, especially for low probabilities of forecasted activity. Our study investigates the impact of the low probability of forecasted activity and optimizes the notification time with reinforcement learning. We also show the gaps between forecasted activities that are useful for self-improvement by people for the balance of important tasks, such as tasks completed as planned and additional tasks to be completed. For evaluation, we utilize two datasets: the existing dataset and data we collected in the field with the technology we have developed. In the data collection, we have 23 activities from six participants. To evaluate the effectiveness of these approaches, we assess the percentage of positive responses, user response rate, and response duration as performance criteria. Our proposed method provides a more effective way to optimize notifications. By incorporating the probability level of activity that needs to be done and needs notification into the state, we achieve a better response rate than the baseline, with the advantage of reaching 27.15%, as well as than the other criteria, which are also improved by using probability.

Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops

PURPOSE

Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments.

DESIGN

Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region.

MEASURES

Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units.

ANALYSIS

Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann-Whitney U, χ2, or Fisher's exact test as appropriate.

RESULTS

Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (-45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (-33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (-6 to 55 range) and 2.9 ± 4.0 (-6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported.

CONCLUSION

Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.

Self-Care and Sense of Coherence: A Salutogenic Model for Health and Care in Nursing Education

Background: Effective advocacy on self-care and the enhancement of a sense of coherence among nurses don’t only benefit control over one’s health and personal performance, but it may have a direct impact on clinical care and on the entire healing system. In this regard, nursing curricula grounded on a salutogenic model of health (SMH) operate with strategies to engage students in self-care and contribute to improving their mental health and wellbeing. The aim of this study was to explore the relationships between self-care agency and a sense of coherence as dependent variables and the age and self-reported academic performance as independent variables in nursing assistant students. Methods: For this cross-sectional study, data were collected from a full sample of 921 Certified Nursing Assistant (CNA) Spanish students. A self-administered questionnaire, including sociodemographic variables, the ‘appraisal of self-care agency’ (ASA), and the ‘sense of coherence’ (SOC) constructs, was administered. Results: Results: Older participants presented significantly stronger values of both constructs. Apart from a significant and positive correlation between ASAS and SOC, ANOVA analyses indicate signif-icant differences in terms of academic performance according to different ASAS and SOC de-grees. Conclusion: The findings of this study endorse the assumption that there is a consistent relationship between ASA and SOC constructs that might, indeed, have a potential effect on stu-dents’ academic performance. In practical terms, it seems relevant to try to recognise the stu-dents’ self-care agency and the sense of coherence as forceful predictive variables of mental health and wellbeing, in addition to academic success as a strength implied in the future career achievement.

Low back pain and associated factors among obstetrics care providers in public hospitals of Amhara Regional State, Ethiopia: a cross-sectional study

OBJECTIVES

Although the study of low back pain (LBP) among healthcare workers in Ethiopia is becoming common, it mainly focused on nurses leaving obstetrics care providers aside. The objective of this study was to assess the prevalence and associated factors of LBP among obstetrics care providers in public hospitals in Amhara Regional State, Ethiopia.

DESIGN

An institution-based cross-sectional study.

SETTINGS

The study settings were nine public hospitals in Amhara Region.

PARTICIPANTS

Randomly selected 416 obstetrics care providers working in public hospitals in Amhara Region, Ethiopia.

OUTCOMES

The outcomes of this study were the prevalence of LBP in the last 12 months among obstetrics care providers and its associated factors.

RESULTS

Overall, the prevalence of LBP was 65.6% (95% CI 61.5% to 70.2%) among obstetrics care providers in the last 12 months.Female gender (AOR 2.33, 95% CI 1.344 to 4.038), not having regular physical exercise habits (AOR 8.26, 95% CI 4.36 to 15.66), job stress (AOR 2.21, 95% CI 1.24 to 3.92), standing longer while doing procedures (AOR 2.04, 95% CI 1.14 to 3.66) and working more than 40 hours a week (AOR 2.20, 95% CI 1.09 to 4.45) were significantly associated with LBP.

CONCLUSION

About two-thirds of obstetrics care providers working in public hospitals in the Amhara region reported LBP. The prevalence of LBP was higher among those who did not have regular physical exercise habits, had job stress, stood longer than 1 hour while doing procedures, worked more than 40 hours a week and female obstetrics care providers. Providing resting periods, decreasing the working hours of obstetrics care providers in a week, and counselling on the importance of doing regular physical exercise help to reduce the prevalence of LBP.

The active ingredients of physical activity and / or dietary workplace-based interventions to achieve weight loss in overweight and obese healthcare staff: a systematic review

This systematic review aims to synthesize the active ingredients, and identify a list of promising behaviour change techniques (BCTs), likely to be present within physical activity and / or dietary interventions in achieving weight loss in overweight and obese healthcare staff. Four electronic databases were searched in February 2021: PsychINFO, CINAHL, PubMed and MEDLINE (no start date-2021). Studies were eligible for inclusion if they: (1) described a quasi-experimental or cluster, cohort or randomised control trial; (2) implemented workplace-based physical activity and / or dietary interventions versus a less intensive intervention or usual care; (3) targeted predominantly (> 50% of participants) overweight or obese healthcare professionals; and (4) reported a weight loss related outcome and included data on that outcome at least 3 months after the intervention began. Three reviewers used the Behaviour Change Technique Taxonomy v1 to extract BCTs with the aim of identifying a list of "promising" BCTs, which were those that were present in interventions that reported a statistically significant difference in weight loss. Nine studies were included in the review. The majority (n = 7) reported a significant reduction in weight post-intervention. A combined physical activity and dietary intervention (n = 8) was the most common type of intervention. Twenty-five BCTs were identified as "promising". Instruction on how to perform the behaviour (n = 9), behaviour practice/rehearsal (n = 8) and self-monitoring of behaviour (n = 6) were the most promising BCTs. The contents of behaviour change interventions are complex and rely on accurate reporting of intervention components and BCTs to allow concrete and robust assumptions to be made regarding which factors are most effective at achieving a desired outcome. Fundamentally the lack of research exploring the effectiveness of physical activity and dietary interventions on weight loss in overweight and obese healthcare staff and the poor quality of existing research, warrant more investigation.

Modification Effect of Job Demand and Contingent Work Schedule on Overweight and Obesity Among Civil Servants in Taiwan

OBJECTIVE

Evidence indicated that shift work is a contributing factor to risk of obesity and leads to cardiovascular diseases (CVDs), but few researches have examined the moderating effects of job demand and contingent work schedule on overweight and obesity. Thus, we assessed the modification effect of contingent work schedules and job demand on overweight and obesity among Taiwan's civil servants.

METHODS

Multistage stratified random cluster sampling was used based on a proportional probabilistic sampling (PPS) in a national survey for civil servants. A total of 20,046 participants from 647 registered governmental institutions were enrolled and anonymously and voluntarily filled out web-based questionnaires.

RESULTS

Compared to fixed work schedule, odd ratios (ORs) of obesity and overweight were 1.63 and 1.78 times in contingent work schedule, respectively. In addition, the modification effects of contingent work schedule and high job demand on overweight and obesity with Rothman's synergy index were 2.43 and 2.56, respectively. Using a hierarchical regression model adjusted for covariates, both high job demand and contingent work schedule were interactively associated with overweight and obesity compared to low job demand and fixed work schedule.

CONCLUSION

Since precarious schedules affect employee's obesity through work-related stress and unhealthy behaviors, further research is needed to determine whether interventions aimed at modification of work schedule may be useful in combating obesity.

Obesity among Health-Care Workers: Which Occupations Are at Higher Risk of Being Obese?

Obesity among health-care workers (HCWs) is an important issue as it can affect both their health condition and their professional capability. Although adult obesity is attributable to occupational factors, few reports are available on Malaysian health-care workers’ obesity and whether different health-care job categories are related to workers’ obesity. This study aimed to determine the prevalence of obesity among HCWs and the association between various HCW job categories and obesity. A cross-sectional study was conducted by analyzing secondary data from the 2019 annual cardiovascular health screening program, which included information regarding all government health-care workers in the east coast region of Peninsular Malaysia. The subject’s body mass index (BMI) was categorized according to WHO criteria. Only 43% of the subjects had a normal BMI, while 33.1% were categorized as overweight, and 21.1% were obese. Different HCWs’ job categories were shown to be significantly associated with their obesity status, with nurses apparently having a higher risk of being obese (Adj OR = 1.91, 95% CI 1.45, 2.53, p-value < 0.001). This study’s results require further exploration of HCWs’ working condition factors and for different job categories that contribute to obesity. Public health intervention programs to combat obesity should be implemented that primarily target HCW groups at the highest risk of obesity.

Impact of 12-hr shifts in general hospitals: Study conducted in two intensive care units

AIM

To evaluate the impact of 12-hr shifts on health status, working conditions and satisfaction among nurses and healthcare auxiliaries in medical and surgical intensive care units in a general hospital.

DESIGN

This study was a descriptive and prospective questionnaire study of personnel involved in the organization of 12-hr shifts.

METHODS

The EVREST questionnaire was used, with the addition of two questions on respondents' health status and five questions on their job satisfaction. The study consisted of a first phase immediately before work was organized in 12-hr shifts and a second within 7-9 months of application of this organization.

RESULTS

Positive effects were found among day nurses including decreased periods of pressure during the working day and improved work-life balance. Conversely, night nurses, who are not in favour of 12-hr shifts, reported dissatisfaction caused by a deterioration both in working conditions and in work-life balance.

Chronic and acute fatigue and intershift recovery in undergraduate nursing students working 12 or 6-hour faculty-supervised clinical shifts

BACKGROUND

Nursing student fatigue and recovery time are important considerations.

PURPOSE

This descriptive research compared chronic/acute fatigue and recovery time between one 12-hour shift or two 6-hour faculty-supervised clinical shifts per week.

METHODS

The Occupational Fatigue and Exhaustion Recovery (OFER) scale was completed by undergraduate students in pediatric and obstetrical courses.

RESULTS

The student (N = 106) mean score on OFER was 37.57 for chronic fatigue, 56.57 for acute fatigue, and intershift recovery was 56.57. No differences in chronic fatigue (P = .40), acute fatigue (P = .14), or intershift recovery (P = .35) were found between groups. Nursing students (79%) preferred 12-hour clinical shifts as compared to 21% who chose two 6-hour clinical.

CONCLUSIONS

No differences in chronic/acute fatigue or intershift recovery between a 12-hour clinical shift or two 6-hour clinical shifts were found. Nursing students preferred the one 12-hour clinical shift.

'You gotta have something to chew on': perceptions of stress-induced eating and weight gain among office workers in South Korea

Objective:

Job-related chronic stress has been discussed as a risk factor for weight change and metabolic disorders. The current study was conducted to understand the situations in which stress-induced eating occurs among office workers and how workers perceive stress to influence their daily eating practices and weight change.

Design:

In-depth, one-on-one interviews were conducted with office workers.

Setting:

Metropolitan areas in South Korea.

Participants:

Twenty-two office workers from thirteen companies participated in the study.

Results:

Most participants mentioned that they often felt work-related stress and reported various levels of perceived stress, as measured with open-ended questions. The main sources of work stress were (i) the nature of job characteristics, (ii) performance evaluations and (iii) relationships within the organisation. Participants linked stress with increased food consumption and cravings for sweet, savoury and greasy foods. Many participants emphasised the links between multiple health behaviours and stress. Not only dietary choices but also alcohol consumption, sleeping difficulty and insufficient physical activity were related to coping with work stress and demands. Finally, most participants who perceived work stress believed that their weight gain in adulthood was triggered by work stress.

Conclusions:

It is necessary to consider promoting behavioural modifications to support weight management and providing a means for stress management and the minimisation of stress-inducing working environments for workers to maintain or achieve a healthy weight and to prevent chronic disease incidence.

Are long working hours associated with weight-related outcomes? A meta-analysis of observational studies

The relationship between long working hours and body weight outcomes remains inconclusive; thus, we conducted a meta-analysis to assess the effect of long working hours on weight-related outcomes. PubMed and Embase databases were searched from their inception to June 2019. A random-effects model was used to assess the pooled odds ratio (OR) and corresponding confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Begg's and Egger's tests. A total of 29 articles involving 374 863 participants were included. The pooled OR of long working hours on weight-related outcomes was 1.13 (95% CI, 1.07-1.19). In subgroup analysis stratified by definition of outcomes, the pooled ORs of long working hours on "weight gain/BMI increase," "BMI ≥ 25 kg/m2 ," and "BMI ≥ 30 kg/m2 " were 1.19 (95% CI, 1.02-1.40), 1.07 (95% CI, 1.00-1.14), and 1.23 (95% CI, 1.09-1.39), respectively. We found evidence of publication bias, but correction for this bias using the trim-and-fill method did not alter the combined OR substantially. There was evidence to suggest that long working hours are associated with adverse weight-related outcomes. Preventative interventions such as improved flexibility and healthy working schedules should be established for employees.

Perceived Facilitators and Barriers to Nigerian Nurses' Engagement in Health Promoting Behaviors: A Socio-Ecological Model Approach

Nurses make up the single largest healthcare professional group in the Nigerian healthcare system. As frontline healthcare providers, they promote healthy lifestyles to patients and families. However, the determinants of Nigerian nurses’ personal health promoting behaviors (HPBs) remain unknown. Utilizing the socio-ecological model (SEM) approach, this study aimed to explore the perceived facilitators and barriers to Nigerian nurses’ engagement in HPBs. HPBs were operationalized to comprise of healthy dietary behaviors, engagement in physical activity, low-risk alcohol consumption, and non-smoking behaviors. Our study was carried out in a large sub-urban tertiary health facility in Nigeria. Data collection was via face-to-face semi-structured interviews and participants were registered nurses (n = 18). Interview data were transcribed verbatim and analyzed thematically to produce nine themes that were mapped onto corresponding levels of influence on the SEM. Findings show that in Nigeria, nurses perceive there to be a lack of organizational and policy level initiatives and interventions to facilitate their engagement in HPBs. The determinants of Nigerian nurses’ HPBs span across all five levels of the SEM. Nurses perceived more barriers to healthy lifestyle behaviors than facilitators. Engagement in healthy behaviors was heavily influenced by: societal and organizational infrastructure and perceived value for public health; job-related factors such as occupational stress, high workload, lack of protected breaks, and shift-work; cultural and religious beliefs; financial issues; and health-related knowledge. Organizations should provide facilities and services to support healthy lifestyle choices in Nigeria nurses. Government policies should prioritize the promotion of health through the workplace setting, by advocating the development, implementation, regulation, and monitoring of healthy lifestyle policies.

Hospital and Shift Work Influences on Nurses' Dietary Behaviors: A Qualitative Study

Background: Nurses working in hospitals face unique influences on their workplace dietary behaviors, but little is known about what nurses experience as dietary influencers in the hospital setting. Understanding these influences is paramount in developing effective programs that target healthy workplace eating. This study aimed to explore hospital shift nurses' experiences and perceptions of influences on making healthy nutritional choices while at work. Methods: This qualitative, descriptive study was guided by the Theoretical Domains Framework and analyzed using thematic analysis. Twenty-one Registered Nurses working 10- to 12-hour shifts in hospitals in South Carolina, USA, in 2018 were interviewed individually or in focus groups about their workplace dietary behaviors and influences. Findings: Framework constructs most relevant to hospital shift nurses included (a) environmental context and resources; (b) social/professional role and identity; (c) memory, attention, and decision processes; (d) social influences; (e) emotion; and (f) behavioral regulation. In addition, four major themes emerged: (a) Nursing roles and responsibilities restrict freedom of movement and minimize individual control over dietary practices; (b) The hospital food environment is oppressively unhealthy; (c) Free food is currency and influences consumption; and (d) Shift work is a major barrier to healthy eating. Conclusions/Applications to Practice: To achieve healthy eating practices in the workplace, hospital shift nurses need supportive systems, policies, and interventions that target and reduce the barriers inherent in hospital-based nursing shift work. To improve hospital shift nurses' workplace dietary behaviors, these findings should inform hospital food policies, workplace wellness programs, administrative practices, and staff education.

Challenges facing oncology nurses in Jordan: A qualitative study

BACKGROUND

The literature shows that oncology nurses have more stressors than nurses in other units. They face many challenges both within and outside the work environment that affect them negatively. Most of the reviewed studies concerning these challenges were conducted in developed countries.

AIM

The purpose of this study was to explore the challenges experienced by oncology nurses in Jordan during their daily practice.

METHOD

A qualitative descriptive approach was adopted. Semistructured individual face-to-face interviews were conducted with 24 nurses. Participants were selected from oncology departments in one of the biggest governmental hospitals in Jordan.

RESULTS

Two main themes were drawn from the data analysis. The first discussed the personal challenges that oncology nurses encountered. These included emotional attachment to patients and difficulties in separating work and personal life. The second related to organizational challenges in the work environment, which included the nurses' lack of authority to inform patients about their diseases, nursing staff and supply shortages, and a lack of orientation programs. All of these factors affected the psychological status of the nurses.

CONCLUSIONS

The results of this study indicated that the working environment for oncology nurses is highly stressful and demanding and these nurses face many challenges in their work. The understanding and consideration of these challenges by stakeholders, managers, and organizational leaders would lead to improvements in the nurses' psychological state, thereby enhancing the quality of care in these units and helping with staff retention.

Pre-employment health lifestyle profiles and actual turnover among newly graduated nurses: A descriptive and prospective longitudinal study

BACKGROUND

Newly graduated nurses' pre-employment health lifestyles play particularly important roles in their smooth adaptation to and retention in clinical nursing; however, the longitudinal relationship between pre-employment health lifestyles and work outcomes, such as turnover, remains underexamined. To identify the health lifestyle profiles of specific populations of interest, recent studies have employed multifaceted approaches using health behaviors and/or statuses.

OBJECTIVES

To identify the pre-employment health lifestyle profiles of newly graduated nurses, and to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

DESIGN

Descriptive and prospective longitudinal study design.

SETTINGS

One tertiary hospital in Seoul, South Korea.

PARTICIPANTS

A total of 464 newly graduated nurses who started work between September 2014 and December 2015.

METHODS

The outcome was actual turnover-whether participants had resigned from the organization and the days they worked up to December 31, 2017. We measured eight health lifestyle variables on the first day of orientation before ward placement (i.e., at baseline): quantity and quality of sleep, eating three meals a day, having a regular diet, alcohol consumption, moderate exercise, depression, and self-rated health. We employed latent class analysis to identify the health lifestyle profiles of new nurses, and used Cox proportional hazards regression to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

RESULTS

We classified newly graduated nurses' pre-employment health lifestyle profiles into two groups: unhealthy lifestyle (15.6%) and discordant (84.4%). Compared with the new nurses in the discordant group, those in the unhealthy lifestyle group had significantly higher probabilities of resigning (HR = 2.38, 95% CIs of HR = 1.62-3.50); this relationship remained significant after adjusting for perceived job stress at six weeks of work (HR = 2.26, 95% CIs of HR = 1.50-3.39).

CONCLUSIONS

This study identified significant differences in the patterns of newly graduated nurses' pre-employment health lifestyles; our analysis showed that classification in the unhealthy lifestyle group was a turnover risk factor. Given that new nurses' health lifestyles affect work outcomes, hospitals should implement organizational and educational initiatives to encourage healthy lifestyles. In considering pre-employment health lifestyle profiles, hospitals should also monitor novice nurses' adaptation and wellness. Nursing education should include strategies to enhance nursing students' own health. Further extensive longitudinal studies should seek to identify the health lifestyle profiles of heterogeneous nurse populations.

How many calories do nurses burn at work? A real-time study of nurses' energy expenditure

Background

Nurses have high rates of overweight and obesity, and physical inactivity is one key determinant of weight gain.

Aims

The present study aims to quantify nurses' energy expenditure over a standard 12-hour shift to establish whether activity levels at work are too low to maintain a healthy body weight.

Methods

Ward-based nurses (n = 96, 90 female, mean age = 36 years, mean experience = 10 years, mean body mass index = 26.6) wore heart rate and physical activity monitors for the duration of one full working shift. Heart rate and activity data were used in combination with demographic information to estimate each nurse's energy expenditure over 12 hours.

Results

On average, nurses burned 2.12 kcals per minute while at work, equating to 1521 kcals/6364 kJ (SD = 403 kcals/1686 kJ) per 12-hour shift. Energy expenditure over 12 hours varied markedly between nurses (from 812 kcals/3397 kJ to 3005 kcals/12,573 kJ) but was sufficient in 72% of participants (assuming minimal resting levels of energy expenditure for the 12 hours not at work) to burn off a daily calorie intake of 2000 kcals.

Conclusions

Three-quarters of nurses expend more energy on working days than is required to maintain a healthy body weight if dietary intake does not exceed recommended levels.

Morbidity associated with overweight and obesity in health personnel: a 10-year retrospective of hospital-based cohort study in Taiwan

PURPOSE

To investigate morbidity associated with overweight and obesity in health personnel and compare the differences among work roles.

MATERIALS AND METHODS

This retrospective cohort study examined measurements obtained during employee medical checkups between 2007 and 2016 in a Taiwan medical center. BMI was used to define overweight (≥24 and <27 kg/m²) and obesity (≥27 kg/m²). Morbidity refers to prevalence, period incidence proportion, and incidence rate. Multivariable Cox model was used to estimate the HRs and 95% CI of the incidence proportion across work roles.

RESULTS

Ten thousand six hundred fifty-one health personnel with 24,295 BMI measurements were recruited. Mean age was 33.4±10.7 years and 72.4% was female. In total, 1,992 (8.2%) health personnel were underweight, 13,568 (55.8%) had a normal BMI, 5,097 (21%) were overweight, and 3,638 (15%) were obese. Five thousand nine hundred one health personnel with 31,172 different interval-year arrangement combinations were obtained. The incidence proportion of overweight and obesity was 1,947 (6.2%) and 1,494 (4.8%), respectively. The incidence rate was 37/1,000 and 15/1,000 person-years, respectively. Compared with that in supporting staff, the HR of overweight in doctors, nurses, and allied health professionals was 0.93 (95% CI =0.73-1.18, P=0.553), 0.92 (95% CI =0.73-1.16, P=0.491), and 0.85 (95% CI =0.67-1.09, P=0.202), respectively. Similarly, the HR of obesity was 0.86 (95% CI =0.66-1.14, P=0.301), 0.89 (95% CI =0.67-1.18, P=0.430), and 0.84 (95% CI =0.63-1.13, P=0.248), respectively.

CONCLUSION

In health personnel, the prevalence of overweight and obesity was 21% and 15%, respectively. The incidence proportion was 6.2% and 4.8%, respectively. Morbidity across the four health work roles examined was not significantly different.

Relationships of Musculoskeletal Symptoms, Sociodemographics, and Body Mass Index With Leisure-Time Physical Activity Among Nurses

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

Associations of eHealth literacy with health-promoting behaviours among hospital nurses: A descriptive cross-sectional study

AIMS

To investigate the associations of eHealth Literacy with health-promoting behaviours among hospital nurses in South Korea.

BACKGROUND

Health-promoting behaviours of nurses are crucial for their own improved health and health-related behaviours of patients. eHealth literacy refers to the ability to search, understand and evaluate health information available online. With the growing use of the Internet, eHealth literacy is emerging as an important factor enhancing health-promoting behaviours.

DESIGN

Descriptive cross-sectional design with self-reported questionnaires.

METHODS

Data were collected between March-May 2016 from five hospitals in South Korea. Health-promoting behaviours and eHealth literacy were assessed using Health Promoting Lifestyle Profile-II and K-eHEALS, respectively. Multiple linear regression models were used to examine the associations of eHealth literacy and health-promoting behaviours.

RESULTS

Nurses with high level of eHealth literacy had significantly positive overall health-promoting behaviours, stress management, interpersonal relations, self-actualization and health responsibility, but not for nutrition and physical activity.

CONCLUSION

Improving eHealth literacy through various strategies could be an effective way to boost health-promoting behaviours among nurses. However, improvement of actual health-promoting behaviours such as nutrition and physical activity will require systematic and organizational changes.

Are Hospital Workers Healthy?: A Study of Cardiometabolic, Behavioral, and Psychosocial Factors Associated With Obesity Among Hospital Workers

OBJECTIVE

This study evaluated the cardiometabolic, behavioral, and psychosocial factors associated with weight status among hospital employees.

METHODS

A total of n = 924 employees across the six hospitals in Texas participated in this cross-sectional study, 2012 to 2013. Association between weight status and waist circumference, blood pressure, biomarkers, diet, physical activity, sedentary behaviors, and psychosocial factors was assessed.

RESULTS

About 78.1% of employees were overweight/obese. Obese participants (body mass index [BMI] ≥30.0 kg/m) had higher consumption of potatoes, fats, sugary beverages, and spent more time watching television, playing computer games, and sitting than those having normal weight. Being obese was positively associated with blood pressure, blood glucose, low-density lipoprotein, and negatively associated with high-density lipoprotein. Finally, 78.8% of workers were dissatisfied with their worksite wellness with dissatisfaction being higher among obese employees. Being overweight (BMI 25.0 to 29.9 kg/m) was positively associated with blood pressure, but not other variables.

CONCLUSION

Understanding the risk profile of hospital workers is critical to developing effective interventions.

Self-Care Posters Serve as a Low-Cost Option for Physical Activity Promotion of Hospital Nurses

Hospital nurses play an important role in the nation's short- and long-term patient care. At the same time, nurses often experience high levels of occupational stress and participate in low levels of physical activity (PA). The purpose of this study was to examine the impact of self-monitoring and a poster campaign on the PA behaviors of hospital nurses. Motivational and instructional exercise posters were hung in break rooms of experimental units and replaced biweekly for 8 weeks. A total of 26 nurses (control: n = 13; experimental: n = 13) wore accelerometers for 3 workdays pre-, mid-, and postintervention. Participants were provided a step counter at baseline and a PA report at each stage. Moderate to vigorous PA (MVPA) and step count (SC) increased pre- to midintervention for control (MVPA: 14.8 ± 7.6%; SC: 19.1 ± 7.8%) and experimental (MVPA: 26.7 ± 18.5%, SC: 17.6 ± 8.3%) participants. Physical activity levels returned to baseline postintervention for control ( p > .05) and increased mid- to postintervention for experimental (MVPA: 16.2 ± 5.2%, SC: 10.7 ± 4.7%, p < .05) participants. In conclusion, a low-cost, self-care poster campaign may increase PA levels of hospital nurses when combined with personalized PA feedback.

Exploratory study on resilience and its influencing factors among hospital nurses in Guangzhou, China

Background

Currently, building resilience in nurses is recognized as an important factor that helps maintain their health and stay in their profession; thus, identifying which factors can help them build resilience is necessary.

Methods

A cross-sectional survey design was used, and 1356 nurses from 11 general hospitals in Guangzhou, China, were assessed using the Chinese version of the Conner–Davidson Resilience Scale, the General Self-Efficacy Scale, the Simplified Coping Style Questionnaire, and the Job Stress Scale of Chinese nurses. The demographic characteristics of participants were also gathered.

Results

The mean total score of nurses' resilience is 59.99 (SD 13.59), which was significantly lower (P < 0.001) than that of the general people in China. The regression analysis affirmed that the factors which influence the resilience of nurses include self-efficacy, coping style, job stress, and education level (R² = 49.4%, P < 0.001).

Conclusion

Nurses had low resilience. They could not effectively cope with job challenges and recover from adversity. Strengthening self-efficacy, choosing active coping, decreasing job stress, and enhancing educational training can effectively improve their resilience.

Shift-work: is time of eating determining metabolic health? Evidence from animal models

The circadian disruption in shift-workers is suggested to be a risk factor to develop overweight and metabolic dysfunction. The conflicting time signals given by shifted activity, shifted food intake and exposure to light at night occurring in the shift-worker are proposed to be the cause for the loss of internal synchrony and the consequent adverse effects on body weight and metabolism. Because food elicited signals have proven to be potent entraining signals for peripheral oscillations, here we review the findings from experimental models of shift-work and verify whether they provide evidence about the causal association between shifted feeding schedules, circadian disruption and altered metabolism. We found mainly four experimental models that mimic the conditions of shift-work: protocols of forced sleep deprivation, of forced activity during the normal rest phase, exposure to light at night and shifted food timing. A big variability in the intensity and duration of the protocols was observed, which led to a diversity of effects. A common result was the disruption of temporal patterns of activity; however, not all studies explored the temporal patterns of food intake. According to studies that evaluate time of food intake as an experimental model of shift-work and studies that evaluate shifted food consumption, time of food intake may be a determining factor for the loss of balance at the circadian and metabolic level.

Chronotype, Sleep Characteristics, and Musculoskeletal Disorders Among Hospital Nurses

Work-related musculoskeletal disorders (WMSDs) persist as the leading occupational injury, accounting for nearly half of nurses' total occupational injuries. Musculoskeletal pain is a known cause of sleep disruption, and individuals with WMSDs that interfere with sleep often report more pain. Evening chronotype has been associated with poor sleep among nurses. However, the associations among chronotype, sleep, and WMSDs are still unclear, and were explored in the present study. A cross-sectional survey was administered to 397 nurses, with 47.4% reporting WMSDs. Robust Poisson regression modeling suggested that evening type (PR = 1.32, p < .05), prolonged sleep onset latency (PR = 1.37, p < .05), and using sleep-promoting substances (PR = 1.35, p < .01) were associated with increased risk of WMSDs among nurses, after adjusting for shift work, regular exercise, body mass index, and other covariates. This study suggests that well-designed evidence-based nonpharmacological interventions to improve sleep may reduce the risk of WMSDs among nurses.

Antecedents and outcomes of nurses' rest break organization: A scoping review

OBJECTIVES

To prevent an accumulation of strain during work and to reduce error risk, many countries have made rest breaks mandatory. In the nursing literature, insufficient rest break organization is often reported. However, the outcomes of nurses' rest break organization and its anteceding factors are less clear.

DATA SOURCES

We searched for academic literature on nurses' rest break organization in electronic databases (PubMed, Medline, PsycArticles, PsycINFO, CINAHL).

REVIEW METHODS

Our search yielded 93 potentially relevant articles published between 01/1990 and 04/2016. The final sample in our scoping review consisted of 36 publications and included data from 35 independent and international study samples and two reviews.

RESULTS

Several studies reported a high prevalence of missed, interrupted, or delayed rest breaks in nursing. Nurses' rest breaks often related to better physical and mental well-being but did not affect motivational outcomes and performance systematically. Results on the effects of napping breaks were inconsistent. Rest break activities and high quality rest break areas are further factors that relieve nurses from job demands and can be helpful in coping with them. Several study results indicated that temporal and quantitative work demands, job resources, and individual characteristics influence rest break organization. However, most of these findings stem from studies that do not allow causal conclusions to be drawn.

CONCLUSIONS

Well-designed rest breaks influence nurses' occupational well-being and behavior positively. However, the mechanisms and moderating break-, work-, and person-related factors involved in producing these effects are not well understood today. Thus, further theory building and stronger empirical data are needed.

Understanding perceived determinants of nurses' eating and physical activity behaviour: a theory-informed qualitative interview study

BACKGROUND

Unhealthy eating and physical activity behaviours are common among nurses but little is known about determinants of eating and physical activity behaviour in this population. The present study used a theoretical framework which summarises the many possible determinants of different health behaviours (the Theoretical Domains Framework; TDF) to systematically explore the most salient determinants of unhealthy eating and physical activity behaviour in hospital-based nurses.

METHODS

Semi-structured qualitative interviews based on the TDF were conducted with nurses (n = 16) to explore factors that behavioural theories suggest may influence nurses' eating and physical activity behaviour. Important determinants of the target behaviours were identified using both inductive coding (of categories emerging from the data) and deductive coding (of categories derived from the TDF) of the qualitative data.

RESULTS

Thirteen of the fourteen domains in the TDF were found to influence nurses' eating and physical activity behaviour. Within these domains, important barriers to engaging in healthy eating and physical activity behaviour were shift work, fatigue, stress, beliefs about negative consequences, the behaviours of family and friends and lack of planning. Important factors reported to enable engagement with healthy eating and physical activity behaviours were beliefs about benefits, the use of self-monitoring strategies, support from work colleagues, confidence, shift work, awareness of useful guidelines and strategies, good mood, future holidays and receiving compliments.

CONCLUSIONS

This study used a theory-informed approach by applying the TDF to identify the key perceived determinants of nurses' eating and physical activity behaviour. The findings suggest that future efforts to change nurses' eating and physical activity behaviours should consider targeting a broad range of environmental, interpersonal and intrapersonal level factors, consistent with a socio-ecological perspective.

Interrelationships between nursing workers' state of nutrition, socio demographic factors, work and health habits

The interrelationships between professional nursing workers' state of nutrition, variables relating to their socio demographic relationships, their professional work, and health behavior, were examined based on a correspondence analysis technique. This is a sectional study carried out involving 917 nursing professionals in a public hospital in Rio de Janeiro. The results show the formation of four groups, three of them grouped under BMI (body mass index) categories. The obese individuals group included poor health, current socio economic conditions, unfavorable past conditions, and former night shift workers. The low/adequate group showed the most favorable conditions, while the group of overweight individuals also included smoking, alcohol consumption, and current night shift work (up to five nights per two-week period). Specifically, among the interrelationships between the states of nutrition levels, we highlight those relating to current and previously evaluated socio economic conditions, and underscore the life-long importance of social indicators.

Translating Physical Activity Evidence to Hospital Settings: A Call for Culture Change

Extensive evidence exists on the multiple physical and psychological benefits of physical activity (PA) across the lifespan. Yet, the vast majority of Americans engage in highly sedentary lifestyles, and most do not meet recommended PA levels that can achieve health benefits. Moreover, nurses and other healthcare providers are highly inconsistent in their PA recommendations to patients in all settings, as well as in achieving their own levels of PA. The consequences are growing obesity and health-related conditions, disability, and mortality. A culture change is sorely needed that reimagines and reintegrates PA into the course of daily life activities. In this article, we present the research on PA benefits, declining PA levels, and healthcare practice deficits and propose designing an inpatient unit of the future with a mission of PA for all that is integrated into the fabric and operations of the unit. Malcolm Gladwell's Tipping Point ideas are used as a change framework to guide strategies recommended in this futuristic unit. These strategies include leadership by clinical nurse specialists, engagement of other key people, resources, and structures. The entire process will require bold leadership and a willingness to think outside existing models of hospital care, which are costly and outdated.

Long working hours in the healthcare system of the Belo Horizonte municipality, Brazil: a population-based cross-sectional survey

BACKGROUND

Health personnel are key players in developing and improving healthcare systems, caring for individuals and their communities, and helping improve quality of life. However, these professionals are often exposed to long working hours because of the pressing need for their services at potentially any time of day. The long working hours they endure are a major risk factor for both acute and chronic health problems. The present study aimed to analyze occurrences of long working hours and their association with individual characteristics and employment factors among workers in the municipal healthcare system in Belo Horizonte, Brazil.

METHODS

In this cross-sectional study, a ramdomly selected proportional sample of 1549 participants was analyzed from among the total of 13 602 workers in the Belo Horizonte municipal healthcare system in 2009. "Long" working hours were defined as >44 h/week. A self-administered questionnaire was used for accumulating data. Associations with outcomes were estimated using logistic regression, in univariate and multivariate models.

RESULTS

The rate of occurrence of long working hours was 31.4% (95% CI 29.1-33.7). Lower educational level (high school, technical, or uncompleted undergraduate [OR 0.60, 95% CI 0.47-0.78 p < 0.001], or elementary [OR 0.33, 95% CI 0.19-0.55 p < 0.001]) was associated with a lower likelihood of self-reporting long working hours in relation to the group with the highest educational level (completed undergraduate or postgraduate). Male sex (OR 1.62, 95% CI 1.26-2.09 p < 0.001), having children (PR 1.54, 95% CI 1.20-1.97 p = 0.001), and being in the healthcare provider group (OR 1.82, 95% CI 1.40-2.35 p < 0.001) were factors associated with greater likelihood of long working hours.

CONCLUSIONS

It was observed that number of long weekly working hours was related to individual characteristics and employment factors.

Predictors of occupational burnout among nurses: a dominance analysis of job stressors

AIMS AND OBJECTIVES

To quantitatively compare dimensions of job stressors' effects on nurses' burnout.

BACKGROUND

Nurses, a key group of health service providers, often experience stressors at work. Extensive research has examined the relationship between job stressors and burnout; however, less has specifically compared the effects of job stressor domains on nurses' burnout.

DESIGN

A quantitative cross-sectional survey examined three general hospitals in Jinan, China.

METHOD

Participants were 602 nurses. We compared five potential stressors' ability to predict nurses' burnout using dominance analysis and assuming that each stressor was intercorrelated.

RESULTS

Strong positive correlations were found between all five job stressors and burnout. Interpersonal relationships and management issues most strongly predicted participants' burnout (11·3% of average variance).

CONCLUSION

Job stressors, and particularly interpersonal relationships and management issues, significantly predict nurses' job burnout.

RELEVANCE TO CLINICAL PRACTICE

Understanding the relative effect of job stressors may help identify fruitful areas for intervention and improve nurse recruitment and retention.

Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review

AIM

The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses.

BACKGROUND

There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses' healthy eating in the workplace.

DESIGN

Integrative mixed method review.

DATA SOURCES

Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000-2016. Of 26 included papers, 21 were qualitative and five quantitative.

REVIEW METHODS

An integrative literature review was undertaken. Quality appraisal of included studies used standardized checklists. A social-ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis.

RESULTS

Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses' dietary intake.

CONCLUSION

Reorientation of the workplace to promote healthy eating among nurses is required.

Physical activity of graduated nurses in one-and multiple-shift work

Introduction: Physical activity enables nurses to better control their mental and physical strain at work, which is important for ensuring quality patient treatment. The aim of the research was to study differences in graduate nurses' physical activity in terms of their working hours, motives and obstacles to regular, free-time physical exercising. Methods: A quantitative survey with two-stage random sampling included 349 graduate nurses employed in the secondary or tertiary levels of healthcare institutions in Slovenia who work one shift (41 %) or multiple shifts (59 %). The data were collected with a questionnaire in 2012 and analysed with a chi-square test, a t-test for independent samples and discriminant analysis. Results: Graduate nurses with one shift perform physical activity more often (p < 0.001) and are more involved in organised physical exercise (p < 0.001) than those who work multiple shifts. The motives for oneshift graduate nurses to engage in physical activity are to control stress, a better mood, along with the desire for exercising, moving and relaxation, whereas nurses who work several shifts encounter obstacles due to not exercising regularly, such as work absences, the fact the effects of exercising are not immediately seen, and the lack of free time (p = 0.025). Discussion and conclusion: The research showed that graduate nurses are not sufficiently physically active. Especially those who work multiple shifts are in danger due to the less organised and lower frequency of activities. It is important to promote health in the workplace in various forms, such as active breaks during work hours and sports games for employees and their families.

Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study

BACKGROUND AND OBJECTIVE

Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses.

METHODS

This study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013.

RESULTS

Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity.

CONCLUSIONS

Our study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

Obesity, Prediabetes, and Perceived Stress in Municipal Workers

The primary cause of death for men and women in the United States is heart disease. Obesity and diabetes are major contributors to heart disease, and the risk is worsened in the presence of stress. It is clinically useful to identify predictors of obesity and prediabetes in a working population. The purpose of this current cross-sectional, correlational study was to examine relationships among obesity, prediabetes, and perceived stress in municipal workers using a subset of worksite wellness program data from employees screened in 2010 and 2011. Multiple regression models indicated that age, gender, race, HA1c, shift schedule, physical activity, and occupation were significant predictors of obesity in municipal workers ( p < .01). Prediabetes in municipal workers was predicted by age, Black race, and body mass index (BMI; p < .01). Perceived stress was not a significant predictor of obesity or prediabetes in municipal workers. Overall, the findings of this study provide guidance to occupational health nurses when evaluating individuals in an occupational health setting. Further research is needed to examine relationships among the variables and validate the models.

Work-related factors, job satisfaction and intent to leave the current job among United States nurses

AIMS AND OBJECTIVES

To examine the relationships of work-related factors (e.g., autonomy, work schedule, supervisory and peer support) to nurses' job satisfaction and intent to leave their current position.

BACKGROUND

Low job satisfaction and high turnover of nurses are major problems for health care. To improve nurse retention, work-related factors associated with job satisfaction and intent to leave should be investigated.

DESIGN

A cross-sectional secondary data analysis.

METHODS

Data were obtained in 2004 from Wave 3 of the Nurses' Worklife and Health Study. A random sample of 5000 actively licenced nurses in Illinois and North Carolina (two U.S. states) were sent the survey in wave 1, of which 1641 actively working bedside nurses participated in wave 3. We examined associations of various work-related factors with job satisfaction and intent to leave the current position.

RESULTS

Nurses who were dissatisfied with their job reported significantly higher psychological demands and lower autonomy than nurses who were satisfied. Nurses were significantly less satisfied with their jobs when they worked longer hours with inadequate breaks or sick days. Lack of support from peers and supervisors was also related to significantly lower odds of job satisfaction. For intention to leave, nurses who said they planned to leave their current job reported significantly lower autonomy and less support from their peers than nurses who intended to stay.

CONCLUSION

A variety of modifiable work-related factors were significantly related to job satisfaction and intention to leave the current job among nurses. Future research should focus on developing interventions that could mitigate these factors (e.g., by improving work schedules, increasing autonomy and/or nurse support). The impact of such interventions on job satisfaction and intention to leave the current position could then be evaluated.

RELEVANCE TO CLINICAL PRACTICE

To increase nurse retention, improved schedules, autonomy and supportive work environments should be promoted.

Obesity/Overweight and the Role of Working Conditions: A Qualitative, Participatory Investigation

The rising U.S. prevalence of obesity has generated significant concern and demonstrates striking socioeconomic and racial/ethnic disparities. Most interventions target individual behaviors, sometimes in combination with improving the physical environment in the community but rarely involving modifications of the work environment. With 3.6 million workers earning at or below the federal minimum wage, it is imperative to understand the impact of working conditions on health and weight for lower income workers. To investigate this question, a university-community partnership created a participatory research team and conducted eight focus groups, in English and Spanish, with people holding low-wage jobs in various industries. Analysis of transcripts identified four themes: physically demanding work (illnesses, injuries, leisure-time physical activity), psychosocial work stressors (high demands, low control, low social support, poor treatment), food environment at work (available food choices, kitchen equipment), and time pressure (scheduling, having multiple jobs and responsibilities). Physical and psychosocial features of work were identified as important antecedents for overweight. In particular, nontraditional work shifts and inflexible schedules limited participants' ability to adhere to public health recommendations for diet and physical activity. Workplace programs to address obesity in low-wage workers must include the effect of working conditions as a fundamental starting point.

Supervisors’ Support for Nurses’ Meal Breaks and Mental Health

Meal breaks promote occupational health and safety; however, less is known about supervisors’ support for nurses’ meal breaks. In this study, the researchers tested whether the frequency of meal breaks was positively related to supervisors’ support of nurses’ meal breaks, and whether more frequent meal breaks were associated with less psychological distress. This study is based on a cross-sectional survey of 1,595 hospital nurses working on 85 units supervised by nursing directors. Specific meal-break support was measured at the nursing director level; frequency of meal breaks and psychological distress were measured at the individual nurse level. Multilevel adjusted models showed a positive association between supervisors’ support for meal breaks and the frequency of nurses’ meal breaks (β = .16, p < .001). Moreover, nurses who took meal breaks more frequently reported lower psychological distress (β = −.09, p < .05). Meal breaks might be daily opportunities to promote mental health and fatigue recovery and provide downtime.