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

Unhealthy Eating Habits and Determinants of Diet Quality in Primary Healthcare Professionals in Poland: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

The aim of this work was to understand the factors influencing the prevalence of dietary behaviors, as well as determinants of unhealthy eating and diet quality among primary care physicians and nurses in Poland.

METHODS

A cross-sectional study involving 161 doctors and 331 nurses was conducted in the years 2020-2022 in primary healthcare settings.

RESULTS

Unhealthy eating habits affected GPs aged 40-54 years (42.9%), females (64.3%), those of normal body weight (67.9%), representing private medical practice (67.9%), who had over 20 years of work experience (42.8%). Similarly, among the group of nurses, unhealthy eating habits were reported in subjects aged 40-54 (46.5%), individuals with normal body weights (49.5%), those with one chronic disease (38.4%), representing public medical practice (63.6%), with over 20 years of work experience (40.4%), seeing ≤100 patients during the work week (84.8%). The univariable logistic regression analyses for unhealthy dietary habits showed that overweight GPs had lower odds of unhealthy eating habits (OR = 0.35; 95% CI: 0.11-1.08; p < 0.05). Among the nurses, the odds of unhealthy eating habits increased with the number of years of work. Nurses with 10-20 years of work experience had 1.23 times greater odds of unhealthy eating habits, while people working for more than 20 years had 1.81 times greater odds of unhealthy eating habits than individuals working for a period shorter than ten years (OR = 1.23; 95% CI: 0.68-2.23; p > 0.05 vs. OR = 1.81; 95% CI: p < 0.05). The multivariable logistic regression analysis did not show statistically significant results.

CONCLUSIONS

These issues should be addressed when planning educational activities aimed at supporting healthcare professionals in implementing lifestyle changes.

Exploring the continuum of eating behaviour, from 'normal' to disordered eating

Eating is a distinct behaviour in humans, in that they must consume food to provide sufficient energy for the body to function and to ensure survival. Behaviours around food consumption can range from 'normal' to disordered, where some people may develop eating patterns that suggest a preoccupation with food or weight. This preoccupation can lead to inappropriate compensatory behaviours, such as purging or excessive exercise, or dysphoric mood following food consumption. This article discusses the continuum between 'normal' eating behaviours and eating disorders, with a focus on binge eating behaviour and binge eating disorder. The author also describes the use of a screening tool for identifying binge eating behaviour and suggests ways in which nurses might support patients in addressing disordered eating behaviours.

Workplace barriers and facilitators to nurses' healthy eating behaviours: a qualitative systematic review

BACKGROUND

Globally, nurses and midwives have a higher rate of being overweight/obese than the general population, influenced by workplace environments that impact dietary habits.

OBJECTIVE

This systematic review aimed to identify barriers/facilitators to healthy eating among nurses in clinical settings.

DESIGN

This systematic review followed Joanna Briggs Institute's guidelines for qualitative systematic reviews.

METHODS

Eight electronic databases: PROQUEST CENTRAL, SCIENCEDIRECT, MEDLINE, CINAHL, PsycINFO, WEB SCIENCE, PUB MED, and SCOPUS were searched. Articles were screened using JBI SUMARI®, and quality assessment was done using the JBI critical appraisal checklist. Data were extracted using the JBI data extraction tool.

RESULTS

Nine qualitative studies were reviewed, involving 488 nurses, concluding 37 distinct findings. Two synthesised findings emerged: barriers, and facilitators to healthy eating, related to organisational (shift work/long working hours), personal, physical workplace environment, and social factors.

CONCLUSIONS

The review emphasises the necessity of promoting attainable healthy eating practices at organisational, personal, environmental, and social levels within the workplace.

REGISTRATION

PROSPERO International prospective register of systematic reviews, ID: CRD42022309259.

UPDATE trial: investigating the effects of ultra-processed versus minimally processed diets following UK dietary guidance on health outcomes: a protocol for an 8-week community-based cross-over randomised controlled trial in people with overweight or obesity, followed by a 6-month behavioural intervention

INTRODUCTION

Obesity increases the risk of morbidity and mortality. A major driver has been the increased availability of ultra-processed food (UPF), now the main UK dietary energy source. The UK Eatwell Guide (EWG) provides public guidance for a healthy balanced diet but offers no UPF guidance. Whether a healthy diet can largely consist of UPFs is unclear. No study has assessed whether the health impact of adhering to dietary guidelines depends on food processing. Furthermore, our study will assess the impact of a 6-month behavioural support programme aimed at reducing UPF intake in people with overweight/obesity and high UPF intakes.

METHODS AND ANALYSIS

UPDATE is a 2×2 cross-over randomised controlled trial with a 6-month behavioural intervention. Fifty-five adults aged ≥18, with overweight/obesity (≥25 to <40 kg/m2), and ≥50% of habitual energy intake from UPFs will receive an 8-week UPF diet and an 8-week minimally processed food (MPF) diet delivered to their home, both following EWG recommendations, in a random order, with a 4-week washout period. All food/drink will be provided. Participants will then receive 6 months of behavioural support to reduce UPF intake. The primary outcome is the difference in weight change between UPF and MPF diets from baseline to week 8. Secondary outcomes include changes in diet, waist circumference, body composition, heart rate, blood pressure, cardiometabolic risk factors, appetite regulation, sleep quality, physical activity levels, physical function/strength, well-being and aspects of behaviour change/eating behaviour at 8 weeks between UPF/MPF diets, and at 6-month follow-up. Quantitative assessment of changes in brain MRI functional resting-state connectivity between UPF/MPF diets, and qualitative analysis of the behavioural intervention for feasibility and acceptability will be undertaken.

ETHICS AND DISSEMINATION

Sheffield Research Ethics Committee approved the trial (22/YH/0281). Peer-reviewed journals, conferences, PhD thesis and lay media will report results.

TRIAL REGISTRATION NUMBER

NCT05627570.

Exploration of the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare-The Shift-Diabetes Study: A qualitative study using the theoretical domains framework

AIM

To identify factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.

METHODS

Semi-structured qualitative interviews based on the theoretical domains framework (TDF) were conducted with a convenience sample (n = 15) of shift workers (32-59 years) diagnosed with T2D who worked night shifts as part of a mixed shift schedule. The TDF was applied to analyse transcripts using a combined deductive framework and inductive thematic analysis approach. Identified influences were mapped to the behaviour change technique taxonomy to identify potential strategies to change dietary behaviour in this context.

RESULTS

Key barriers to healthy dietary behaviours were access and cost of food available during night work (TDF domain: Environment Context and Resources). Factors identified as both enablers and barriers included: availability of staff facilities and time to take a break, (Environment Context and Resources), the physical impact of night work (Beliefs About Consequences), eating in response to stress or tiredness (Emotion), advance planning of meals/food and taking own food to work (Behavioural Regulation). Potential techniques to address these influences and improve dietary behaviour in this context include: meal planning templates, self-monitoring and biofeedback, and increasing accessibility and availability of healthier food choices during night shifts.

CONCLUSIONS

The dietary behaviour of shift workers with T2D is influenced by interacting individual, socio-cultural and environmental factors. Intervention should focus on environmental restructuring and strategies that enable monitoring and meal planning.

Predictors of Clinical Performance Among Emergency Nurses: A Cross-Sectional Study

Introduction

Poor nursing performance is considered a threat to patient safety, affecting the quality of care provided and ultimately impacting patient outcomes.

Objectives

The main aim of this study was to identify the predictors of nursing performance.

Methods

A cross-sectional predictive design was used. A convenient sampling technique was used to recruit 251 emergency nurses in three health sectors. They were assessed using the secondary traumatic stress scale and the nursing performance scale. Data were collected between June and August 2022.

Results

Nurses experienced severe levels of secondary traumatic stress (M = 57.9, SD = 14.94). The nursing performance level was below average (M = 27.48, SD = 9.36), and the mental performance subscale received the lowest rating (M = 5.82, SD = 2.69). There was a strong negative association between the secondary traumatic stress total score and the total score of nursing performance (r = -.77). Additionally, factors such as high body mass index, smoking, the presence of chronic diseases, working overtime, and high levels of secondary traumatic stress were identified as significant predictors of nursing performance.

Conclusion

It is recommended that emergency nurses be provided with treatment programs and interventions to reduce their secondary traumatic stress to improve their performance, thereby ensuring high-quality patient care.

Individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare: A cross-sectional survey

BACKGROUND

The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.

METHODS

A cross-sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five-point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change.

RESULTS

From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) - mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) - identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non-night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non-night and 70% night workers; 74% non-night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non-night compared to a night shift (p = 0.002).

CONCLUSIONS

Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D.

Barriers and Facilitators of Diet, Physical Activity Levels, and Sleep Among Nursing Undergraduates and Early-Career Nurses: A Qualitative Descriptive Study

PURPOSE

Mechanisms leading to burnout, associated with high turnover in nursing, may start as early as in nursing school. Given health habits (e.g., diet, physical activity, and sleep) can exacerbate or lessen the impact of burnout, this study examined current barriers and facilitators to healthy diet, physical activity levels, and sleep among nursing undergraduates (UGs) and early-career nurses (ECNs).

RESEARCH DESIGN

Qualitative descriptive study.

SAMPLE

25 nursing UGs and 25 ECNs (within 3 years of graduation) from a Southeastern college of nursing.

DATA COLLECTION AND ANALYSIS

After development of theory-informed interview guides, participants conducted interviews either in-person or by phone, which were audio-recorded and transcribed. Braun and Clarke's six-step thematic analysis was used to analyze the transcripts.

RESULTS

All but one (aged 54) UG was in their early 20s and ECNs were in their early to mid-20s. Most participants were white, females. Time and stress were the strongest barriers among UGs and ECNs for adherence to healthy diet, physical activity, although stress did act as a facilitator for physical activity in a subset of both UGs and ECNs. Shiftwork was a common barrier to healthy behaviors among ECNs.

CONCLUSION

The fact that the more common and stronger barriers to healthier behaviors among UGs and ECNs were the same give credence to the idea that processes associated with burnout begin during or before nursing education and are persistent.

Shift Work Domains and their Interactions with Empty Calorie Food/Beverage Consumption: A 14-day Intensive Longitudinal Study

BACKGROUND/OBJECTIVES

Shift work has been linked to unhealthy eating behaviors such as imbalanced diet, or increased empty calorie food/beverage consumption. However, most research has focused on the impact of shift timing. The concept of shift work is complex, and it contains several domains such as shift timing, intensity, and speed. Previous studies have suggested that greater shift intensity and quicker shift speed may contribute to adverse health effects. However, evidence regarding associations between other domains of shift work and empty calorie food/beverage consumption has been relatively lacking. Therefore, the purpose of this study was to evaluate how other shift work domains related to empty calorie food/beverage consumption and whether different shift work domains interacted to influence the intake of foods or beverages.

DESIGN

A 14-day intensive longitudinal study employing ecological momentary assessment.

SETTINGS AND PARTICIPANTS

Eighty registered nurses working in 24 accredited Taiwanese hospitals (i.e., 9 medical centers, 12 regional hospitals, and 3 district hospitals) were recruited.

METHODS

During the study period, a convenience sample of 77 participants completed 2444 momentary surveys about empty calorie food/beverage consumption on a smartphone. Three shift work domains (shift timing, intensity, and speed) were evaluated based on registry-based work schedules. To study how these shift work domains influenced empty calorie food/beverage consumption, we employed three-level mixed-effects regression models for data analyses.

RESULTS

Findings suggested that greater night shift intensity increased the likelihood of sugar-sweetened beverage intake (odds ratio = 1.64, 95% confidence interval [1.01, 2.68]). The impacts of work shift intensity and shift timing on sugar-sweetened beverage consumption varied by shift speed. Among participants assigned a schedule with either medium or rapid shift speed, higher work shift intensity was associated with a higher probability of sugar-sweetened beverage consumption. Compared to day shifts, those who were assigned a quicker shift speed on evening shifts were more likely to consume sugar-sweetened beverages. However, associations between night shift intensity and sugar-sweetened beverage intake did not change by shift speed. Furthermore, shift intensity and shift timing did not interact to affect empty calorie food/beverage consumption.

CONCLUSIONS

This study demonstrated assignments of shift schedules (i.e., high night shift intensity, more changes in shift timings) might influence workers' consumption of empty calorie foods/beverages. Therefore, identifying and mitigating hazardous shift schedules may help to improve shift workers' eating behaviors and benefit their overall health.

Enablers and barriers to healthy eating among hospital nurses: A systematic review

BACKGROUND

Nurses are the largest health professional body globally. Despite the significant role they play in healthcare, nurses exhibit poor dietary habits and have high rates of chronic diseases. Understanding the factors underlying healthy eating for nurses in the workplace is important to implement effective interventions.

OBJECTIVE

To identify enablers and barriers related to healthy eating among nurses employed in a hospital setting.

DESIGN

A systematic literature review of qualitative, quantitative, and mixed methods research (PROSPERO ID: CRD42021290913).

DATA SOURCES

A comprehensive systematic search was conducted across PubMed, CINAHL, Embase, Web of Science and ProQuest databases for papers published after January 2015.

METHODS

Two authors independently screened titles and abstracts of 4139 deduplicated studies, performed critical appraisals on eligible studies using the Mixed Methods Appraisal Tool and extracted data relevant to the research question. This review includes papers that examined nurses' eating behaviours specifically, were conducted in a hospital setting and distinguished healthy eating from other behaviours. Data synthesis was conducted through descriptive summarisation of studies and enablers and barriers were classified according to the socio-ecological model.

RESULTS

A total of 29 studies were identified with 8024 participants. 8 studies were qualitative, 18 quantitative, and 3 were mixed method design. At an environmental level, barriers were high accessibility and availability of unhealthy foods, high cost and low availability of healthy foods and lack of storage and preparation facilities, while an enabler was close proximity to healthy options. Novel organisational enablers were considered roster planning which allowed for established routines around meals, and structured workplace programs that encouraged improvement in health behaviours, while barriers were shift work, inconsistent rosters and high work demands. An interpersonal enabler was supportive networks while barriers were work culture, social norms of celebrations and gifts of food from patients. Finally, intrapersonal barriers were stress and fatigue, personal values, beliefs, attitudes, and individual characteristics, with the latter two also acting as enablers.

CONCLUSIONS

This review identifies the complexity and interconnectedness of enablers and barriers to healthy eating across four domains of the socio-ecological model. Multi-faceted strategies which address factors across several domains are recommended for healthcare organisations to facilitate healthy eating among nurses. Further research is needed to assess these strategies and understand the extent to which eating behaviours can be improved.

The Information Sharing Behaviors of Dietitians and Twitter Users in the Nutrition and COVID-19 Infodemic: Content Analysis Study of Tweets

Background

The COVID-19 pandemic has generated an infodemic, an overabundance of online and offline information. In this context, accurate information as well as misinformation and disinformation about the links between nutrition and COVID-19 have circulated on Twitter since the onset of the pandemic.

Objective

The purpose of this study was to compare tweets on nutrition in times of COVID-19 published by 2 groups, namely, a preidentified group of dietitians and a group of general users of Twitter, in terms of themes, content accuracy, use of behavior change factors, and user engagement, in order to contrast their information sharing behaviors during the pandemic.

Methods

Public English-language tweets published between December 31, 2019, and December 31, 2020, by 625 dietitians from Canada and the United States, and Twitter users were collected using hashtags and keywords related to nutrition and COVID-19. After filtration, tweets were coded against an original codebook of themes and the Theoretical Domains Framework (TDF) for identifying behavior change factors, and were compared to reliable nutritional recommendations pertaining to COVID-19. The numbers of likes, replies, and retweets per tweet were also collected to determine user engagement.

Results

In total, 2886 tweets (dietitians, n=1417; public, n=1469) were included in the analyses. Differences in frequency between groups were found in 11 out of 15 themes. Grocery (271/1417, 19.1%), and diets and dietary patterns (n=507, 34.5%) were the most frequently addressed themes by dietitians and the public, respectively. For 9 out of 14 TDF domains, there were differences in the frequency of usage between groups. "Skills" was the most used domain by both groups, although they used it in different proportions (dietitians: 612/1417, 43.2% vs public: 529/1469, 36.0%; P<.001). A higher proportion of dietitians' tweets were accurate compared with the public's tweets (532/575, 92.5% vs 250/382, 65.5%; P<.001). The results for user engagement were mixed. While engagement by likes varied between groups according to the theme, engagement by replies and retweets was similar across themes but varied according to the group.

Conclusions

Differences in tweets between groups, notably ones related to content accuracy, themes, and engagement in the form of likes, shed light on potentially useful and relevant elements to include in timely social media interventions aiming at fighting the COVID-19-related infodemic or future infodemics.

Type A Behaviour Pattern and Health Behaviour of Polish Nurses

“Coronary prone behaviour pattern” refers to a way of coping with environmental stressors, otherwise known as type A behaviour patterns. Stress, unlimited working hours, and the shift system are conducive to an “unhealthy life style”, conducted by nurses. The aim of the study was to assess the “coronary prone behaviour pattern”, taking into account health behaviour and work performed by Polish nurses. Method: This was a descriptive study conducted from June 2017 to May 2018 among nurses (N = 1080) working primary care or in training facilities in Silesia, Poland. Data were acquired through a series of questionnaires and are presented as descriptive statistics. Results: The “coronary prone behaviour pattern” (type A behaviour) was manifested by 333 (30.8%) nurses, type B by 272 (25.2%). The “coronary prone behaviour pattern” respondents showed a risk of developing a problem with alcohol (p = 0.003) less frequently compared with other respondents. In addition, nurses with the abovementioned behaviour pattern ate better (M = 16.66; SD = 6.11) compared with those with the type B behaviour pattern (M = 15.49; SD = 6.52). In terms of mental and physical wellbeing, people with type A behavioural patterns had significantly (p < 0.001) better mental and physical wellbeing and, on average, better results in coping with stress compared with other behavioural patterns of nurses. Conclusion: The occurrence of the “coronary prone behaviour pattern” was associated with the health-promoting behaviours of nurses being the subject of the analysis, i.e., better mental and physical wellbeing, better ability to cope with stress, and a lower risk of problems with alcohol and proper nutrition.

Barriers in adopting health-promoting behaviours among nurses: A qualitative systematic review and meta-synthesis

AIMS

Nursing is a highly stressful occupation where irregular shifts and working overtime lead to unhealthy behaviours. This qualitative systematic review and meta-synthesis aims to examine nurses' barriers in adopting health-promoting behaviours.

METHODS

Six electronic databases were searched from their respective inception dates to October 2021: EMBASE, Web of Science, PubMed, PsycINFO, CINAHL and ProQuest Dissertations and Theses. The Critical Appraisal Skills Program checklist was used to appraise the quality of included studies. Data synthesis followed Sandelowski's and Barroso's two-step approach.

RESULTS

Fourteen studies were included in this review, and three themes were generated as follows: (1) work environment and workplace culture, (2) nature of the job and (3) intrinsic factors.

CONCLUSION

This review synthesized available evidence on the barriers nurses experienced while adopting health-promoting behaviours. Health-care institutions should target these factors when providing facilities and services to support nurses in adopting health-promoting behaviours. Policies should focus on workplace health promotion by advocating for healthy lifestyle policies. Future research should be conducted in more multicultural and geographically diverse regions to obtain a more global view of nurses' barriers to adopt health-promoting behaviours.

Nurses' eating habits in Lebanon during the economic and health crises: a cross-sectional study

BACKGROUND

Nurses face multiple stressors that can influence their lifestyle, thus affecting their health status. Scarce are the scientific data on the nutritional status of nurses, especially during health crises. The aim of this study was to assess the impact of the COVID-19 pandemic on the eating habits of hospital nurses in the context of an exceptional economic situation in Lebanon.

METHODS

A cross-sectional study was conducted using a web-based questionnaire, targeting a non-random sampling of frontline nurses using the snowball technique. Descriptive and bivariate analyses were carried out. The population of the study included all registered nurses working in the Lebanese hospitals. A total of 533 nurses completed the questionnaire; 500 surveys were selected after excluding the ones presenting conditions that may affect their eating behavior.

RESULTS

The majority of the respondents were women (78.6%) with a mean age of 33 years [18-60] [SD,7.44 years]. Most of them (57.6%) had a crowding index ≥1. The consumption of different food groups decreased during these crises. There was a significant correlation between stress and deterioration of healthy food consumption, which provides beneficial nutrients and minimizes potentially harmful elements, especially for meat (OR 2.388, CI 1.463 to 3.898, P < 0.001). The decrease in monthly income showed a real impact on the consumption of healthy food such as meat (OR 2.181, CI 1.504 to 3.161, P < 001), fruits (OR 1.930, CI 1.289 to 2.888, P = 0.001), and milk and dairy products (OR 1.544, CI 1.039 to 2.295, P = 0.031).

CONCLUSIONS

The pandemic and in particular the economic crisis has changed the consumption of healthy food among hospital nurses in Lebanon. Similar research and support may be extended to include other frontline health care workers.

A Chronic Inflammatory Inductive Condition in the Nursing Profession: A Scoping Review

BACKGROUND

Literature focuses on the well-being of patients and little on the wellbeing of nurses who, in turn, should be educated about well-being. On the other hand, the latter often work under serious pressure with inadequate resources and shift organizations, exposing them to health risk factors.

OBJECTIVE

To highlight which relationships exist between diet, physical activity, body mass index (BMI) and mental health in nursing.

METHODS

The author searched the Medline (PubMed) database for medical subheadings terms and free full text referred to "Diet," "Mental Health," "Physical Activity," and "Nurses" before 31st December 2020.

RESULTS

A total of 11 studies were included in this perspective review, which better defined the relationships between diet, physical activity, mental health and the nursing profession.

CONCLUSION

From the studies present in the literature, it emerges that the nursing profession has an inherent imbalance in the regular circadian activity of human nature, as nursing assistance is provided 24 hours a day and during the night. Numerous studies have highlighted significant differences between mental and eating disorder levels among nurses who work at night versus those who only work during the day. Therefore, it is possible to speak of the nursing profession as an "inductive inflammatory-chronic" activity based on the extensive scientific evidence provided by the literature.

Start Healthy and Stay Healthy: A workplace health promotion intervention for new graduate nurses: A mixed-methods study

AIMS

This study explored the acceptability of a workplace health promotion intervention embedded into a transition to practice (TTP) programme to assist new graduate nurses in establishing healthy dietary and physical activity (PA) behaviours from career commencement.

DESIGN

A sequential mixed methods design.

METHODS

The Start Healthy and Stay Healthy (SH&SH) intervention, informed by the Behaviour Change Wheel, was conducted in an Australian Local Health District. It included face-to-face education sessions, the use of a fitness tracker and twice-weekly short answer messages. Participants completed three online surveys: at orientation, 6 weeks and 6 months. A sub-sample participated in semi-structured interviews to explore their experience of the intervention. Interview data were analysed thematically.

RESULTS

The intervention was delivered from February to December 2019. A total of 99 nurses completed the baseline survey, 62 at 6 weeks and 69 at 6 months. After 6 months, health knowledge increased as participants correctly identified recommended amounts of fruits, vegetables and PA. Fruit consumption increased at 6 months with little change to vegetable intake. Takeaway consumption decreased, but consumption of some discretionary foods increased. Across the three time points, there was a low engagement in PA during leisure time. The interviews identified three themes: (1) Support of Colleagues and Peers, (2) The Work Environment and (3) Engagement with SH&SH.

CONCLUSION

Providing a targeted intervention for new graduate nurses embedded into a TTP programme improved their health knowledge, some dietary behaviours, and participation in PA by some participants.

IMPACT

Ensuring a healthy nursing workforce is critical to retaining staff. Implementing a workplace health promotion intervention that targets new graduate nurses can help them adopt and maintain healthy lifestyle behaviours to support them in their future careers.

Eating and Physical Activity Patterns in Day and Night Shift EMS Clinicians

Objective: EMS clinicians work in shifts to provide 24-hour care. Shift work is linked with metabolic disease and over 70% of EMS clinicians report having overweight or obesity. Inability to store food in their vehicles combined with limited overnight dining establishments, and unpredictable job demands leads to reliance on convenience and fast foods. The objective of this study was to describe the eating and physical activity patterns among EMS clinicians on days on and off shift.Methods: EMS clinicians throughout the United States participated in a study involving four 24-hour monitoring periods. Participants wore activity monitors to measure physical activity level and remote food photography was used to collect dietary data on two work days and two days off. Repeated measures analysis of variance was conducted to compare energy and macronutrient intake and activity levels in day and night workers on and off shift.Results: We analyzed data from 39 EMS clinicians (29.7 + 8.5yrs old). Controlling for sex, those working night shifts consumed more kilocalories (p=.037) and total fat (p=.043) compared to day shift workers. Night shift workers had fewer steps (p = 0.045), more sedentary time (p = 0.053), and less moderate activity (p = 0.037) during a shift compared to day workers.Conclusion: Among EMS clinicians, night shift is associated with greater energy intake, and decreased physical activity during shifts. This may contribute to positive energy balance and weight gain overtime, increasing risk for metabolic disease.

The Health Behaviour of German Outpatient Caregivers in Relation to the COVID-19 Pandemic: A Mixed-Methods Study

The COVID-19 pandemic has affected outpatient caregivers in a particular way. While the German population becomes increasingly older, the number of people in need of care has also increased. The health and, thus, the health behaviour of employees in the outpatient care become relevant to maintain working capacity and performance in the long term. The aims of the study were (1) to examine the health behaviour and (2) to explore pandemic-related perceived change of health behaviour among outpatient caregivers during the COVID-19 pandemic. In a mixed-methods study, 15 problem-centred interviews and a web-based cross-sectional survey (N = 171) were conducted with outpatient caregivers working in Northern Germany. Interviewees reported partially poorer eating behaviour, higher coffee consumption, lower physical activity, skipping breaks more often and less sleep duration and quality during the pandemic. Some quantitative findings indicate the same tendencies. A majority of participants were smokers and reported higher stress perception due to the pandemic. Preventive behaviour, such as wearing PPE or hand hygiene, was increased among interviewees compared to the pre-pandemic period. Our findings indicate that the COVID-19 pandemic could negatively affect outpatient caregivers' health behaviour, e.g., eating/drinking behaviour and physical activity. Therefore, employers in outpatient care should develop workplace health promotion measures to support their employees in conducting more health-promoting behaviours during the COVID-19 pandemic.

The Health Behaviour of German Outpatient Caregivers in Relation to Their Working Conditions: A Qualitative Study

Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the professional group of outpatient caregivers is highly relevant. Their work is characterised not only by interacting with patients in a mobile setting but also by working in shifts. Health behaviour under these specific working conditions is crucial for ensuring long-term work ability and performance. Little is known about the health behaviour of German outpatient caregivers and its potential impact on their work. The aims of the study were (1) to examine health behavioural patterns (nutrition, exercise, smoking, regeneration) of outpatient caregivers, (2) to illuminate their personal health-promoting behaviours, and (3) to identify potential work-related factors influencing their health behaviour. Fifteen problem-centred interviews were conducted with outpatient caregivers working in Northern Germany in the period January-April 2020. Interviews were analysed by using qualitative content analysis. Outpatient caregivers reported improvable nutrition and hydration, with simultaneous high coffee consumption, low physical activity, poor regeneration (breaks and sleep quality), and good personal health-promoting behaviour (e.g., back-friendly habits), although the majority were smokers. Barriers to the implementation of health-promoting behaviours were a high perception of stress due to increased workload and time pressure, while aids to better health-promoting behaviour were described as being social support and personal resources. The respondents perceived their working conditions as potentially influencing their health behaviour. On the basis of their descriptions, various practice-relevant strategies were derived. The data explore a potential need for outpatient care services to develop interventions on behavioural and structural levels that can help create healthier working conditions for their employees so these caregivers can adopt better health behaviours.

Understanding the determinants of stress-induced eating - A qualitative study

The relationship between stress and food consumption is complex and often characterised by substantial between- and within-person variation. From a theoretical and practical perspective, more research is needed to improve our understanding of the factors that influence this relationship. The aim of this study was to identify those factors, and to derive insight into the nature of their effects on the relationship between stress and food consumption. Using semi-structured interviews, 41 adult participants (M ± SD age = 26.7 ± 6.3 yr, BMI = 22.9 ± 3.0 kg/m²) were invited to reflect on their food consumption following stressor exposure, and to elaborate on the factors that influence stress-induced eating behaviour. Reflexive thematic analyses revealed insight into the different ways in which individuals respond to stress in terms of food quantity and choices, and more significantly, highlighted a range of factors that may influence stress-induced eating behaviours. These factors included the intensity and/or nature of the stressor, aspects of prioritisation, rewarding, knowledge of and perceptions about food, normative (e.g., family, friend) influences, automated or habituated behaviours, the availability of food, and selected coping mechanisms. These findings present important directions for researchers seeking to study the variation in stress-induced eating, and may hold substantial practical value by way of informing interventions designed to alleviate unhealthy dietary responses to stress.

Associations between Daily Work Hassles and Energy-Balance Behaviors in Female African American Workers: An Ecological Momentary Assessment Study

Objective

Despite their high rate of labor force participation, African American women earn less and are overrepresented in service jobs that tend to have fewer benefits, longer work hours, and less flexibility. The aim of our study was to examine associations between work-related daily hassles and energy balance behaviors among female African American workers.

Design

A secondary analysis of a 7-day intensive longitudinal study using ecological momentary assessment (EMA).

Setting

Metropolitan area of Chicago, Illinois, United States; July 2012 through January 2013.

Participants

A convenience sample of 70 female African American workers.

Methods

EMA was used to collect information over seven days on work hassles and energy balance behaviors: empty calorie food intake; moderate-to-vigorous physical activity (MVPA); sedentary behavior; sleep duration; and sleep disturbance. Within-person associations between daily work hassles and each of these daily energy balance behaviors were analyzed using person fixed-effects regression.

Results

A total of 334 person-day observations from 70 female African American workers were included in the final analysis. Reporting at least one daily work hassle was associated with same-day higher empty calorie food intake (OR: 2.2, 95% CI: 1.0, 4.6) and more daily minutes of sedentary behavior (b: 35.8, 95% CI; .2, 71.3). However, no significant associations were found between prior-day work hassles and either food intake or sedentary behavior. Daily work hassles were not related to MVPA, sleep duration, or sleep disturbance.

Conclusions

Our study showed that daily work hassles were associated with female African American workers' empty calorie food intake and sedentary behaviors. Strategies to eliminate daily work hassles may help to improve their energy balance behaviors.

Promoting healthy eating in nurses

Across the world obesity rates in the general population have been increasing in recent years, a trend that has also been seen among nurses. Alongside the negative health effects of obesity such as type 2 diabetes mellitus and cardiovascular disease, the condition affects an individual's ability to work and results in increasing rates of absenteeism. However, the nature of nursing shift patterns and the healthcare workplace itself can influence a nurse's ability to eat healthily. This article discusses how obesity and healthy eating can affect the nursing role, as well as examining leadership and management practices that can support healthy eating in the workplace. The article is aimed at supporting nurse managers to reflect on their own lifestyle behaviour, which in turn will enable them to engage more with the topic of healthy eating among staff.

Development of a behaviour change workplace-based intervention to improve nurses' eating and physical activity

BACKGROUND

There is a critical need for an intervention to improve nurses' eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses.

METHODS

The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses' eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques.

RESULTS

Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses' beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention.

CONCLUSIONS

An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses' eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Are our nurses healthy? Cardiorespiratory fitness in a very exhausting profession

OBJECTIVES

Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results.

METHODS

Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol.

RESULTS

90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders).

CONCLUSIONS

It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Factors That Influence Health-Promoting Self-care in Registered Nurses: Barriers and Facilitators

Nurses are instrumental in the battle against lifestyle-related diseases, yet nurses may not be participating in their own health-promoting self-care. This study used qualitative content analysis of survey responses to explore nurses' perceptions regarding barriers and facilitators to health-promoting behaviors such as exercise, healthy eating, and participation in stress reduction activities. Seven themes emerged: lack of time/overwork, lack of resources/facilities, fatigue, outside commitments, "unhealthy" food culture, supportive versus unsupportive individuals, and positive versus negative role models. Institutional, interpersonal, and intrapersonal changes are needed to adequately address barriers to nurses' participation in health-promoting behaviors.

Promoting and supporting healthy eating among nurses

Maintaining a healthy diet is important for health and longevity. Many diets are recommended for their health-promotion properties. Despite their role in providing health education to patients, nurses do not always maintain healthy diets themselves. The literature shows that a significant number of nurses are overweight or obese. This article reviews the recommended healthy eating guidance and explores why nurses may not always eat healthily. It appears that several characteristics of the nursing role and workplace - notably shift work, fatigue, stress, and suboptimal facilities and availability of healthy foods - make it increasingly challenging for nurses to maintain healthy diets. The article also discusses strategies employers can use to adapt the work environment to support healthy eating.

Analysis of Selected Body Composition Parameters and Ergonomic Safety among Professionally Active Nurses in Poland: A Preliminary Prospective Monocentric and Observational Study

Nurses consist of an occupational group that is particularly exposed to harmful work-related factors such as prolonged working hours, severe stress, fatigue, and excessive strain on the musculoskeletal system. According to nurses, the limitation of the application of ergonomic principles of work may contribute to the occurrence of numerous dangerous behaviors, improper eating habits, or deficiency of systematic physical activity. The most common consequences are nutritional disorders and musculoskeletal system dysfunctions. This prospective observational study was aimed at evaluating selected parameters of the body composition of professionally active nurses and at determining work-related risks during nursing activities. The study group consisted of 37 active nurses (38.38 ± 11.33 years). The research tool was a device for bioelectrical impedance analysis (BIA). A questionnaire designed by the authors was also implemented, which covered ergonomic principles, musculoskeletal injuries, and nutritional habits. In the present study, it was shown that all average values of the tested nurses' body composition parameters were within the normal range. The majority of respondents (97.3%) reached a high level of body water. A statistically significant correlation was found between the knowledge of the workplace ergonomic principles and body mass index. In conclusion, musculoskeletal pain and lack of implementation of ergonomic behaviors are a significant problem among nurses, which may be the cause of overweight or obesity in this occupational group.

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.

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.

Factors perceived to influence healthy eating: a systematic review and meta-ethnographic synthesis of the literature

Context

Dietary risks are leading contributors to global morbidity and mortality and disproportionately burden individuals of lower socioeconomic positions.

Objective

The aim of this review is to understand, holistically, what factors are perceived to influence healthy eating and to determine whether perceived factors differ when comparing the general population with lower socioeconomic subgroups.

Data Sources

Four academic databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library) and 3 gray literature databases were searched systematically, along with reference lists.

Study Selection

Studies were included if they were qualitative and were conducted with community-dwelling adults in high-income countries and if they focused specifically on healthy eating. Eligibility was determined through author consensus.

Data Extraction

Thirty-nine eligible studies (of 11 641 records screened) were identified. Study characteristics were extracted using a standard template, and quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted using meta-ethnography, with themes categorized according to the socioecological model.

Results

Factors across the individual, social, lived, and food environments were perceived to influence healthy eating. Meta-ethnography revealed that multiple environmental and social factors were frequently reported as barriers to healthy eating. While factors were largely generalizable, diet affordability and the lower availability of stores offering healthy food appeared to be more salient barriers for lower socioeconomic groups.

Conclusions

Actions to improve population diets should mitigate the barriers to healthy eating to create environments that support healthy eating across the socioeconomic gradient. Systematic Review Registration: PROSPERO registration number CRD42017065243.