Lifestyle practices and the health promoting environment of hospital nurses

The effects of nurses' perceived stress and life satisfaction on their emotional eating behaviors

PURPOSE

To examine the effects of the nurses' perceived stress and life satisfaction on their emotional eating behaviors.

DESIGN AND METHODS

A cross-sectional study was conducted among a random sample of 297 nurses in a research hospital.

FINDINGS

There is a negative correlation between nurses' emotional eating and life satisfaction (β = -0.192, p < 0.001), and a positive correlation between emotional eating and perceived stress (β = 0.392, p < 0.001). Perceived stress, life satisfaction, and marital status constituted 24% of the factors affecting emotional eating behaviors.

PRACTICE IMPLICATIONS

Psychiatric nurses would benefit from developing effective training programs that support nurses in making healthy lifestyle choices.

Sleep quality and associated factors among nurses working at comprehensive specialized hospitals in Northwest, Ethiopia

BACKGROUND

Poor sleep quality is common among nurses. This problem possibly results in negative emotional and psychological consequences in nurses which secondary affect their work performances. However, in Ethiopia, there is a paucity of information about poor sleep quality and associated factors among nurses. This study aimed to assess the prevalence of poor sleep quality and associated factors among nurses working at comprehensive specialized hospitals in Northwest Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 542 nurses who worked at University of Gondar (UOG), Tibebe Ghion, Felege Hiwot Comprehensive Specialized Hospitals, Ethiopia, who were incorporated into the study through a simple random sampling technique from 1 May to 2 June 2021. The Pittsburgh sleep quality index (PSQI) with a cut score of above 5 was used to assess sleep quality using a structured self-administered questionnaire. Other tools used are Depression Anxiety Stress Scales (DASS-21), Shift Work sleep disorders (SWSD), and Oslo-3 social support scales. Epi-Data version 3.1 was used for data entry and SPSS version 25 was used for data analysis. A multivariable logistic regression analysis was performed to identify variables that have a significant association with poor sleep quality among nurse professionals. The degree of association was assessed using an odds ratio (OR) with a 95% confidence interval (CI) at a two-tailed p-value of <0.05.

RESULTS

A total of 510 nurses were included in the study with a response rate of 94%. The study showed that the overall prevalence of poor sleep quality among nurses was 75.5% (95% CI (71.8, 79.1). Being female (AOR = 1.72:95% CI = 1.19, 2.28), depressive symptoms (AOR = 2.24:95% CI = 1.24, 3.85), anxiety symptoms (AOR = 2.12: 95% CI = 1.23, 3.62), stress (AOR = 2.85: 95% CI = 1.67, 4.82) and current alcohol drinking (AOR = 1.84 :95% CI = 1.27, 3.13) were significantly associated with poor sleep quality.

CONCLUSION

The overall prevalence of poor sleep quality among nurses was high. Being female, depressive symptoms, anxiety symptoms, stress, and current alcohol drinking had been significantly associated with poor sleep quality. Therefore, it is essential to institute effective intervention strategies emphasizing contributing factors to poor sleep quality.

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.

Sleep disturbances among Chinese clinical nurses in general hospitals and its influencing factors

BACKGROUND

This study aimed to determine the prevalence of sleep disturbances among clinical nurses in general hospitals in Mainland China, and identify its associate factors.

METHODS

Using a cross-sectional design, a total of 5012 clinical nurses selected by random cluster sampling completed the survey on the Pittsburgh Sleep Quality Index (PSQI), measures of quality of life indexed by the Medical Outcomes Study 12-item Short-Form Health Survey, occupational stress evaluated by the Job Content Questionnaire, lifestyle and sociodemographic details.

RESULTS

The average PSQI score of 4951 subjects was 7.32 ± 3.24, including 3163 subjects with PSQI ≥5, accounting for 63.9%. Multivariate Logistic regression analysis showed that the risk factors for sleep disturbances in nurses were female gender, the Emergency department and ICU, many years of service, high night shift frequency, professional status: primary and intermediate, employment status: temporary, poor quality of life: poor mental health, low perceived health, high occupational stress (high psychological demand, low job control and low workplace social support).

CONCLUSIONS

Sleep disturbances are highly prevalent among clinical nurses in general hospitals in Mainland China. Many of the factors listed above were associated with the prevalence of sleep disturbances in nurses, and occupational stress plays an important role in the development of sleep disturbances in Chinese clinical nurses.

An international review of tobacco smoking research in the nursing profession, 1976-2006

Tobacco smoking represents a contentious issue in the nursing profession, and one that has now become an important topic in nursing research. Despite this fact, the epidemiological quality of research varies widely, and it has been difficult to accurately determine the true incidence of smoking among nurses. Given these inconsistencies, we conducted a state-of-the-art review to identify international trends in tobacco usage among nurses, to ascertain how the epidemiological quality of research has improved over the past 30 years, and also to elucidate the directions in which nursing research has evolved. A total of 73 English-language studies that met the inclusion criteria were located and analysed. Overall, our review suggests that, while tobacco smoking among nurses appears to be decreasing in many countries during recent years, the international trend is far from uniform, and some developed nations still report high smoking rates among their nursing staff. From a methodological perspective, the relative epidemiological quality of smoking research has also fluctuated over time, making it difficult to compare the results of one study to the next. Despite these caveats, tobacco smoking remains a key topic in nursing research, as well as a critically important occupational-health issue for the entire nursing profession. In order to make the next generation of tobacco research data as comparable as possible, future scholars should consider devising and implementing a standardised format for conducting international tobacco smoking research within the nursing profession.

Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study

Recent epidemiological data suggests 13.3% of Hong Kong residents suffered from Common Mental Disorders, most frequently mixed anxiety and depressive disorder. This study examines the weighted prevalence and associated risk factors of depression, anxiety and stress among Hong Kong nurses. A total of 850 nurses were invited to participate in this cross-sectional study. Participants completed the Depression, Anxiety and Stress Scale 21 and multiple logistic regression was used to determine significant relationships between variables. Chronic past-year illness and poor self-perceived mental health were significant correlates of past-week depression, anxiety and stress. It confirmed further positive correlations between depression and divorce, widowhood and separation, job dissatisfaction, disturbance with colleagues, low physical activity levels and sleep problems. Marital status; general medicine; sleep problems, and a lack of leisure significantly correlated with anxiety. Stress was significantly associated with younger age, clinical inexperience, past-year disturbance with colleagues, low physical activity, no leisure and drinking alcohol. Nurses were more depressed, anxious and stressed than the local general population, with over one-third of our respondents classified as subject to these disorders.

Factors and symptoms associated with work stress and health-promoting lifestyles among hospital staff: a pilot study in Taiwan

BACKGROUND

Healthcare workers including physicians, nurses, medical technicians and administrative staff experience high levels of occupational stress as a result of heavy workloads, extended working hours and time-related pressure. The aims of this study were to investigate factors associated with work stress among hospital staff members and to evaluate their health-promoting lifestyle behaviors.

METHODS

We conducted a cross-sectional study from May 1, 2010 to July 30, 2010 and recruited 775 professional staff from two regional hospitals in Taiwan using purposive sampling. Demographic data and self-reported symptoms related to work-related stress were collected. Each subject completed the Chinese versions of the Job Content Questionnaire (C-JCQ) and The Health-Promoting Lifestyle Profile (HPLSP). Linear and binary regression analyses were applied to identify associations between these two measurements and subjects' characteristics, and associations between the two measurements and stress symptoms.

RESULTS

Self-reported symptoms of work-related stress included 64.4% of subjects reporting nervousness, 33.7% nightmares, 44.1% irritability, 40.8% headaches, 35.0% insomnia, and 41.4% gastrointestinal upset. C-JCQ scores for psychological demands of the job and discretion to utilize skills had a positive correlation with stress-related symptoms; however, the C-JCQ scores for decision-making authority and social support correlated negatively with stress-related symptoms except for nightmares and irritability. All items on the HPLSP correlated negatively with stress-related symptoms except for irritability, indicating an association between subjects' symptoms and a poor quality of health-promoting lifestyle behaviors.

CONCLUSIONS

We found that high demands, little decision-making authority, and low levels of social support were associated with the development of stress-related symptoms. The results also suggested that better performance on or a higher frequency of health-promoting life-style behaviors might reduce the chances of hospital staff developing stress-related symptoms. Our report may contribute to the development of educational programs designed to encourage members of high stress groups among the hospital staff to increase their health-promoting behaviors.

Physical activity and mental well-being in student nurses

There is strong evidence that suggests physical activity can enhance mental well-being. However, this relationship has not been widely investigated in student nurses. A cross-sectional study was conducted to examine the relationship between physical activity and mental well-being in undergraduate student nurses (n=215). Physical activity was measured using the International Physical Activity Questionnaire. Other outcomes included self-esteem, anxiety, depression, life satisfaction, outcome expectations and self-efficacy. Almost, a quarter (23.8%) of the total sample, were meeting the Department of Health's physical activity guideline. Mean body mass index (BMI) was 25.0 with 40% being in the overweight to morbidly obese category. Self-esteem was significantly positively correlated with total physical activity (r=0.16, p=0.038) and moderate intensity activity (r=0.17, p=0.021). No other significant relationships were found between anxiety, depression and satisfaction with life and physical activity. Outcome expectations for exercise and self-efficacy were significantly positively correlated with moderate (r=0.17, p=0.019) and vigorous (r=0.28, p=0.000) intensity activity and total physical activity (r=0.29, p=0.000). BMI was significantly positively correlated with age (r=0.242, p=0.001), significantly negatively correlated with self-efficacy for exercise (r=0.257, p=0.000) and satisfaction with life (r=-0.144, p=0.041). Regression analysis showed that low self efficacy for exercise and increasing age were significant predictors of BMI with a small effect size r(2)=0.126, adjusted r(2)=0.112. BMI and physical activity variables collectively explained only 2% of the variance for anxiety, 4% for depression, 5% for self esteem and 6% for satisfaction with life. BMI was a significant predictor of satisfaction with life (Beta=-0.171, p=0.027). Participation in physical activity may be influential in improving mental well-being in student nurses. Promoting physical activity in student nurses has the potential to increase self-esteem and life satisfaction and decrease the risk of anxiety and depression. Further research is needed to establish whether this relationship is causal and exists in other student nurse populations.

Nursing students' attitudes to health promotion to: implications for teaching practice

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.

‘Do as I say, but not as I do’: Are next generation nurses role models for health?

Aim: Promoting healthy lifestyles plays a key role in professional nursing yet nurses do not always practice what they preach. Efforts are currently being made to improve the health of NHS staff, yet little is known about the health and lifestyle behaviours of pre-registration nurses in the UK although these individuals are our next generation of NHS employees. The aim of this study was to investigate the health behaviours and wellbeing of pre-registration nurses based at an acute NHS teaching hospital in England.

Methods: In this cross-sectional questionnaire survey, 325 pre-registration nurses (50% response rate) completed a health and lifestyle questionnaire, measuring levels of physical activity, smoking and alcohol behaviour, dietary practices and general health.

Results: Age ranged from 19-53 years, and 96% of the sample was female. More than half of the sample did not meet public health recommendations for physical activity. Just under one-fifth were current smokers and over three-quarters did not consume five servings of fruit/vegetables per day. Two-thirds reported exceeding the recommended maximum daily alcohol intake and around one third were classified as either overweight or obese. Those who were physically inactive were less likely to report good general health, good dietary practices and more sleep, and were more likely to report cigarette smoking and alcohol consumption than their active counterparts.

Conclusions: This study indicates that the health profile of pre-registration nurses is relatively poor, and that those who are sedentary engage in other negative lifestyle behaviours also. Despite significant education relating to health promotion and health behaviours of patients being targeted at pre-registered nurses, it seems that this knowledge is not always transferred to their own behaviour. There is a need for timely intervention to establish healthy lifestyle behaviours amongst nurses early in their career.

How healthy are our nurses? New and registered nurses compared

This study examined the health behaviour of nursing staff, comparing registered and pre-registered nurses in terms of their self-reported health and lifestyle behaviour. In total, 325 pre-registered nurses and 551 registered nurses, based at the same university teaching hospital and located within an acute NHS trust, completed a self-administered health and lifestyle questionnaire survey. With the exception of smoking behaviour, registered nurses generally had a healthier lifestyle compared with pre-registered nurses. However, when examining the overall health profile of the sample, the study reveals that there is room for improvement in the health and lifestyle behaviour exhibited by both registered and pre-registered nurses. Almost half of the sample failed to meet public health recommendations for levels of physical activity, almost two-thirds did not consume five portions of fruit or vegetables daily and almost half ate foods that were high in fat and sugar content on a daily basis. These findings are alarming given the current government emphasis on the health of NHS staff and the important role that nurses play in influencing lifestyle choices among their patients. There is an urgent need to target education and support services to improve the diet and exercise habits of nursing professionals.

Smoking habits of students of nursing: a questionnaire survey (2004-2006)

AIM

To determine changes in the prevalence of tobacco use among students of nursing and associated factors.

BACKGROUND

The prevalence and distribution of smokers among nursing students varies according to the country and period of study.

METHOD

Transversal descriptive study by self-answered questionnaire. Eight hundred and fifty four subjects (94.9%) were questioned in the period 2004-2006.

FINDINGS

Twenty eight percent of the students declared themselves to be smokers. The habit began before the students started university. The tendency of prevalence by year of survey and by graduation year was downward. The students shown a low nicotine dependency according to Fagerström and little motivation to give up. The average age at the onset of consumption was 14.6 (1.8) years. From the logistical regression analysis, the model best explaining the prevalence of tobacco consumption included the variable of year surveyed and academic background, those coming from the baccalaureate showing a lesser prevalence and tendency to smoke.

CONCLUSIONS

Tobacco consumption among students of health sciences was less than in the general population of the same age but high given their future profession. The tendency to smoke is decreasing and most started smoking before joining the university. We recommend an intensification of actions directed at teenagers and the promotion of anti-tobacco campaigns in universities.

The association between shift duty and abnormal eating behavior among nurses working in a major hospital: a cross-sectional study

BACKGROUND

Shift work induces stress, disturbs family life and interrupts regular meal schedules. Few studies have addressed the association between shift duties and abnormal eating behavior among hospital nurses.

OBJECTIVES AND DESIGN

We tested the hypothesis that shift duties were independent predictors of abnormal eating. Self-administered surveys consisting of socio-demographic data, working pattern, Perceived Organizational Support (POS) questionnaire and the patterns of eating style identified by the Dutch Eating Behavior Questionnaires (DEBQ) were used.

SETTINGS

One major acute hospital in one Territory of Hong Kong.

PARTICIPANTS

All 662 nurses who worked on a full-time basis in this hospital were invited to join the study and among them, 378 completed surveys were collected with a response rate of 57.1%. The average age was 37.2 years, and 91.5% were female. 67.3 were registered nurses, 17.9% enrolled nurses; and 14.5% were ranked nursing officers or above. 39.1% worked in acute settings (medical wards, intensive care units and emergency departments), and 62.1% of respondents had at least 11 years of clinical experience and 76.2% of respondents had shift duties with 81.9% having at least four shift duties per month. Only 66.7% of respondents had normal body mass index (BMI 18.5-22.9 kg/m2).

METHODS

Three binary logistic regression analyses were conducted with abnormal emotional, external and restraint DEBQ as outcome variables, respectively. We controlled for age, gender, marital status, work setting (acute vs. non-acute), years of clinical experience, the frequency of shift duties, body mass index, perception of body weight changes in the past 6 months, self-perception of recent overeating and POS.

RESULTS

The proportions of participants having abnormal emotional, external and restraint DEBQ scores were 66.4%, 61.4% and 64.0%, respectively. From multiple regression analysis, nurses having 4 or more shift duties per month were more likely to present with abnormal emotional (adjusted odds ratio aOR 2.91, 95% C.I. 1.57-5.42, p=0.001) and restraint (aOR 3.35, 95% C.I. 1.76-6.38, p<0.001) DEBS scores.

CONCLUSIONS

Shift duties were positively associated with abnormal eating behavior among nurses working in hospitals. More health promotional initiatives should be targeted towards hospital nurses whose duties require frequent night shifts to enhance healthy eating.

Correlation of the health-promoting lifestyle, enrollment level, and academic performance of College of Nursing students in Kuwait

This descriptive study of 224 nursing students assessed their health-promoting lifestyle profile and correlated it with the levels of enrollment in nursing courses and academic performance. The health-promoting lifestyle profile was measured by Walker's Health-promoting Lifestyle Profile II instrument. Academic performance was measured by assessing the nursing grade point average and general grade point average of the students. The students had positive health-promoting lifestyles with significant differences noted between males and females in the overall profile, physical activity, interpersonal relations, and stress management. Sociodemographic variables, such as age, nationality, and marital status, but not income, showed an association with students' health-promoting lifestyles. A significant correlation was noted between students' nursing enrollment and level of health responsibility. No significant correlation was established between a health-promoting lifestyle and academic performance. This study poses a challenge for nurse educators to provide an effective environment to maximize students' potential to be future vanguards of health.

Tobacco smoking habits among a complete cross-section of Australian nursing students

This study was undertaken as a complete cross-sectional survey of tobacco smoking habits among 270 undergraduate students at an Australian nursing school (response rate: 84.6%). An anonymous, self-reporting questionnaire survey was used to gather the data. The overall prevalence of current smoking was 15.9%, with a further 8.5% being ex-smokers. The nursing students consumed an average of 11.5 cigarettes per day, they began smoking at 20.8 years of age, and had an average smoking duration of 7.2 years. The students who had previously worked as a nurse were twice as likely to be current smokers. This study suggests that although tobacco smoking remains fairly common among Australian nursing students, its prevalence and distribution vary according to the individual demographics of the group under study. Future researchers will need to consider the changing demographic base from which the new generation of nursing students are drawn.

Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses

AIM

This paper reports on the non-participant observational findings from a study, which examined hospital-based nurses' health promoting nursing practice in an acute setting.

BACKGROUND

Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital-based nurse in health promotion has been slow and is not well-understood.

METHOD

The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non-participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one-to-one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed.

RESULTS

Two categories were identified 'health promotion strategies and content' and 'patient participation'. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was 'preparatory information'. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion.

CONCLUSIONS

Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted.

RELEVANCE TO CLINICAL PRACTICE

Nursing programmes must highlight health promotion as integral to practice and emphasis the socio-political dimensions of health promotion.

Use of factor analysis in Journal of Advanced Nursing: literature review

AIM

This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing.

BACKGROUND

Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable.

METHOD

Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study.

RESULTS

One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used.

CONCLUSIONS

Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.

A systematic review of tobacco smoking among nursing students

This study was conducted to systematically and critically evaluate the large number of academic publications which have investigated tobacco smoking among nursing students in recent years. It was performed as a state-of-the-art examination of all modern literature published in peer-reviewed, English-language journals since 1990. Although smoking appears to be fairly common among nursing students, its prevalence and distribution varies widely depending on the country of study and time period during which the research was undertaken. Although there is some evidence to suggest that smoking rates increase by year of study in the nursing course, not all research has shown a clear association in this regard. Similarly, the value of anti-smoking interventions for nursing students appears to be limited, based on currently available information. Given these conflicting issues, further research which helps to ascertain why student nurses do not wish to give up their habit is clearly needed both locally and internationally. The development of an international smoking questionnaire may also be useful to help standardize future research on tobacco usage among this vulnerable demographic.

Smoking among Greek nurses and their readiness to quit

AIM AND RATIONALE: The preventable nature of smoking-associated diseases places a responsibility on health professionals for smoking-related health promotion. This paper disseminates information from a survey of qualified Greek nurses, comparing smoking attitudes, influences on smoking behaviours and desire to quit with their motivation to act as health promoters with patients and other health professionals who smoke.

METHOD AND SAMPLE

A random sample (n=402) of qualified nurses employed by hospitals in Athens was surveyed with a self-administered questionnaire in a cross-sectional survey which had a 73% response rate. Following quality control measures, a final sample of 308 was achieved.

RESULTS

Results showed that almost half of the nurses in the sample were current smokers, almost a quarter were former smokers, with just less than a third non-smokers. Using the Stages of Change model as a measure, the survey reported that 11% of the smokers in the sample expressed a desire to stop within the next month, another 12% in the coming 6 months and 23% of current smokers were still in the pre-contemplation stage. The main reasons given for continuing to smoke included using tobacco for enjoyment and as a coping mechanism for stress. Organizational problems were identified as the main source of stress. Finally, the majority of respondents confirmed the important part that they can play as role models in promoting health behaviours in their patients.

CONCLUSIONS

Findings suggest that smoking prevalence among qualified Greek nurses is greater than that reported in the general Greek population. Implications and recommendations for nursing practice, education and research include the early provision of smoking education in nurse training. Interventions should be directed at nurses who smoke to assist them to stop and to maintain cessation according to their stages of change.

Self-rated health, work characteristics and health related behaviours among nurses in Greece: a cross sectional study

Background

Previous studies on self-rated health among nurses have indicated an association of low job satisfaction and stress in relation to poor self-rated health. The relationship between self rated health and the specific work characteristics and health related behaviours of nurses to our knowledge have not been adequately studied.

Objective

To investigate the health profile of nurses working in hospitals in North West Greece and to examine the associations between self rated health (SRH) and health related behaviours and work characteristics in this group of hospital employees.

Methods

A self-administered questionnaire was distributed to a random sample of 443 nurses working in all the hospitals in North West Greece. Regression analysis was used to examine the relationship of health related behaviours and work characteristics with self rated health among the nurses.

Results

A total of 353 responded to the questionnaire (response rate 80%) of which 311 (88%) were female and 42 (12%) male. The mean age (standard deviation) of the respondents was 36 years (5.6) and their mean years of working as nurses were 13.5 years (5.9). Almost half of the nurses' smoked, and about one third were overweight or obese. About 58% (206) of the nurses reported having poor health while 42% (147) reported having good health. Self-rated health was independently associated with gender, effort to avoid fatty foods and physical activity, according to multiple logistic regression analysis.

Conclusion

The population studied presented a relatively poor health profile, and a high proportion of poor SRH. Though female gender and effort to avoid fatty foods were associated with poor SRH, and exercise and white meat consumption with good SRH, specific work characteristics were not associated with SRH.

Accident and Emergency nurses' attitudes towards health promotion

AIM

This paper presents a study exploring Accident and Emergency nurses' attitudes towards health promotion.

BACKGROUND

Much has been written about nurses and health promotion. Research has focused mainly on community nurses, less on nurses working in acute hospital settings, and apparently not at all on those working in Accident and Emergency units.

METHODS

Q methodology, a technique for extracting subjective opinions, was used. Eleven nurses working in Accident and Emergency departments completed 33-item Q-sorts and wrote personal definitions of health promotion. Based on published literature in the field, the Q sample was structured with reference to nurses' attitudes as they related to health promotion. Factor analysis was performed on the data, and the resulting factors were interpreted. The data were collected in 2003.

RESULTS

Three alternative constructions emerged from the data, representing three alternate views about health promotion. The most widely held opinion (representing nine of the 11 nurses) was a positive view of health promotion and the nurses' role in health promotion in Accident and Emergency environments.

CONCLUSIONS

It is not possible to generalize the findings of this study due to the small number of participants. However, their knowledge of, and commitment to, health promotion is encouraging. Recommendations for practice are that there is continued and increased post-registration education in health promotion for nurses and continuing exploration of the hospital nurses' health promotion role. Further research is needed to explore nurses' perceptions of barriers to effective health promotion and nurses' health promotion activities in Accident and Emergency environments.

Nurses, smoking, and the workplace

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.

Short-Term Effects of a Health Promotion Course for Taiwanese Nursing Students

The purposes of this study were to (a) develop a teaching course on health promotion for nursing students in Taiwan, (b) evaluate the effects of this teaching course, and (c) understand students' appraisals of its effectiveness in helping them to change unhealthy behavior. A sample of 65 randomly selected female nursing students took an 18-week course developed by the investigators, which included 30 h of classroom lectures and 4 weeks of written reports by students chronicling the changes in their behavior. Health promotion questionnaires administered before and after the course and content analysis of the students' reports were used to evaluate the effects of the course. Students' questionnaire scores after course completion indicated significantly increased intent to adopt healthy lifestyles. Content analysis of students' reports on their personal behavior-changing experiences showed that they accepted the potential value of curriculum aspects such as experiencing the struggle, suffering, and even abandonment of the process, experiencing the benefits of change, increasing self-confidence, and empathizing with how difficult it is for clients to change behavior. These results support the value of teaching courses on health promotion to nursing students. The authors recommend including such a course as part of a regular nursing education.

The Health Styles of Nurse Practitioners

PURPOSE

To examine the formal and informal health care beliefs, behaviors, and practices of nurse practitioners (NPs).

DATA SOURCES

A self-administered questionnaire with a primarily closed-ended format was distributed over a 3-day period to a convenience sample of 321 NPs attending a national NP conference.

CONCLUSIONS

The overall health status and health practices of NPs were found to be fairly good, but there was room for improvement, particularly with regard to nutrition, health responsibility, physical activity, and stress management.

IMPLICATIONS FOR PRACTICE

Respondents were more likely to self-diagnose and self-treat minor illnesses and largely received their primary health care from physicians. The majority of NPs indicated a willingness to receive health care from an NP; however, the nonavailability of NPs restricted this option.

Health-related beliefs and behaviours of health visitors in Scotland

There is some evidence that health professionals' performance of health promotion activities is strongly influenced by their own health beliefs and health-related behaviours. In the light of the current trend in health policies in Scotland and elsewhere towards a health promotion focus, this study sought to gain a description of, and to identify an association between, health beliefs and health-related behaviours among a sample of Scottish health visitors. A questionnaire was sent to randomly selected health visitors in a large Scottish city. Respondents reported behaviours they believed to be important to health, e.g. not driving under the influence of alcohol, dental care and smoking. While the health visitors' own performance of some health-related behaviours, such as smoking, was associated with their health beliefs, others such as drinking coffee, were not. Health visitors could be advised to reconsider some of their health beliefs, in particular those related to areas where the government has focused its attention.

Workplace stress in nursing: a literature review

BACKGROUND

Stress perception is highly subjective, and so the complexity of nursing practice may result in variation between nurses in their identification of sources of stress, especially when the workplace and roles of nurses are changing, as is currently occurring in the United Kingdom health service. This could have implications for measures being introduced to address problems of stress in nursing.

AIMS

To identify nurses' perceptions of workplace stress, consider the potential effectiveness of initiatives to reduce distress, and identify directions for future research.

METHOD

A literature search from January 1985 to April 2003 was conducted using the key words nursing, stress, distress, stress management, job satisfaction, staff turnover and coping to identify research on sources of stress in adult and child care nursing. Recent (post-1997) United Kingdom Department of Health documents and literature about the views of practitioners was also consulted.

FINDINGS

Workload, leadership/management style, professional conflict and emotional cost of caring have been the main sources of distress for nurses for many years, but there is disagreement as to the magnitude of their impact. Lack of reward and shiftworking may also now be displacing some of the other issues in order of ranking. Organizational interventions are targeted at most but not all of these sources, and their effectiveness is likely to be limited, at least in the short to medium term. Individuals must be supported better, but this is hindered by lack of understanding of how sources of stress vary between different practice areas, lack of predictive power of assessment tools, and a lack of understanding of how personal and workplace factors interact.

CONCLUSIONS

Stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues. Achieving this will require further comparative studies, and new tools to evaluate the intensity of individual distress.

International efforts in tobacco control

OBJECTIVES

To review international nursing involvement in tobacco control and discuss opportunities and challenges to enhance nurses' participation in decreasing tobacco-related morbidity and mortality.

DATA SOURCES

Published literature and published and unpublished material developed by nurses in their tobacco control initiatives.

CONCLUSION

Worldwide, nurses have been involved in tobacco control. However, many opportunities remain for involvement in the areas of education, research, and practice.

IMPLICATIONS FOR NURSING PRACTICE

There are numerous opportunities for nurses throughout the world to enhance their involvement in tobacco control.

Health promotion and tobacco control: student nurses' perspectives

This article reports findings about student nurses' understanding of the nursing role in health promotion related to tobacco issues. These findings were derived from the data of a larger project, examining smoking practices of baccalaureate nursing students in Manitoba, Canada. The study was conducted with second-year, third-year, and fourth-year university nursing students studying at several sites throughout the province (N = 272). From the data analysis of the interviews, class forums, and open-ended survey questions, five themes emerged (i.e., who they are-who they are becoming, central beliefs and attitudes, learning the facts, practice world-limited options, role conflict). Students expressed considerable uncertainty and conflict concerning individual autonomy around decisions about tobacco use. This resulted in confusion about themselves as role models and their use of health promotion interventions.

Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours

AIM

To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.

RATIONALE

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role.

METHODS

A cross-sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self-administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale.

FINDINGS

Two hundred and seventy-two students (61.9%) responded. Sixty (22.1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91.4% said they wanted to quit, few were actively engaged in the quitting process (16.9%). When comparing the beliefs and attitudes of smoking and non-smoking students, proportionally more of the non-smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non-smoking example. Non-smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management.

CONCLUSIONS

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.

Nursing staff anxiety versus smoking habits

The aim of this study was to assess smoking habits versus anxiety levels of 114 female nurses. The Spielberger State-Trait Anxiety Inventory Scale (STAI, Questions 21-40) was used. Current smokers (n=52) had the highest levels of anxiety (STAI score: mean+/-SD, 43.04+/-8.48) compared to non-smokers (n=30), and ex-smokers (n=32) (38.94+/-6.45 and 36.56+/-6.62, respectively; P<0.02). Differences in STAI scores were greater between non-smokers and ex-smokers (P<0.01), while the STAI scores of current smokers were positively correlated with their per day quota of cigarettes (Pearson's: +0.65; P<0.002). We concluded that even in people who are well-acquainted with the ill-effects of nicotine abuse, smoking habits persist and are correlated with levels of anxiety. Apparently the (perceived) stress-relieving effects of nicotine outweigh anxiety of nursing staff. Preventive programs, if based exclusively on information on the effects of smoking on health, seem to be ineffective. Alternatively, techniques aimed at the relief of anxiety may yield better results.

Factors related to stress and coping among Chinese nurses in Hong Kong

Few empirical studies have investigated the issues linked to Hong Kong nurses work-related health. The present study investigated factors related to stress and coping among Chinese nurses in Hong Kong. The researchers employed a cross-sectional survey and made within-group comparisons of nurses' stress and coping. Using stratified random sampling the researchers selected nurses from the mailing list of a local professional organization. One hundred and sixty-eight (33.6%) nurses responded. Nurses reported lower stress levels than other workers assessed with the same measure. Paediatric nurses reported the highest stress levels. Nurses at the lower grades reported higher stress levels than nurses at the higher grades. Single nurses had marginally higher stress scores than married nurses and females had slightly higher stress scores than males. However, none of these results were statistically significant. The respondents' major sources of stress were related to nursing issues like too much work, interpersonal relationships, and dealing with hospital administration. The respondents coped with their stresses by seeking support from friends and colleagues, using different cognitive strategies and through leisure activities. There was a statistically significant link between the respondents' stress and sickness levels. The results raise issues about the nature of nurses' working experiences.