Systematic review: What works to address obesity in nurses?

A comparative study of the effectiveness of self-management and group management on the amount of weight loss of nurses under low-calorie diet treatment: A simultaneous mixed-methods study

BACKGROUND

Nursing is a profession that is associated with a lot of stress and a risk of being overweight or obese. The purpose of this research was to determine the comparative effectiveness of self-management (self-M) and group management (group-M) on nurses who were following a diet with the aim of proposing a proper planning and a healthy lifestyle for them.

MATERIALS AND METHODS

This study was a simultaneous mixed-methods design (interventional and qualitative). The participants were all overweight or obese nurses working in teaching hospitals at Guilan University of Medical Sciences in 2019 (n = 96). In the qualitative part, data were extracted from semi-structured interviews. For quantitative data analysis, relevant statistical methods such as Kolmogorov-Smirnov test, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used. For qualitative data analysis, the conventional content analysis approach was used and Lincoln and Guba's criteria were applied to ensure the accuracy of the data.

RESULTS

In both quantitative and qualitative sections, the results showed that following a diet treatment with group-M is more effective than self-M.

CONCLUSION

The results showed that a healthy lifestyle can be achieved for nurses if they participate in training classes and group programs, which are proven to be effective based on this article and some other studies. Also, since weight gain and obesity, as one of the most important problems of health systems, continue to increase and can impose a heavy economic and social burden on human societies, various general policies should be used and these solutions can range from home to society to prevent and control them.

Nurse-led lifestyle counseling in Polish primary care: the effect of current health status and perceived barriers

Introduction

Our study included counseling on diet and physical activity, smoking, e-cigarette use, and alcohol consumption. The aim was to examine the correlates of counseling provided by primary care nurses with the health status/health behaviors of nurses and the barriers in the advice provided.

Materials and methods

In 2022, we conducted a cross-sectional survey among 331 nurses employed in the primary care sector in Lodz. The questionnaire consisted of three sections: characteristics of the patient population receiving treatment and provided with healthy lifestyle counseling by nurses, barriers to the process of assessing, controlling, and guiding patients, and health status/health behaviors of nurses.

Results

Eighty percent of the nurses in our study provided advice on diet and physical activity to primary care patients. Over 70% of the survey participants performed minimal anti-smoking interventions forsmokers, 67.7% for alcohol drinkers, and 56.8% for e-cigarette users. The correlates of counseling in the field of diet and physical activity turned out to be the knowledge and skills, which enabled nurses to provide advice (OR = 2.57, p < 0.01). The correlates of the conducted minimal anti-smoking interventions in smoking patients were: subjective assessment of overweight and obesity in nurses, knowledge and skills in conducting counseling (OR = 1.92, p < 0.05), and measuring body weight, height and BMI (OR = 2.18, p < 0.01). Among the three most common barriers identified by the nurses in the process of assessing, monitoring, and guiding patients were the opinion that patients are not interested in improving their diet, physical activity, and weight loss (60.7%), lack of time (51.4%), as well as the belief that patients find it too difficult to change their current habits (54.1%).

Conclusion

The results of our survey indicate that nurses' participation in healthy lifestyle counseling in adult patients is unsatisfactory. Interventions in primary care should be designed considering the specific obstacles nurses may face in leading healthy lifestyles. Further training of nursing staff is required to increase their knowledge on healthy lifestyles.

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Health and Sedentary Behaviors within Polish Nurses: A Cross-Sectional Study

Health behaviors play a pivotal role in improving and strengthening health. Nurses, who constitute the vast majority of employees in the health sector, play a crucial role not only in treating disease but also in promoting and maintaining optimal health for themselves and society. The purpose of the study was to assess the level of health and sedentary behavior and the factors influencing them among nurses. A survey, cross-sectional study was conducted among 587 nurses. Standardized questionnaires evaluating health and sedentary behavior were used. The study utilized both single-factor and multifactor analyses, employing the linear regression method and Spearman correlation coefficient. The results showed that the health behaviors of the survey nurses were at an average level. Sedentary time (in hours) was an average of 5.62 h (SD = 1.77) and correlates significantly (p < 0.05) and negatively (r < 0) with health behaviors in terms of the positive mental attitude subscale; the longer the sitting time, the lower the intensity of this type of health behaviors. The efficient functioning of the healthcare system is greatly dependent on nursing staff. To improve health behaviors among nurses, systemic solutions such as workplace wellness programs, incentives for healthy behaviors, and education on the benefits of a healthy lifestyle are needed.

Self-care neglect through the voices of nurses working in primary healthcare clinics in Gauteng, South Africa

BACKGROUND

Self-care is essential, but while professional nurses often pay attention to the health of their patients, they give little heed to their own well-being. With the current pandemic continuing to negatively affect the world, the need for health professionals to make time for self-care is imperative. The concept "self-care" is not a new phenomenon; however, this study strives to show the importance of self-care practices in the world of nurses and its benefit for the nursing profession. The reality for nurses taking care of themselves will assist them in providing consistent quality care for their patients.

METHOD

A qualitative approach with a descriptive, phenomenological, contextual method was used in this study. Ten professional nurses employed within different primary healthcare clinics were selected through purposeful sampling. Through in-depth, individual interviews, the professional nurses shared their lived experiences with self-care practices while being employed within a primary healthcare clinic. The recorded interviews were transcribed verbatim and then analyzed using Colaizzi's method.

RESULTS

The findings revealed: Theme 1: Participants experienced internal and external factors that compromised self-care practices Theme 2: Holistic well-being and the quality of patient care are compromised by self-care neglect Theme 3: Participants experienced the need to take responsibility and accountability to promote self-care practices.

RECOMMENDATIONS

Specific recommendations were formulated to facilitate professional nurses' empowerment to practise self-care as a lifestyle. These specific recommendations focused on reducing the burden of caring for others to the extent that professional nurses working in primary healthcare settings have nothing left for themselves.

Nurses' Quality of Life and Healthy Behaviors

Quality of life (QoL) is closely linked to the health status of the individual. In turn, health status strongly depends on lifestyle. Health behavior, which is defined as the actions and attitudes of a person that affect their physical and mental health, is one of many lifestyle components. The nursing community, which is exposed to a range of dangers associated with the job position and responsibilities of the nursing profession, has to contend with several negative impacts. This results in a decreased quality of life among the nursing staff and reduced effectiveness in providing care services to patients.

METHODS

This study was conducted using an online Google questionnaire, which was completed by 312 nurses nationwide. The questionnaire included questions about the respondents' socio-demographic survey and included the Health Behavior Inventory (HBI) by Juczyński and the WHOQoL-BREF questionnaire.

RESULTS

The mean QoL reported by respondents was 3.65 points (SD = 0.67), meaning that QoL ranked between good and average results. The respondents' mean rating of their own health was 3.58 points (SD = 0.79), indicating that they rated their health status between satisfactory and average. Low health-behavior prevalence was reported by 139 of the 312 survey participants (44.55%), while 111 respondents (35.58%) had average health-behavior prevalence and 62 (19.87%) had high health-behavior prevalence. Each of the QoL domains correlated significantly (p ˂ 0.05) and positively (r ˃ 0) with the total HBI score and all its subscales.

CONCLUSIONS

Higher quality of life improves the level of health behavior by nursing staff. Obesity lowers the quality of life in physical, psychological, and social domains. The psychological sphere was the best-rated quality of life domain by nurses. A good material situation for nurses has a positive effect on their quality of life.

The Prevalence of Obesity Among Employees of a Tertiary Healthcare Organization in Saudi Arabia and Its Impact on the Organization

Background: Obesity is a significant risk factor for multiple diseases such as diabetes mellitus and cardiovascular diseases. Many healthcare organizations worldwide have identified a high prevalence of obesity among their employees. In this study, we are looking at the prevalence of obesity among the employees of our healthcare organization and its impact on the employees' productivity and if its current prevalence is costly to the employer.

Methods: This is a non-interventional cross-sectional study conducted at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Data on the current employees were obtained from medical records. We investigated a random sample of employees who worked in the hospital for at least one year between January 1, 2021 and January 1, 2022. We explored the prevalence of obesity among hospital employees at the beginning of their employment and its current prevalence. In addition, we aimed to investigate the effect of having employees suffering from obesity on their productivity and their utilization of healthcare during their employment period.

Results: We identified that our hospital has relatively younger healthcare workers and more employees who are suffering from obesity than in different other countries. The percentage of obese male and female employees was comparable. We had a relatively high increase in the prevalence of obesity among our employees during the last few years. We found a higher number of obesity-related medical problems, more office visits, more sick leaves, and more medications prescribed for overweight and employees who are suffering from obesity compared to those with normal weight.

Conclusion: Healthcare workers suffering from obesity had lower productivity and they had higher utilization of healthcare. Therefore, employers should investigate the prevalence of obesity in their organization and implement diverse strategies to prevent and manage this issue to help their employees have better health and, at the same time, be more productive and lower their utilization of healthcare.

Exploring barriers, motivators and solutions to achieve a healthy lifestyle among undergraduate student nurses

BACKGROUND

Many preregistration student nurses tend to be overweight or obese and have unhealthy lifestyles.

AIMS

This study aimed to quantify the prevalence of these issues, to identify barriers to adopting a healthy lifestyle as well as potential solutions, and to explore the use of smartphone health apps.

METHODS

An online questionnaire examined diet and physical activity habits, general health and attitudes to eHealth. An in-class questionnaire with a new sample assessed current lifestyle, barriers to healthier living, support needed to achieve goals and the use of health apps.

FINDINGS

Half of student nurses were overweight or obese and only 41% met the recommended levels of physical activity. An in-class questionnaire revealed that more than half of them wanted to have a better diet and to exercise more.

CONCLUSION

Generally, student nurses were not satisfied with their current lifestyles. A lack of motivation and time were the most frequently reported barriers; an intervention focusing on motivational support could be an acceptable and effective means of achieving and sustaining positive behaviour change.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

Supporting student nurses to develop healthy conversation skills

As advocates for health, nurses are ideally situated to deliver effective health promotion in their daily interactions with people. This work evaluates the integration of healthy conversation training, making every contact count (MECC), into a health promotion module in an undergraduate nursing degree at a higher education institute (HEI). In all, 108 students completed the online questionnaire I year after receiving healthy conversation training. 67% of students reported the regular or occasional use of healthy conversation skills and identified a wide range of scenarios where they had used the skills. 65% of students used health action planning framework in their own personal self-care. Student nurses acknowledged barriers and enablers to their use of healthy conversation skills. Having knowledgeable mentors who role modelled healthy conversations skills in their consultations was the most frequently raised factor, in addition to lack of knowledge of local resources, time and confidence. All placement settings should ensure that registered nurses, especially those undertaking mentorship responsibilities have access to healthy conversation training.

Independent review seeks to tackle obesity and other diet-related diseases

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recent government-commissioned review on the food system of the UK.

Health symptoms and impacts of work on nursing professionals in a public hospital

OBJECTIVE

To relate self-reported health symptoms and the impacts of work in terms of physical, social, and psychological illness in nursing professionals.

METHOD

Cross-sectional, correlational study carried out in a public hospital in the southern region of Brazil. A sample of nursing professionals who worked in direct care participated in the study. A social-occupational questionnaire of self-reported health symptoms and the Work-Related Damage Assessment Scale were used. The analysis was descriptive and analytical. Chi-square test and Spearman's correlation coefficient were used, with a significance level of 5%.

RESULTS

A total of 308 professionals participated, with a prevalence of physical illness and higher means for pain in the body, legs and back. Significant relations were identified among the social-occupational variables, health symptoms, and physical, social or psychological illness. High and moderate correlations among the factors investigated were evidenced.

CONCLUSION

The impact of work on nursing professionals' health is evidenced by the association between self-reported health symptoms and illness, especially the physical or social one, and reinforces the need for professional awareness over situations that are harmful to health.

Factors Influencing Sleep Quality among Female Staff Nurses during the Early COVID-19 Pandemic in the United States

This study aimed to assess the overall level of sleep quality among female staff nurses in the United States during the early COVID-19 pandemic. It also aimed to examine factors associated with sleep quality and its seven subcomponents: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction. A descriptive, correlational, and cross-sectional study design was used. We performed descriptive, and regression analyses with a sample of 215 female staff nurses enrolled in post-licensure online nursing programs at a southeastern state university. Data collection was conducted using an online survey from April to May 2020. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Nurses working part time (p = 0.02), with lower perceived physical health (p = 0.01), a lower self-care self-regulation score (p < 0.001), and higher work stress (p < 0.05) showed poorer sleep quality. Factors associated with subcomponents of sleep quality varied. Poor sleep quality among nurses during the COVID-19 pandemic was reported. Various factors, including work environmental factors were associated with the sleep quality in this sample. Hospital administrators should consider developing intervention programs for improving the work environment, which would impact sleep quality, health status, and job performance.

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.

Relationship Between Health-Promoting Lifestyle and Body Mass Index in Male Nurses Based on Demographic Variables

Behaviors such as an appropriate diet, physical activities, health responsiveness such as attending diagnoses and treatment recommendations, preventing from known health risks such as smoking, allocating time to rest and peace and managing stress are related to health-promoting lifestyles (HPLs). The objective of the current study was to determine the relationship between HPL and body mass index (BMI) of male nurses based on demographic variables. A descriptive correlation survey was conducted among 108 male nurses using the nonprobability sampling technique. Data were gathered through a questionnaire consisting of two parts: demographic characteristics and Pender's health promotion questionnaire. Data were analyzed by presenting measures, mean, standard deviation, independent t-test, Pearson's coefficient correlation, and one-way analysis of variance (ANOVA), using SPSS version 22. The mean score for male nurses' HPL was good (3.13). The highest mean was from spiritual growth (3.48) and the lowest was from physical activity (2.69). Approximately 24.07% participants were overweight and obese. The mean of HPL in normal-weight people was better than that of obese ones. Participants did not pay much attention to their family's health-promoting behaviors. They also were exposed to occupational hazards, including psychological (47.2%), ergonomic (21.7%), physical (20.8%), and biological hazards (10.4%). There was no significant relationship between age (p = .14), educational level (p = .95), marital status (p = .32), job experiences (p = .17), and HPL variables. As health providers, nurses should both provoke patients to attain their health and to strive to maintain and sustain their own health, especially for obesity prevention. From society's perspective, a nurse is one who knows more and acts better; therefore, paying attention to nurses' HPL is a professional and social expectation.

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.

Strategies to promote nurses' health: A qualitative study with student nurses

Developing strategies to support student nurses' health is a global priority for healthcare organisations and governments. This is because emerging international evidence indicates that improvements in student nurses' health are required to increase the longevity of careers and reduce the loss of time, skill and financial cost of sickness absence and workforce exit. However, we do not know what intervention strategies student nurses think would support their health. The study aim was to explore student nurses' views on factors that influence health-related behaviours and strategies that could improve health. Data were collected through participatory activities during focus groups with student nurses in Scotland. Analysis was theoretically informed and involved mapping to the Behaviour Change Wheel framework. Students identified several factors that influenced health-related behaviours. Four were ranked most important: knowledge, culture, time constraints, and stress. Strategies student nurses thought should be prioritised to improve nurses' health-related behaviours were: stimulating a health-promoting environment by reviewing shift work, improving workplace support, increasing staffing levels, subsidising and role-modelling of healthy food and exercise; and creating applied health-promoting curricula by integrating time and stress management training and lifestyle advice into nursing education. Educational and environmental interventions are needed to support student nurses' health.

The health of the nursing workforce. A survey of National Nurse Associations

AIM

This investigation explored the extent to which nurses' own health is a priority for global National Nursing Associations.

BACKGROUND

There is a growing body of evidence linking staff health and well-being and key dimensions of service quality, including patient safety, patient experience and the effectiveness of patient care.

INTRODUCTION

The International Council of Nurses is a federation of more than 130 National Nurses Associations, representing more than 20 million nurses worldwide. Representatives from these Associations attended a Congress in Singapore in 2019 at which a survey was conducted.

METHODS

A convenience sample of 37 leaders of National Nurse Associations from 33 countries and 61 nurse representatives took part in a survey.

RESULTS

The majority of nurse leaders and participants believed that nurses' own health should be a priority to be addressed, principally because a healthy nurse is better able to provide good patient care. All of the examples offered about how these Associations address nurses' own health were about actions to prompt individual health behaviour change.

DISCUSSION

The National Nurses Associations did not have a common terminology to talk about nurses' own health. Taking care of one's own health was included as part of the professional role and most nurse leaders thought that working conditions contributed to ill health.

CONCLUSIONS

There is widespread agreement that nurses' own health matters but for most National Nurses Associations it is not a current priority.

IMPLICATIONS FOR NURSING POLICY

Going forward nurse health and wellbeing should be a core principle for health services and professional associations, and additional research is needed that demonstrates if improving working environments contributes to nurse retention and recruitment.

Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review

BACKGROUND

Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown.

OBJECTIVE

To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses.

METHODS

A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9-3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed.

RESULTS

Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change.

CONCLUSIONS

Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses' health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.

Nurses and health-promoting self-care: Do we practice what we preach?

AIMS

To examine the health-promoting behaviours performed by registered nurses (RNs), as well as workplace factors that influence participation in those behaviours.

BACKGROUND

Nurses have high levels of overweight/obesity and may not be engaging in health-promoting self-care.

METHODS

A cross-sectional Web-based survey collected information from 335 RNs regarding their physical activity, sedentariness and fruit/vegetable consumption.

RESULTS

More than half were overweight (34.1%) or obese (23.4%), and 80.1% were "sedentary" (≥3 hr sitting/day), particularly those working outside of direct patient care in management, research and education. Only 47.2% consumed 5+ servings of fruits/vegetables daily. Nurses who enjoyed their jobs (higher levels of compassion satisfaction) reported higher levels of physical activity (p = 0.03) and fruit/vegetable consumption (p = 0.02).

CONCLUSION

RNs who work outside of direct patient care might be at increased risk for sedentariness and obesity. RNs who enjoy their jobs may experience less stress and have more energy to exercise and to prepare/consume healthy meals.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should practice self-care by engaging in exercise, proper nutrition and demonstrating work-life balance, both to protect their own health and to serve as role models for RNs in direct patient care.