A formative assessment of nurses' lifestyle behaviours and health status

• Main Author: Phiri, Lindokuhle P
• Other Authors: Kolbe-Alexander, Tracy
• Format: Dissertation
• Language: English
• Published: University of Cape Town 2015
• Subjects: Biokinetics
• Online Access: http://hdl.handle.net/11427/15678

Includes bibliographical references === Background: Previous research has identified health care workers (HCWs) and shift workers as having an increased risk for non-communicable diseases (NCDs). Nurses in particular have a high prevalence of obesity, poor eating habits and insufficient physical activity and are at an increased risk for NCDs. Nurses are required to work non-traditional hours, outside the parameters of traditional day shift. Furthermore, shift work is associated with obesity and lower levels of physical activity. Even though nurses' occupations require them to be active in doing ward rounds and other duties, it is possible for these professionals to be physically active, yet highly sedentary. Sedentary behaviours such as occupational sitting, leisure-time sitting and television (TV) viewing may be associated with overweight and obesity independent of physical activity. Aim: The primary aim of this mini-dissertation was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. The mini-dissertation included two different research methods. Study 1: The main purpose of this qualitative descriptive study was to describe health concerns, health priorities and determinants of healthy lifestyle behaviours among nurses. The objectively measured and self-reported physical activity and sedentary behaviour in day and night shift nurses were compared in Study 2. Combined, the results of these studies may be used to inform the development of worksite-related interventions for South African nurses. Methods: Participants for the first study were purposively sampled from public hospitals based in Cape Town, South Africa. The participants included 103 nurses, of whom 57 worked night shift and 36 worked day-shift. Twelve focus group discussion (FGD's) were conducted with nursing staff to obtain insight into their health concerns, lifestyle behaviours and the nature of and access to worksite health promotion programmes (Whip's). Nine hospital management personnel participated in key informant interviews (KII) to gain their perspective on health promotion in the worksite. The FGDs and interviews were conducted by a trained facilitator using guided questions. These included questions such as: 'What are your main personal health concerns?' and 'How does your work affect your lifestyle behaviours and health?' Thematic analysis was used 12 to analyse the qualitative data with the assistance of (Atlas.ti Qualitative Data Analysis Software (Scientific Software Development GmbH, Berlin, Germany). In a sub-study, 64 nurses (day shift n=30 and night shift n=34) working at two of the five public hospitals volunteered to complete a socio-demographic questionnaire and wear the ActiGraph GT3x accelerometer for 7 consecutive days to measure physical activity levels. Valid data was defined as ≥ 600 minutes wear time per day, minimum of 4 days (2 shift days and 2 non-shift days). In addition, self-reported physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). Statistical analyses included a T-test to determine differences in PA and SB between day and night shift nurses. If data were normally distributed, ANOVA (analyses of variance) was performed to determine the significant differences in continuous outcome variables between day and night shift nurses. If data were not normally distributed, such as the GPAQ data, a non-parametric comparison Mann Whitney U test was applied. Results: Study 1: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. The hospital environment was perceived to have a negative influence on the nurses' lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling and advisory services, an online employee wellness programme. The Western Cape Department of Health also offered wellness days in which clinical outcomes, such as blood glucose were measured. Most nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Both nurses and management personnel frequently mentioned lack of time to prepare healthy meals and/or participate in physical activity due to being overtired from the long working hours. Furthermore, both management and nurses reported a stressful working environment. The fact that the nurses were most concerned with the problems of overweight, obesity and living with NCDs such as diabetes and hypertension indicate that there is a need and desire for WHPP's aimed at addressing these concerns. Study 2: Based on the objectively-measured results from accelerometry, all the nurses in the sub-study met the physical activity recommendations of 150 minutes or more of moderate to vigorous intensity physical activity per w eek. The day shift nurses reported more leisure-time moderate and vigorous intensity physical activity than the night shift nurses (p=0.028). Objectively-measured physical activity also showed that night shift nurses accumulated significantly more moderate intensity physical activity than the day shift nurses ( 16.6 ± 5.6 hrs/week versus 12.1 ± 13 4.5 hrs/week, respectively, p=0.001). In addition, night shift nurses accumulated more steps per day than day shift nurses (10324 ± 3414 versus 8022 ± 3245, p=0.013). Self-reported sedentary behaviour was similar for the two shifts, 3.0 ± 1.8 hours versus 4.0 ± 2.6 hours a day, for day and night shift, respectively. Objectively-measured sedentary behaviour (SB) was significantly lower (as a % of wake time) in night shift compared to day shift workers, 66% and 69%, respectively, p= 0.047. These differences between groups remained significant, even after adjusting for differences in body size and age. Furthermore, results from the Bland – Altman plots indicate that the nurses significantly underreported their sedentary time. Summary: The nurses in this study were concerned about NCDs and being overweight. They expressed an interest and willingness to participate in future hospital-based intervention programmes. The most frequently identified preference for WHPPs was access to fitness facilities or support groups. Despite the fact that all the nurses met the current public health recommendations for physical activity, objectively-measured SB was substantial, with both day and night shift nurses spending an average of 13 hours a day in SB. Findings from this study highlight the need for WHPPs that minimize sedentary behaviour and create a more supportive environment for physical activity.