Академический Документы
Профессиональный Документы
Культура Документы
a
Institute for Health and Social Science Research, Central Queensland University, Bruce Hwy,
Rockhampton, Queensland 4702, Australia
b
Centre for Mental Health Nursing Innovation, Central Queensland University, Bruce Hwy, Rockhampton,
Queensland 4702, Australia
c
School of Nursing and Midwifery, Central Queensland University, Bruce Hwy, Rockhampton, Queensland
4702, Australia
Received 26 November 2012; received in revised form 11 February 2013; accepted 28 February 2013
KEYWORDS Summary Occupational stress is common among nurses. Two factors that may influence stress
levels are diet and physical activity. The purpose of this study was to investigate the diets and
Burnout;
physical activity levels of nurses and to quantify the relationships between these behaviours
Diet;
and anxiety, depressed mood, stress, and burnout. Nurses (N = 52) from one regional hospital
Nurses;
completed a survey assessing physical activity, nutrition, and psychological functioning. Almost
Physical activity;
two-thirds (65%) of participants had met recommended levels of both moderate and vigorous
Stress
physical activity in the week prior. Participants met recommended levels for fruit, but not veg-
etable, consumption. Burnout and stress levels were close to norms for physicians and nurses.
Scores for depressed mood, anxiety, and stress symptoms were within one standard devia-
tion of norms for the Australian adult population. Several moderately sized correlations were
found between the psychological constructs measured and both physical activity and nutrition.
Although most of the participants were physically active and seemed to be consuming nutritious
diets, some nurses may need encouragement to adopt similarly healthy behaviours.
© 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
∗ Corresponding author at: Institute for Health and Social Science Research, Central Queensland University, Bruce Hwy, Rockhampton,
1322-7696/$ — see front matter © 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
http://dx.doi.org/10.1016/j.colegn.2013.02.005
72 B. Happell et al.
each item relates to them using a 7-point Likert scale study. After these presentations, the survey was distributed
anchored with never and every day. The MBI has undergone to nursing staff who showed interest in being involved with
extensive psychometric testing in various populations, the research. Additional surveys were also given to those
with the findings of meta-analytic studies attesting to nurses who volunteered to distribute them to nurses who did
its validity (Worley, Vassar, Wheeler, & Barnes, 2008) and not attend the sessions. Completed surveys were returned to
reliability (Aguayo, Vargas, de la Fuente, & Lozano, 2011). boxes in nursing stations or directly to the researchers using
The sound psychometric properties of the MBI have also postage-paid envelopes. Participants’ survey responses were
been confirmed in studies with nurses as participants (e.g., inputted into an electronic database and used as the data
Kanste, Miettunen, & Kyngäs, 2006; Poghosyan, Aiken, & for the analysis.
Sloane, 2009). Group norms for physicians and nurses for
the emotional exhaustion, depersonalisation, and personal
Data analysis
accomplishment subscales are 22.19, 7.12, and 36.53,
respectively (Maslach et al., 1996).
Physical activity data tends to be highly skewed, with
many people reporting engaging in minimal physical activity
Depression, anxiety, and stress (AIHW, 2003). Therefore, nonparametric descriptive statis-
The short form of the depression, anxiety, and stress scales tics were used in reporting the data. Sedentary behaviour
(DASS-21; Lovibond & Lovibond, 1995) was used to mea- was defined as participation in no physical activity. Suffi-
sure these constructs. The DASS-21 has 7 items in each of cient physical activity was defined as having undertaken at
three subscales: depression, anxiety, and stress. Participants least 150 min of moderate intensity physical activity (30 min
respond to each item on a 4-point Likert scale anchored with per day on most, if not all, days per week) and at least
did not apply to me at all and applied to me very much, 60 min of vigorous physical activity (20 min per day on 3—4
or most of the time. The DASS-21 has undergone extensive days per week; Egger, Donovan, Swinburn, Giles-Corti, &
psychometric testing, with evidence supporting the valid- Bull, 1999). Descriptive statistics (frequencies, percentages,
ity and reliability of this test (e.g., Antony, Bieling, Cox, means, standard deviations) were used to report the findings
Enns, & Swinson, 1998; Crawford, Cayley, Lovibond, Wilson, from the nutrition and psychological measures.
& Hartley, 2011; Henry & Crawford, 2005). Although Lovi- Correlations were undertaken to determine the strength
bond and Lovibond recommend doubling the scores obtained of the relationships between specific behaviours (physical
through using the DASS-21 to make them comparable to activity and nutrition) and anxiety, depressed mood, stress,
those obtained with the DASS-42, only raw scores were cal- and burnout. Because the physical activity data (and some
culated for the present study to enable comparisons to be of the nutrition data) was skewed, non-parametric tests,
made with norms from the Australian general adult popu- in the form of Spearman’s rank correlation coefficients
lation (Crawford et al., 2011). Scores on each subscale can (rs ), were undertaken. Consistent with statistical advice
range between 0 (does not occur at all) and 21 (occurs most for the field of mental health nursing (Gaskin & Happell,
of the time). 2013), effect sizes are reported and adjustments to reduce
Type I error were made. According to Cohen (1988) guide-
Nursing stress lines, small, medium, and large effects for rs are .1,
The nursing stress scale (NSS; Gray-Toft & Anderson, 1981) .3, and .5, respectively. To control the experiment-wise
was used to measure the frequency with which nurses error rate, the sharper Bonferroni procedure for multiple
experienced potentially stressful situations in hospital envi- tests of significance, as described in Hochberg (1988), was
ronments. The NSS has 34 items and seven subscales, used. Applying this procedure, ˛ was set at .0002 for this
each representing a grouping of similar potentially stress- study.
ful experiences: death and dying, conflict with physicians,
inadequate preparation, lack of support, conflict with other
nurses, work load, and uncertainty concerning treatment.
Findings
Participants respond to each item on a 4-point Likert scale
anchored with never and very frequently. The factor anal- Physical activity
ysis performed in the initial study provides partial support
for the construct validity of the NSS (Gray-Toft & Anderson, Most of the physical activity data were skewed, with sub-
1981). Further support for the validity of the NSS comes from stantial numbers of participants reporting not engaging in
its positive relationships with anxiety (both trait and state), various types of activity. Non-parametric descriptive statis-
turnover, and nursing roles. The NSS has adequate reliability, tics are for this data are presented in Table 1. Almost
with the alpha values for the seven subscales ranging from two-thirds (65%) of participants had undertaken sufficient
.65 to .80. amounts of both moderate and vigorous physical activity
in the week prior (data not shown). A further 29% of par-
ticipants were insufficiently physically active and 6% were
Procedure
sedentary.
Following ethical approval, nurses from one public hospital
in regional Queensland, Australia, were recruited to partic- Nutrition
ipate in the study. All nursing staff were invited to attend
general information sessions at the hospital, during which Most participants reporting consuming two serves or less of
they were informed of the purpose and methods of the fruit per day (73%) and between two and four serves of
74 B. Happell et al.
Fruit Vegetables
n % n %
1 serve or less 19 37 6 12
2 serves 19 37 16 31
3 serves 10 19 12 23
4 serves 3 6 8 15
5 serves or more 0 0 8 15
vegetables each day (69%; see Table 2). The frequencies With respect to milk, most participants consumed
with which participants consumed various foods are shown low/reduced fat or skim milk (71%), and a further 15% used
in Table 3. Based on the medians of responses, participants whole or full cream milk. Most participants consumed less
consumed fruit juices less that once per week, fruit six times than 150 ml (54%) or between 150 and 300 ml (29%) per day.
per week, chips (or equivalent foods) once per week, pota- There were broad ranges of responses to questions about
toes twice per week, salad three times per week, cooked whether participants added salt before or during cooking
vegetables four times per week, red meat three times per (never, 37%; rarely, 17%; sometimes, 23%; usually, 14%;
week, meat products once per week, bread four times per always, 10%) or after cooking (never, 39%; rarely, 15%; some-
week, and other cooked cereals twice per week. times, 27%; usually, 14%; always, 4%).
<1 1 or 2 3 or 4 5 or 6 ≥7
n % n % n % n % n %
Fruit juices 29 56 6 12 10 19 3 6 3 6
Fruita 1 2 5 10 7 13 17 33 21 40
Chipsb 22 42 24 46 2 4 3 6 0 0
Potatoesc 9 17 23 44 13 25 5 10 1 2
Salad 3 6 18 35 16 31 7 13 7 13
Cooked vegetablesd 2 4 4 8 21 40 12 23 12 23
Red meat 3 6 14 27 21 40 14 27 0 0
Meat productse 22 42 23 44 5 10 2 4 0 0
Bread 4 8 12 23 11 21 18 35 7 13
Other cooked cerealsf 4 8 23 44 12 23 9 17 4 8
a Not including fruit juice.
b Including French fries, wedges, fried potatoes, or crisps.
c Not including chips, French fries, wedges, fried potatoes, or crisps.
d Not including potatoes and salad.
e Sausages, frankfurter, Belgium, Devon, salami, meat pies, bacon or ham.
f Including pasta, rice, noodles, but not including cooked breakfast cereals.
Nurses’ physical and psychosocial wellbeing 75
Emotional Deperso- Personal Depression Anxiety Stress Death Conflict with Inadequate Lack of Conflict with Workload Uncertainty
exhaustion nalisation accomplish- and physicians preparation support other nurses concerning
ment dying treatment
Physical activity
Walking −.11 −.13 −.09 −.26 −.12 −.24 .09 −.03 .23 −.21 .13 −.04 −.06
Moderate activity −.14 −.12 −.08 −.32 −.05 −.27 .12 −.04 .28 −.18 .09 −.05 .01
Vigorous gardening .14 .18 −.07 .09 .02 .22 .26 .07 .23 .15 −.09 .37 .19
Vigorous activity .33 .33 −.31 .06 .16 .14 .25 .18 .42 .15 .20 .29 .37
Total activity .11 .11 −.20 −.20 −.04 −.11 .30 .14 .49 −.02 .21 .18 .22
Nutrition
Fruit juices .13 .09 .06 .14 .20 .15 .28 .02 .35 .14 −.01 .28 .13
Fruita .35 .13 −.03 .15 −.06 −.10 .18 .14 .23 .26 .13 .31 .27
Chipsb −.06 −.04 .15 .08 .10 .03 −.10 −.02 −.07 −.10 .16 −.22 −.04
Potatoesc −.15 −.18 .07 −.08 −.01 −.09 −.18 −.40 −.32 −.36 −.21 −.31 −.23
Salad .10 .31 −.16 .11 .07 .14 .15 .26 .07 .05 .14 .18 .27
Cooked .08 .08 −.02 −.12 −.17 −.06 .10 −.04 .17 .05 −.22 −.02 −.08
vegetablesd
Red meat .20 .05 −.08 .02 .09 .01 .20 .04 .19 .02 −.06 .01 .00
Meat productse −.25 −.16 .00 −.22 −.05 .15 −.13 −.30 −.16 −.25 −.24 −.34 −.14
Bread −.07 −.02 −.12 −.08 .06 −.11 −.02 −.13 −.08 −.34 −.30 −.11 −.05
Other cooked −.11 −.11 .00 −.10 .15 −.07 .22 .00 .01 −.14 −.10 .11 .02
cerealsf
Note: No correlations were statistically significant at the ˛ = .0002 level.
a Not including fruit juice.
b Including French fries, wedges, fried potatoes, or crisps.
c Not including chips, French fries, wedges, fried potatoes, or crisps.
d Not including potatoes and salad.
e Sausages, frankfurter, Belgium, Devon, salami, meat pies, bacon or ham.
f Including pasta, rice, noodles, but not including cooked breakfast cereals.
B. Happell et al.
Nurses’ physical and psychosocial wellbeing 77
time (Henwood et al., 2012). Such an initiative would involve Blake, H., Malik, S., Mo, P. K., & Pisano, C. (2011). ‘Do as
a radical departure from the status quo and, to ensure say, but not as I do’: Are next generation nurses role mod-
its implementation and success, require the cooperation of els for health? Perspectives in Public Health, 131, 231—239.
healthcare organisation, government, and union officials, as http://dx.doi.org/10.1177/1757913911402547
well as nurses themselves. Brown, W., Bauman, A., Timperio, A., Salmon, J., & Trost, S. (2002).
Measurement of adult physical activity: Reliability, comparison
Two limitations of this study are the sample size and
and validity of self-report surveys for population surveillance.
the composition of the sample. With so many inferential Summary and recommendations. Unpublished report to the
statistics undertaken, the sample size would only have been Department of Health and Ageing.
sufficient for reasonably large effect sizes to have been Casper, R. C. (2011). Diet and mental health: An up-to-date anal-
statistically significant. The descriptive statistics on the ysis. World Review of Nutrition and Dietetics, 102, 98—113.
physical activity data, in particular suggest that this sam- http://dx.doi.org/10.1159/000327798
ple engaged in healthier behaviours than would be expected Chang, E. M., Daly, J. W., Hancock, K. M., Bidewell, J., Johnson,
of nurses and people from the general population. It may be A., & Lambert, V. A. (2006). The relationships among work-
that, when informed about the research or upon reading the place stressors, coping methods, demographic characteristics,
and health in Australian nurses. Journal of Professional Nursing,
questions in the survey, some people who typically under-
22, 30—38. http://dx.doi.org/10.1016/j.profnurs.2005.12.002
took low levels of physical activity opted not to participate
Cohen, J. (1988). Statistical power analysis for the behavioral sci-
in the study. A second alternative was sampling bias, in that ences (2nd ed.). HilIsdale, NJ: Erlbaum.
the majority of the nurses were from the one unit. It may Crawford, J. R., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley,
be plausible that this cohort is actively involved in primary C. (2011). Percentile norms and accompanying interval esti-
health education. If this is the case, it has skewed the study’s mates from an Australian general adult population sample for
findings. self-report mood scales, (BAI, BDI, CRSD, CES-D, DASS, DASS-
The profile of nurses obtained through this study was gen- 21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist, 46,
erally positive. Over half were engaged in sufficient levels of 3—14. http://dx.doi.org/10.1111/j.1742-9544.2010.00003.x
physical activity and, except for eating too few vegetables, Edenfield, T. M., & Blumenthal, J. A. (2011). Exercise and stress
reduction. In R. J. Contrada, & A. Baum (Eds.), The handbook of
the nurses seemed to be have healthy diets. Their psycholog-
stress science: Biology, psychology, and health (pp. 301—319).
ical health was comparable to norms for the Australian adult
New York, NY: Springer.
population and for their profession. Encouragement may still Egger, G., Donovan, R., Swinburn, B., Giles-Corti, B., Bull, F. (1999).
be needed, however for some participants to become phys- Physical activity guidelines for Australians — Scientific back-
ically active and to consume nutritious foods. ground report. A report by the University of Western Australia
and The Centre for Health Promotion and Research Sydney for
Acknowledgements the Commonwealth Department of Health and Aged Care. The
University of Western Australia and The Centre for Health Pro-
motion and Research Sydney.
The authors extend their thanks to the Queensland Nurs- Eriksson, S., & Gard, G. (2011). Physical exercise and
ing Council for providing the funding for this research. depression. Physical Therapy Reviews, 16, 261—268.
Thanks to the nurse participants who gave so freely of their http://dx.doi.org/10.1179/1743288x11y.0000000026
time. Thanks to those who assisted with the conduct of this Gaskin, C. J., & Happell, B. (2013). Power of mental health
research, particularly Mina Flanders from the renal unit. nursing research: A statistical analysis of studies in the
International Journal of Mental Health Nursing. Inter-
national Journal of Mental Health Nursing, 22, 69—75.
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