Letter from the Editor
Happy New Year! The new year is upon us and many people are going through the yearly ritual of letting go of bad habits and creating goals for the year. If you are not the New Year’s resolution type you are not alone, but most people at least take a measure of where they have been and where they might want to go next in their careers, their relationships, or their health. The new year is a good time to quit a bad habit or to start an healthy one. Some of the most popular resolutions are: spending more quality time with family and friends, exercising more, losing weight, quitting smoking, enjoying life more, quitting drinking, getting out of debt, learning something new, volunteering, or getting organized.
No matter the desired outcome, nurses play a vital role in helping patients set and accomplish their health goals. Nurses are also using SMART goal setting strategies and cognitive behavioral strategies to direct their own healthy lifestyle initiatives as well as their patients. One group that has been studying women’s health issues for generations is the Nurses’ Health Study. The study has grown and expanded into 3 separate studies that examine different aspects of the lives and health of nurses.
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Editor, NurseRecruiter.com Newsletter
Changing Unhealthy Behaviors: A Review of Behavior Change Models
Addressing unhealthy behaviors and making positive changes for the betterment of one’s health is a good idea any time of year. But, it seems that patients tend to use the new year as a stepping off point for lifestyle changes. Individuals who have an understanding of the implications of risky behavior and a desire to make an improvement in their life often choose January 1st as their start date instead of choosing a date arbitrarily during the year. Whether it is beginning a new exercise regime, joining a gym, or simply cutting back on caloric consumption, the new year is the time for many to start setting healthy and achievable goals. Nurses help patients in addressing undesirable behaviors – like excessive alcohol consumption, a sedentary lifestyle, weight gain, or smoking – by educating patients, giving advice, and by helping patients set achievable goals.
What drives a person to want to make a change? Change begins with a motivating factor, some internal impetus brought on by an untenable health situation or a hope for a better life, and a healthier future. There are several theories of behavior change out there: the Health Belief Model, the Theory of Reasoned Action, the Transtheoretical Model, and the Health Action Process. There are many more but here is a brief review of those models just mentioned.
The Health Belief Model is probably the most well known in medical circles. It examines the role of a person’s knowledge of a disease or unhealthy lifestyle choice, combined with that person’s perceptions of how the disease or unhealthy behavior might effect them and their acceptance of personal responsibility for their actions. The theory includes four constructs: perceived susceptibility (one’s personal beliefs about their likelihood of having a behavior/disease effect them), perceived severity (one’s opinion of how bad a condition is and what the consequences could be of inaction), perceived barriers (obstacles to change), and perceived benefits. The perceived cost (what one will be giving up in exchange for the change) is often included is often included in this model.
The Theory of Reasoned Action is similar to the health belief model, but states that a person’s attitude (a weighted sum of the one’s beliefs about a behavior) combined with their subjective norm (how one perceives that others feel about the behavior) will result in their behavioral intentions (whether or not one will perform the behavior).
The Transtheoretical Model addresses 5 stages in behavior change: precontemplation (change is not even on their radar), contemplation (awareness of a desire to change), preparation (weighing the benefits of the change and seriously considering action), action (and potential for relapse), and maintenance (the person has successfully maintained the desired action for 6 months).
Health Action Process is an extensive theory of behavioral change that possesses both stage-based and continuum-based models of change. In a nutshell, the process has five principles of change, the first being motivation and volition. The second principle is two volitional phases and includes both those who are willing to change but haven’t, and those who are willing to change and are making strides toward that change. The third principle is postintentional planning. Postintentional planning occurs when one is intending on changing a behavior but needs additional education or information prior to taking action. The fourth principle is two kinds of mental stimulation and refers to two types of planning that are involved in behavior change action planning and coping planning (barriers to change). The final principle, principle five, is called phase specific self-efficacy. The theory states that self-efficacy (one’s belief in their own ability to complete tasks and goals) is evident in each phase of change but that it functions differently in each phase.
Setting goals is a pinnacle part of making a change. One well-known method of goal setting is the SMART goal. SMART is a mnemonic for the terms Specific, Measurable, Attainable, Relevant and Time-sensitive. When one creates a SMART goal the criteria need to fall under one of the term headings. The first term, specific, refers to creating a goal that answers the questions of who is involved, what is the desired outcome, which aspects are required, where it is happening, and why it is happening. The second letter, M, refers to whether the goal is measurable to track progress and realize completion. Next, the goal needs to be attainable, but it also needs to be relevant to the big picture; goals that are not relevant are certainly achievable but may not be the best use of resources. The last letter refers to having a deadline for the goal. The goal needs to have a termination date – a time frame within which it can be accomplished. Having a deadline on the goal helps maintain focus on the process and steps to achieve it.
So, no matter which change model one subscribes to, achieving and maintaing the change is the ultimate goal. It might take a combination of strategies and trials to effect permanent change and obtain the desired outcome in patients. Also, educating patients on how to make changes may be as simple as having a conversation around the topic or teaching them how or where to look for additional resources because sometimes people need motivation, but sometimes they just need inspiration.
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Health belief model. (2012, December 9). In Wikipedia, The Free Encyclopedia. Retrieved 17:29, January 7, 2013, from http://en.wikipedia.org/w/index.php?title=Health_belief_model&oldid=527132859
Domrose, C. RNs use behavior-change concepts to develop healthy habits. (2012, December 31). In Nurse.com Where the Nurses Are. Retrieved 13:39, January 7, 2013, from http://news.nurse.com/article/20121231/NATIONAL01/312310004
Anderson, L. Nursing responsibilities: are nurses setting a bad example for their patients? (2013, January 6). In Nurse Together. Retrieved 13:50, January 7, 2013, from http://www.nursetogether.com/Career/Career-Article/itemId/1918/Nursing-Responsibilities-Are-Nurses-Setting-a-Bad.aspx#.UOn-UInjm2s
Transtheoretical model. (2013, January 1). In Wikipedia, The Free Encyclopedia. Retrieved 17:20, January 7, 2013, from http://en.wikipedia.org/w/index.phptitle=Transtheoretical_model&oldid=530709102
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Nurses Health Study
In 1976, a researcher named Dr. Frank Speizer was interested in the longterm effects of use of oral contraceptives by women. He chose nurses to serve as the basis for the research because they fulfilled certain criteria of the study, the first of which was that they were women (at the time it was very rare for a man to be a nurse). He selected nurses because they would be more motivated to continue their participation in the experiment due to their interest in medicine and moreover because of their education in the medical field. Dr. Speizer felt that nurses would be better able to understand the technical jargon in the questionnaires.
Dr. Spitzer chose only married nurses, women aged 30-55, for the study. The original participating nurses were from California, Connecticut, Florida, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania and Texas. Out of the 170,000 nurses contacted, 122,000 participated in the study that originally focussed on diseases and other health-related topics such as smoking, hormone use, and menopausal status. The study changed over the years to include other topics such as nutrition, quality of life questions, and even toenail and blood samples to look for genetic markers, hormone levels, and food components found in soil. Even after all these years the study still sees a response rate of 90% on the questionnaires.
When he began the study little did he know he was starting one of the largest investigations into the risk factors linked to major chronic diseases in women that has ever been conducted. His study begat the Nurses’ Health Study 2 (NHS2), and most recently the Nurses’ Health Study 3 (NHS3).
Research is often directed by the geist of a society, and Dr. Spitzer’s study focused on older women, but as times changed and the use of oral contraceptives shifted to a younger population a new study was created. Funded by the National Institutes of Health and enacted in 1989 by Dr. Walter Willett and colleagues, The Nurses’ Health Study 2 was brought about to examine the use of oral contraceptives, diet and lifestyle risk factors in a younger population (aged 25 to 42) than the original ongoing study. The new study focused on women who started using oral contraceptives as adolescents and the implications of higher incidence of breast cancer in that population. Mailings went out to nurses in California, Connecticut, Indiana, Iowa, Kentucky, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania, South Carolina and Texas to over half a million nurses. The study has 116,686 active nurse participants and response to the questionnaires is 90%. Dr. Willet and his colleagues added questions relating to nutrition and health related topics in addition to examining blood and urine samples. One major difference in the NHS2 from the NHS1 is that researchers of the NHS2 are documenting the types of oral contraceptives ingested.
The most recent addition to the studies is the Nurses’ Health Study 3. It began in 2010 by Drs. Walter Willett, Janet Rich-Edwards, Stacey Missmer, and Jorge Chavarro in collaboration with the Channing Laboratory and the Harvard School of Public Health. The study is funded by the National Institute for Occupational Safety and Health (NIOSH) and the Breast Cancer Research Foundation.
The study is entirely web based and is set to examine lifestyle, fertility, pregnancy, environment, and nursing exposures of nurses from diverse backgrounds aged 20 to 46. The study includes licensed vocational nurses as opposed to solely registered nurses as well as nurses from Canada.
The three ongoing longitudinal studies incorporate the talents of clinicians, epidemiologists, and statisticians. They have yielded tremendous information and insight into women’s health issues such as the prevention of cancer, cardiovascular disease, diabetes and other diseases. The studies have led to hundreds of published peer reviewed papers. Highlights from the data collected in the studies can be found here.
Nurses wishing to participate in the NHS3 study can find information here.
The nurses health study. In The Nurses Health Study. Retrieved 16:05, January 7, 2013. From http://www.channing.harvard.edu/nhs/
Nurses health study 3. In The Nurses Health Study 3. Retrieved 16:26, January 7, 2013. From http://www.nhs3.org/
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Leading by Example
Are nurses heeding their own advice when it comes to healthy lifestyle choices? Several studies have shown that though nurses have the education to direct healthy initiatives in their own lives, they often give 100% to patients while ignoring their own health. Nurses are people too, and they are subject to the same unhealthy lifestyle choices and decreased recovery time as their patients. Nursing today is a different animal than nursing 10, 20, or 30 years ago. Nurses have increased pressures on them to perform at high levels, often independently, while they take on extra roles and work longer hours. This observation has broader implications than just unhealthy nurses, it can over time create burnout, on the job injuries, callouts, and in extreme cases can even put patients at risk.
So, what can nurses do to ease the stress and take back some control over their health? Here are seven helpful tips and gentle reminders.
- Stay Positive: When the world is in total chaos around you, remind yourself that whatever the trouble, it won’t last forever and that you are competent to do your job.
- Take Time for Yourself: This applies on the job and off the job.
- Learn Something New: Learning a new skill or new language is door opening and improves self esteem.
- Adopt Healthy Habits: This could be eating healthy, to starting a new exercise routine.
- Learn to Say No: Establish control over excessive engagements on your time.
- Do Yoga: Yoga has been found to have many health benefits in addition to stress reduction.
- Build a Support Network: There is a beneficial effect of social support on psychological well-being and productivity.
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Jennings, B. M.Work stress and burnout among nurses: role of the work environment and working conditions. National Center for Biotechnology Information: Bookshelf. Retrieved 17:15, on January 7, 2013. From http://www.ncbi.nlm.nih.gov/books/NBK2668/