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How healthy are your nursing students?
Teaching and Learning in Nursing (2006) 1, 55 – 60
www.jtln.org
How healthy are your nursing students? Sharon Staib MS, RN*, Sally Fusner PhD, RN, Kitty Consolo PhD Ohio University, 1425 Newark Road, Zanesville, OH 43701, USA
KEYWORDS: Nursing students; Lifestyle; Healthy behaviors
Abstract This study surveyed the health behaviors of 159 nursing students. The major finding of this study is that there is a need for improvement in the areas of physical activity and weight control. Recommendations include nursing educators addressing these behaviors within the curriculum if future nurses are to model healthy behaviors for patients, as well as encouraging staff educators to continue to emphasize healthy behaviors. D 2006 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
1. Introduction Since 1979, the Department of Health and Human Services (HHS) has led a nationwide process to formulate and monitor health promotion and disease prevention activities. Building on 20 years of experience, HHS issued Healthy People (2010), a 10-year plan for disease prevention and health promotion objectives. Healthy People (2010) is about improving the health of people, communities, and nations (healthypeople.gov). The Leading Health Indicators identified in Healthy People (2010) used to measure the health of nations are closely linked to lifestyle patterns that reflect individual behaviors (healthypeople.gov). The indicators are selected based on their ability to motivate positive change in lifestyle activities. Included on the list of indicators are physical activity, obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury, and violence (healthypeople.gov). As medical practice focuses more on lifestyle patterns, health behaviors, disease prevention, and health promotion, * Corresponding author. Tel.: +1 740 588 1527 (work); Fax: +1 740 453 6161. E-mail address: [email protected] (S. Staib).
it becomes more important than ever that health care providers model those behaviors. Today’s nursing students will soon become health care providers. In view of the current issues identified in Healthy People (2010), studying the health behaviors, risk factors, and preventive health beliefs of nursing students is of interest. The assumption of this study is that health behaviors of nursing students stand out among the general public. To test this assumption, we gave a questionnaire consisting of health behaviors relating to smoking, drinking, drug use, eating habits, exercise fitness, safety measures, and stress control to 159 first- and second-year nursing students. The nursing students of today will be the role models for future populations; thus, improving their current health behaviors may positively impact their future nursing practice.
2. Review of related literature 2.1. Nursing students’ health behaviors Several studies have investigated the health behaviors of nursing students. Najem, Passannante, and Foster (1995), in a study of health-promoting behaviors of medical, dental,
1557-3087/$ – see front matter D 2006 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2006.06.001
56 and nursing students, found that preventive care beliefs and practices of health science students stand out among the general population, but these students can do substantially better than the findings of this study indicated. In a study of college-aged women, Clement, Schmidt, Bernaix, Covington, and Carr (2004) found that although most of these women had normal BMI, poor nutrition levels were still prevalent among this group. In a longitudinal study involving a large number of nursing students, Clement et al. (2002) found that except for inadequate sleep, nursing students’ health behaviors did not differ from those of the general public. Shriver and Scott-Stiles (2000) compared the health habits of nursing students with those of nonnursing students. Their findings indicated a statistically significant difference between groups over time, with nursing students scoring higher in healthy behaviors from Time 1 to Time 2, whereas the nonnursing students showed no improvement. Stark, Manning-Walsh, and Vilem (2005) found that nursing students may engage in the practice of health-related behaviors when given time to develop health-related activities as part of a nursing course. Adderley-Kelly and Green (2000) compared the health behaviors of undergraduate African American nursing students and other college students. Fifty-one percent of those studied had low scores for exercise and fitness, indicating risk factors in those areas. A study by Ziccardi, Sedlak, and Doheny (2004), looking at knowledge and health beliefs of nursing students regarding osteoporosis, suggests that including health promotion behaviors in nursing curricula may lead to lifestyle changes among nursing students. Although there is research on stress levels and coping mechanisms of nursing students (Admi, 1997; Beddoe & Murphy, 2004; Gwele & Uys, 1998; Shipton, 2002), the authors were not able to find any research that compares nursing students at various levels within a nursing education program, nor is there any research that compares male and female nursing students with stress levels.
2.2. Benefits of students The results of these studies suggest that nursing students lack outstanding health-promoting behaviors. The behaviors of nursing students seem to parallel the health behaviors exhibited by the general population. Lack of exercise and poor nutrition are areas where nursing students exhibit the least healthy behaviors. According to Stark et al. (2005), nurses often sacrifice their own health when caring for others. Introducing self-care to nursing students can be beneficial to them. Students obtain additional personal benefits as they try to improve their health. Caring for oneself provides resources that students can draw upon when caring for others (Stark, 2005); nursing is a physically and mentally exhausting profession. Healthy lifestyle behaviors can help nurses replenish physical and emotional energy. Nurses are expected to be role models for patients (Shriver & Scott-Stiles, 2000).
S. Staib et al. Practicing healthy behaviors as students can help them understand the problems that patients face when trying to maintain a healthy lifestyle (Stark, 2000).
2.3. Curricular implications Nursing faculties are in an ideal position to create and encourage health promotion and illness prevention programs (Clemmens, Engler, & Chinn, 2004). There is some evidence that shows that if such faculties intervene, there may be opportunities to reverse unhealthy lifestyle behaviors before students become professionals. In studies reported by Shriver and Scott-Stiles (2000), Stark et al. (2005), and Ziccardi et al. (2004), emphasizing healthpromoting behaviors in the nursing curricula can make a difference in nursing students’ willingness to change current unhealthy lifestyle to a more health-oriented one.
3. Methods A survey that studies the health behaviors of 159 first-year (n = 74; 47%) and second-year (n = 85; 54%) nursing students from the Zanesville campus of Ohio University, composed of 21 males (13%) and 138 females (87%), was conducted in Spring 2005. The survey used was developed by the U.S. Public Health Services to assess health behaviors and is free to users. No special permission is required for use. The study was designed to assess which health behaviors nursing students exhibited most frequently and to ascertain if there were any differences between first- and second-year nursing students and between male and female students. The instrument used to assess the health behaviors was the Health Style Self Test developed by the U.S. Public Health Service (Health Style). This instrument assesses nutrition, drug and alcohol use, smoking, fitness, stress, and safety. Students were informed of the study during a nursing class. At the end of the class, the instructor explained the study and left informed consent forms and the questionnaire in the room and requested interested students to completely fill out the document. Only those students who volunteered and gave consent were used in the study. Participants were assured of anonymity and confidentiality of information. The questionnaires were coded to make sure that students could not be identified and that data were kept locked. Data were entered into SPSS, and independent t tests were used to compare means between groups. Missing responses or blanks were excluded from the analyses.
4. Findings This study was based on the following assumptions: 1.
Because health care providers are role models for their clients, nursing students should lead healthier lifestyles than the general population.
How healthy are your nursing students? 2.
3.
Second-year nursing students will exhibit a greater number of unhealthy lifestyles because of the increased stress of nursing school. Male nursing students will exhibit different lifestyle choices as compared with female nursing students.
The areas of comparison include physical activity, overweight and obesity, smoking, and substance abuse. In the area of physical activity, Healthy People (2010) reports that only 15% of adults aged 18 and above engage in the recommended amount of physical activity (30 minutes/ day for at least five times a week). The student survey results show that 20% of the student population responded balmost alwaysQ to exercising 20–60 minutes for at least three times a week, whereas 45% responded bsometimesQ and 36% responded bnever.Q Healthy People (2010) reports that 23% of the adult population in the United States are overweight. In the student population, 28% responded that they never maintain a desired weight, whereas 37% responded that they sometimes maintain a desired weight. Only 35% of the students responded that they almost always maintain a desired weight. It was reported in Healthy People (2010) that 24% of adults smoke cigarettes. In the student survey, 65% responded that they have never smoked; 11% responded that they sometimes smoke, whereas 17% do smoke. Healthy People (2010) reports that 17% of adults engaged in binge drinking during the past month. Although the nursing students were not asked specifically about binge drinking, responses to the statement bI avoid alcoholic beverages or I drink no more than 1 or 2 drinks a dayQ indicate a lower rate than reported in Healthy People (2010). Only 4% responded that they do not avoid drinking alcoholic beverages or they drink no more than 1 or 2 drinks a day.
4.1. Assumption 2 Assumption 2, which assumes that second-year nursing students will exhibit a greater number of unhealthy lifestyles because of the increased stress of nursing school, was found not to be valid. A comparison of the total scores in each of the following categories found no significant difference in means between the two groups: cigarette smoking, drugs and alcohol, eating habits, exercise, safety, and stress control. A comparison of the scores on each subcategory of healthy behaviors showed a few significant differences between the scores of first-year and second-year nursing students. Those health behaviors that were found to be significantly different between these two groups of students included the following: bI am careful not to drink alcohol when taking certain medicationsQ ( p = .001); bI limit the amount of fat, saturated fat, and cholesterol I eatQ ( p = .014); bI maintain a desired weightQ ( p = .011); bI avoid driving while under the influence of alcohol and other drugsQ ( p = .005); bI am careful when using potentially harmful products and substancesQ ( p = .000);
57 bI avoid smoking in bedQ ( p = .000); and bI recognize early and prepare for events or situations likely to be stressful for meQ ( p = .014). For the subcategory bI am careful not to drink alcohol when taking certain medicines,Q the first-year students responded more positively by answering balmost alwaysQ in a greater percentage than the second-year students (87% vs. 79%, respectively; 11% of the first-year students and 21% of the second-year students responded bsometimesQ). The responses to the question bI limit the amount of fat, saturated fat, and cholesterol I eatQ again indicate that firstyear students responded more positively than second-year students (31% vs. 17%, respectively; 53% and 65% of firstyear and second-year students, respectively, responded bsometimes,Q whereas 16% and 18% of first-year and second-year students, respectively, responded balmost neverQ). First-year students reported a tendency to maintain a desired weight more often than second-year students as evidenced by the following responses: 45% for first-year students and 27% for second-year students; 45% and 40% of first-year and second-year students, respectively, responded bsometimesQ; 23% and 33% of first-year and second-year students, respectively, responded balmost never.Q Although responses to the subcategory bI avoid driving while under the influence of alcohol and other drugsQ were positive for both groups, first-year students responded balmost alwaysQ at a significantly higher rate than second-year students (96% vs. 88%, respectively; 3% and 11% of first-year and second-year students, respectively, responded bsometimesQ; 1% of both first-year and secondyear students responded balmost neverQ). Both first-year and second-year students responded to bI avoid smoking in bedQ positively, with 94% of first-year and 86% of second-year students responding balmost always.Q The significant difference was found in the response bsometimes,Q with 4% and 8% of first-year and second-year students, respectively, responding positively. The responses for the last subcategory, bI recognize early and prepare for events or situations likely to be stressful for me,Q were as follows: 34% and 44% of first-year and second-year students, respectively, responded balmost alwaysQ; 61% and 44% of first-year and second-year students, respectively, responded bsometimesQ; 5% and 13% of first-year and second-year students, respectively, responded balmost neverQ (Table 1).
4.2. Assumption 3 For Assumption 3, male nursing students will exhibit different lifestyle choices as compared with female nursing students; the total scores, again, showed no significant difference in these two populations. Several subcategories were found to be significant. These included the following subcategories: bI avoid cigarette smokingQ ( p = .002); bI wear a seat belt while riding in a carQ ( p = .007); bI am careful when using potentially harmful productsQ ( p = .000); and bI have a job or do other work that I enjoyQ ( p = .007).
58
S. Staib et al.
Table 1 Results of health behaviors survey Health behaviors
Almost always
Sometimes
Never
I do exercise that enhances my muscle tone for 15–30 minutes at least twice a week I maintain a desired weight, avoiding being overweight and underweight
Total, 28 (18%)
Total, 56 (35%)
Total, 75 (47%)
Total, 56 (35%) 1st year, 33 (45%) 2nd year, 23 (27%)
Total, 58 (37%) 1st year, 24 (45%) 2nd year, 34 (40%)
Total, 10 (6%) Males, 3 (14%) Females, 7 (5%) Total, 119 (75%)
Total, 17 (11%) Males, 3 (14%) Females, 14 (10%) Total, 32 (20%)
Total, 45 (28%) 1st year, 17 (23%) 2nd year, 28 (33%) Total, 103 (65%) Total, 27 (17%) Males, 3 (14%) Females, 24 (17%) Total, 6 (4%)
Total, 131 (82%) 1st year, 64 (87%) 2nd year, 67 (79%) Total, 37 (23%) 1st year, 23 (31%) 2nd year, 14 (17%) Total, 146 (92%) 1st year, 71 (96%) 2nd year, 75 (88%)
Total, 26 (16%) 1st year, 8 (11%) 2nd year, 18 (21%) Total 94, 59%) 1st year, 39 (53%) 2nd year, 55 (65%) Total, 11 (7%) Males, 4 (19%) Females, 13 (9%) 1st year, 13 (18%) 2nd year, 4 (5%) Total, 17 (11%) Males, 4 (19%) Females, 13 (9%) 1st year, 13 (18%) 2nd year, 4 (5%) Total, 10 (6%) 1st year, 3 (4%) 2nd year, 7 (8%) Total, 82 (52%) 1st year, 45 (61%) 2nd year, 37 (44%) Total, 22 (14%) Males, 4 (19%) Females, 18 (13%) Total, 41 (26%) Males, 6 (29%) Females, 35 (25%)
Total, 27 (17%) 1st year, 12 (16%) 2nd year, 15 (18%) Total, 1 (1%) Males, 1 (5%) Females, 0 1st year, 1 (1%) 2nd year, 0 Total, 1 (1%) Males, 1 (5%) Females, 0 1st year, 1 (1%) 2nd year, 0 Total, 4 (3%) 1st year, 0 2nd year, 4 (5%) Total, 15 (9%) 1st year, 4 (5%) 2nd year, 11 (13%) Total, 2 (1%) Males, 1 (5%) Females, 1 (1%) Total, 14 (9%) Males, 5 (24%) Females, 9 (7%)
If you never smoke, enter a score of 10 I avoid smoking cigarettes
I avoid drinking alcoholic beverages or I drink no more than 1 or 2 drinks a day I am careful not to drink alcohol when taking certain medicines or when pregnant I limit the amount of fat, saturated fat, and cholesterol I eat I avoid driving while under the influence of alcohol and other drugs
I am careful when using potentially harmful products or substances
I avoid smoking in bed
I recognize early and prepare for events or situations likely to be stressful for me I wear a seatbelt while riding in a car
I have a job or do other work that I enjoy
Total, 141 (89%) Males, 16 (76%) Females, 125 (91%) 1st year, 60 (82%) 2nd year, 81 (95%) Total, 142 (89%) 1st year, 69 (93%) 2nd year, 73 (86%) Total, 62 (39%) 1st year, 25 (34%) 2nd year, 37 (44%) Total, 134 (84%) Males, 16 (76%) Females, 118 (86%) Total, 103 (65%) Males, 10 (48%) Females, 93 (67%)
The responses to the subcategory bI avoid cigarette smoking,Q were as follows: 14% of male students and 5% of female students responded balmost always,Q 14% of male students and 10% of female students responded bsometimes,Q and 14% of male students and 17% of female students responded balmost never.Q For the subcategory bI wear a seat belt while riding in a car,Q the responses were as follows: 76% of male students and 86% of female students responded balmost always,Q 19% of male students and 13% of female students responded bsometimes,Q and 5% of male students and 1% of female students responded balmost never.Q Responses to the subcategory bI am careful when using potentially harmful productsQ were as follows: 76% of male students and 91% of female students responded balmost always,Q 19% of male students and 9% of female students responded bsometimes,Q and 5% of
male students and 0% of female students responded balmost never.Q The last subcategory that showed a significant difference between male and female students was bI have a job or do other work that I enjoy,Q with the following responses: 48% of male students and 67% of female students responded balmost always,Q 29% of male students and 25% of female students responded bsometimes,Q and 24% of male students and 7% of female students responded balmost never.Q
5. Conclusions As for Assumption 1, the student survey results are reflective of the general population as reported in Healthy
How healthy are your nursing students? People (2010). It was found that 81% of the nursing students either never or only sometimes achieve the recommended level of exercise and that 65% are sometimes or never achieve their desired weight. If nurses are supposed to be role models for the general population, then their health behaviors in the area of weight and physical activity need improvement. The figures for smoking are not as high, with 28% reporting that they at least sometimes smoke, although this is still an area of concern if nurses are to be role models. bIt seems likely that these students’ beliefs, and attitudes or perhaps their behaviors relating to preventive care may effect the clinical preventive services which they offer to their patientsQ (Najem et al., 1995, p. 842). Nursing students need encouragement and support to achieve these goals. Because it would be difficult for most to find extra time outside the classroom, these need to be built into the curriculum. As the nursing curriculum progresses, the knowledge becomes more complex; hence, it was assumed that the second-year nursing students would have fewer beneficial health behaviors because of increased stress. Although the total scores did not support this statement, there were some behaviors that reflect that first-year students were making healthier choices. First-year students are more likely not to drink alcohol when driving and taking certain medications; they are more likely to eat healthier; they are more likely to maintain a desired weight; and they are more likely not to smoke in bed. Second-year students responded with healthier choices that were significant in only two areas: bI am careful when using potentially harmful productsQ and bI recognize early and prepare for events or situations likely to be stressful for me.Q The latter higher response for second-year students might be reflective of time management skills learned during the first year of the nursing program. It was assumed that male students would have different health behaviors as compared with female students. Again, the total scores did not reflect any differences, but female students were found to be more likely to smoke, to use a seat belt, to be more careful when using potentially harmful products, and to have a job or do other work that they enjoy.
6. Recommendations This study was focused on one particular group of students; thus, it is recommended that this study be repeated with another group of nursing students to validate findings. The study was also self-reported, which can be limiting. It is recommended that a group of students keep track of their activities through a diary for a more accurate reporting. Undergraduate nursing education faculty members need to stress to nursing students that their being a healing presence to others entails that they exhibit healthy self-care
59 behaviors (Burkhardt & Nagai-Jacobson, 2001). Developing a healthy lifestyle entails time and effort (Timmerman, 1999); hence, nursing faculty needs to incorporate extra time and additional education in their nursing curricula to foster healthy self-care behaviors as suggested by Grossman and Wheeler (1999). This study showed the main areas in the nursing curriculum that need emphasis—physical exercise and weight control. Of equal importance is that nursing faculty members attempt to model healthy self-care behaviors to their students; their being an active role model for nursing students empowers both students and educators. Students and nurses who practice self-care behaviors are better able to care for others than those who ignore their personal health. Once students become nurses, these selfcare health-promoting behaviors should be continued during their professional lives, which will help lead the nation to live healthier lifestyles.
References Adderley-Kelly, B., & Green, P. M. (2000). Health behaviors of undergraduate African American nursing students. Association of Black Nursing Faculty Journal, 11(1), 7 – 13 [Retrieved November 14, 2005, from ProQuest Nursing Journal database]. Admi, H. (1997). Nursing students’ stress during the initial clinical experience. Journal of Nursing Education, 36(7), 323 – 328 [Retrieved January 1, 2005 from ProQuest Nursing Journal Database]. Beddoe, A. E., & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(7), 305 – 317 [Retrieved January 1, 2005 from ProQuest Nursing Journal Database]. Burkhardt, M., & Nagai-Jacobson, M. (2001). Nurturing and caring for self. Nursing Clinics of North Amercia, 16, 23 – 31. Clement, J. M., Schmidt, C. A., Bernaix, L. W., Covington, N. K., & Carr, T. R. (2004). Obesity and physical activity in college woman: Implications for clinical practice. Journal of the American Academy of Nurse Practitioners, 16(7), 291 – 299. Clement, M., Nurs, M., Jankowski, L. W., Bouchard, L., Perreault, M., & Lepage, Y. (2002). Health behaviors of nursing students: A longitudinal study. Journal of Nursing Education, 41(6), 257 – 265. Clemmens, D., Engler, A., & Chinn, P. L. (2004). Learning and living health: College students’ experiences with an introductory health course. Journal of Nursing Education, 43(7), 313 – 318 [Retrieved April 20, 2006 from ProQuest Nursing Journal database]. Grossman, S., & Wheeler, K. (1999). Integrating multidimensional stress management into a baccalaureate nursing curriculum. Nursing Connections, 12(2), 23 – 29. Healthstyle: A self-test. National Health Information Clearinghouse. Washington, DC7 U.S. Public Health Service. Gwele, N. S., & Uys, L. R. (1998). Levels of stress and academic performance in baccalaureate nursing students. Journal of Nursing Education, 37(9), 404 – 408 [Retrieved January 4, 2005 from ProQuest Nursing Journal Database]. Healthy People, 2010. Retrieved October 12, 2005, from www.healthypeople.gov. Najem, G. R., Passannante, M. R., & Foster, J. D. (1995). Health risk factors and health promoting behavior of medical, dental, and nursing students. Journal of Clinical Epidemiology, 48(6), 841 – 849. Shipton, S. P. (2002). Process of seeking stress-care: Coping as experienced by senior baccalaureate nursing students in response to appraised clinical stress. Journal of Nursing Education, 41(6), 243 – 257 [Retrieved January 4, 2005 from ProQuest Nursing Journal Database].
60 Shriver, C. B., & Scott-Stiles, A. (2000). Health habits of nursing versus non-nursing students: A longitudinal study. Journal of Nursing Education, 39(7), 308 – 314. Stark, M. A., Manning-Walsh, J., & Vliem, S. (2005). Caring for self while learning to care for others: A challenge for nursing students. Journal of Nursing Education, 44(6), 266 – 271 [Retrieved November 14, 2005 from ProQuest Nursing Journal database].
S. Staib et al. Timmerman, G. (1999). Using self-care strategies to make life-style changes. Journal of Holistic Nursing, 17, 169 – 183. Ziccardi, S. L., Sedlak, C. A., & Doheny, M. O. (2004). Knowledge and health beliefs of osteoporosis in college nursing students. Orthopaedic Nursing, 23(2), 128 – 131 [Retrieved July 15, 2005 from Ebsco Host Research datatbase].
www.jtln.org
How healthy are your nursing students? Sharon Staib MS, RN*, Sally Fusner PhD, RN, Kitty Consolo PhD Ohio University, 1425 Newark Road, Zanesville, OH 43701, USA
KEYWORDS: Nursing students; Lifestyle; Healthy behaviors
Abstract This study surveyed the health behaviors of 159 nursing students. The major finding of this study is that there is a need for improvement in the areas of physical activity and weight control. Recommendations include nursing educators addressing these behaviors within the curriculum if future nurses are to model healthy behaviors for patients, as well as encouraging staff educators to continue to emphasize healthy behaviors. D 2006 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
1. Introduction Since 1979, the Department of Health and Human Services (HHS) has led a nationwide process to formulate and monitor health promotion and disease prevention activities. Building on 20 years of experience, HHS issued Healthy People (2010), a 10-year plan for disease prevention and health promotion objectives. Healthy People (2010) is about improving the health of people, communities, and nations (healthypeople.gov). The Leading Health Indicators identified in Healthy People (2010) used to measure the health of nations are closely linked to lifestyle patterns that reflect individual behaviors (healthypeople.gov). The indicators are selected based on their ability to motivate positive change in lifestyle activities. Included on the list of indicators are physical activity, obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury, and violence (healthypeople.gov). As medical practice focuses more on lifestyle patterns, health behaviors, disease prevention, and health promotion, * Corresponding author. Tel.: +1 740 588 1527 (work); Fax: +1 740 453 6161. E-mail address: [email protected] (S. Staib).
it becomes more important than ever that health care providers model those behaviors. Today’s nursing students will soon become health care providers. In view of the current issues identified in Healthy People (2010), studying the health behaviors, risk factors, and preventive health beliefs of nursing students is of interest. The assumption of this study is that health behaviors of nursing students stand out among the general public. To test this assumption, we gave a questionnaire consisting of health behaviors relating to smoking, drinking, drug use, eating habits, exercise fitness, safety measures, and stress control to 159 first- and second-year nursing students. The nursing students of today will be the role models for future populations; thus, improving their current health behaviors may positively impact their future nursing practice.
2. Review of related literature 2.1. Nursing students’ health behaviors Several studies have investigated the health behaviors of nursing students. Najem, Passannante, and Foster (1995), in a study of health-promoting behaviors of medical, dental,
1557-3087/$ – see front matter D 2006 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2006.06.001
56 and nursing students, found that preventive care beliefs and practices of health science students stand out among the general population, but these students can do substantially better than the findings of this study indicated. In a study of college-aged women, Clement, Schmidt, Bernaix, Covington, and Carr (2004) found that although most of these women had normal BMI, poor nutrition levels were still prevalent among this group. In a longitudinal study involving a large number of nursing students, Clement et al. (2002) found that except for inadequate sleep, nursing students’ health behaviors did not differ from those of the general public. Shriver and Scott-Stiles (2000) compared the health habits of nursing students with those of nonnursing students. Their findings indicated a statistically significant difference between groups over time, with nursing students scoring higher in healthy behaviors from Time 1 to Time 2, whereas the nonnursing students showed no improvement. Stark, Manning-Walsh, and Vilem (2005) found that nursing students may engage in the practice of health-related behaviors when given time to develop health-related activities as part of a nursing course. Adderley-Kelly and Green (2000) compared the health behaviors of undergraduate African American nursing students and other college students. Fifty-one percent of those studied had low scores for exercise and fitness, indicating risk factors in those areas. A study by Ziccardi, Sedlak, and Doheny (2004), looking at knowledge and health beliefs of nursing students regarding osteoporosis, suggests that including health promotion behaviors in nursing curricula may lead to lifestyle changes among nursing students. Although there is research on stress levels and coping mechanisms of nursing students (Admi, 1997; Beddoe & Murphy, 2004; Gwele & Uys, 1998; Shipton, 2002), the authors were not able to find any research that compares nursing students at various levels within a nursing education program, nor is there any research that compares male and female nursing students with stress levels.
2.2. Benefits of students The results of these studies suggest that nursing students lack outstanding health-promoting behaviors. The behaviors of nursing students seem to parallel the health behaviors exhibited by the general population. Lack of exercise and poor nutrition are areas where nursing students exhibit the least healthy behaviors. According to Stark et al. (2005), nurses often sacrifice their own health when caring for others. Introducing self-care to nursing students can be beneficial to them. Students obtain additional personal benefits as they try to improve their health. Caring for oneself provides resources that students can draw upon when caring for others (Stark, 2005); nursing is a physically and mentally exhausting profession. Healthy lifestyle behaviors can help nurses replenish physical and emotional energy. Nurses are expected to be role models for patients (Shriver & Scott-Stiles, 2000).
S. Staib et al. Practicing healthy behaviors as students can help them understand the problems that patients face when trying to maintain a healthy lifestyle (Stark, 2000).
2.3. Curricular implications Nursing faculties are in an ideal position to create and encourage health promotion and illness prevention programs (Clemmens, Engler, & Chinn, 2004). There is some evidence that shows that if such faculties intervene, there may be opportunities to reverse unhealthy lifestyle behaviors before students become professionals. In studies reported by Shriver and Scott-Stiles (2000), Stark et al. (2005), and Ziccardi et al. (2004), emphasizing healthpromoting behaviors in the nursing curricula can make a difference in nursing students’ willingness to change current unhealthy lifestyle to a more health-oriented one.
3. Methods A survey that studies the health behaviors of 159 first-year (n = 74; 47%) and second-year (n = 85; 54%) nursing students from the Zanesville campus of Ohio University, composed of 21 males (13%) and 138 females (87%), was conducted in Spring 2005. The survey used was developed by the U.S. Public Health Services to assess health behaviors and is free to users. No special permission is required for use. The study was designed to assess which health behaviors nursing students exhibited most frequently and to ascertain if there were any differences between first- and second-year nursing students and between male and female students. The instrument used to assess the health behaviors was the Health Style Self Test developed by the U.S. Public Health Service (Health Style). This instrument assesses nutrition, drug and alcohol use, smoking, fitness, stress, and safety. Students were informed of the study during a nursing class. At the end of the class, the instructor explained the study and left informed consent forms and the questionnaire in the room and requested interested students to completely fill out the document. Only those students who volunteered and gave consent were used in the study. Participants were assured of anonymity and confidentiality of information. The questionnaires were coded to make sure that students could not be identified and that data were kept locked. Data were entered into SPSS, and independent t tests were used to compare means between groups. Missing responses or blanks were excluded from the analyses.
4. Findings This study was based on the following assumptions: 1.
Because health care providers are role models for their clients, nursing students should lead healthier lifestyles than the general population.
How healthy are your nursing students? 2.
3.
Second-year nursing students will exhibit a greater number of unhealthy lifestyles because of the increased stress of nursing school. Male nursing students will exhibit different lifestyle choices as compared with female nursing students.
The areas of comparison include physical activity, overweight and obesity, smoking, and substance abuse. In the area of physical activity, Healthy People (2010) reports that only 15% of adults aged 18 and above engage in the recommended amount of physical activity (30 minutes/ day for at least five times a week). The student survey results show that 20% of the student population responded balmost alwaysQ to exercising 20–60 minutes for at least three times a week, whereas 45% responded bsometimesQ and 36% responded bnever.Q Healthy People (2010) reports that 23% of the adult population in the United States are overweight. In the student population, 28% responded that they never maintain a desired weight, whereas 37% responded that they sometimes maintain a desired weight. Only 35% of the students responded that they almost always maintain a desired weight. It was reported in Healthy People (2010) that 24% of adults smoke cigarettes. In the student survey, 65% responded that they have never smoked; 11% responded that they sometimes smoke, whereas 17% do smoke. Healthy People (2010) reports that 17% of adults engaged in binge drinking during the past month. Although the nursing students were not asked specifically about binge drinking, responses to the statement bI avoid alcoholic beverages or I drink no more than 1 or 2 drinks a dayQ indicate a lower rate than reported in Healthy People (2010). Only 4% responded that they do not avoid drinking alcoholic beverages or they drink no more than 1 or 2 drinks a day.
4.1. Assumption 2 Assumption 2, which assumes that second-year nursing students will exhibit a greater number of unhealthy lifestyles because of the increased stress of nursing school, was found not to be valid. A comparison of the total scores in each of the following categories found no significant difference in means between the two groups: cigarette smoking, drugs and alcohol, eating habits, exercise, safety, and stress control. A comparison of the scores on each subcategory of healthy behaviors showed a few significant differences between the scores of first-year and second-year nursing students. Those health behaviors that were found to be significantly different between these two groups of students included the following: bI am careful not to drink alcohol when taking certain medicationsQ ( p = .001); bI limit the amount of fat, saturated fat, and cholesterol I eatQ ( p = .014); bI maintain a desired weightQ ( p = .011); bI avoid driving while under the influence of alcohol and other drugsQ ( p = .005); bI am careful when using potentially harmful products and substancesQ ( p = .000);
57 bI avoid smoking in bedQ ( p = .000); and bI recognize early and prepare for events or situations likely to be stressful for meQ ( p = .014). For the subcategory bI am careful not to drink alcohol when taking certain medicines,Q the first-year students responded more positively by answering balmost alwaysQ in a greater percentage than the second-year students (87% vs. 79%, respectively; 11% of the first-year students and 21% of the second-year students responded bsometimesQ). The responses to the question bI limit the amount of fat, saturated fat, and cholesterol I eatQ again indicate that firstyear students responded more positively than second-year students (31% vs. 17%, respectively; 53% and 65% of firstyear and second-year students, respectively, responded bsometimes,Q whereas 16% and 18% of first-year and second-year students, respectively, responded balmost neverQ). First-year students reported a tendency to maintain a desired weight more often than second-year students as evidenced by the following responses: 45% for first-year students and 27% for second-year students; 45% and 40% of first-year and second-year students, respectively, responded bsometimesQ; 23% and 33% of first-year and second-year students, respectively, responded balmost never.Q Although responses to the subcategory bI avoid driving while under the influence of alcohol and other drugsQ were positive for both groups, first-year students responded balmost alwaysQ at a significantly higher rate than second-year students (96% vs. 88%, respectively; 3% and 11% of first-year and second-year students, respectively, responded bsometimesQ; 1% of both first-year and secondyear students responded balmost neverQ). Both first-year and second-year students responded to bI avoid smoking in bedQ positively, with 94% of first-year and 86% of second-year students responding balmost always.Q The significant difference was found in the response bsometimes,Q with 4% and 8% of first-year and second-year students, respectively, responding positively. The responses for the last subcategory, bI recognize early and prepare for events or situations likely to be stressful for me,Q were as follows: 34% and 44% of first-year and second-year students, respectively, responded balmost alwaysQ; 61% and 44% of first-year and second-year students, respectively, responded bsometimesQ; 5% and 13% of first-year and second-year students, respectively, responded balmost neverQ (Table 1).
4.2. Assumption 3 For Assumption 3, male nursing students will exhibit different lifestyle choices as compared with female nursing students; the total scores, again, showed no significant difference in these two populations. Several subcategories were found to be significant. These included the following subcategories: bI avoid cigarette smokingQ ( p = .002); bI wear a seat belt while riding in a carQ ( p = .007); bI am careful when using potentially harmful productsQ ( p = .000); and bI have a job or do other work that I enjoyQ ( p = .007).
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Table 1 Results of health behaviors survey Health behaviors
Almost always
Sometimes
Never
I do exercise that enhances my muscle tone for 15–30 minutes at least twice a week I maintain a desired weight, avoiding being overweight and underweight
Total, 28 (18%)
Total, 56 (35%)
Total, 75 (47%)
Total, 56 (35%) 1st year, 33 (45%) 2nd year, 23 (27%)
Total, 58 (37%) 1st year, 24 (45%) 2nd year, 34 (40%)
Total, 10 (6%) Males, 3 (14%) Females, 7 (5%) Total, 119 (75%)
Total, 17 (11%) Males, 3 (14%) Females, 14 (10%) Total, 32 (20%)
Total, 45 (28%) 1st year, 17 (23%) 2nd year, 28 (33%) Total, 103 (65%) Total, 27 (17%) Males, 3 (14%) Females, 24 (17%) Total, 6 (4%)
Total, 131 (82%) 1st year, 64 (87%) 2nd year, 67 (79%) Total, 37 (23%) 1st year, 23 (31%) 2nd year, 14 (17%) Total, 146 (92%) 1st year, 71 (96%) 2nd year, 75 (88%)
Total, 26 (16%) 1st year, 8 (11%) 2nd year, 18 (21%) Total 94, 59%) 1st year, 39 (53%) 2nd year, 55 (65%) Total, 11 (7%) Males, 4 (19%) Females, 13 (9%) 1st year, 13 (18%) 2nd year, 4 (5%) Total, 17 (11%) Males, 4 (19%) Females, 13 (9%) 1st year, 13 (18%) 2nd year, 4 (5%) Total, 10 (6%) 1st year, 3 (4%) 2nd year, 7 (8%) Total, 82 (52%) 1st year, 45 (61%) 2nd year, 37 (44%) Total, 22 (14%) Males, 4 (19%) Females, 18 (13%) Total, 41 (26%) Males, 6 (29%) Females, 35 (25%)
Total, 27 (17%) 1st year, 12 (16%) 2nd year, 15 (18%) Total, 1 (1%) Males, 1 (5%) Females, 0 1st year, 1 (1%) 2nd year, 0 Total, 1 (1%) Males, 1 (5%) Females, 0 1st year, 1 (1%) 2nd year, 0 Total, 4 (3%) 1st year, 0 2nd year, 4 (5%) Total, 15 (9%) 1st year, 4 (5%) 2nd year, 11 (13%) Total, 2 (1%) Males, 1 (5%) Females, 1 (1%) Total, 14 (9%) Males, 5 (24%) Females, 9 (7%)
If you never smoke, enter a score of 10 I avoid smoking cigarettes
I avoid drinking alcoholic beverages or I drink no more than 1 or 2 drinks a day I am careful not to drink alcohol when taking certain medicines or when pregnant I limit the amount of fat, saturated fat, and cholesterol I eat I avoid driving while under the influence of alcohol and other drugs
I am careful when using potentially harmful products or substances
I avoid smoking in bed
I recognize early and prepare for events or situations likely to be stressful for me I wear a seatbelt while riding in a car
I have a job or do other work that I enjoy
Total, 141 (89%) Males, 16 (76%) Females, 125 (91%) 1st year, 60 (82%) 2nd year, 81 (95%) Total, 142 (89%) 1st year, 69 (93%) 2nd year, 73 (86%) Total, 62 (39%) 1st year, 25 (34%) 2nd year, 37 (44%) Total, 134 (84%) Males, 16 (76%) Females, 118 (86%) Total, 103 (65%) Males, 10 (48%) Females, 93 (67%)
The responses to the subcategory bI avoid cigarette smoking,Q were as follows: 14% of male students and 5% of female students responded balmost always,Q 14% of male students and 10% of female students responded bsometimes,Q and 14% of male students and 17% of female students responded balmost never.Q For the subcategory bI wear a seat belt while riding in a car,Q the responses were as follows: 76% of male students and 86% of female students responded balmost always,Q 19% of male students and 13% of female students responded bsometimes,Q and 5% of male students and 1% of female students responded balmost never.Q Responses to the subcategory bI am careful when using potentially harmful productsQ were as follows: 76% of male students and 91% of female students responded balmost always,Q 19% of male students and 9% of female students responded bsometimes,Q and 5% of
male students and 0% of female students responded balmost never.Q The last subcategory that showed a significant difference between male and female students was bI have a job or do other work that I enjoy,Q with the following responses: 48% of male students and 67% of female students responded balmost always,Q 29% of male students and 25% of female students responded bsometimes,Q and 24% of male students and 7% of female students responded balmost never.Q
5. Conclusions As for Assumption 1, the student survey results are reflective of the general population as reported in Healthy
How healthy are your nursing students? People (2010). It was found that 81% of the nursing students either never or only sometimes achieve the recommended level of exercise and that 65% are sometimes or never achieve their desired weight. If nurses are supposed to be role models for the general population, then their health behaviors in the area of weight and physical activity need improvement. The figures for smoking are not as high, with 28% reporting that they at least sometimes smoke, although this is still an area of concern if nurses are to be role models. bIt seems likely that these students’ beliefs, and attitudes or perhaps their behaviors relating to preventive care may effect the clinical preventive services which they offer to their patientsQ (Najem et al., 1995, p. 842). Nursing students need encouragement and support to achieve these goals. Because it would be difficult for most to find extra time outside the classroom, these need to be built into the curriculum. As the nursing curriculum progresses, the knowledge becomes more complex; hence, it was assumed that the second-year nursing students would have fewer beneficial health behaviors because of increased stress. Although the total scores did not support this statement, there were some behaviors that reflect that first-year students were making healthier choices. First-year students are more likely not to drink alcohol when driving and taking certain medications; they are more likely to eat healthier; they are more likely to maintain a desired weight; and they are more likely not to smoke in bed. Second-year students responded with healthier choices that were significant in only two areas: bI am careful when using potentially harmful productsQ and bI recognize early and prepare for events or situations likely to be stressful for me.Q The latter higher response for second-year students might be reflective of time management skills learned during the first year of the nursing program. It was assumed that male students would have different health behaviors as compared with female students. Again, the total scores did not reflect any differences, but female students were found to be more likely to smoke, to use a seat belt, to be more careful when using potentially harmful products, and to have a job or do other work that they enjoy.
6. Recommendations This study was focused on one particular group of students; thus, it is recommended that this study be repeated with another group of nursing students to validate findings. The study was also self-reported, which can be limiting. It is recommended that a group of students keep track of their activities through a diary for a more accurate reporting. Undergraduate nursing education faculty members need to stress to nursing students that their being a healing presence to others entails that they exhibit healthy self-care
59 behaviors (Burkhardt & Nagai-Jacobson, 2001). Developing a healthy lifestyle entails time and effort (Timmerman, 1999); hence, nursing faculty needs to incorporate extra time and additional education in their nursing curricula to foster healthy self-care behaviors as suggested by Grossman and Wheeler (1999). This study showed the main areas in the nursing curriculum that need emphasis—physical exercise and weight control. Of equal importance is that nursing faculty members attempt to model healthy self-care behaviors to their students; their being an active role model for nursing students empowers both students and educators. Students and nurses who practice self-care behaviors are better able to care for others than those who ignore their personal health. Once students become nurses, these selfcare health-promoting behaviors should be continued during their professional lives, which will help lead the nation to live healthier lifestyles.
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