Running head: SIGNIFICANCE OF OBESITY IN NURSING

The Significance of Obesity and Night Shift Nursing Jessi Chipman Ferris State University

SIGNIFICANCE OF OBESITY IN NURSING Abstract The purpose of this paper was to provide an evident problem, intervention, comparison, and

outcome (PICO) to the correlation between obesity (BMI >30) and night shift nursing. The PICO question in this particular paper is, Are nurses (Licensed Practical Nurses and Registered Nurses) who work the night shift (7 p.m. - 7 a.m.) at a greater risk of obesity then the nurses who work the day shift (7 a.m. 7 p.m.)? Three articles were critiqued to gather information to support the idea that obesity is more prevalent in night shift workers than in day shift nursing. After reviewing the results, there was little data to support the idea that there is a correlation. However, the data suggests that obesity can have detrimental effects on a nurses performance reducing the overall quality and safe care a patient receives.

SIGNIFICANCE OF OBESITY IN NURSING Significance of Obesity in Night Shift Nursing PICO Question

The purpose of PICO papers is to interpret research findings, use evidence-based research to support nursing decisions, and to reflect how nursing knowledge is disseminated for use in personal and professional practice (Singleterry, 2013, p.8). When using PICO, it identifies the patient problem or a significant issue in the health care industry, intervention of interest or what appears to be an appropriate intervention measure, comparison intervention or what has been researched or done in the past, and outcome of interest or how this revision could improve patient quality and safety. In this particular paper, the PICO question addressed is: Are nurses (Licensed Practical Nurses and Registered Nurses) who work the night shift (7 p.m. - 7 a.m.) at a greater risk of obesity then the nurses who work the day shift (7 a.m. 7 p.m.)? This PICO question addresses the incidence of elevated body mass (BMI) amongst night shift nurses, which is a growing problem in the United States. Quality in health care is crucial and goes hand in hand with safety. Providing quality care to a patient means providing the best current nursing care safely while achieving optimal outcomes. Optimal outcomes can be defined through policies as well as the patients perceptions of their treatment or care. Using the method of PICO, enhances quality and safety by educating the healthcare industry and their employees on the most current and safe care that can be provided. For instance, if there is a consistent problem that is decreasing patient quality outcomes, there needs to be a PICO intervention to improve the care being provided. There may be a new method discovered or even a new best practice that would enhance a patients experience while ensuring safety.

SIGNIFICANCE OF OBESITY IN NURSING Discovering a way to decrease obesity within the nursing industry would ensure patient safety and impact quality in several different ways. According to Huth, Eliades, Handwork, Englehart, and Messenger (2013), There are several health risks associated with an elevated BMI including heart disease, hypertension, type II diabetes, endometrial, breast, and colon cancers, stroke, and obstructive sleep disorders (p. 64). These comorbidities to obesity could

have detrimental effects on the performance of a nurse, decreasing the ability to work efficiently and safely. In some instances, nurses who are obese and subsequently working the night shift may be often fatigued, which is a huge safety concern (Miller, Alpert, & Cross, 2009, p. 260). Discovering a way to decrease the incidence of obesity in nursing would in return increase quality of care and patient safety. Rogers (2008) states, Patient safety and quality care are at the core of health care systems and processes and are inherently dependent upon nurses. To achieve goals in patient safety and quality, and thereby improve health care throughout this nation, nurses must assume the leadership role (p. 1). Methodology Several articles and resources were needed for accurate information on the correlation between night shift nursing and obesity. The articles used in this paper were gathered through advanced searches on PubMed and CINHAL databases provided through Ferris State Universitys Library webpage. The key words consisted of; nurse body mass index, nurse obesity, obesity in nursing, obesity education, nursing knowledge on obesity, and night shift nursing. The key words assisted in narrowing down articles that pertained to the PICO topic. There was also advanced search criterion used to find nursing research that was conducted by nurses and then published in a nursing journal. The importance of using nursing research,

SIGNIFICANCE OF OBESITY IN NURSING according to the American Association of Colleges of Nursing (2013) is that, nursing research

focuses on the understanding of the symptoms of acute and chronic illness; prevention or delayed onset of disease or disability, finding effective approaches to achieve and sustain optimal health; and improvement of clinical settings in which care is provided. Each article was critiqued and consisted of a purpose statement, method, results, discussion, and references which are important in increasing credibility to an article. All articles were current (within the last five years) and were all evidence-based. The articles that were picked contained information on the correlation between night shift nursing and obesity. Discussion of Literature Article 1 Purpose and methodology. Huth, Eliades, Handwork, Englehart, and Messenger (2013) suggested that there may be a relationship between working the night shift and the quality of sleep with a possible correlation of decreased quality of sleep to an elevated BMI (p. 65). The purpose of this article was to explore the relationship between working the day or night shift and having an elevated BMI using a descriptive, quantitative, and correlational design. This study was conducted at Akron Childrens Hospital in Ohio and consisted of 420 pediatric nurses (Licensed Practical Nurses and Registered Nurses). The majority of the sample was female, with median age of 38.7 years, and 58.2% reported to have children in their home. It was also reported that 220 nurses work the day shift and 158 work the night shift (Huth et al, 2013, pp 64-68). The structure of this study was based upon the theoretical framework of the Neuman Systems Model. The Nueman Systems Model studies the five person variables; physiological, psychological, developmental, socio-cultural while keeping the person being studied as the basic

SIGNIFICANCE OF OBESITY IN NURSING structure (Huth et al., 2013, p. 65). It is to be believed that the five person variables may impact the BMI of night shift nurses due to internal and external stressors. The nurses filled out an electronic survey that consisted of ten questions focusing on age, gender, level of nursing education, hours and shift worked, self-reported height and weight, and sleep pattern (p. 68). Results, limitations, and recommendations. The results from Huth et al. (2013) indicated that, there was no statically significant difference of elevated BMI (>30) between night shift and day shift nor quality of sleep (p. 69). The reported number of night shift nurses within the obesity range of BMI > 30; was 27.5%, which is lower than the national percentage of obese nurses at 33.8% (p. 70). Although the results within this study were to be opposite of the hypothesis, there were limitations and threats

of validity. The questionnaire could have been hard to understand or could have been misleading. There was no way to determine the amount of hours the participating nurses were working. According to Huth et al. (2013) was long shifts may potentially impact the stability of the nurse client system and may require intervention to maintain the nurses well-being (p. 72). There were no questions pertaining to heath/family history or wellness activities outside of work. Working the night shift may have no significance to obesity in some instances when the stressors are home related rather than work related. Recommendations consisted of monitoring well-being of nurses inside and outside of work, monitoring sleep patterns, and increasing knowledge on obesity for staff. Article 2 Purpose, methodology, and results. According to Zapke, Lemon, Magner, and Hale (2009), The purpose of this study was to describe the weight, weight-related perceptions, and lifestyle behaviors of hospital-based nurses

SIGNIFICANCE OF OBESITY IN NURSING and to explore the relationships of demographics, health, weight, and job characteristics with lifestyle behaviors (p. 853). There was a sample of 194 nurses from six hospitals in central Massachusetts that consented to participate in this study that used a 30-minute self-administered survey and anthropometric measurements (p. 854). The results of this study indicated that, in respect to BMI, 28% of the participants were considered obese (>30) and 37% were considered overweight (>25) (p. 856). Of the 194 participants, 15% worked night shift which consisted of 8-12 hour shifts. It was not indicated what percentage of night shift participants whom fell into the obese category. However, it was reported that those who worked the night shift used the flight of stairs up or down significantly less than those who worked during the day. Discussion, limitations, and recommendations. Although this article did not pertain to the night shift nursing only, it gave a lot of useful information on creating healthy work environments no matter what shift a nurse may be on. In a

small sample size of 194 participants, 19% (37 nurses) worked the night shift and more than half could be considered overweight or obese (Zapke et al., 2009, p. 856). This is an alarming number and the issue needs to be addressed. This study had limitations and threats to validity. Because this study contained a small sample size and was self-reported, social desirability bias and generalization may be a concern (p. 858). Much like the article discussed previously, outside factors may have a huge impact on this obesity epidemic seen in night shift nursing. Recommendations included; promoting healthy work environments, encourage walking on breaks and taking the stairs, promote healthy lifestyle and food choices using posters and offering free healthy snacks (p. 858). Article 3

SIGNIFICANCE OF OBESITY IN NURSING Purpose, methods, and results. According to Zhao, Bogossian, and Turner (2012) the purpose of this study was to examine the associations between shift work types and overweight/obesity among female nurses and midwives (p. 854). From previous research conducted through these nurses, it was found that night shift workers are 1.3 times more likely to be overweight/obese compared to the day shift. The participants in this particular study were from the Nurses and Midwives e-cohort Study (NMeS) in Australia, New Zealand, and United Kingdome. The NMeS is a longitudinal

population-based study that examined both the workforce and health outcomes (Zhao et al, 2012, pg. 854). The participants needed to meet certain criteria to qualify for being examined. The nurses had to be female, working as a nurse, not pregnant at the time, list her modifiable lifestyle factors, and define shift worked. There were 2086 nurses that participated (does not indicate with or without consent) and of those nurses, with a median age of 43.4 years, 115 were night-only shift workers. In this sample 60% of the participants (day and night shift) were classified as being overweight or obese. Of the 115 night-only shift workers, 31.3% were obese, which was the highest percentage in this study (p. 856). Discussions, limitations, and recommendations. The article discussed certain aspects of nursing that may impact the incidence of obesity in night shift nursing. This could be related to age, how long nursing career has been established, and personal perception on health status. Zhao et al. (2012) suggested that many new graduates are forced to work undesirable night shift hours which, biologically, could be reducing the quality of sleep and increasing BMI. The nurses on the day shift may be a little bit more established allowing them to work the desired day shift, but are older in age quite often. Both, being high risk factors to obesity (pg. 857). These factors would be hard to determine because

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there several threats to validity. One was that there was no health history included and the survey was conducted electronically. This leaves room for self-perceived responses and biases. The article recommended studying both female and male nurses in the incidence of obesity in night shift nursing since in this particular study, only females were evaluated. (p. 858). Significance to Nursing The research findings in this paper were inconclusive. There was little data supporting the idea that there is a correlation between night shift nursing and obesity. However, it is evident that there is a problem with obesity in nursing as a whole. This issue needs to be addressed because obesity can have detrimental effects on a nurses performance, decreasing quality and safe care. The American Association of Colleges of Nursing (2013) states, The priorities for nursing research reflect nursing's commitment to the promotion of health and healthy lifestyles, the advancement of quality and excellence in health care, and the critical importance of basing professional nursing practice on research. Not only do nurses have a responsibility of promoting healthy lifestyles, they have made a commitment to remain healthy themselves in order to provide holistic and individualized care to patients. With all of the comorbidities following obesity, it can be said that nurses who are obese may struggle with providing quality care. They are often fatigued and complain of sleepiness more often than the day shift nurses (Huth et al, 2013, p. 72). In order to increase quality care and ensure safety, health care organizations need to promote healthy lifestyles to their employees and further investigate the problem with nursing and obesity.

SIGNIFICANCE OF OBESITY IN NURSING References

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American Association of Colleges of Nursing (2013). Nursing research. Washington DC: American Association of Colleges of Nursing. Retrieved on November 23, 2013 from http://www.aacn.nche.edu/publications/position/nursing-research Huth, J. J., Eliades, A., Handwork, C., Englehart, J. L., & Messenger, J. (2013). Shift worked, quality of sleep, and elevated body mass index in pediatric nurses. Journal of Pediatric Nursing, 28(6), e64-73. doi:10.1016/j.pedn.2013.02.032. Miller, S. K., Alpert, P. T., Cross C. L. (2008). Overweight and obesity in nurses, advanced practice nurses, and nurse educators. Journal of the American Academy of Nurse Practitioners, 259-265. doi: 10.1111/j.1745-7599.2008.00319.x Rogers A. E., (2008). The effects of fatigue and sleepiness on nurse performance and patient safety: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (pp 1-38). Rockville, MD: Hughes. Singleterry, L. (2013). NURS research in nursing [course syllabus fall 2013]. Retrieved from: http://www.ferris.edu/HTMLS/colleges/alliedhe/Nursing/BSN/BSN_Nursing_Course_Sy llabi.htm. Zapka, J. M., Lemon, S., Magner, R. P., & Hale, J. (2009). Lifestyle behaviors and weight among hospital-based nurses. Journal of Nursing Management, 17, 853-860. doi: 10.1111/j.3652834.2008.00923.x Zhao, I., Bogossian, F., Turner C., (2012). A cross-sectional analysis of the association between night-only or rotating shift work and overweight/obesity among female nurses and midwives. Journal of Environmental Medicine, 54, 854-857. doi: 10.1097/JOM.0b013e31824e1058.