New graduate nurses who took part in a health promotion intervention program during their transition to practice programs (TTP) improved their health knowledge and some dietary behaviours, research has found.
Dr Elizabeth Brogan, a lecturer at the University of Technology Sydney (UTS) and a registered nurse with over 20 years’ of experience, conducted the study to explore if a health intervention could capture new grad nurses to form healthy diet and exercise habits from the start of their transition to practice programs (TTP).
“I developed my passion for supporting new graduate nurses when I worked as a Nurse Educator, and it was this experience that inspired me to implement the Start Healthy and Stay Healthy intervention,” Dr Brogan explains.
“New graduate nurses are our future and if we do not support them to establish healthy behaviours from career commencement, we won’t have a future workforce.”
The Start Healthy and Stay Healthy (SH&SH) intervention was embedded into the TTP delivered at four metropolitan sites across one Local Health District (LHD) in Sydney from February to December 2019.
It included face-to-face education sessions, the use of a fitness tracker and short text messages twice a week. Participants had to complete three online surveys – at orientation, six weeks, and six months. Some were also interviewed and shared their experiences of the intervention.
A total of 99 new graduate nurses completed the baseline survey, 62 at six weeks and 69 at six months.
The study found that after six months, health knowledge had increased, with participants correctly identifying the recommended amount of fruits, vegetables and physical activity required, according to peak body guidelines. Fruit consumption increased but there was little change to vegetable intake. And while takeaway consumption fell, consumption of some discretionary foods grew.
Interestingly, participation in exercise improved for some participants, yet across the three time points, there was low engagement in physical activity during leisure time, the study found.
“The results of the study were encouraging, with the participants engaging in healthy behaviours including increased fruit consumption and low consumption of takeaway foods despite being fatigued and feeling like they have limited time to engage in healthy behaviours,” Dr Brogan says.
“A surprising finding was the improvement in health knowledge of participants, specifically the recommended minutes of physical activity. I believe it is important nurses engage in healthy lifestyle behaviours because if we do not look after our own health, this may reduce our ability to provide safe and adequate care for others.”
When outlining the proposal for the study in 2019, Dr Brogan noted that nurses need to engage in healthy lifestyle behaviours to ensure they can meet rising demands for healthcare. Yet, experienced nurses often have poor dietary and physical activity behaviours.
Her study embedding a health promotion intervention into TTP programs aimed to fill the gap in the limited current research examining diet and exercise habits among graduate nurses as they begin their careers.
Dr Brogan’s 2020 paper, Healthy eating and physical activity among new graduate nurses: A qualitative study of barriers and enablers during their first year of clinical practice, initially investigated the barriers and enablers to healthy eating and exercise for new graduate nurses during their first year of clinical practice.
That paper found new graduate nurses experience the same hurdles in maintaining healthy lifestyles as more experienced nurses. Four key barriers emerged – time, shift work, work environment, and work culture. Importantly, there was high interest in an intervention program.
The latest study, which implemented the intervention, Start Healthy and Stay Healthy: A workplace health promotion intervention for new graduate nurses, identified three themes – support of colleagues and peers, the work environment, and engagement with the Start Healthy and Stay Healthy (SH&SH) intervention.
The results revealed that health knowledge increased and some diet habits improved. However, only a small number of participants consumed vegetables at the recommended daily serve at any time point. Meanwhile, the consumption of discretionary food, such as crisps and confectionary, significantly increased between six weeks and six months.
When it came to physical activity, low engagement in exercises was reported across the three time points, with no change observed for any activity.
Tellingly, most participants reported that shift work negatively impacted their ability to engage in both healthy eating and physical activity, as did fatigue from the physical demands of nursing.
“They described having no energy after a shift to prepare a healthy meal at home, despite a desire to eat healthy foods,” the study stated.
“As a result, they reported consuming ready-made meals or takeaway, as it required less energy and effort despite being an unhealthy option.”
Similarly, graduate nurses reported the lack of time, impacted by shift work, to be able to shop and prepare for healthy meals.
At six months, about half of the participants said the intervention helped them engage in health behaviours, especially the face-to-face education sessions and SMS texts on healthy eating. Regular use of the Fitbit occurred between six weeks and six months but motivation to exercise also dropped during the period.
Semi-structured interviews delved further into the participants’ experience of the intervention and barriers to taking part. They revealed three themes – the influence of colleagues and peers, the work environment, and engagement with SH&SH.
Most participants said their colleagues had little to no impact on their dietary and physical activity behaviours, with peers not always supporting new graduate nurses to engage in healthy behaviours. However, a small number of grads revealed that colleagues supported them to choose healthier options by sharing healthy snack ideas.
Importantly, one factor that increased participants’ engagement with the intervention was support from the LHD executive and nurse education team through awareness of the importance of healthy behaviours from career commencement.
Positively, the LHD that delivered the intervention has integrated the findings into a hospital-wide health promotion intervention for their employees, including nurses.
Unsurprisingly, the majority of participants described how the easy availability of discretionary food at the nurses’ station or in the tearoom presented a barrier to maintaining a healthy diet, and limited their ability to be healthy while at work.
Overall, the study found that all participants would recommend the program to future new graduate nurses.
“Most new graduate nurses reported that the intervention was not burdensome and did not attempt to change too many behaviours at once,” the paper says.
It now provides valuable insights for developing future workplace health intervention programs that target new graduate nurses, arguing that they can help early career nurses adopt and maintain healthy lifestyle behaviours to support them throughout their careers.
“It is vital to implement interventions that incorporate strategies that target specific behaviours such as diet and physical activity to ensure the next generation of nurses start their careers healthy and stay healthy.”