Introduction

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Nursing with EASE (Eating, Activity, and Supportive Environment) Gayle Roux PhD, NP-C, FAAN Nancy DiMarco PhD, RD, CSSD Yufang Gu, DNP, FNP-C

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Nursing with EASE (Eating, Activity, and Supportive Environment) Gayle Roux PhD, NP-C, FAAN Nancy DiMarco PhD, RD, CSSD Yufang Gu, DNP, FNP-C. - PowerPoint PPT Presentation

Transcript of Introduction

Page 1: Introduction

Nursing with EASE (Eating, Activity, and Supportive Environment)Gayle Roux PhD, NP-C, FAAN

Nancy DiMarco PhD, RD, CSSDYufang Gu, DNP, FNP-C

Page 2: Introduction

Nursing with EASE (Eating, Activity, and Supportive Environment)

College of Nursing and Departments ofNutrition and Food Sciences, Kinesiology, & Psychology

Nutrition: Intervention on Nutrition, Portions, Labels

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Nursing with EASE (Eating, Activity, and Supportive Environment)

Nursing: Intervention Motivational Interviewing

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Nursing with EASE (Eating, Activity, and Supportive Environment)

Kinesiology: Intervention Physical Activity

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Nursing with EASE (Eating, Activity, and Supportive Environment)

Psychology: Intervention Support and Body Image

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IntroductionObesity/Overweight- Imbalance between energy intake and

energy expenditure

• The fifth leading cause of death around the world, killing at least 2.8 million adults yearly

• More than 30 % of adults (>20 years) are overweight• Close to 34 % are obese• Nearly 6% are morbidly obese• Close to 17% of children and adolescents ( 2 to 19 yrs old) are

obese(Ben-Sefer, 2009; Media Centre WHO, 2011; Ogden & Carroll, 2010)

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Risk Factors for Obesity Genetic predisposition Lack of exercise and sedentary

lifestyle Unhealthy dietary habits Stress Overconsumption of energy

drinks Lack of sleep Shift schedules

(Ben-Sefer, 2009; Britz & Pappas, 2010; Clauson, Shields, McQueen, & Persad, 2008; Duncan et al., 2011;

Malinauskas, Aeby, Overton, Carpenter-Aeby, & Barbar-Heidal, 2007; Mohfouz et al., 2011; Watson et al., 2008)

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Medical Complications of Obesity Cardiovascular diseases Type II diabetes Digestive diseases Liver diseases Musculoskeletal diseases Pulmonary diseases Reproductive problems Certain cancers

Al-Rethaiaa, Fahmy, & Al-Shwaiyat, 2009; Poon & Tarrant, 2009

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Psychological Complications of Obesity

Low self-esteem Depression Engagement in high risk

behaviors Poor school

performance

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Purpose

• To conduct a feasibility study at Texas Woman’s University Institute for Women’s Health (TWU IWH) on obesity prevention (NURS with EASE) in prenursing students.

• To determine the impact of a 6-week nutrition and physical activity intervention on body composition, weight, body mass index, and readiness for health behavior changes in prenursing students at TWU campus in Denton, Texas.

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Problem Statement• Excessive weight gain occurs in freshman college students related to:

– More independence and autonomy – Increased stress levels – Limited access to healthy snack foods and meal choices – Diet and physical activity habits are still forming in early adulthood– Irregular sleeping hours and lack of sleep– Irregular physical activity– Consumption of high-calorie energy drinks

Evan, Moyle, & Purcell, 2006; Laska et al., 2011, Watson et al., 2008

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Problem Statement on Obesity in Prenursing Students

Obesity affects their own health.

Obesity also affects their capability to perform as healthy role models and

patient educators.

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Research Questions

• What are modifiable risk factors for obesity and overweight among prenursing students on TWU Denton Campus?

• What are self-reported barriers to behavior changes among prenursing students?

• Does a 6-week nutrition and physical activity intervention have an impact on body composition measurements, body mass index, and readiness for behavioral change?

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Theoretical Framework

Prochaska’s Stages of Change model

• Pre-contemplation• Contemplation• Preparation• Action• Maintenance• Relapse

(Kern, 2008; Prochaska, Diclemente, & Norcross, 1992)

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Operational Definitions• Body mass index (BMI) used as standard measure for

overweight and obesity; kg of body weight/height in m2. Overweight defined as a BMI of 25 or more, and obesity is defined as a BMI of 30 or more.

• Obesity can be classified as Class I, BMI is 30 to 34.9; class II, BMI is 35 to 39.9, and class III, BMI is 40 and above.

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Theoretical and Operational Definitions

• Prenursing students are defined as freshman and sophomore students, 18 years of age or older, and have declared nursing as their desired major.

• Initial stage of readiness among prenursing students is initial self-reported pretest measure at intake assessment for all study participants regarding their readiness to change their diet and participate in physical activity (Prochaska, 1992).

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InstrumentsFor the feasibility study (6-week nutrition and physical activity intervention)• Body Composition Measures –height, weight, skinfolds • 24-hour Dietary Record• Texas Woman’s University Health Questionnaire• IWH Wellness & Sport Evaluation Program Demographic Questionnaire • Stages of Change Questionnaire (consists of 7-item, 5-point Likert-type scale)• Readiness and Confidence for Change: How Ready are You?• Self-Rated Abilities of Health Practices Questionnaire

For the 8-week nutrition and physical activity intervention, will add• PAR-Q Form• The Body Self-Esteem Scale

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ParticipantsFor the feasibility study

• 31 prenursing students at TWU Denton campus; • 18-21 years old; • female; 16 in the intervention group and 15 in control group

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Data Analysis

• SPSS 19.0• Descriptive statistics including means, standard deviations, and median

for each group

• Mann-Whitney U analyses • to test differences between each of pre-intervention measures by group • to test differences between intervention and control group post-tests

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Mann-Whitney U Analysis

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Data Analysis• Overweight and Obesity in Students

• Pre-intervention BMI• Intervention (n=13): mean 29.8• Control (n=10): mean 31.6

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Data Analysis• No significant changes in post-test measures in sample

• Thigh circumference change in intervention group trended toward significant change at p=0.063.

• Students rated satisfaction with study very high. They were articulate about their challenges to make healthy diet and exercise choices in college environment.

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Data Analysis

A marginally significant difference between groups for post-intervention thigh measurement, U = 35.00, p = .063

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Implications Stress was experienced in science courses and during exams. Pressure to achieve an “A” to be admitted into nursing school.

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Next Study: Fall 2012• Larger sample size to achieve power (n=50)• Longer duration of intervention program – 8 weeks

Peer Mentors

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Next Steps• Manuscript about feasibility study accepted in Nursing Forum.

• The 8-week intervention study has IRB approval and will begin in Fall 2012.

• Based on pilot study’s effect size (η2 = .114), alpha of .05, and power of .80, total sample size of 46 is needed to account for 20% attrition across 8 weeks. An additional four individuals will be recruited: 25 prenursing students will be in intervention group and 25 in control group.

• Each peer mentor will be assigned a group of 6-7 students, with a total of 8 peer mentors.

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Research Questions for the Next Step Study- An 8-Week Intervention

• Do weight loss and physical activity differ between intervention and control groups?

• What is overall impact of an 8-week nutrition and physical activity intervention on body weight, body mass index (BMI), waist circumference, and body image in pre-nursing students at Texas Woman’s University Denton campus?

• Will use of peer mentors increase prenursing students’ participation in Nursing with EASE program?

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Implications for Education

• Self-care and health promotion must be included in education.

• Nursing is stressful and can have irregular work schedules. This can lead to overeating and lack of exercise.

• Student nurses need to be taught health-promoting behaviors and stress-relieving techniques during their education.

• Universities, the healthcare industry, and employee health and wellness programs must focus on nursing students and nurses as a special population for weight management.

• Weight should be included as a topic in diversity training.

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Position of ANA 2011-2012. ANA helps nurses integrate healthy habits into their personal and professional lives and become “Models of Wellness in Action” for patients, their families, and the larger community.

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References• Adderley-Kelly, B. (2007). The prevalence of overweight and obesity among undergraduate

health sciences students. The ABNF Journal, 46- 50.• Al-Rethaiaa, A., Fahmy, A., & Al-Shwaiyat, N. (2010). Obesity and eating habits among college students in Saudi Arabia: a cross

sectional study. Nutrition Journal, 9, 39- 48. doi: 10.1186/1475-2891-9-39.• Bandura, A. (1995). Self-efficacy in changing societies. Cambridge University Press.• Ben-Sefer, E. (2009). The childhood obesity pandemic: Promoting knowledge for undergraduate nursing students. Nurse Education in

Practice, 9, 159- 165. doi: 10.1016/j.nepr.2008.07.006.• Britz, J., & Pappas, E. (2010). Sources and outlet of stress among university students: Correlations between stress and unhealthy habits.

Undergraduate Research Journal for the Human Science, 9, 00004355. Retrieved from http://www.kon.org/urc/urc_research_journal9.html

• Clauson, K. A., Shields, K. M., McQueen. C. E., & Persad, N. (2008). Safety issues associated with commercially available energy drinks. Journal of the American Pharmacist Association, 48(3), e55-e67.

• Duncan, S., Duncan, E., Fernandes, R., Buonani, C., Bastos, K. D.,… Freitas Jr., I. (2011). Modifiable risk factors for overweight and obesity in children and adolescents from Sao Paulo, Brazil. BMC Public Health, 11, 585- 593. doi:

10.1186/1471-2458-11-585.• Evans, K., Moyle, W., & Purcell, C. (2006). An exploration of modifiable health associated risk factors within a cohort of undergraduate

nursing students. Contemporary Nurse, 23 (1), 100- 106.• Hofstrand, D., & Holz-Clause, M. (2009). What is a feasibility study? Retrieved from

http://www.extension.iastate.edu/agdm/wholefarm/html/c5-65.html

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References• Kern, M. (2008). Stages of change model. Retrieved from http://www.addictioninfo.org/articles/11/1/Stages-of-Change-

Model/Page1.html• Laska, M., Pasch, K., Lust, K., Story, M., & Ehlinger, E. (2011). The differential prevalence of obesity and related behaviors in two- vs.

four- year colleges. Obesity, 19 (2), 453- 456. doi: 10.1038/oby.2010.262.• Mahfouz, A., Shatoor, A., Khan, M., Daffalla, A. A., Mostafa, O. A., & Hassanein, M. V. (2011). Nutrition, physical activity, and gender

risks for adolescent obesity in Southwestern Saudi Arabia. The Saudi Journal of Gastroenterology, 17 (5), 318- 322. doi: 10.4103/1319-3767.84486.

• Media Centre (2011). Obesity and Overweight. World Health Organization. Retrieved from World Health Organization fact sheet/obesity http://www.who.int/mediacentre/factsheets/fs311/en/

• Ogden, C., & Carroll, M. (2010). Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Centers for Disease Control and Prevention Retrieved from

http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf• Poon, M., & Tarrant, M. (2009). Obesity: Attitudes of undergraduate student nurses and registered nurses. Journal of Clinical Nursing,

18, 2355-2365. doi: 10.111/j.1365-2702.2008.02709.x• Prochaka, J., Diclemente, C., & Norcross, J. (1992). In search of how people change:

Applications to additive behaviors. American Psychologist, 47 (9), 1102- 1114.• Watson, R., Gardiner, E., Hogston, R., Gibson, H., Stimpson, A., Wrate, R., & Deary, I. (2008). A Longitudinal Study of Stress and

Psychological Distress in Nurses and Nursing students. Journal of Clinical Nursing, 18(2), 270-278. doi: 10.1111/j.1365-2702.2008.02555.x


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