Introduction 3/18/2015. Implementation of a Novel Weight Management Program for older Nurses: A Feasibility Study

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Implementation of a Novel Weight

Management Program for older

Nurses: A Feasibility Study

BS2_{; Erika Friedmann, PhD}1 1. _{University of Maryland School of Nursing} 2. _{Medstar Franklin Square Medical Center}

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Research / Practice / Education

• Research Emphasis

–Use of eHealth/mHealth interventions to promote and manage the health of adults age 50 and older.

–Hospital information systems evaluation and implementation

• Academic area

–Program Director, Nursing Informatics Program –The center for Biology and Behavior Across the Lifespan

• Clinical Practice

–Gerontology Nurse Specialist / CNS –Information Systems Administrator

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Introduction

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Overweight/Obesity and Nurses

• Overweight and obesity are significant public health problems, affecting 68% of American adults. • Overweight people are at a higher risk for many

chronic illnesses.

• Postmenopausal women are especially prone to

weight gain and other health problems.

• American nurses are the largest group of direct care professionals (3.1 million).

–Predominantly female (93.3%).

–Rapidly aging as a profession (mean age, 47)

Overweight/Obesity and Nurses

• High prevalence of overweight in nurses – 53.8% (N = 122, FSMC) - 65% (N = 187)

• Nurses often neglect to take care of their own health

–E.g., 21.7% nurses (N= 394) reported poor health, lack of exercise and trouble sleeping.

Concerning trends as nurses are an important source of health information for the public and lead current efforts in health promotion projects, including obesity prevention.

Study Aim

• To examine the feasibility of an 8-week novel health behavior intervention program using a small sample.

–The primary outcomes included weight, stress, activity behaviors, and job satisfaction.

7 practice.

• The participant-centered (P-C) framework

–Originated from the field of usability engineering (i.e., user-centered design).

–The P-C framework values participant friendliness in the intervention and engages participants in the intervention development.

8 1. Specify the

context for the program

* Goals for the program: Stress reduction & weight management

* Conditions: (1) Participants are direct healthcare providers; (2) perform physically and mentally demanding work; and (3) work long hours on foot.

2. Specify user requirements

* Participants’ preferred types of health behaviors via online survey: e.g., majority of participants used multimedia-based exercise programs, such as DVDs (n = 109, 64.5%) and Wii exercise games (n = 72, 42.6%).

3. Develop solutions * The intervention was developed (see Intervention section). 4. Evaluate

solutions

* 21 volunteer nurses in the selected hospital evaluated the intervention program.

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Intervention

The 8-week program was comprised of three components:

(1) two face-to-face sessions (introduction, diet, and exercise) (2) Wii exercise games (e.g., boxing, tennis) and various DVDs

for dance exercises

(3) eHealth portal, including eHealth journals and other optional resource materials on a balanced diet and exercise (learning modules, virtual libraries, and blogs)

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Intervention

• All participants received a pedometer and a dance DVD of their choice.

• Two FTF sessions:

–Taught by MFSMC dieticians and the exercise trainer who had worked with nurses previously

–Included an introduction to Wii exercise and DVD programs

–Participants set their own activity and diet goals (recommended national guideline).

Intervention

• Upon the completion of the 2 FTF sessions, participants worked on their preferred exercise

independently at their convenience.

• A DVD rental program by the nursing research office

Exercise DVD Rental Program / Pedometer • Weight Loss Yoga

• Step and Dance Aerobics • Walk Away the Pounds

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Diet Education Session

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25 26

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Methods

32 3 observations (baseline, end-of treatment [EOT] 8-week], and at 3 months)

• The primary outcomes:

–Weight, stress, activity behaviors, and job satisfaction –Potential issues for a future larger scale trial

• Data collection: Online surveys and measurements of wgt, hgt, WC, and steps

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Methods: Sample

• The eligibility criteria:

(1) Registered female nurse (RN) who worked at least 0.5 FTE at the FSHC

(2) Age > 45 years

(3) Having access to the Internet/e-mail and being able to use the Internet/e-mail independently

(4) BMI > 24

• Recruitment: 3/30/2012 - 5/6/2012

–E-mail listserv and flyers posted in the nurses’ break rooms

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Methods: Measures

Outcome Measure # items Value range Scale R & V

Stress Perceived stress scale

10 0-40 (more stress) 0, 1,…4 alpha = .71- .86 Concurrent and predictive validity Fat Rapid Block food

screener: Dietary fat screener

17 0-68 (more fat) 0, 1,…4 Predictive validity Fruit and

Veggie

total of fruit and vegetables

7 0-35 0, 1,…5 Predictive validity Enjoyment Enjoyment scale 7 7-42 1, 2,…6

Exercise (min & Kcal) Yale Physical Activity Survey 27 6 * 5 categories of PAs * Exercise category Min / Kcal Stability (r = .63) Exercise (steps) Pedometer (Omron)

Mean and total steps for 7 days

Interdevice reliability (r = 0.8); Criterion validity Hgt, wgt,

WC

Calibrated scale BMI > 24

Methods: Procedures

• After consenting, placed on a waiting list • Measurements of hgt, weight, WC and step counts. • Baseline survey (one week)

• Two FTF sessions

Methods: Analysis

• Descriptive statistics (mean, frequency, %, etc.)

–Demographic data, other job-related characteristics and intervention usages

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Results

Ethnicity African American 1 (4.00)

White 24 (96.0)

Position Administration 25 3 (12.00)

Direct care RN 18 (72.00)

Other 4 (16.00)

Shift 8-h rotation shift 24 1 (4.17)

8-h fixed shift 19 (79.17)

12-h-fixed shift 3 (12.50)

Irregular shift 1 (4.17)

Highest degree Associated degree 25 6 (24.00)

Diploma degree 8 (32.00)

Baccalaureate degree 9 (36.00)

Master’s degree 2 (8.00)

Yrs of web exp. 24 12.60 ± 5.39

PC knowledge Beginner 25 2 (8.00)

Advanced beginner 8 (32.00)

Competent / Proficient 15 (60.00)

39 Outcome Estimate Std. Error df t Sig. 95% Confidence

Interval Lower Upper BMI 8 weeks -.444 .150 39.112 -2.959 .005 -.748 -.141 12 weeks -.184 .156 39.117 -1.175 .247 -.500 .132 Enjoyment 8 weeks .839 .724 36.846 1.159 .254 -.628 2.306 12 weeks -.583 .708 36.799 -.823 .416 -2.018 .852 Stress 8 weeks -.5460 1.120 42.411 -.487 .629 -2.806 1.714 12 weeks 1.310 1.100 41.596 1.190 .241 -.912 3.532 Fat 8 weeks -1.958 1.274 38.917 -1.537 .132 -4.534 .619 12 weeks -1.406 1.247 38.807 -1.128 .266 -3.928 1.116

Fruit and Veggies

8 weeks 1.650 .705 38.048 2.339 .025 .221 3.078

12 weeks .363 .690 37.923 .525 .603 -1.035 1.760

Main Outcome Variables

40 Outcome Estimate Std. Error df t Sig. 95% Confidence Interval

Lower Upper

Exercise total min

8 weeks 164.550 35.488 40.988 4.637 .000 92.882 236.220 12 weeks 20.623 33.332 39.298 .619 .540 -46.781 88.0266 Exercise total kcal

8 weeks 468.384 1084.634 37.331 .432 .668 -1728.635 2665.404 12 weeks 502.192 988.336 36.171 .508 .614 -1501.918 2506.301 Pedometer step mean

8 weeks 173.530 705.299 40.440 .246 .807 -1251.437 1598.496 12 weeks -2292.874 762.121 41.933 -3.009 .004 -3830.968 -754.779

Main Outcome Variables

Results: eHealth Portal Usage

• All participants used the eHealth portal.

• For health goals, 21 participants (84%) entered their initial health goals into their eHealth journal

–10 revised their health goals at the 5th_wk. • 88% (n = 20) used the learning modules

–balanced diet and exercise (X 91) –wgt management (X 135)

• 52% (n = 13) used the virtual libraries (X 54). • 53% (n = 13) used the blogs; however, only 13

postings were posted by the participants.

Discussions

• At 8 weeks, a significance decrease in body weight (mean change: 5 lbs; BMI, 0.6), increased fruit and vegetable consumptions (2.16; range, 0-35), and increased exercise min (161 min/wk).

–Promising results, considering that the intervention required minimal supervision and mainly relied on nurses’ own execution of behavior changes.

• The July 4th_{holiday presented participants with} challenges in controlling foods and exercise.

43 the prevalence of high BP (n =5, 20%)

–At 8 wks, a trend in the reduction of fat consumption (not significant)

–A future target area for further education • Findings on pedometers

–At 8 wks, a trend in the increase from 7504 to 8005 (not significant )

–A considerable reduction at 12 weeks (5846.91 ± 1769.06 )

–The pedometer could have been a motivating factor at baseline.

–As contrary to our expectation, nurses liked the pedometers, which also served as a linkage for peer support.

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–Some nurses used their own tracking system

–“..I liked the fact that a big sister watching which helped to motivate...”

• Few used of blogs (optional) –Unfamiliarity with blogs

–Need for moderated blogs that offer additional information • Use of other learning sources (optional)

–Frequent access

–Use of resources for their patients

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Limitations

• The small sample size recruited from one hospital • Mainly Caucasian and day shift nurses

• Assessment of dietary consumption using self-reported data

• No significant correlation between the amount of exercise and the step counts (c.f., nurses’ work) • Only fat-consumption served as a moderator for the

changes in BMI at 8 weeks.

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Conclusion

• The overall findings showed a great potential that

hospitals can improve their staffs’ healthy behaviors

with relatively low costs.

• Although nurses are expert health care providers, they preferred a more regimented health program

with some face-to-face lectures. • Further research is needed to investigate

sustainability of the program and more influential factors that can motivate clinicians to maintenance of their healthy behaviors.

Dissemination

• Nahm, E.-S., Warren, J., Zhu, S., An, M.-J., & Brown, J. (2012). Nurses’ self-care behaviors related to weight and stress. Nursing Outlook, 60(5), e23-e31. • Nahm, E.-S., Warren, J., Friedmann, E., Brown, J.,