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Introduction

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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Introduction

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  1. Nursing with EASE (Eating, Activity, and Supportive Environment)Gayle Roux PhD, NP-C, FAANNancy DiMarco PhD, RD, CSSDYufang Gu, DNP, FNP-C

  2. 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

  3. Nursing with EASE (Eating, Activity, and Supportive Environment)Nursing: Intervention Motivational Interviewing

  4. Nursing with EASE (Eating, Activity, and Supportive Environment)Kinesiology: Intervention Physical Activity

  5. Nursing with EASE (Eating, Activity, and Supportive Environment)Psychology: Intervention Support and Body Image

  6. Introduction Obesity/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)

  7. 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)

  8. 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

  9. Psychological Complications of Obesity • Low self-esteem • Depression • Engagement in high risk behaviors • Poor school performance

  10. 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.

  11. 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

  12. 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.

  13. 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?

  14. Theoretical Framework Prochaska’s Stages of Change model • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Relapse (Kern, 2008; Prochaska, Diclemente, & Norcross, 1992)

  15. 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.

  16. 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).

  17. Instruments For 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

  18. Participants For 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

  19. 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

  20. Mann-Whitney U Analysis

  21. Data Analysis • Overweight and Obesity in Students • Pre-intervention BMI • Intervention (n=13): mean 29.8 • Control (n=10): mean 31.6

  22. 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.

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

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

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

  26. 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.

  27. 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?

  28. 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.

  29. 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.

  30. 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

  31. 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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