Are first-year nursing students' lifestyles coherent with their future career?

Depósito de investigación de la Universidad de Sevilla https://idus.us.es/ Esta es la versión aceptada del artículo publicado en: This is a accepted manuscript of a paper published in: International Journal of Nursing Practice (2017): 23 de enero DOI: 10.1111/ijn.12511 Copyright: ©2017 John Wiley & Sons Australia, Ltd El acceso a la versión publicada del artículo puede requerir la suscripción de la revista. Access to the published version may require subscription. “This is the peer reviewed version of the following article: [Rodriguez‐Gazquez M, Chaparro‐Hernandez S, González‐López JR. Are first‐year nursing stu-dents' lifestyles coherent with their future career?. Int J NursPract. 2017;23:e12511. https://doi.org/10.1111/ijn.12511], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self- Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited." 1 Are first year Nursing students’ lifestyles coherent with their future career? Abstract Aim.The objective of this study was to evaluate the lifestyles of first year Nursing students of two Universities (one in Spain, the other in Colombia). Background. Nursing students are going to be professionals in the near future and as carers it will be essential for them to behave in a way which will allow them to have a positive influence on the health of others as well as their own health. Design. A cross-sectional descriptive study design using validated surveys was adopted. Methods. A sample of 140 Nursing students enrolled in 2014 in their first year of two Universities (Seville in Spain, n=37 and Antioquia in Colombia, n=93) self-reported the FANTASTICO Lifestyle checklist. Results. Findings reveal that (I) the lifestyles are not appropriate in 1 of 3 of nursing students in both Universities, (II) there are statistically significant differences for family items, positive thinkers, the use of safety belts and alcohol consumption before driving. Conclusion. A high proportion of the study’s participants have inappropriate lifestyles which involve risks for the deferred development of chronic diseases. It is necessary for Universities to develop educational interventions in the design of Nursing Degrees to strengthen healthy behaviours during training. Summary statement What is already known about this topic? • Lifestyles are a product of people’s motivations to protect or improve their own health and to avoid illnesses. 2 • The lifestyles of Nurses have an influence on their patients acquiring healthy behaviours. • The literature shows that nurses’ lifestyles are not as coherent as they should be. • To care for others, nurses first have to take care of themselves. What this paper adds • A high proportion of first year nursing students had inappropriate lifestyles. • The participants have risks of developing illnesses, especially those which are chronic. The implications of this paper • Nursing students are mostly young people who are at a stage in which some of the most important behaviours for adult life can still be modified. • It is necessary to develop educational interventions in Nursing Degrees to strengthen healthy behaviours during training. • Nursing Schools not only have the duty to train professionals, but also to foster the health, welfare and quality of those who study and work there. They must encourage knowledge and skills oriented to having more healthy lifestyles. Key words: Colombia, Cross-Sectional Studies, Health Behaviour, Lifestyle, Nursing, Spain, Students, Universities. 3 INTRODUCTION In recent decades, the health personnel has had to assume the role of more relevantly influencing the education of the general population regarding the prevention of risk factors of lifestyles that are open to change.1 This task more usually lies with nurses, who are seen as role models by their patients. This is why it is important for these professionals to not only have a good knowledge of healthy behaviours but also to practise them.2 Today’s nursing students will be tomorrow’s professionals 3 and to fulfill their role in caring they not only need knowledge, they also must maintain behaviours which enable them to improve and protect both the health of others and their own.4 With this in mind, Universities present a unique environment of opportunities to foster the maximum potential of health which the families of their students and the community at large will also benefit from.5 To care for others, people first have to take care of themselves. This statement is especially important for Nursing, in which promoting healthy lifestyles is a priority.6 Some research shows that Nursing students´ lifestyles are inappropriate.7, 8 Additionally, exacerbating this situation, it has also been described that during Nursing Degrees some unhealthy lifestyles not only worsen, but also may start. 9, 10 This panorama is far from promising in the new professionals who are joining the labour market.6 Lifestyles are a product of people’s motivations to protect or improve their own health and to avoid illnesses.11 Therefore, it is really relevant to evaluate if Nursing students´ lifestyles are healthy enough at the beginning of their university education, so that Nursing Schools may design timely interventions which improve the health behaviours of the future professionals. METHODS Aims The objectives of this research are to analyse the lifestyles of Nursing students and to compare 4 differences between the two Universities involved (Seville and Antioquia). Study Design This is a cross-sectional and descriptive study using a validated self-reported survey. Participants The objective sample was Nursing students enrolled in 2014 in their first year in the University of Antioquia –UdeA (Colombia) – and in the University of Seville –US (Spain). 93 of the 157 Nursing students of the UdeA (59.2%) and 37 of the 50 of the Macarena Teaching Unit of the US (74%) were included. Nonparticipation was due to some students not attending class that day or their not being enrolled in the course the information was taken from. No student present when the information gathering took place rejected filling out the form. The instrument A survey was used in which was included data on age, gender, marital status and the questions of the FANTASTIC Lifestyle Assessment Questionnaire scale which was developed in the University of McMaster (Canada).12 This instrument provides information about the person’s healthy behaviour over the last 30 days. The word “FANTASTIC” comes from the acronym of the names of the ten domains in which there are 30 items: Family and friends (F), Activity (A), Nutrition (N), Tobacco (T), Alcohol and other substances (A), Sleep and stress (S), Type of personality (T), Introspection (I) and, Control of health (C). Each item has three Likert-type answer options (0-1-2). The total scale score is the sum of the values of each item multiplied by two. The greater the value attained, the better the lifestyles of the person. The Spanish version was adapted in Chile to be used in youth populations,5 and this translation is the one used in this research. In this version, as a new section at the end about “Other behaviours” was included the questionnaire was renamed as “FANTASTICO”. Depending on the total, the health of the survey respondent´s health is classified as 5 dangerous (≤46), bad (47-72), normal (73-84), good (85-102), or fantastic (103-120). The reliability of the instrument was adequate13 and it has been tested in the first study (Cronbach alpha 0.88)12 and also in 550 healthy adults in Colombia (Cronbach alpha 0.7).14 Our study presents a Cronbach’s alpha value of 0.7. Data collection To gather the information, the researchers used the subject’s class hours when the greatest number of students was present during the first semester of the academic year 2014/15. After explaining the aims, the methodology and the results expected from the research, the students were asked to voluntarily take part in the study and those who gave their consent filled out the self-report of the FANTASTICO questionnaire. The questionnaire was subjected to a semantic and legibility validation by 14 Nursing students (7 from each university). The following procedure was carried out: first a written example of the questionnaire was handed out for each participant to resolve; second, we asked for their opinions about the comprehension and appropriateness of the language of each of the items ; third, we requested the students to give synonyms or statements in their own words of words or phrases which proved to be difficult; fourth, the researchers evaluated the observations in this test and compared the theoretical concepts with which it was meant to measure each of the questionnaire’s items with the statements proposed by the participants in the semantic validation, establishing if there was an equivalence - in the case of there being differences the researchers determined the statement of each item by consensus; fifth, the researchers approved the scale’s final version on the basis of consensus. Ethical considerations This study was approved by the Ethical Committee of the Nursing School of the University of Antioquia. The participants gave their informed consent and the survey was answered 6 voluntarily and anonymously. Each survey had an annex for each student to rate and to interpret the score obtained and, according to this, advice to improve health behaviours was given. Data Analysis The information gathered was analysed by the SPSS v. 21.00 programme (Chicago, USA). All the quantitative variables were examined for outliers and non-normal distributions. When they fulfilled normality criteria their average, their standard deviation and their minimum and maximum values were calculated, and percentages were determined for the qualitative variables. In the exploration of the relation between the university and the student: a) a one-tailed ANOVA statistic was used for the total score and that of the the FANTASTICO’s domains; and b) the 2 test was employed for the percentages of healthy lifestyles - the Yates correction was carried out when the expected cell result was less than 5. In all cases, there was considered to be statistical significance of p<0.05. RESULTS There were not statistically significant differences between the two universities regarding the average age (UdeA: 18.8±1.9 and US: 19.6±4.1), the proportion of female students (UdeA: 89.5% and US: 78.4%) and the proportion of single students (UdeA: 96.8% and US: 100.0%). The total sum of the FANTASTICO scale was slightly higher in the US students than in the UdeA students (UdeA: 86.9±10.9 and US: 89.2±7.9), though this difference was not significant (t of Student= 1.164, p=0.247). There was not a statistical difference in the total or per item scores between the two universities when stratified by gender, age or marital status. Statistically significant differences were found for some items. In Table 1 it is seen that 73.0% of the US students versus 63.4% of the UdeA students had good or fantastic lifestyles (p value of the Fisher test: 0.783). We note that the UdeA students doubled the percentage of dangerous or bad lifestyles with respect to the US students. 7 (Insert Table 1 here) Table 2 describes the frequency of healthy behaviours corresponding to the FANTASTICO scale’s 30 items in the first year students of Nursing in the two universities. We highlight the following in each domain: (Insert Table 2 here) Family and friends. The US participants are more supported by their family and friends than those of the UdeA. These provide them with affection and they can talk with them about subjects which are important in their life. These differences were statistically significant. Activity. In both universities, and in spite of the youth of the participants, less than one in three in both universities carried out vigorous physical activity for at least 30 minutes three of more times per week and two out of three performed moderate activity with the same duration and frequency. Our attention is drawn to the fact that only one out of five Nursing students in both universities is an active member of sports or self-care groups or organisations. Nutrition. The proportion of first year Nursing students of both universities who had appropriate eating behaviours in consuming vegetables and fried food and who restricted foods rich in sugar, salt and fat was low. Four out of five perceived their current weight to be close to the ideal weight. Tobacco. Eight out of ten stated that they had never smoked and less than one out of ten that they were currently smokers. Alcohol and other substances. In both universities almost all the respondents reported that they did not consume illicit psychoactive substances (marijuana, cocaine and others) and that they had less than three drinks with caffeine per day. With respect to alcohol consumption, almost all of the participants have less than seven drinks in the same week and one out of two has four or more drinks on the same occasion. A statistically significant difference was found 8 for not driving after drinking alcohol: this protective practice was greater in the UdeA students. Sleep and stress. It is very worrying that only one out of three Nursing students of both universities sleeps well, that a similar proportion feels capable of controlling the stress of their daily life and that only three out of five are capable of relaxing and enjoying their free time. Type of personality. It is also alarming that more than 80% of the students of both universities are always in a hurry, that two out of three feel annoyed or aggressive and that one out of three is not content with the activities that they carry out. Introspection. The UdeA participants had a significantly greater percentage of positive thinkers than those of the US (62% versus 35%). On the other hand, in the other two items which make up this subscale (I rarely feel tense, and I don’t feel depressed or sad) the percentage was higher in the US students, though this difference was not significantly significant. Control of health. In both universities, despite the Nursing students having been trained in illness prevention, less than one out of three has regular health check-ups. With respect to sexual health, less than half talk with their partner or family about these matters and have safe sex. Other behaviours. Nine out of ten students of the two universities respect street rules as pedestrians, drivers or passengers. For the item on the use of safety belts, the US students had a greater percentage than those of the UdeA (94.6% and 69.9%, respectively) – a statistically significant difference. DISCUSSION In our research of 93 students at the UdeA and 37 at the US enrolled in the first year of the Nursing programme, the total average of the FANTASTICO scale was very similar (86.9 points for the former and 89.2 for the latter), without there being statistically significant gender-based 15 behaviour of Turkish University nursing students from beginning to end of nurse training. Nurse Education and Practice 2008; 41: 382–388. 10. Saad C, Ibañez E, Leon C, Colmenares C, Vega N, Díaz Y. Cambios en los hábitos alimentarios de los estudiantes de enfermería de la Universidad del Bosque durante su proceso de formación académica, Bogotá, D.C., 2007 [Changes in eating habits of nursing students from the Universidad del Bosque during their academic training, Bogotá DC, 2007]. Revista Colombiana de Enfermería 2008; 3: 51–60. 11. Pender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. Upper Saddle River, NJ: Pearson Education, 2006. 12. Wilson DM, Nielsen E, Ciliska D. Lifestyle assessment: testing the FANTASTIC instrument. Canadian Family Physician 1984; 30: 1863–1866. 13. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. International Journal of Medical Education 2011; 2: 53–55. 14. Ramírez-Velez R, Agredo RA. Fiabilidad y validez del instrumento "Fantástico" para medir el estilo de vida en adultos colombianos [The Fantastic instrument's validity and reliability for measuring Colombian adults' life-style]. Revista de Salud Pública (Bogota) 2012; 14: 226–237. 15. Cancino J, Urzua R, Ulloa D. Estilos de vida y nivel de actividad física de los alumnos de kinesiología de la Universidad de las Américas (Chile) durante el primer semestre del año 2008 [Lifestyles and fitness levels of kinesiology students at UDLA University (Chile) in the first half of 2008]. Kronos 2008; 8: 39–44. 16. Seignon C. Estilos de vida y nutrición en universitarios de la Benemérita Universidad Autónoma de Puebla (BUAP) [Lifestyles and nutrition at the Autonomous University of Puebla (UAUP)]. In: Científico SdDyV, (ed). México: Benemérita Universidad Autónoma de Puebla, 2008. 16 17. Universidad Austral de Chile. Promoción de salud integral, un desafío permanente en la construcción de una universidad saludable. Avances de su ejecución [Global health promotion, a permanent challenge in building a healthy university. Progress of implementation]. Chile: Universidad Austral de Chile, 2007. Available from URL: http://www2.uacj.mx/universidadsaludable/memorias/documentos/PDF%20Presentaciones/Vi ernes%20Psicologico/5.pdf Accessed 15 March 2016. 18. Prochet TC, Silva MJ, Ferreira DM, Evangelista VC. Affection in elderly care from the nurses' perspective. Revista da Escola de Enfermagem da USP 2012; 46: 96–102. 19. Gillen S. Unhealthy lifestyles adversely affect nurses’ ability to deliver quality care. Nursing Standard 2014; 28: 12–12. 20. Evagelou E, Vlachou E, Polikandrioti M, Koutelekos L, Dousis E, Kyritsi E. Exploration of Nursing students' dietary habits. Health Science Journal 2014; 8: 452–478. 21. Ezzati M, Lopez AD, Rodgers A, Van der Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347–1360. 22. Clark E, McCann TV, Rowe K, Lazenbatt A. Cognitive dissonance and undergraduate nursing students’ knowledge of, and attitudes about, smoking. Journal of Advanced Nursing 2004; 46: 586–594. 23. Sejr HS, Osler M. Do smoking and health education influence student nurses’ knowledge, attitudes, and professional behaviour? Preventive Medicine 2002; 34: 260–265. 24. Phun ET, Santos CB. Alcohol consumption and stress in second year nursing students. Revista Latinoamericana de Enfermagem 2010; 18: 496–503. 25. Wong P, Gutierrez C, Romani F. Autorreporte de accidentes de tránsito en una encuesta nacional en la población urbana de Perú. [Self-reporting of road traffic accidents in a national survey of urban population in Peru]. Revista Peruana de Medicina Experimental y Salud 17 Pública 2010; 27: 170–178. 26. Oliveira EB, Furegato ARF. Nursing students' work, a risk factor for the consumption of alcohol and other drugs. Revista Latinoamericana de Enfermagem 2008; 16: 565–571. 27. Parikh D, Sattigeri BM, Kumar A, Brahmbhatt S. A survey study on use of over the counter (OTC) drugs among medical students, nursing and clerical staff of a tertiary care teaching rural hospital. International Journal of Research in Medical Sciences 2013; 1: 83–86. 28. Lovell GP, Nash K, Sharman R, R. LB. A cross-sectional investigation of depressive, anxiety, and stress symptoms and health-behaviour participation in Australian university students. Nursing and Health Sciences 2015; 17: 134–142. 29. Dominguez S, Díaz MA, Rivera G, Rivera N. Prevalencia de deterioro del patrón del sueño en estudiantes de enfermería en Huelva [Prevalence of deterioration in the sleeping patterns in nursing students from Huelva]. Enfermeria Global 2007; 6: 1–10. 30. Mirzaei T, Oskouie F, Rafii F. Nursing students' time management, reducing stress and gaining satisfaction: a grounded theory study. Nursing and Health Sciences 2012; 14: 46–51. 31. Bencomo J, Paz C, Liebster E. Rasgos de personalidad, ajuste psicológico y síndrome de agotamiento en personal de enfermería [Personality Traits, Psychological adjustment and burnout syndrome in nurses]. Investigación Clinica 2004; 45: 113–120. 32. Conversano C, Rotondo A, Lensi E, Della Vista O, Arpone F, Reda MA. Optimism and Its Impact on Mental and Physical Well-Being. Clinical Practice and Epidemiology in Mental Health 2010; 6: 25–29. 33. Luthans KW, Lebsack SA, Lebsack RR. Positivity in healthcare: relation of optimism to performance. Journal of Health Organization and Management 2008; 22: 178–188. 34. Cummings G, Hayduk L, Estabrooks C. Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership. Nursing Research 2005; 54: 2– 18 12. 35. World Health Organization. Road traffic injuries. Geneva: World Health Organization, 2016. Available from URL: http://www.who.int/mediacentre/factsheets/fs358/en/ Accessed 30 September 2016. 19 Table 1. Distribution of the category of lifestyle according to the university Lifestyle University Antioquia (n=93) Seville (n=37) Dangerous 1.1% 0.0% Bad 4.3% 2.7% Normal 31.2% 24.3% Good 60.2% 70.3% Fantastic 3.2% 2.7% Total 100.0% 100.0% 20 Table 2. Percentage of students who have healthy lifestyles according to each university Characteristics University 2 p Antioquia (n=93) Seville (n=37) Domain Item Family and friends I’ve people to talk with about my things 73.1% 94.6% 7.419 0.006† I give and receive affection 76.3% 94.6% 5.857 0.016† Activity I carry out vigorous daily activity 23.7% 29.7% 0.516 0.473 I carry out moderate daily activity 62.4% 64.9% 0.071 0.790 I’m an active member of sports or self-care groups 16.1% 24.3% 1.181 0.227 Nutrition I eat two servings of vegetables and three of fruit each day 16.1% 10.8% 0.600 0.439 I don’t eat food with a lot of sugar, salt or fat 8.6% 13.5% 0.709 0.400 My weight is ideal 81.7% 83.8% 0.077 0.778 21 Tobacco I’ve never smoked 80.6% 81.1% 0.003 0.955 I don’t smoke even one cigarette a day 97.8% 91.9% 2.543 0.111† Alcohol and other substances I don’t take psychoactive substances 94.6% 97.3% 0.430 0.512† I don’t take medicaments without a prescription 47.3% 51.4% 0.173 0.678 I have less than three drinks with caffeine per day 94.6% 94.6% 0.000 0.995† I have less than 7 drinks of alcohol in a week 100.0% 97.3% 2.533 0.111† I have four or less drinks of alcohol on the same occasions 41.9% 45.9% 0.174 0.677 I don’t drive after drinking alcohol 93.5% 75.7% 8.283 0.004 Sleep and stress I sleep well and I feel rested 31.2% 40.5% 1.035 0.309 I control stress in my daily life 30.1% 24.3% 0.435 0.510 I relax and enjoy my free time 55.9% 59.5% 0.136 0.713 Type of personality I don’t walk in a hurry 17.2% 13.5% 0.266 0.606 I don’t feel annoyed or aggressive 22.6% 32.4% 1.356 0.244 22 I feel content with my activities 65.6% 70.3% 0.262 0.609 Introspection I’m a positive thinker 62.4% 35.1% 7.918 0.005 I rarely feel tense 9.7% 21.6% 3.322 0.068 I don’t feel depressed or sad 16.1% 21.6% 0.548 0.459 Control of health I have health check-ups 17.2% 27.0% 1.596 0.206 I talk about subjects of sexuality 40.9% 27.0% 2.175 0.140 I have safe sex 88.2% 89.2% 0.027 0.870 Other behaviours I respect street rules 90.3% 91.9% 0.078 0.780† I use a safety belt when I drive or when I’m a passenger 69.9% 94.6% 9.099 0.003† † 2 with Yates correction