Table of Contents
According to Letvak et al (2013) nursing is a demanding profession, and it has become stressful due to the increase in chronic diseases and an aging population. In my facility, there is no fitness equipment and as such, practitioners do not have an avenue to practice physical exercises.
Recently, three nurses at my facility were admitted suffering from muscular injuries. There is therefore a critical need for an intervention that will promote the fitness of all the employees within the nursing facility. Kempainnen et al (2012) contends that despite the benefits of regular exercise, most nurses and healthcare professionals do not frequently exercise due to lack of time and a place to use. Promoting exercise at the workplace will help improve the fitness and physical health of health professionals, which will, in turn, boost their morale and enhance service delivery at the Nursing facility.
Stakeholders in the interventional program
The interventional program targets nurses and other healthcare professionals within the Nursing facility. The program will encourage nurses to exercise frequently by providing a fitness facility that will be free for use at their convenient time (Safaei et al, 2014).
In light of this a number of stakeholders will be involved including the materials managers who need to ensure that the Nursing facility operates under a lean budget. The fitness center should also employ instructors who will guide users on the use of machines and provide advice on suitable fitness programs. The Nursing Director has the responsibility for overseeing the overall implementation of the interventional program and ensuring that both legal and ethical concerns are in check (Barene et al, 2014).
Evidence Critique Table
| Article in full APA citation | Evidence Strength and evidence hierarchy |
| Letvak, S., & Gupta, C.R. (2013). Differences in health, productivity and quality of care in younger and older nurses. Journal of Nursing Management, 21(7), 914- 921. Doi: 10.1111/jonm.12181 | 6 and qualitative study |
| Kemppainen, V., Tossavainen, K., & Turunen, H. (2012). Nurses’ role in health promotion practice: an integrative review. Health Promot. Int. 28 (4):490-501.doi: 10.1093/heapro/das034. | 2 and randomized controlled study |
| Safaei, M., Abedian, Z., Mazloum, S.R., Hosseini, S.R.A. (2014). Effect of Jogging Program on Midwives’ Physical Fitness: A Randomized, Controlled Trial. Journal of Midwifery and Reproductive Health, 2(4), 215-219. Doi: 10.1080/10810730.2015.1018639 | 2 and randomized controlled study |
| Barene, S., Krustrup, P., & Holtermann, A. (2014). Effects of the Workplace Health Promotion Activities, Soccer and Zumba on Muscle Pain, Work Ability and Perceived Physical Exertion among Female Hospital Employees. PLoS ONE, 9(12), e115059. doi:10.1371/journal.pone.0115059 | 2 and randomized controlled study |
| Phiri, L.P., Draper, C.E., Lambert, E., & Kolbe-Alexander, TL. (2014). Nurses’ lifestyle behaviors, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study. BMC Nursing, 13, 38. Doi: 10.1186/s12912-014-0038-6 | 1 and systematic review |
Evidence Summary
Kempainnen et al (2012) carried out a study and found a wide range of information on the theoretical background for promotion of positive health practices by nurses, the extent of their expertise as well as how much organizational culture is linked with health promotion. They found that nurses consider promotion of health as critical, however a number of challenges linked with organizational culture mean that delivery of promotion of health is not as effective.
Safaei et al (2014) also examined the physical fitness of healthcare workers focusing their study on midwives. They found that the presence of a jogging program could be helpful in bringing about an improvement in the levels of physical fitness for these midwives.
Barene et al (2014) also examined a physical training program which involved examining the impact of soccer and Zumba on the level of muscle pain and ability of work of female employees at hospitals over a span of 12 weeks. They found that putting in place activities such as soccer and Zumba at the workplace enabled these employees to reduce the intensity of their neck pain and enhance the duration of their work.
In the same light, Phiri et al (2014) carried out a study where they examined the lifestyle behaviors of nurses, their priorities for health and the barriers that they have towards living a lifestyle that is healthy. They found that workplace health programs which provide support to nurses in terms of managing their stress are helpful in changing the work environment.
Letvak et al (2013) carried out a study that sought to find out if there were differences in the manner in which younger and older nurses employed in hospitals reported on their health, their level of productivity as well as the quality of care. They found that older nurses, especially those that are dealing with health challenges need to have their health assessed in order to ensure that they take advantage of their skills for critical thinking as opposed to their physical abilities.
As has been seen above, there is significant evidence showing that the presence of workplace health promotion strategies enables more positive health outcomes for health workers. Kempainnen et al (2012) and Safaei et al (2014) found that health workers view health promotion in the workplace as a positive aspect however they often blame organizational culture for putting in place challenges to implementation. Similarly, Barene et al (2014) was of the opinion that physical training programs enable health workers to lessen muscle pain and fatigue. In addition Phiri et al (2014) and Letvak et al (2013) found that the presence of workplace health programs enabled older nurses to be given more appropriate work.
Recommended Change of Practice
Based on the above evidence, the best practice recommendation is workplace health promotion at the Nursing facility. As Kempainnen et al (2012) points out, in the large majority of instances, health professionals are of the opinion that promotion of health at the workplace is a positive aspect but they find that management of the organization does not always encourage the setting up of a healthy work environment. In this regard, one of the ways in which this can be solved by the nursing facility is the setting up of a fitness center. The fitness center will include equipment for cardio exercise such as exercise bikes and treadmills. This type of equipment will be helpful in boosting the stamina of the nurses and endurance while at the same time burning fat. It would also be helpful to have strength training equipment such as machines for weight training and weights to provide the nurses with a complete body workout helping to reduce instances of neck pain and fatigue.
The Stetler Model of Change
Phiri et al (2014) argue that the Stetler model will be appropriate for the interventional program. Using each of the categories as a heading, the change model will evolve by including the strategic initiative of reducing the number of musculoskeletal injuries among nurses in the facility. The wish is that the guidelines in the nursing facility can be changed to include the setting up of a fitness center since it has been proven to have a positive impact on the health of nursing practitioners.
Preparation Phase
The preparation phase entails identification of the issue, which is fatigue of nurses and high prevalence of musculoskeletal injuries among health care practitioners. The Nursing directors will assist in the identification of this need and verifying why it is important for this program and its support will be gotten from the key members of staff and the advisory board for the clinic (Letvak et al, 2013). In order to achieve this, the key staff members and advisory board will be encouraged to bring in their input. Safaei et al (2014) argues that a program that is provided support by management often has a strong foundation and is far more likely to have a greater amount of engagement as well as involvement from the staff. Phiri et al (2014) also points out that workers need to be involved in the discussions in the beginning since it is during this time that ideas are set out regarding the type of program needed and how it might be integrated into the facility and more importantly who would want to be involved.
Validation Phase
Barene et al (2014) point out that this step involves synthesizing evidence from both empirical literature and systematic reviews. The rating system for hierarchy of evidence will then be used to rate the level of the evidence provided. Based on how strong the evidence on the benefits of a workplace fitness program is, it will be determined if this evidence is enough to continue. As Barene et al (2014) points out fitness facilities that include Zumba at the workplace have not only been seen to have positive results in terms of reducing stress for health care professionals but have also significantly helped in the reduction of musculoskeletal injuries such as neck pain. Safaei et al (2014) also found that integrating a program for jogging within a fitness center could go a long way in enabling the effective management of stress among nursing practitioners.
Comparative evaluation
Once a summary of the evidence has been done from the research, the stakeholders of the nursing facility will need to come to a decision regarding whether or not to put in place the fitness center. Criteria for utilization will need to be determined in order to find out what aspects of the fitness center can align with the facility’s guidelines (Kempainnen et al, 2012).
Application phase
Safaei et al (2014) argue that this step involves making decisions on how to engage the target group, which includes nurses and other healthcare practitioners. The change will need to be put in place through operational breaking down of the information and the fitness center will need to be set up to reflect the need for critical assessment of the health needs of the nursing practitioners. Kemppainen et al (2012) sets out that the use of the fitness center can be encouraged by using the ambassador strategy. These ambassadors are nurses working in the center who are interested in living a healthy lifestyle. These ambassadors are critical in that they can function as champions for the fitness center among their colleagues. In participating in this fitness center, these nurses can encourage others to become more actively involved.
Evaluation phase
Considering the expected outcome and advantage to implementing the fitness center is to help to increase the overall productivity of the nurses in the facility, evaluating its effectiveness might need financial assessment in the long run. As has been stated before, there is a hypothetical relationship between better fitness among health care practitioners and their productivity and motivation (Barene et al, 2014). In order to determine how effective the fitness center has been, a survey will be created to find out the extent to which the nurses are satisfied with the presence of the fitness center. In this regard, a five point rating system will be used to identify aspects such as the perceived quality of the program, the experiences that the participants had, the aspects of the program that they found to be effective and which areas need to be improved (Safaei et al, 2014).
Potential Barriers
As Phiri et al (2014) argue, implementing change is never easy, and sometimes there may be obstacles that hinder health education and health promotion. In the case of the proposed intervention, anxiety of nurses can lead to resistance to change. While a change in culture requires a large amount of education, vigilance as well as encouragement, the Stetler model could be helpful since it places focus on modification of the behavior of individuals.
Ethical Considerations
According to Provision 5 of the ANA Code of Ethics for Nurses, the nurse is entitled to similar duties to the self as he does to others especially in terms of the promotion of health as well as safety (Lachman et al, 2015). However, Letvak et al (2013) argue that one of the most distinct ethical issues that might accompany the presence of a fitness center is the conflict that might arise between the hours that nurses will be allowed to use the facility and the concern from patients that nurses will not offer them full care. Another concern is that of privacy for the employees since coaches and other people involved will need to collect health information that is sensitive. There is the risk that the information might be stolen and the concerns of discrimination of employees who are considered as unhealthy. These particular employees might feel that the presence of the fitness center could be a way to encourage them to resign from their work (Safaei et al, 2014).
- Barene, S., Krustrup, P., & Holtermann, A. (2014). Effects of the Workplace Health Promotion Activities, Soccer and Zumba on Muscle Pain, Work Ability and Perceived Physical Exertion among Female Hospital Employees. PLoS ONE, 9(12), doi:10.1371/journal.pone.0115059.
- Kemppainen, V., Tossavainen, K., & Turunen, H. (2012). Nurses’ role in health promotion practice: an integrative review. Health Promot. Int, 28 (4):490-501. Doi: 10.1093/heapro/das034.
- Lachman, V.D., O’Connor, E.S., & Winland-Brown, J. (2015). The New ‘Code of Ethic for Nurses with Interpretive Statements’ (2015): Practical Clinical Application, Part II. Ethics, Law, and Policy, 24(5): 364.
- Letvak, S., & Gupta, C.R. (2013). Differences in health, productivity and quality of care in younger and older nurses. Journal of Nursing Management, 21(7), 914- 921. Doi: 10.1111/jonm.12181.
- Phiri, L.P., Draper, C.E., Lambert, E & Kolbe-Alexander, T.L. (2014). Nurses’ lifestyle behaviors, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study. BMC Nursing, 13, 38. Doi: 1186/s12912-014-0038-6
- Safaei, M., Abedian, Z., Mazloum, S.R., Hosseini, S.R.A. (2014). Effect of Jogging Program on Midwives’ Physical Fitness: A Randomized, Controlled Trial. Journal of Midwifery and Reproductive Health, 2(4), 215-219. Doi: 10.1080/10810730.2015.1018639.