Promoting Student Nurses' Health: Tackling Stress Factors, Exams of Nursing

Download Promoting Student Nurses' Health: Tackling Stress Factors and more Exams Nursing in PDF only on Docsity! Helping students to self-care and enhance their health-promotion skills Anne Mills ABSTRACT Nurses have a public health role, requiring them to promote the health of individuals and communities and to engage at a political and policy level to improve population health. There is also a professional expectation that nurses will model healthy behaviours and take responsibility for their personal health and wellbeing. However, studies have indicated that undergraduate nurses find the academic and practice elements of their nursing programmes stressful. To manage their stress many use coping behaviours that negatively impact on their health and wellbeing and may influence their ability and willingness to effectively support health promotion in practice. It is widely recognised that environments influence health outcomes and personal health behaviours. This article addresses some of the structural causes of student nurse stress and highlights a recent educational initiative at a UK university that aims to equip student nurses with the practical skills required to engage in health promotion and thereby provide benefits for service users and student nurses alike. Public Health England’s (PHE) Nursing and Midwifery Contribution to Public Health guidance document (2013) identifies the public health role required of every registered nurse. It calls upon practitioners to address health at an individual, community and population level, helping and supporting people to maximise their wellbeing. In addition, the Nursing and Midwifery Council (NMC) (2018a: 8) requires nurses to take ‘professional responsibility to adopt a healthy lifestyle’ and within the new Standards Framework for Nursing and Midwifery Education (2018b) the NMC details the significant involvement and skills nurses must demonstrate in promoting health to people, families, communities and populations. In order to act as healthy role models and be seen as credible figures within health promotion, nurses must value themselves enough to practise self-care and demonstrate healthy behaviours. This involves nurses taking personal responsibility for their own health and embracing a healthy lifestyle (Royal College of Nursing (RCN), 2018). However, it is well documented that many registered and undergraduate nurses practise health behaviours that contribute to poor personal health (Ross et al, 2017) and may further increase their reluctance to initiate discussions on health and wellbeing (Kyle et al, 2016; Blake and Patterson, 2015) while others adopt an information-giving approach to clients, failing to recognise the complexity of behaviour change (Whitehead, 2006). It is well known that health and health behaviours are shaped and influenced by a range of social determinants (Marmot et al, 2010), which encompass the settings in which ‘people are born, live, work and age’ (Commission on Social Determinants of Health (CSDH), 2008:2; Wilkinson and Marmot, 2003). It therefore follows that to encourage and support healthy lifestyles requires a multifaceted approach for everyone—nurses included. Carlson and Warne’s (2007) review of the literature on the barriers and enablers of healthier nursing practice recognises the importance of two instrumental factors for health: the nurses’ working environment and their educational experience of health-promoting practice. This article centres on student nurses. It identifies some of the environmental and organisational influences on their health and discusses how a number of educational initiatives, including the embedding of PHE’s initiative ‘Making Every Contact Count’ (MECC) (PHE et al, 2016) within the undergraduate nursing programme, may improve the practice of promoting health and provide an opportunity for nurses to reflect upon and manage their own health. Background Undertaking a higher education nursing degree provides great opportunities but also numerous challenges. All students, in all age groups, negotiate a variety of personal adventures as they grapple with their new academic landscape, its terminology, requirements and schedules. However, in addition to the academic work, nursing students are required to undertake extensive hours in clinical placement learning, practising and being assessed on their evidence-based practical nursing skills. It is well documented that nursing students find their nurse education stressful; clinical placements are frequently mentally challenging and physically demanding (Moridi et al, 2014), while the extensive academic workload is also a major stressor (Evans and Kelly, 2004). Work by Chernomas and Shapiro (2013) identified that nursing students experience higher levels of anxiety, stress and depression than people of similar ages undertaking other university programmes or in work. Furthermore, Edwards et al (2010) reported that stress levels peak at the beginning of the third year, when they are considerably higher than at any other stage of the programme. Nursing students experience a range of NMC-stipulated clinical placements within their degree and, although they are supernumerary to the NHS workforce, students are expected to work their weekly 37.5 hours and receive supervision according to their learning requirements and stage of learning (NMC 2018c: 6). Many clinical settings providing 24-hour care require staff to work shifts—early, late or night—which can be 12 hours in duration. Learning to adapt to shift work takes time; however, there are immediate physiological impacts on eating and sleeping patterns. In the longer term shift work has been linked to sleep disturbance, feelings of fatigue, increased anxiety, depression and chronic conditions (Harrington, 2001). The programme challenges will differ, depending on the age group of the student. Younger students will be assuming adult responsibilities and adjusting to new environments devoid of home comforts, while older students often face a continuous balancing act with family commitments (Middleton, 2018). Organisational influences on health As the causes of ill health become more clearly understood there is recognition that many structural factors, including the working environment, influence lifestyle choices and contribute to consequent health outcomes (Marmot et al, 2010). For registered and student nurses, the practice setting is often a busy and demanding place. This is evident from a recent survey (Jones-Berry, 2018) of almost 2000 registered nurses, which reported that 75% of respondents admitted to never having time for a break while on shift and 59% stating they go through a whole shift without being able to drink water. This raises a health concern not just for the registered nurses themselves, but also for student nurses, who are influenced by their registered colleagues. It normalises unhealthy self-care and demonstrates how disempowered nurses are in changing and managing some clinical settings. It also calls into question the organisation’s interest and responsibility for the health and wellbeing of its employees. Opportunities for health As the new education standards come into force (NMC, 2018b) many institutions will revalidate their nursing programmes, thereby generating numerous opportunities for nurse academics to address health promotion, both within and alongside the curriculum. Initiatives to actively promote student health should be considered, such as walking seminars (held outside, to promote physical activity, critical thinking and problem solving group discussions) and stress-management workshops. Teaching and learning strategies must ensure students have the skills to move beyond a a health education style of information delivery to a more person-centred communication approach, which seeks to support service users to help them increase control over, and improve their health. In addition, nurse educators have an obligation to act as healthy role models to student nurses and lobby for universities to become health-enhancing settings, both in their policies and the environment. Additionally, current workplace challenges provide nurses with opportunities to move beyond a health education view of health promotion, recognising the workplace as a health influencing factor and working towards this key Public Health England (2013) action area. As a way of improving their own health, safeguarding the health of student nurses and the client/patient; registered nurses and nurse leaders must lobby and work towards the creation of sustainable healthy workplaces that benefit both service users and staff. Conclusion Undergraduate nurse are the registered nurses of tomorrow and consequently they require nurturing and support as they navigate their nurse education, which many find stressful. Current registered nurses in practice and education unwittingly provide role modelling opportunities for undergraduate nurses. However, to be valuable and credible role models they have an obligation to incorporate evidence-based public health strategies into their everyday practice and must address personal health behaviours that contribute to poor health outcomes. In addition, nurse leaders have a responsibility to highlight the structural causes of ill health in the workplace and work with organisational partners to move beyond paying lip service to the tenets of health and wellbeing, ensuring the development of health-promoting workplace settings that improve health and minimise injury and illness for service users and staff alike. Incorporating MECC into nurse education may improve the health outcomes and health promotion communication skills of undergraduate nurses; however, it is not possible for them to change the skills and ethos of organisations on their own. Although it is anticipated that students will be agents of change, they will require the support and encouragement of their registered nurse colleagues, nurse leaders and wider healthcare organisations to bring about sustained change. 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