Psychological Factors Affecting Eating Habits Among Nurses in General Hospitals
Submitted by Cik Norfidah Binti Mohamad, RN
1. Zaleha Binti Mohd Hashim, Registered Nurse
2. Umi Kalsom Binti Ibrahim
3. Nordiana Binti Borhan Designation: PA Head, Department of Nursing
1.1 Background Information
Every one level of improvement in the healthy food consumption index was relevant with a significantly less mortality rate in the men and women (Tabor, 2011). Taking meal and snack can effect to the health status (Song et al, 2005: Ma et al 2003) eating habit influence on a person physical, mental and emotional (Kiran, 2006). To keep healthy and good quality of life are affected by taking enough and balance diet (Menis, 2010). Complete diet intake required for the process of growing the strength to be active and maintenance (Akinyemi and Ibraheem, 2009).
1.2 Problem Statement
This global problem eating unhealthy food on a large scale and its impact on health needs health education and emphasis which can largely contribute to its limited consumption and changing over to healthy eating habits for the better the way of life (Ashakiran, 2012).
Studies in Malaysia shows that unhealthy diet ,bad food selection ,anorexia bulimia and obesity has been associated with stress diet habit in working women in Malaysia (Adriana, Haslinda , Nobaya &Rahimah, 2013).
1.3. Significance of the Study
This study was conducted to examine and identify the relation of frequency and pattern of social and psychosocial factors that affecting the eating habits among staff nurses. Then, recommend strategies to improve knowledge and practice of a healthy eating habit, working schedules, as well as improvement of the employer’s and government policies to improve and maintain the healthy eating habits among nurses.
1.4. Objective of the Study
1.4.1 General objective:
To determine pattern of eating habit and its psychological factors among nurses in general hospital.
1.4.2 Specific objectives:
1. To identify pattern of eating habit among nurses.
2. To determine psychological factors affecting eating behavior.
3. To determine the association between pattern of eating habit with demographic data.
4. To determine the association between psychological factors with eating habit.
Daily activities have a correlation effect on food consumption habits. Long working hours has an impact on food consumption behavior. The eating habits among nurses were prominently determined by psychological and social potential mediators.
Taking meal and snack can effect to the health status (Song et al, 2005: Ma et al., 2003) eating habit influence on a person physical, mental and emotional (Kiran, 2006). To keep healthy and good quality of life are affected by taking enough and balance diet (Menis and Sanbier, 2010).
Complete diet intake required for the process of growing the strength to active and maintenance (Akinyemi, 2009).Globalization and development has brought a dietary alteration among people in Malaysian (Wan Hafiz, 2005).
According to Khor (2002) status of process eating was changed. Taking meal and snack can effect to the health status (Song et al, 2005: Ma et al 2003) eating habit influence on a person physical, mental and emotional (Kiran, 2006). To keep healthy and good quality of life are affected by taking enough and balance diet (Menis, 2010). Complete diet intake required for the process of growing the strength to be active and maintenance (Akinyemi, 2009).
2.2 Eating Disorder
Eating disorder: any concern and attitude disorder in taking food habits that result in negatively impact on health. This definition of eating disorders excludes starvation resulting from the inability to find suitable food supplies and also unhealthy eating resulting from inadequate information about nutrition. Also excluded are disturbances in eating behavior such as pica, or the eating of nonnutritive substances such as plastic and wood, and the rumination disorder of infancy-that is, regurgitation of food without nausea or gastrointestinal illness (Brannon, 2010).
An earlier research by the American Dietetic Association revealed that obesity, or being severely overweight, is an issue associated with fast food.
2.3 Social Factors
Social factors is the facts and experiences that influence individuals' personality, attitudes and lifestyle. Social factors because of lifestyle working shift as work not in a day time hours considering a not regular or circulating working time plans. The process of correlate working in shift to health disorder remain unclear but changes of circadian rhythm, sleep disorder, pressure ,behavior and lifestyle alteration for instances food consuming and smoking possibly become a risk factors.
According to the researchers at the University of Maryland’s School of Nursing 55 percent of the 2,103 female nurses they investigated were overweight, citing work pressure, also the consequences on sleep of long, abnormal working period as the source. Another research shows prove to compensate the usual 12 hours shift in nursing that possibly causes an inadequate sleep larger changes for patient care is takes and health problem.
In 2011, Gan et al. highlighted the presence of unhealthy eating behaviors and inadequate nutrient intake among university students. A study conducted at Midwestern University among students revealed that they perceived that it is important to eat a various type of foods for good health.
2.4 Psychosocial Factor
Social factors include general factors at the level of human society concerned with social structure and social processes that impinge on the individual. Psychological factors include individual-level processes and meanings that influence mental states. Sometimes, these words are combined as "psychosocial." This is shorthand term for the combination of psychological and social, but it also implies that the effects of social processes are sometimes mediated through psychological understanding (Stansfeld, 2007).
Lebanon has been going through a nutrition changes in food selection from the ordinary Middle East diet to the junk food hallmark. For this concern overweight and obesity are highly being seen in the youth. (Najat, 2008).
Article from Nutrition Quality of Life among Female- Majority Malay Undergraduate Students of Health Sciences Food has mentioned that intake and dietary a major behavior play role in a person’s physical, mental, and emotional well-being. Most of the time, eating habits becomes worse during college years, due to several factors, such as financial problems, meal-skipping, inadequate variety of food intake, snacking, and physical inactivity although they are generally aware of the negative consequences of those habits (Lua Pei Lin, 2012)
3.2 Study setting
Researchers selected 2 medical and 2 surgical wards to conduct the study because the wards are full with patients.
3.3 Study design
Researchers choose cross sectional study also known as prevalence study (non probability). It is a quantitative approach.
Population of staff nurses in general hospital are 1342(N= 1342)
Researchers select sample of 100 nurses from general hospital, 2 wards from medical and 2 ward from surgical. Convenience sampling is a non-probability method. All staff nurses working in shifts are inclusion. Exclusion criteria for this sample are staffs that are on maternity leave and study leave. (n = 100).
3.6 Instruments / tools
Researchers used a self-administered questionnaire on eating habits which adopted and from Kurubaran Ganasegaran, Sami, Ahmad, Al-abed, Rizal & Syed (2012). Social and Psychological factors affecting eating habits among university students in a Malaysian medical school: a cross-sectional study. The questionnaire consists of three parts.
Part A consists nine items of social demographic data such as gender, age, BMI, race, marital status, duration service and lifestyle such as exercise.
Part B includes questions on eating habits and type of meals consumed (12 items), such as frequency of meals and fruits consumption of fast food.
Part C included six items of questions on psychological factors that influence dietary habits of respondents..Most of the answer are multiple answer and respondent have to select the answer.
3.7 Data collection procedure
Researchers collect data from the selected wards. Questionnaires were kept in an envelope after being answered and respondent should put the envelope inside the box provided. Participants are given 3 days to fill up the questionnaire. Permission was taken from matron and sister in charge. Objectives and benefits of the study were explained to the respondents orally and in written form attached to the questionnaire. They were assured that information obtained would be confidential.
3.8 Ethical approval
Approval of the study was obtained from the ethics committee of the Universiti Teknologi MARA (UiTM) and was registered with National Medical Research Register (NMRR) registration number: 20421. Permission to conduct the study was obtained from the Director of the public hospital.
3.9 Data analysis
The statistical package for social sciences (SPSS) was used to analyze the data in this study. The BMI was calculated as height in kilograms divided by height in square meters (kg/m²). In this study based on the WHO Body Mass Index for the Asian population ,a BMI ˂ 18.5kg/m² was categorical as underweight, 18.5-22.9 kg/m² as the normal range,23.0 -27.4 kg/m² as pre obese ,27.5-34.9 kg/m² as obese Class I, 35.0-39.9 kg/m² as obese Class II and ≥40 kg/m² as obese Class III ( Lancet 2004). All variable was using descriptive analysis to interpret the data. ANOVA and independent t-test was performing to association between eating habits with socio demographic variables.
RESULTS AND DATA ANALYSIS
4.3 Analysis of Data
4.3.1 Demographic Characteristic
100 of staff nurses questionnaire were distributed in this study with a response rate of (100%). A majority of (89%) participants was from a female group while a number of male participants are only (11%). Most of the participants are Malays (77%) while the second largest group of participant is an Indian race (16%), while a total of (5%) is a Chinese and the others are only (2%). A large portion of (95%) participants are from the age of 21 to 40 years old and the rest of (5%) were from the age of 41 until 60 years old. A (46%) of participants are single, meanwhile the other proportion of (54%) are married. The duration of the service of the (91%) participants is from 1 to 15 years, while the other (9%) of participants has a service experience from 16 to 30 years. A majority of participants stated that they are not living with their family (54%), and (46%) live with their family. Most of the participants did perform a regular exercise (84%) but only (16%) did not practice regular exercise routinely. Only (46%) has a normal BMI range, while (8%) participants stated that they are underweight, (27%) is a pre-obese group, a (14%) is an obese class 1, (4%) is from the obese class 2 and (1%) from obese class 3. From the result, majority is having normal BMI and performs a regular exercise (Table 4.1).
4.3.2 Pattern of eating habit among nurses
A slightly more than half (53%) took meals routinely and (47%) respondents did not take meals regularly. A majority of (51%) took breakfast every day and (49%) did not take breakfast daily. A total of (60%) respondents took snacks less than three times per week, while about (40%) took snacks three or more times every week. A large percentage of (51%) eat green, red and yellow colored vegetables daily. A (37%) of participants take fruits three or four times per week. Only (37%) eat fried foods at a frequency of three or four times per week. Most of them had fried food twice a week or more (52%), while (11%) rarely eat a fried food. The majority of (98%) consumed fast food often and took meals with family and friends (92%). Most of them preferred to eat a variety of food (56%) and eat a balanced nutrition (55%). Many of them taken less than two liters water intake every day (90%), while only (10%) did took water more than two liters a day according to the daily requirement. From this result, most of them did not perceived that they have a healthy eating habits (53%) (Table 4.2).
4.3.3 The psychological factors affecting eating habits
A number of (62%) of respondents ate because of feeling lonely, (60%) of participants felt completely out of control when it comes to food, while (61%) respondents stated that they ate till stomach hurts, (58%) of respondents ate because of feeling upset or nervous, meanwhile an (80%) of participants ate because of feeling bored. The majority of (86%) respondents ate because of feeling happy (Table 4.3)
4.3.4 The association between eating habits and demographic characteristic
Mean with (SD) total score of eating habits was not associated throughout the categorical selected variables in the study. Mean for male was 24.27 (SD ±3.31) while for female participant 23.84(SD ±3.32). Male has higher mean eating habit score than females but it is statistically not significant. Mean for the participant for the aged 21 until 40 years and those 41 until 60 years was 23.92 (SD ±3.29) and 23.40 (SD ±3.91) relatively and this comparison was significant (p = 0.457).Those in the age group 21-40 years has higher eating habit score then those 41-60 years but it is statically not significant. Mean score for single status 28.78 (SD ±3.68) and those married 29.27(SD ±3.24). Mean score between races among respondent Malay 23.94(SD ±3.17), Indian 22.50(SD ±3.79), and Chinese 26.20 (SD ±1.92) while others 27.50 (SD ±0.70). There is no significant difference in eating habit score among different races. Significant different in eating habits score found between participants who lives with family 24.80 (SD ±3.33) and those who does not lives with family 23.11 (SD ±3.11), (p = 0.702). Those living with family have significantly higher score than those who do not. Duration of services of 1 till 15 years, 23.86 (SD ±3.29) and those with duration of services of 16 to 30 years, 24.22 (SD ±3.63), (p = 0.468). Mean score for respondent who exercise 23.94(SD ±3.17) and those who do not 23.63(SD ± 4.01). There is no significant difference in eating habit score among those who exercise and those who do not. It was hypothesized that a negative relationship would exist between all variables except living arrangement. Result of the significant test indicates that socio-demographic factors are not associated with eating habit patterns (Table 4.4).
4.3.5 The Association between eating habits and psychological factors
Mean with (SD) of total score of eating habit was compared between respondents who answered ‘yes’ and those who choose to answer ‘no’ on each variables of the psychological factors. Mean total score for eating habit for those who ate when lonely was 23.61 (SD ±3.30) and those who answer ‘’no’ 24.39 (SD ±3.29) (p = 0.93). Mean score for those who feel completely out of control when it comes to food was 23.71 (SD ±3.35) and those who did not was 24.15 (SD ±3.25) (P = 0.49). While mean score for those who ate till stomach hurt was 23.57 (SD ±3.35) and those who did not 24.38 (SD ±3.20) (P =0.39). The total mean score for those who eat when feeling upset or nervous was 23.77 (SD ±3.32) and those who was not are 24.05 (SD ±3.31) (p = 0.79). Mean score for those who eat because of feeling bored was 23.76 (SD± 3.21) and those who did not was 24.38 (SD ±3.66) (P = 0.35). Mean score for those who eat because of feeling happy was 23.69 (SD ±3.18) and those who did not was 25.00 (SD ± 3.83) (p = 0.23) (Table 4.5)
5.1.1 Demographic Characteristic
A majority of (89%) participants was from a female group while a number of male participants are only (11%). The result conducted by Ganasegaran et al (2012), female is larger group (70.5%) compare to male (29.5%) participant. In Most of the participants are Malays (77%) while the second largest group of participant is an Indian race followed by Chinese and the others are only (2%). Most of the participants did perform a regular exercise (84%). Only (46%) has a normal BMI range, while (8%) participants stated that they are underweight, (27%) is a pre-obese group, a (14%) is an obese class 1, (4%) is from the obese class 2 and (1%) from obese class 3. This result was comparatively from previous study which was conducted in Malaysia. The result for BMI is more than half (53%) normal BMI, followed by underweight (22.7%), pre obese (16.7%) and obese (7.6%).
5.1.2 Pattern of eating habit among nurses
Complete diet intake required for the process of growing the strength to be active and maintenance (Akinyemi and Ibraheem, 2009). In this study, majority of participants had breakfast routinely (51%). This result was comparatively higher than previous study which was conducted in Malaysia. (Ganasegaran, Sami, Ahmad, Al-Abed, Rizal & Syed, 2012) which found that respondents consumed breakfast (43.9%). However some study from Korea (Kim, et al. 2013) found that there is a high skipping breakfast rate among shift working staff nurses (43.1%).
Changes in consumer eating habits, seen in the patterns of eating-out and eating at hawker stalls are rapidly becoming the hallmark of an urban lifestyle (Hafiz, 2005). This study finding shows an almost equal result of our study, (40%) of participants took junks food in the frequency of three times per week compared to the same variables result conducted by Ganasegaran et al (2012) with the outcome of (42.4%).
Majority of participants in this study ate vegetables every day (79%), and this finding is consistent with the previous study done in Malaysia (Ganasegaran et al, 2012) with the result of (81.8%). This study has found that (58%) of respondents ate fruits for at least three times a week. Contrary to the finding reported by Yahia et al, (2008).
In this study, most of the participants go to fast food restaurant (98%) while research conducted by School nutrition survey in Ireland has reported that (48.6%) lunch consumed by children falls under fast food category (O’Connor et al, 2003).
However this study also found that majority of participants eat variety of foods (56%) which was similar with that found by a previous study (Ganasegaran et al, 2012).
Majority of respondents had meals with family and friends (92%) more than three times every week. This is comparatively higher than that found by previous study in which (81.1%) of medical students ate with family and friends more than three times per week.
Our study shows that majority of respondents having normal BMI (46%) and performs a regular exercise (84%) drinking of an inadequate amount of water as according to body daily requirement (2 liters /day) which is involving (90%) of all participants. While previous study on medical students reveals a total of (59.8%) respondents drink water less than two liters/ day.
5.1.3The psychological factors affecting eating habits
An earlier research shows that people is at risk elevate their consumption of high cholesterol foods and reduced intake of fruits and vegetables when they are feeling stressed (Habhan, 2009:Zellner et al,2006:Cartwright et al, 2003:Hudd et al,2000). A possible new idea in this study was association between social and psychological factors affecting eating habits among staff nurses in Malaysia; eating habit score in this study was significantly higher among those who answered ‘yes’ on the following statements: “eat because of feeling lonely”, “eat until stomach hurts”, “eat because of feeling upset nervous” and “eat because of feeling bored.”
Currently our country is having a growing number of working women who is actively contributing in the working field. A ready to eat or prepared food also known as fast food is widely available for ready to eat or take away making it a preferred food among nurses.
Our study shows that majority of (86%) respondents ate because of feeling happy followed by eating because of feeling lonely (80% ) and most of them did not perceived that they have a healthy eating habits (53%).
5.1.4 The association between eating habits and demographic characteristic
In this research majority of participants consume meals regularly (53%) and (51%) of respondents took breakfast every day. This result was comparatively consistent with that reported by previous study (Ganasegaran, Sami, Ahmad, Al-Abed, Rizal & Syed, 2012) in which (57.6%) of medical students ate regular meals, with (43.9%) took breakfast daily. Another study done in Malaysia has also reported that (77.18%) participants of working women had taken meals every day (Adriana, Haslinda, Nobaya &Rahimah, 2013).
RECOMMENDATION & CONCLUSION
6.1.1 Nursing management
Ward managers are encouraged to implement a supportive management and supervisory and to allow nurses to participate in the work scheduling to reduce psychosocial stressors and physical demands.
Employers are recommended to allow sufficient period for nurses to take meals (at least single time out). Also employers are suggested to identify physical workload that acceptable to avoid excessive tiredness and risk of unhealthy eating habits.
Employers are also suggested to monitor the availability of healthy food in the worksite and if possible, to subsidize a healthy food to the worker.
6.1.3 Government/ Policies
Government and policies maker are recommended to increase funding for continuous study on working condition and eating habit.
Unions and worker groups are suggested to give education to employee regarding the influence working condition on BMI and encourage them in voluntary program to improve the health status.
6.2 Study limitations
However, the study has a several limitations. Firstly, our data was obtained by using self-report questionnaires, an additional implementation is needed such as an experimental/ observational study method and laboratory nutrition and metabolic markers should be included in further research for a better understanding of the association between working in shifts and eating habits.
Secondly, staffs nurses who are working in shifts are exposed to a various aspects of working scopes such as a different in duration or night, morning and evening shifts rotation cycle in every clinical area were not included in the current study.
Thirdly, in this study we did not investigate the amount and energy taken that relatively meets the individual daily requirement, this should be further examined.
Eating habits have been a major concern among nurses in General Hospital as a determinant of health status. The aim of this study was to assess the pattern of eating habits and its association psychological factors among nurses. This study has included a large, representative sample of nurses working in shifts in both medical and surgical clinical areas. The purpose of this study was to determine pattern of eating habit and its psychological factors among nurses in general hospital.
A cross-sectional study design was carried out whereby a multiple-choice questionnaire was distributed to 100 medical and surgical nurses in general Hospital. A self- administered questionnaire on demographic characteristic, eating habits and psychosocial factors was used. From the result, majority is having normal BMI and performs a regular exercise. Psychological factors affecting eating behavior, the majority of respondents ate because of feeling happy. Association between eating habits and demographic characteristic the result of the significant test indicates that socio-demographic factors are not associated with eating habit patterns.
In conclusion, researchers found that generally most of nurses in this study had a healthy eating behavior except in frequency of visiting fast food restaurants, daily amount of water intake and the perception of having eating habit. A working shifts schedule and a constraints of time has restricted the nurse’s ability to practice a healthy eating habits. Most of nurses in this study had a healthy eating behavior.
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