The road to change Community nurses can find it even harder to eat healthily than nurses in the acute sector. But with careful planning, progress is possible. Erin Dean reports
Nurses who are constantly travelling to appointments can end up eating in the car. Forward planning is essential to avoid becoming reliant on the convenience food sold in shops and petrol stations. Homemade sandwiches are likely to be lower in fat and salt than shop-bought options. This article helps nurses to consider what stops them from eating healthily. Author Erin Dean is a freelance journalist
QNI chief executive Crystal Oldman says community nurses struggle to find the time and opportunity to eat well. Workloads are going up, squeezing the time available for meal breaks. And while nurses in the acute sector will generally have access to some kind of canteen, those in the community either spend a lot of time in their cars or work in small community hospitals, clinics or nursing homes, where facilities are limited. ‘Carving out time for a proper nutritious meal appears to be a challenge,’ Ms Oldman
A Nursing Standard survey of almost 3,400 nurses undertaken in September and October revealed that healthy eating is a significant concern. Almost three quarters said they were heavier than they would like to be and a similar number said they felt they should eat more healthily. A total of 65 per cent said they were trying to lose weight. Staff based in the community told the survey that they were often driving during what should be their break times, and that work fridges were too small to
NURSES ARE THE ONES WHO DELIVER PUBLIC HEALTH MESSAGES, BUT FIND IT DIFFICULT TO CHANGE THEIR OWN BEHAVIOUR says. ‘It tends to be a sandwich or something you have quickly bought and eaten in the car. ‘There is hydration too. Nurses won’t very often, as a principle, drink in patients’ homes, as neighbours talk to one another and if you drink at one person’s house and not another, it can get quite competitive. Nurses also don’t tend to use patients’ toilets, as it is seen as unprofessional, and some will restrict what they are drinking so they don’t have to stop and use a toilet. These are practical issues that nurses in the community have to think about.’ If a nurse is at the office, generally in a GP practice or clinic, the facilities available may be just a fridge and a kettle. Community nurses can also miss the social aspects of mealtimes, adds Ms Oldman.
store food. One clinical nurse specialist who works nights at a community hospital said the only food options for staff on site were crisps and chocolate from a vending machine. Another community-based clinical nurse specialist said senior staff often brought cakes to meetings, and that she was treated as odd for choosing to eat healthily. Parkinson’s disease specialist nurse Jacqueline Young, who recently moved to a hospital-based position after 16 years in the community in Cambridgeshire, says her former colleagues survived on snacks: ‘A number of nurses went without until they got home in the evening. They had no time to fit in a lunch break, despite most of them allocating a lunch break in their daily planner. ▼
SUMMARY
‘With the numbers of patients I see every day – between 12 and 17 – it can become overwhelming, especially if some of those have complex issues,’ a district nurse said when describing a working day. ‘I always miss my lunch hour – I usually take ten minutes to grab something in a shop and eat in my car.’ This comment by a respondent to a Queen’s Nursing Institute (QNI) survey published earlier this year reveals why many nurses in the community struggle to find time for even a brief meal break. Nurses in all settings have a responsibility to encourage patients to follow a healthy lifestyle – but according to the 2009 Department of Health report Healthy Weight, Healthy Lives: One Year On, plenty of NHS staff are not good role models in this area. About a quarter of the 1.2 million NHS staff are obese, and a further third are overweight, according to the report. Research suggests that lifestyle advice to patients can be less effective when it is delivered by nurses who are overweight.
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DANIEL MITCHELL
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HEALTHY LUNCHBOX SUGGESTIONS Homemade sandwiches are often a better choice than shop-bought ones because they will have less salt. Bread, bagels and wraps are all good choices, and it is better to choose higher fibre, wholemeal and seeded options. Variety will help prevent boredom. Good filling choices include egg, which is high in protein and low in fat, tuna and sweetcorn, bound with low-fat salad cream, or low-fat crème fraiche and salmon. Cheese should be low fat. Pasta or noodle salad with vegetables is transportable and can be kept in the car. Rice can also be used, but will need to be kept in a chiller bag due to the risk of food poisoning. Healthy snacks include vegetable sticks, fruit and individual portion sizes of crackers. Recommended by dietitian Sioned Quirke
Be prepared
Regional director of dining and procurement Christopher Dean says: ‘At Sunrise, we take nutritional provision very seriously. Wherever we can, we always try to use fresh ingredients that are locally sourced. Every staff member,
Calorie values of convenience food Walkers crisps 34g pack McDonalds Big Mac Ginsters Cornish pasty Pot Noodle beef and tomato Kit Kat four finger
181 cals 490 cals 549 cals 424 cals 510 cals
Source: Collins Gem Calorie Counter
ISTOCK
▼
‘Many community nurses will continue working through their allocated lunch break and multi-task, doing paperwork and answering patient telephone queries.’ She adds that nurses in multidisciplinary teams tended to eat better. ‘Therapists are much better at taking planned lunch breaks and this has a knock-on effect on the nurses.’ Ms Young says she has found it easier to take breaks in hospital. ‘There is a mealtime protection policy which means there are no ward rounds, interventions or visitors at these times. It allows me to either go back to my office for my lunch or walk to the allocated staff-only eating areas within the hospital. Despite being as busy in my new job as I was in the community, I seem to be more able to stick to my lunch breaks and actually have a 30-minute break.’ Not all community staff have to travel for their work. Some care home staff, for example, can access catering facilities. The nearly 200 nurses who work at the 27 sites of Sunrise, which provides residential, nursing and dementia care for older people, can have the same meals as the residents. All staff working night shifts or a longer-than-normal day receive a free meal, and during the day meals are available at cost price.
11.4g fat 24.0g fat 32.2g fat 14.7g fat 26.7g fat
regardless of which community they work in, has access to a staff room. These all have a fridge, a microwave and tea and coffee-making facilities, and are stocked with fresh fruit.’ Sioned Quirke, lead specialist dietitian for an NHS organisation in South Wales and spokesperson for the British Dietetic Association, works in the community. She says that for people on the move who want to eat healthily, the secret is preparation. ‘I try to take some time to plan out all my lunches and snacks for the week, so that I am not in the situation where I have to stop and get whatever is available. If you stop at a local shop you are most likely to buy a pre-packed sandwich, pasta bowl or sausage roll, and these tend to be high in fat and not good for healthy eating or weight management.’ Nurses can control the amount of fat and salt they consume, says Ms Quirke, by making their own sandwiches or pasta salads.
She recommends carrying a bottle of water and choosing small individual packages of snacks to avoid ‘grazing’ through a large pack. While most nurses are likely to know what makes a healthy diet, many do not manage to stick to one. Coventry University chartered psychologist Charlotte Hilton says: ‘There is a wealth of literature that says people in caring professions tend to put themselves last and consider other people’s health before their own. Most people, and definitely most healthcare professionals, know what constitutes a healthy lifestyle, but there is something that people find pleasurable about engaging in behaviours that are not good for us. ‘Nurses are at the front line of public health messages and are the ones who deliver these messages, but we know that they find it difficult to maintain the behaviours themselves.’ Behaviour change is difficult and complex for everyone, including nurses, says Dr Hilton. However, she believes that a useful approach is motivational interviewing, which is a counselling technique many nurses use on their patients. Motivational interviewing focuses on exploring and resolving ambivalence, then motivating an individual to change. ‘When it comes to helping someone towards behaviour change, we need to consider how important it is for them to make these changes,’ Dr Hilton says. ‘There is often a relationship between increasing importance and increasing confidence, helping the person feel ready for change. Motivational interviewing is not something that nurses should reserve for patients. We forget that if it is good for patients’ lifestyles, it is also good for our own’ NS
22 december 3 from :: volRCNi.com 29 no 14 by :: 2014 STANDARD Downloaded ${individualUser.displayName} on Nov 12, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Nurses who are constantly travelling to appointments can end up eating in the car. Forward planning is essential to avoid becoming reliant on the convenience food sold in shops and petrol stations. Homemade sandwiches are likely to be lower in fat and salt than shop-bought options. This article helps nurses to consider what stops them from eating healthily. Author Erin Dean is a freelance journalist
QNI chief executive Crystal Oldman says community nurses struggle to find the time and opportunity to eat well. Workloads are going up, squeezing the time available for meal breaks. And while nurses in the acute sector will generally have access to some kind of canteen, those in the community either spend a lot of time in their cars or work in small community hospitals, clinics or nursing homes, where facilities are limited. ‘Carving out time for a proper nutritious meal appears to be a challenge,’ Ms Oldman
A Nursing Standard survey of almost 3,400 nurses undertaken in September and October revealed that healthy eating is a significant concern. Almost three quarters said they were heavier than they would like to be and a similar number said they felt they should eat more healthily. A total of 65 per cent said they were trying to lose weight. Staff based in the community told the survey that they were often driving during what should be their break times, and that work fridges were too small to
NURSES ARE THE ONES WHO DELIVER PUBLIC HEALTH MESSAGES, BUT FIND IT DIFFICULT TO CHANGE THEIR OWN BEHAVIOUR says. ‘It tends to be a sandwich or something you have quickly bought and eaten in the car. ‘There is hydration too. Nurses won’t very often, as a principle, drink in patients’ homes, as neighbours talk to one another and if you drink at one person’s house and not another, it can get quite competitive. Nurses also don’t tend to use patients’ toilets, as it is seen as unprofessional, and some will restrict what they are drinking so they don’t have to stop and use a toilet. These are practical issues that nurses in the community have to think about.’ If a nurse is at the office, generally in a GP practice or clinic, the facilities available may be just a fridge and a kettle. Community nurses can also miss the social aspects of mealtimes, adds Ms Oldman.
store food. One clinical nurse specialist who works nights at a community hospital said the only food options for staff on site were crisps and chocolate from a vending machine. Another community-based clinical nurse specialist said senior staff often brought cakes to meetings, and that she was treated as odd for choosing to eat healthily. Parkinson’s disease specialist nurse Jacqueline Young, who recently moved to a hospital-based position after 16 years in the community in Cambridgeshire, says her former colleagues survived on snacks: ‘A number of nurses went without until they got home in the evening. They had no time to fit in a lunch break, despite most of them allocating a lunch break in their daily planner. ▼
SUMMARY
‘With the numbers of patients I see every day – between 12 and 17 – it can become overwhelming, especially if some of those have complex issues,’ a district nurse said when describing a working day. ‘I always miss my lunch hour – I usually take ten minutes to grab something in a shop and eat in my car.’ This comment by a respondent to a Queen’s Nursing Institute (QNI) survey published earlier this year reveals why many nurses in the community struggle to find time for even a brief meal break. Nurses in all settings have a responsibility to encourage patients to follow a healthy lifestyle – but according to the 2009 Department of Health report Healthy Weight, Healthy Lives: One Year On, plenty of NHS staff are not good role models in this area. About a quarter of the 1.2 million NHS staff are obese, and a further third are overweight, according to the report. Research suggests that lifestyle advice to patients can be less effective when it is delivered by nurses who are overweight.
20 december :: volRCNi.com 29 no 14 by :: 2014 STANDARD Downloaded3 from ${individualUser.displayName} on Nov 12, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
DANIEL MITCHELL
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 12, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
HEALTHY LUNCHBOX SUGGESTIONS Homemade sandwiches are often a better choice than shop-bought ones because they will have less salt. Bread, bagels and wraps are all good choices, and it is better to choose higher fibre, wholemeal and seeded options. Variety will help prevent boredom. Good filling choices include egg, which is high in protein and low in fat, tuna and sweetcorn, bound with low-fat salad cream, or low-fat crème fraiche and salmon. Cheese should be low fat. Pasta or noodle salad with vegetables is transportable and can be kept in the car. Rice can also be used, but will need to be kept in a chiller bag due to the risk of food poisoning. Healthy snacks include vegetable sticks, fruit and individual portion sizes of crackers. Recommended by dietitian Sioned Quirke
Be prepared
Regional director of dining and procurement Christopher Dean says: ‘At Sunrise, we take nutritional provision very seriously. Wherever we can, we always try to use fresh ingredients that are locally sourced. Every staff member,
Calorie values of convenience food Walkers crisps 34g pack McDonalds Big Mac Ginsters Cornish pasty Pot Noodle beef and tomato Kit Kat four finger
181 cals 490 cals 549 cals 424 cals 510 cals
Source: Collins Gem Calorie Counter
ISTOCK
▼
‘Many community nurses will continue working through their allocated lunch break and multi-task, doing paperwork and answering patient telephone queries.’ She adds that nurses in multidisciplinary teams tended to eat better. ‘Therapists are much better at taking planned lunch breaks and this has a knock-on effect on the nurses.’ Ms Young says she has found it easier to take breaks in hospital. ‘There is a mealtime protection policy which means there are no ward rounds, interventions or visitors at these times. It allows me to either go back to my office for my lunch or walk to the allocated staff-only eating areas within the hospital. Despite being as busy in my new job as I was in the community, I seem to be more able to stick to my lunch breaks and actually have a 30-minute break.’ Not all community staff have to travel for their work. Some care home staff, for example, can access catering facilities. The nearly 200 nurses who work at the 27 sites of Sunrise, which provides residential, nursing and dementia care for older people, can have the same meals as the residents. All staff working night shifts or a longer-than-normal day receive a free meal, and during the day meals are available at cost price.
11.4g fat 24.0g fat 32.2g fat 14.7g fat 26.7g fat
regardless of which community they work in, has access to a staff room. These all have a fridge, a microwave and tea and coffee-making facilities, and are stocked with fresh fruit.’ Sioned Quirke, lead specialist dietitian for an NHS organisation in South Wales and spokesperson for the British Dietetic Association, works in the community. She says that for people on the move who want to eat healthily, the secret is preparation. ‘I try to take some time to plan out all my lunches and snacks for the week, so that I am not in the situation where I have to stop and get whatever is available. If you stop at a local shop you are most likely to buy a pre-packed sandwich, pasta bowl or sausage roll, and these tend to be high in fat and not good for healthy eating or weight management.’ Nurses can control the amount of fat and salt they consume, says Ms Quirke, by making their own sandwiches or pasta salads.
She recommends carrying a bottle of water and choosing small individual packages of snacks to avoid ‘grazing’ through a large pack. While most nurses are likely to know what makes a healthy diet, many do not manage to stick to one. Coventry University chartered psychologist Charlotte Hilton says: ‘There is a wealth of literature that says people in caring professions tend to put themselves last and consider other people’s health before their own. Most people, and definitely most healthcare professionals, know what constitutes a healthy lifestyle, but there is something that people find pleasurable about engaging in behaviours that are not good for us. ‘Nurses are at the front line of public health messages and are the ones who deliver these messages, but we know that they find it difficult to maintain the behaviours themselves.’ Behaviour change is difficult and complex for everyone, including nurses, says Dr Hilton. However, she believes that a useful approach is motivational interviewing, which is a counselling technique many nurses use on their patients. Motivational interviewing focuses on exploring and resolving ambivalence, then motivating an individual to change. ‘When it comes to helping someone towards behaviour change, we need to consider how important it is for them to make these changes,’ Dr Hilton says. ‘There is often a relationship between increasing importance and increasing confidence, helping the person feel ready for change. Motivational interviewing is not something that nurses should reserve for patients. We forget that if it is good for patients’ lifestyles, it is also good for our own’ NS
22 december 3 from :: volRCNi.com 29 no 14 by :: 2014 STANDARD Downloaded ${individualUser.displayName} on Nov 12, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
