Barriers to cardiovascular

health in cardiac nurses

Emma Donlon (BSc, MSc)

Staff Nurse Step Down Unit, Cork University Hospital.
Email: edonlon@hotmail.com

Cardiovascular disease (CVD) is the leading cause of death in Ireland and diminishes quality of life and places a burden on healthcare
services. There is little known about CVD with regard to nurses’ health in Ireland.1 As most hospital nursing is shift work, routine is interrupted
and some believe that nurses lack the opportunities needed to make healthy changes.2 These barriers to a healthier lifestyle can increase
nurses’ own risk of developing CVD. The overall aim of this study was to assess the lifestyle of cardiac nurses working in an acute setting for
the first time in Ireland. Perceived barriers these nurses face in achieving a healthier lifestyle and risk factors for CVD were identified.3 The
INTERHEART case-control study has identified that CVD is largely preventable through the modification of these risk factors.4

METHODS
This study took place over a two-month period in the Cardiology
Department of Cork University Hospital (CUH). A mixed method survey
was employed to assess the lifestyle behaviours of cardiac nurses.
A modified version of the FANTASTIC Lifestyle Assessment Tool was
adapted.3-5 BMI was calculated in order to assess the prevalence of
excess weight, a known risk factor predisposing to CVD.3
RESULTS
A total of 70 female nurses working in the Cardiology Department
participated. Risk factors noted were: smoking, poor diet, inadequate
physical activity and obesity. Details from the lifestyle assessment tool
are summarised in Table 1.
PERCEIVED BARRIERS TO A HEALTHY LIFESTYLE
Most nurses studied faced barriers in achieving a healthy lifestyle Table 1. Key findings from the lifestyle assessment
in 70 nurses.
(85.7%). Shift work was the most prominent barrier (68.6%),
followed by tiredness (51.4%) (Figure 1). Nurses who did ● Smoking: 61.4% never smoked, 27.1% of nurses were
experience barriers to a healthy lifestyle tended to be overweight ex-smokers with 11.4% quitting tobacco use in the past
(mean BMI 25.2 kg/m2, SD 4.37)(Figure 2). 6-12 months. 11.4% current smokers.
NURSES’ LIFESTYLE BEHAVIOURS COMPARED WITH ● Physical activity: 62.9% physically active at moderate in-
NATIONAL FINDINGS tensity 5x per week. Of the 37.1% who were not, 5.7%
Currently 23% of the Irish population smoke. There are more ex- were physically active once or twice a week. Physical ac-
tivity at vigorous intensity was practised 3x per week by
smokers in Ireland today than smokers (28%).6 A similar trend can
31.4%.
be seen in this study: 11.4% of nurses smoke and 27.1% are ex-
smokers for over 10 years. Smoking is considered the most ● Diet and alcohol: 71.4% did not consume enough fruit
and vegetables. Only 24.3% ate 5-6 portions a day. Most
important risk factor to modify in order to prevent CVD.3
drank alcohol occasionally (47.1%) whereas 18.6%
Only 26% of the Irish population follow international guidelines
drank alcohol on a regular basis.
of eating five pieces of fruit and vegetables daily.6 This study found
● Psychosocial wellbeing: 80% stated that they always had
similar results among cardiac nurses with only 28.6% of
family support; 35.7% could relax some of the time.
participants following this guideline. However, the nation of Ireland
42.9% felt uptight/tense some of the time, with 15.7%
was more overweight (31%) and obese (22%) than the uptight/tense fairly often.
participants (25.7% and 10% respectively).6
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 Healthy Ireland Survey found that ‘being
Figure 1: Barriers to a healthy lifestyle experienced by nurses (%).
more physically active’ was the change
most frequently selected (38%) by Irish
people to increase health and wellbeing.6
In this survey, only 24% of the nurses met
national CVD prevention physical activity
guidelines.
THE ROLE OF THE NURSE
Nurses have a leading role as initiators and
supporters of health promotion and as role
models for a healthy lifestyle.7 Nurses are
encouraged to promote healthy lifestyles
through delivery of smoking cessation,
physical activity and dietary advice. It is
important to note that nurses’ own health Figure 2: Mean Body Mass Index (BMI) of nurses with and without barriers
to a healthy lifestyle.
behaviours may also negatively impact their
engagement and credibility in fulfilling this
duty.8
CONCLUSION
This study provides a valuable insight into
the risk factors for CVD which cardiac
nurses experience. Nurses’ educational
needs regarding their own health
behaviours should be investigated further.
Initiatives to promote nurse cardiovascular
health are needed.
REFERENCES
1. Health Service Executive. Changing
cardiovascular health: National cardiovascular
health policy: 2010-2019. Dublin: Department of
Health and Children; 2010. ISBN:
9780755776399. potentially modifiable risk factors associated with from:
2. Zhao I, Bogossian F, Song S, Turner C. The myocardial infarction in 52 countries (the http://health.gov.ie/blog/publications/healthy-
association between shift work and unhealthy INTERHEART study): Case-control study. Lancet ireland-survey-2015-summary-of-findings/.
weight. Journal of Occupational and 2004 Sep; 364(9438):937–52. 7. Donkor N, Farrell K, Constable A, et al.
Environmental Medicine 2011 Feb;53(2):153–8. 5. Wilson D, Ciliska D. Lifestyle assessment: Cardiovascular and type 2 diabetes risk factors in
3. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes Development and use of the FANTASTIC Liberian nurses. International Journal of Africa
and cardiovascular disease: A statement for checklist. Canadian Family Physician 1985 Apr; Nursing Sciences 2016;4(20):1–6.
healthcare professionals from the American Heart 30:1527-1532. ISBN: 9780826105080 8. Chan CW, Perry L. Lifestyle health promotion
Association. Circulation 1999 Sep 6. Health Service Executive. Healthy Ireland survey interventions for the nursing workforce: A
7;100(10):1134–46. 2015 – summary of findings - Department of systematic review. Journal of Clinical Nursing
4. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of Health; 2010 Jul [cited 2016 Feb 12]. Available 2012 Jul 13;21(15-16):2247–61.

Editor’s View
This article on the impact of nursing as a career on CVD risk is fascinating. The study showed
that barriers to a healthy lifestyle increased CVD risk and Emma Donlon specifically identified
shift-working as an issue. One of the (many) attractions of working in general practice is that
shift work is no longer an issue, although many community nurses still have to work shifts.
However, Emma’s study showed that it was the impact that shift work was having on lifestyle
choices that was the real culprit. Risk factors identified as contributing to increased CVD risk
included smoking, poor diet, inadequate physical activity and obesity. Whilst all of these might be
made worse by shift work, I suspect many of us will recognise at least some of these poor health behaviours even if
we work more sociable hours. Emma’s paper is a health warning for many nurses, not just those who work shifts.
I’m now off for a walk into the village to buy some fresh fish and vegetables for supper…

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 Key Practice Points
Click on other
● Unhealthy lifestyle activity may put cardiac nurses
interesting articles: at risk of CVD.
● 85.7% of nurses studied experienced barriers to a
CVD prevention pathway rolled out across England healthier lifestyle.
Lifestyle change programmes recommended in NICE ● Nurses must realise that their health affects not
diabetes guidelines only themselves but also their patients in terms
of the quality of care they provide and their
Any physical activity in elderly better than none to re-
credibility as role models.
duce CV risk

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