Evidenced based practice guidelines are used to improve health status and address gaps in care populations in the rural work environment. This QI project evaluates strategies using concepts related to community, environment, occupational health, and socioeconomic dimensions of health.
This project aims: 1) to raise awareness of the importance of preventing weight gain during the holiday season for rural hospital nightshift employees; 2) to address internal and external factors for the nightshift that may impede obesity prevention during the holiday season and 3) to highlight the spectrum of relevant interventions through collaboration for providing education for the rural night shift hospital employees.
The objectives are to educate the educated (hospital employees). By doing this, improvement of the population health may be achieved. The rural environment including work environments have limited resources. When educating hospital employees with a greater knowledge base of healthy lifestyles, the same information can be translated into education for patients.
Employers have a compelling interest to create a healthy work environment and promote healthy behavior. Healthy employees live longer, contribute to a productive work environment, and are a vital asset to the stability of the work place. Many employers associate poor health with reduced employee performance, safety, and morale. The organizational costs of workers in poor health, and those with behavioral risk factors, include high medical costs, disability, and workers’ compensation expenses. Other cost considerations are elevated absenteeism and employee turnover, and decreased productivity at work, referred to as presenteeism. A peer’s poor health may negatively affect the performance of others who work with him or her.
Many employers provide health insurance and may provide some type of wellness benefit. This QI project was conducted at a rural hospital setting that is self-insured when providing health insurance to the employees. This rural hospital’s mission statement is “Dedicated to promoting optimal health and well being of the entire community in a respectful and safe environment.” This statement includes employees of the hospital as the environment for population.
A 2010 review by the Community Guide Task Force from the CDC, reported well-designed wellness programs created a positive influence on many health behaviors, biometric measures, and financial outcomes that are important to population health and employers.
The framework used for this QI program is a combination of Plan, Do Act, Evaluate (quality improvement model), STAR Model of Knowledge Transformation (for translational research) and Kurt Lewin’s freeze, unfreeze, and refreeze (change model)
The interventions used were weekly educational evidenced based guidelines from each collaborating team member. This was accomplished through creating a wellness team that included physical therapy, registered dietician, financial analyst, social worker and family nurse practitioner that provided education with evidenced-based guidelines for creating a healthy lifestyle environment for weight gain prevention. Each team member sent one weekly educational email from their discipline to the participants. The emails include five educational themes containing health information about the increased risk of chronic disease in the nightshift risk (obesity and other comorbidities), dietary recommendations, physical activity recommendation, tips for managing stress and increasing financial literacy.By providing collaborative education and reflecting evidenced-based practice guidelines concerning lifestyle modifications, each nightshift employee will be able to make adjustments in their lifestyle as needed.
This project was implemented to prevent holiday weight gain among rural hospital night shift employees. There are three target elements in this project that can lead to weight gain and obesity. These are: holiday time frame, rural environment and night shift workers. Obesity is a major public health challenge. Rural environments in the United States also have an increased rate of obesity than non-rural areas. Night shift workers can gain more weight, which can lead to an increased risk for cardiovascular diseases, metabolic syndrome and diabetes. Another factor associated with weight gain is the holiday season that includes Thanksgiving through Christmas. During this QI project pre and post holiday season data was collected including Health Promoting Lifestyle Profile II survey, age, gender, education level, marital status, number of children living in the home, blood pressure, BMI, weight, waist circumference and neck circumference measurements. Five interventions were developed that included financial literacy, stress management, disease awareness, nutrition and physical activity. These interventions included recommendations with evidenced-based educational guidelines (EBG) for obesity and weight gain prevention through weekly emails. An interdisciplinary wellness team included a licensed physical therapist, registered dietician, financial analyst, licensed social worker and a board certified family nurse practitioner presenting the EBG. The prevention of holiday weight gained was achieved by 88% of the nightshift participants by applying these five interventions.
This project provided the initial steps for introducing a hospital-wide wellness program. Current recommendations include beginning a sustainable institutional wide wellness program using interdisciplinary teams identifying five areas for promoting a healthy lifestyle. These include stress awareness and resiliency training through social services, nutritional guidance and ongoing education with a registered dietician, increasing financial literacy that is facilitated through human resources, increasing physical activity levels with the physical therapy department, and providing chronic disease awareness by a nurse practitioner.