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Chronic Stress, Behavioral Tendencies, and Determinants of Health Promoting Activities in Nurses: A Mixed-Methods Approach


 Background

Demographic changes and medical advances require a highly professionalized nursing sector while nurses experience high, and often chronic, levels of stress. As high-quality care can only be sustained with a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health promoting activities in nurses with different stress levels (and work-related behavioral tendencies) and identified health behavior determinants based on the Health Action Process Approach (HAPA) model.
Methods

Applying a cross-sectional mixed methods design, 43 nurses first filled out questionnaires assessing chronic stress (SSCS) and work-related behavior patterns (AVEM). Subsequently, interviews were conducted. With content analysis, categories of health promotion-related barriers and resources emerged. behavior determinants (self-efficacy, outcome expectancies), current health behavior, and B&Rs were quantified with magnitude and frequency coding. Finally, stress and AVEM patterns were triangulated with behavioral determinants and barriers and resources.
Results

Of the included nurses, 84% were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) were identified that influence health promotion behaviors. Stress was associated with resource frequency (p = .027) and current health promotion activities (p = .07) whereas results concerning AVEM patterns were not easily interpretable. Self-efficacy significantly explained variance in health behaviors (p = .003). Implications for future health behavior change interventions in nursing populations are discussed.
Conclusion

Health promotion related barriers & resources affect health promotion in nurses. Practitioners need to design interventions that address population specific barriers for sustainable health promotion.