Health promotion: Helping nursing students "walk the talk"

1 March 2012

FIONA CASSIE talks to Faye Cobden-Grainge about a Manukau Institute of Technology pilot study getting nursing students to ‘walk the talk’ of health promotion.

First year nursing students tend to be desk bound and sedentary. So how do you help them establish and maintain a healthy lifestyle that sets them on the road to being community role models of the future?

Faye Cobden-Grainge returned several years ago from an international health promotion in education conference motivated to help Manukau Institute of Technology nursing students do just that.

The nursing school serves the South Auckland community, which has a high rate of diabetes, obesity, and heart disease, and a number of students have family members with chronic health issues. The campus lies between “a very large McDonalds and a leisure centre” and the student car park is right outside the school’s front door. “So although the leisure centre is there they tend to gravitate more to the McDonald’s side of the campus.”

Cobden-Grainge joined forces with fellow senior lecturer Susan Duraisamy to run a pilot study to challenge students to look at their own exercise patterns and help them “step-up” and inspire others.

The research aim of the study was to investigate using steps and stairs at the nursing school campus to promote physical and psychosocial well-being. Students were issued with pedometers and asked to increase their daily step count as well as keep an exercise journal during the 16-week study.

First year bachelor of nursing students were invited to take part with 51 students aged 18-55 signing up to the pre-study tests and survey.

In their second week of study (and in the space of two hours), the students were weighed, measured, had a fasting blood test and skin fold test, and their cardiovascular fitness was checked via a VO2 test after a brisk walk.

Cobden-Grainge said the initial test results showed that the majority of the students were a healthy bunch with a BMI in a healthy range. The blood tests did confirm that one student had diabetes (she’d previously had gestational diabetes), one student had very high (but normal for them) cortisol levels, and one had high cholesterol.

The survey showed that students’ preferred mode of exercise was predominantly walking, but jogging, aerobics, swimming, and stair climbing were also popular.

It also found that the 90% of students felt they could put in 30-45 minutes of exercise four days a week and they were encouraged to do that exercise on campus using the stairs or a lunchtime walk.

“But a lot had not exercised for some time, a few had had negative experiences before and they all wildly overestimated how much time they could give to the exercise.”

So the reality was that only just over a quarter of students finished all aspects of the study, including handing in their journal and completing the post-study tests, and just over a third provided step count evidence.

Cobden-Grainge says a lot of the students had family or work pressure above and beyond their studies and she believed this contributed to students not meeting their own exercise expectations. In retrospect she also believes the pilot study was too complex and, at 16 weeks, was too long, with most exercise studies only 10 to 12 weeks.

However, those students that did complete the full challenge showed minor improvements in their health measurements and attitudes to exercise. Another positive upshot was that it did stir many other students on to do other forms of exercise, with some resuming gym membership or horse-riding, some taking up aquarobics, and others became keen attendees at zumba classes.

But stair walking habits did not radically change. Cobden-Grainge says there are signs encouraging people to take the stairs to their classroom, but unfortunately, the “lift is right in your face” when you enter the nursing school building.

“Also, the lift is somewhere students gather outside – it’s like a social setting, then they chat and talk in the lift and there’s a mirror there so they preen themselves.”

Another discouragement is that the stairs are steep and require concentration to navigate, so talking on cell phones or checking iPods on the stairs is difficult.

If the team repeats the study, they will try to make stair walking a more social option and also put students into teams to foster competitive. Staff, who regularly take part in Auckland’s spring Feet Beat challenge, will also be encouraged to set an example.

Overall, the study met its aim of raising people’s consciousness of health promotion, says Cobden-Grainge, who is keen to carry out a simplified and refined study this year.