1. Nurses as role models
for healthy behaviours
Muireann Kelly
Prof. Jane Wills, Prof. Rebecca
Jester & Prof. Viv Speller
School of Health and Social Care

2. Aim of my study
“To explore the expectation that nurses
be role models for healthy behaviours”

3. Background
“Nurses and midwives must acknowledge that they are
seen as role models for healthy living, and take
personal responsibility for their own health.” (2010)
“…ensure the NHS as an employer sets a national
example in the support it offers its own 1.3 million
staff to stay healthy, and serve as “health
ambassadors” in their local communities.” (2014)
“You should be a model of integrity and leadership for
others to aspire to… Be aware at all times of how your
behaviour can affect and influence the behaviour of
other people… Maintain the level of health you need to
carry out your professional role.” (2015)

4. A contentious issue
“To be effective as a professional, nurses and the regulatory bodies
may need to consider whether certain lifestyles are compatible with
being a healthcare professional and a role model for patients and the
face of healthcare systems” (While, 2014)
“…an indication of their personal commitment to health promotion.”
(Hope, Kelleher and O’Connor, 1998)
“Mandating standardised behaviours in the name of professionalism is
a violation of personal freedoms and rights.” (Scott, 1996)
“Healthcare professionals are people, and if the general trend is
towards an increase in obesity then it is likely they will follow suit. What
we need to look at it is whether it interferes with the job they are doing.”
(Scullion, 2013)

5. Research question
What are the drivers
of the expectation that
nurses should be role
models for healthy
behaviours?

6. What did I do?
Traditional Delphi
• Decision-making tool
• Appropriate for technical
topics
• Homogenous groups of
expert opinion on a topic
• Continues until an
acceptable level of
consensus is reached
• Typically produces
numerical data
Modified Delphi
• Analysis of informed opinion
and their supporting
assumptions
• Appropriate for complex
health policy issues
(Rayens and Hahn, 2000)
• Stakeholders with
knowledge and experience
of the topic who represent a
wide range of opinion
• Typically produces verbal
data

7. Methods
Piloting of interview questions
Identification of stakeholders
Analysis of telephone interviews
Development of second round statemen
February – June
2015

8. Participants
• 26 participants drawn from 6 stakeholder
groups
– Service users
– Student nurses
– Practicing nurses
– Stakeholders relating to nursing policy
– Stakeholders relating to nursing education
– Stakeholders relating to nursing workforce

9. Analytical approach
• Thematic analysis
• Inductive approach
–Themes identified are strongly
linked to the data themselves
(Patton, 1990)

10. Findings
1. It’s not about being perfect
2. One focuses on what one can see
3. Fit to do the job
4. Appreciation

11. It’s not about being perfect
“This is not about everybody being a size
ten, non-smoking, non-drinking robot.” (P7,
policy)
“…that’s not the sort of support that people
need to change their own health and I think
they need, they need realism. They need
people who can understand what their
issues are and help them.” (P4, policy)

12. It’s not about being perfect
“…it’s about somebody you can identify with, and
to some extent copy.” (P14, workforce)
“I mean talking to them, they tell you how it felt – in
fact they quite liked the fact that I wasn’t a skinny
stick, because then you could talk to them about
it.” (P17, policy)

13. One focuses on what one
can see: Looking the part
“I mean, I guess one focuses on what one can
see, and I guess the fat nurses issue, that’s often
quite visible. You don’t necessarily know if
somebody drinks, abuses drugs, or um smokes,
unless you see them smoking outside a hospital.
But you know the size of a person is much more
visible and so is often the thing that gets focused
on.” (P16, workforce)
“You think, ‘Oh god, please don’t be the one who’s
coming to look after me’. And I’m sure they’re
perfectly nice people but it just doesn’t inspire you.

14. One focuses on what one
can see: View of nurses
“…to the public, they’re all nurses. So it’s,
there’s an extra difficulty here, which is if you
say that we should make nurses do, educate
them to be role models, but you’ve got a
population who call everybody a nurse, um and
it can work badly and sort of counter it .” (P17,
policy)
“…all the negative publicity, they view nurses
as lazy, overweight, and they’re uneducated.”
(P15, student nurse)

15. Fit to do the job
“I think it’s important that people maintain their health in order
to keep contributing and be able to work as well um, because
if you’re not looking after your health, then you’ve got more
chance I think of being off work sick, and um injury as well,
and then you’ve got all the heavy lifting and sort of the
physical side of nursing” (P13, student nurse)
“If you’ve got somebody that’s already grossly obese, you’ve
got somebody that’s a heavy smoker, yeah you know, heavy
smokers that’s already likely to have had a series of chest
infections, problems with their health through training. It’s like
is that who you want when you know, for people applying. I
don’t know, it sounds really cruel but it’s, it’s actually getting to
the stage of trying to make sure that people are fitter and

16. Appreciation
“You know, we are expected to do everything and be all things to all
people. In a sense, it’s another thing that’s landed on us, not one of
the…You know I think it’s fair enough, but it’s another of the many
things that we’re supposed to be doing. So I suppose we’re an easy
shot from that point of view.” (P5, education)
“…what often happens is that translates into these rather, you know,
crude criticisms of, for example, overweight nurses, without, without
appreciation of the stresses and the pressures and the strains that
those people are under.” (P6, policy)
“…the only time it’s sort of mentioned is when you’re doing, like
moving and handling, and you need to look after your back. But
that’s the only time they would ever say, ‘Yeah you have to look
after your health’.” (P23, practicing nurse)

17. Considerations
• Participants’ description of an effective role model differed
from that of the literature
• Looking healthy conflated with being healthy but also with
being professionally competent
• Recognition of impact of organisational and environmental
factors on nurses’ ability to lead a healthy lifestyle

18. Next steps
• Formulation of statements for online
survey
• Analysis of survey responses

19. Thank you for your attention