JOURNAL CLUB

STUDIES
 TITLE

Nursing Intervention Strategies and Their

Effectiveness on Restless Leg Syndrome and
Psycho‑Social Problems in Chronic Kidney
Disease Patients
• Kaur P, Jaspal S, Kaur T. Nursing intervention strategies and their

effectiveness on restless leg syndrome and psycho‑social problems in

chronic kidney disease patients. Indian J Community Med 2024;49:367-74.

• Received: 10‑11‑23, Accepted: 01‑12‑23, Published: 07-03-24
 INTRODUCTION
• Chronic kidney disease is a worldwide problem with a major cause to the

health system. An increase in the hypertension, obesity, and primary renal

problems are the major reasons for chronic kidney disease disorders. It is

now recognized as a major health problem. With an increase in life

expectancy and prevalence of life style diseases, chronic kidney disease has

increased by 30% in USA.

• In Western countries, about two-thirds of the cases of chronic kidney disease

account for diabetes and hypertension patients. Diabetes and hypertension are

of major concern in India today, which account for 40–60% cases of chronic

kidney disease.
• Chronic kidney disease is a progressive, irreversible deterioration in renal

function in which the body’s ability to maintain metabolic, fluid, and

electrolyte balance fails, resulting in uremia or azotemia, which disturbs the

homeostasis of all systems of the body. It can progress to end‑stage renal

disease (Stage 5 CDK), in which the glomerular filtration rate (GFR) falls

to 15 ml/minute/1.73 m2 (normal GFR = 125 ml/minute/1.73 m2.

Chronic kidney disease patients are not diagnosed timely because people lack knowledge about hypertension and diabetes, which can also lead to chronic kidney disease,

and screening is not done timely. Chronic kidney disease is not being detected early enough to initiate treatment regimens and reduces death and disability. Interventions are

being delivered too late to improve population‑based outcomes.

 BACKGROUND
• Chronic kidney disease is a global health problem affecting 843.6 million

people with 1 million deaths and the 12th leading non‑communicable cause of

death worldwide. Insomnia is a disturbing problem found in chronic kidney

disease patients, leading to physiological problems like fatigue, edema, and

restless leg syndrome most of the time. The objective of this study was to assess

the effectiveness of nursing intervention strategies on physiological and

psycho‑social problems.
 AIM

• To assess the effectiveness of Nursing Intervention Strategies

and their effectiveness on restless leg syndrome and psychosocial
problems in chronic disease patients.
STUDY DESIGN

• Quasi-experimental research design and convenient sampling methods

were considered to enroll for the subjects.

• All participants were divided into two groups. First, the data were
collected from the experimental group, pre-test was done on day 1,and
the first post test was done on the sixth day (before discharge) after
receiving interventions on days 2, 3, 4, and 5.
The second post-test was conducted after 7-10 days on their first follow-

up visit. The same procedure was implemented for the control group

except giving interventions (routine care was given). All the participants

were tested three times, that is, day 1 (pre), day 6 (post-test 1), and day

15 (post-test 2).
Participants were free to withdraw from implementations of nursing intervention strategies or assessment at any point of time during study. The final number of each group who completed the study is shown in the flow diagram diagram of quasi-experimental trials [Figure 1].
 POPULATION AND SAMPLE

• The population comprised 30 chronic kidney disease patients who were

admitted in a selected hospital of Punjab. Data collection of the pilot
study was done from July 8, 2022 to August 14, 2022 among 30 chronic
kidney disease patients (15 in the experimental group and 15 in the
control group) to check the feasibility of the study and reliability of the
tool. The subjects were selected by using the convenience sampling
technique and the pre-determined criteria.
Inclusion Criteria
• The inclusion criteria in the study were chronic kidney disease patients

admitted in the nephrology ward of the selected hospital between age 18 and

72 years and who were conscious and co-operative

Exclusion Criteria

•The exclusion criteria were chronic kidney disease patients who were mentally
unstable, non-co-operative, and not willing to be the part of study.
 DATA COLLECTION

• The study data collection form consisted of the registration form,

the participant's information sheet and consent form, the

demographic data collection form and the Community-Based

Assessment Checklist (CBAC) form for NCD data collection.

• The registration form provided participants with a unique
identification number.

• It allowed them to register using their mobile number and the

flexibility to participate in the study at any time using their
registered mobile number.
• The demographic data collection form collected details of the

participant's name, gender, marital status, age, current

designation, years of experience, department of work and baseline

data on their present and past history of NCD screening.

• The CBAC form is a screening tool developed, validated and
recommended by the government of India for community-level
screening of NCDs and common cancers.

• The All India Institute of Medical Sciences has validated the

CBAC form and reported that the prevalence of NCDs
calculated in their study using the CBAC form was in line with
the findings of the 5th National Family Health Survey (NFHS-
5) data.
• The CBAC form has previously been reported to be a valid tool for

screening NCDs and high-risk behaviours (Ministry of Health and Family

Welfare, 2017; Kalidoss et al., 2021).

• The CBAC form collected data on risk assessment and early detection of

NCDs.
• The risk assessment section captured data on tobacco and alcohol
use, waist measurement, physical activity, and NCD family history,
with each risk factor category scored between 0 and 2. A score of
≥4 was considered high risk (Ministry of Health and Family
Welfare, 2016; Community-based assessment checklist).

• The early detection section collected information on present

symptoms of tuberculosis, cervical and breast cancer and
abnormalities in the oral cavity.
• Risk Assessment Score:

• Risk assessment in the CBAC form involves assigning point values

to each identified risk factor, including age, tobacco use, alcohol use,
waist circumference, and family history of NCD.

• First, each risk factor is given a score between 0 and 2 based on the
level of risk.
• After adding the points for all identified risk factors, scores of four or
higher are considered high risk.

• This score prioritizes interventions to reduce the risk of NCDs in the

population (Ministry of Health and Family Welfare, 2016;
Community-based assessment checklist).

• However, the risk score is not a definitive measure of NCD risk but
rather a tool to guide the development of interventions and strategies.
• For a comprehensive understanding of the risk of NCDs,
considering the risk score in the context of other factors such as
population demographics, socioeconomic status and
environmental factors is essential.

• The paper-based CBAC form is the data collection tool used in

national population-based cancer screening in India.

• Digital format of the CBAC form is used, which participants can

fill out for data collection on NCDs
 PILOT STUDY

Based on the pilot study conducted among the nursing

staff of the organization, modifications were made on
the tool.
 ETHICAL CONSIDERATIONS

• The study conducted following the Helsinki Declaration

ethical standards and principles.

• The Institutional Ethics Committees of the sites approved

the study.

• After submitting the completed form, short IEC videos on

NCD prevention were accessible to the participants.
• Non-participant nurses (those who refused to participate) could access the

IEC videos on filling out the refusal form.

• Of the 750 returned surveys, 68 surveys were incomplete and were excluded

from the analysis, leaving us with 682 complete datasets for analysis.

• The collected data were automatically stored in a portal on a dedicated

password-protected webpage to maintain the confidentiality of the data.

• Statistical analysis is done using STATA version 17.0. Categorical
data were presented as frequencies and percentages and
Chi-square/Fisher's exact test to compare frequency data across
categories as appropriate.

• In addition, Mantel–Haenszel Chi-square test is used to compare age-

adjusted rates between genders.

• univariate and multivariable logistic regression is used to evaluate and

identify risk variables associated with high-risk NCDs.
• Univariate logistic regression analysis is conducted by categorizing the NCD
score as a binary variable, with scores of >4 classified as high risk and scores of
≤4 classified as low risk.

• The remaining study factors were treated as independent variables. Reported

adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for statistically
significant variables that emerged from the multivariable logistic regression
analysis.

• a two-sided probability of P < 0.05 to be statistically significant for all

statistical tests is considered.
RESULTS

Demographic Details
• Table 1 presents the demographic characteristics of the participants in
the study.
• Most respondents (71%) were female nursing staff and 80% reported
being married and living with their spouses.
• Ninety-six percent of individuals were employed in the government
sector, whereas 92% were employed in the Delhi National Capital
Region.
• A total 73% were nursing officers.
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Age (in years)
30-89 171(87.7) 311(63.9) 482(70.7) <0.001
40-49 21(10.8) 122(25.1) 143(21.0)
50 and above 3(1.5) 54( 11.1) 57(8.4)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Marital Status 163(83.6) 381(78.2) 544(79.8) <.049
Married 29(14.9) 78(16.0) 107(15.7)
Unmarried
Single 3(1.5) 28( 5.7) 31 (4.5)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Qualifications
Diploma in 46(23.6) 185(38.0) 231(33.9) <.001
nursing
BSc. Nursing 129(66.1) 226(46.4) 350(51.3)
MSc. Nursing 20(10.3) 70( 14.4) 90(13.2)
PhD in Nursing 0(0) 1(.2) 1(.1)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Years of work
experience
0-5 79(40.5) 112(23) 191(28.0) < .001
6-10 57(29.2) 85(17.5) 142(20.8)
11-15 36(18.5) 105(21.6) 141(20.7)
16-20 19(9.7) 72(14.8) 91(13.3)
21-25 4(2.1) 61(12.5) 65(9.5)
26-30 0(0) 52(10.7) 52(7.6)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Department of work
Obstetrics & 3(1.5) 38(7.8) 41(6.0) <.001
Gynecology
Medicine 25(12.8) 50(10.3) 75(11.0)
Surgery 23(11.8) 64(13.1) 87(12.8)
Paediatric 14(7.2) 36(7.4) 50(7.3)
Emergency/trauma 31(15.9) 23(4.7) 54(7.9)
Oncology 47(24.1) 144(29.6) 191(28.0)
Cardiology 24(12.3) 64(13.1) 88(12.9)
Others 28(14.4) 68(14.0) 96(14.1)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Work Sector
Government 190(97.4) 462(94.9) 652(95.6) <.180
Private 5(2.6) 18(3.7) 23(3.4)
Not working 0(0) 7(1.4) 7(1.0)
Working State
Delhi NCR 167(85.6) 457(93.8) 624(91.5) <.001
Other States 28(14.4) 30(6.2) 58(8.5)
Table 1- Demographic Data
Variables Male Female Total Chi- square
n=195 n= 487 n= 682 p- Value
n(%)
Designation
Nursing Officer 184(94.4) 311(63.9) 495(72.6) <.001
Senior Nursing 7(3.6) 122(25.1) 129(28.1)
officer
Sister in charge 2(1.0) 37(7.6) 39(5.7)
Faculty 2(1.0) 17(3.5) 19(2.8)
• Table 2 presents data about risk variables associated with NCDs obtained

through the self-reported CBAC form.

• Overall, the study found that there was a substantially higher prevalence of

high-risk scores (≥4) among male nursing staff of all age group (34%) than

among the female nurses of all age groups.

Variable AgeGenderMale 30–39(n = 30–39(n = 40–49 (n = 40–49(n = ≥50(n = ≥50(n = P-
(n = 195)Female 171)Malen (%) 311)Femalen (%) 21)Malen (%) 122)Femalen (%) 3)Malen (%) 54)Femalen (%) valueb(M.H.
(n = 487) Chi-2 test)

Tobacco use Non useruser 138 (80.7)33(19.3) 299(96.1)12 (3.9) 17 (81.0) 4 (19.0) 121 (99.2)1 (0.8) 3 (100)0 (0) 54 (100)0 (0) <0.001

P-valuea<0.001 <0.001 NA
Alcohol use Non-userUser 168 (98.2)3 (1.8) 310 (99.7)1 (0.3) 20 (95.2)1 (5.2) 121 (99.2)1 (0.8) 3 (100)0 (0) 54 (100)0 (0) 0.097
Measurement of the ≤90 >90 118 (69.0) 53 291 (93.6) 20 (6.4) 16 (76.2) 5 (23.8) 98 (80.3) 24 2 (66.7) 1 (33.3) 39 (72.2)15 (27.8) <0.001
waist(cm) (31.0) (19.7)
P-valuea<0.001 0.163 0.835
Physical activity <150 min ≥150 79 (46.2) 92 (53.8) 190 (61.1) 121 12 (57.1) 9 (42.9) 70 (57.4) 52 0 (0) 3 (100) 34 (63) 20 (37) 0.002
min (38.9) (42.6)
Tobacco use Non useruser 138 (80.7)33(19.3) 299(96.1)12 (3.9) 17 (81.0) 4 (19.0) 121 (99.2)1 (0.8) 3 (100)0 (0) 54 (100)0 (0) <0.001

P-valuea<0.001 <0.001 NA
Measurement of the ≤90 118 (69.0) 291 (93.6) 16 (76.2) 98 (80.3) 2 (66.7) 39 (72.2) <0.001
waist(cm)
<0.001 3 (1.8) 1 (0.3) 1 (5.2) 1 (0.8) 0 (0) 0 (0)
P-valuea0.130 0.273 NA
Measurement of the ≤90 118 (69.0) 291 (93.6) 16 (76.2) 98 (80.3) 2 (66.7) 39 (72.2) <0.001
waist(cm)
>90 53 (31.0) 20 (6.4) 5 (23.8) 24 (19.7) 1 (33.3) 15 (27.8)
P-valuea< 0.001 0.163 0.835
Physical activity <150 min ≥150 79 (46.2) 92 190 (61.1) 121 12 (57.1) 9 (42.9) 70 (57.4) 52 0 (0) 3 (100) 34 (63) 20 (37) 0.002
min (53.8) (38.9) (42.6)
P-value 0.002 0.984 0.030
a

Family history for No Yes 95 (55.6) 76 109 (35) 202 (65) 7 (33.3) 14 (66.7) 48 (39.3) 74 3 (100) 0 (0) 25 (46.3) 29 <0.001
NCD (44.4) (60.7) (53.7)
P-valuea0.001 0.601 0.112
NCD score Low Low risk (<4) High 113 (66.1) 58 260 (83.6) 51 7 (33.3) 14 59 (48.4) 63 0 (0) 3 (100) 16 (29.6) 38 <0.001
risk (>4) P-valuea (33.9) <0.001 (16.4) (66.7)0.202 (51.6) 0.552 (70.4)
• Table 3 presents comprehensive information regarding the screening

process for NCDs among the participants.

• More than 70% of participants had never undergone any form of

screening for NCDs, which includes screening for prevalent

malignancies.
Table 3 Details on awareness of NCD and cancer
screening among the participants
Variable Age 30-39 40-49 >50 p-value
Gender n=171 n= 311 n=21 n=122 n=3 n=54 chi-2
Male(n=195) Male Female Male Female Male Female test
Female(n=487) n% n% n% n% n% n%
Ever Hypertension 7(4.1) 7(2.3) 2(9.5) 6(4.9) 0(0) 5(9.3) .312
screened
Diabetes 8(4.7) 12(3.9) 0(0) 8(6.6) 0(0) 3(5.6) .975

Diabetes & 5(2.9) 22(7.1) 4(19) 8(6.6) 0(0) 13(24.1) .364

Hypertension
HTN, DM with 3(1.8) 31(10) 0(0) 12(9.8) 0(0) 7(13) <.001
cancer screening
HTN, DM , 11(6.4) 10(3.2) 1(4.8) 10(8.2) 0(0) 8(14.8) .420
cardiovascular
disease
Never NCDs including 137(80. 229(73. 14(66.7) 78(63.9) 3(100) 18(33.3) .071
screened common cancers 1) 6)
• The symptoms of NCDs among the participants based on their self-reports are
presented in Table 4.

• Among female nursing personnel aged 40–49 years, 3% experienced

challenges with mouth opening and 5% reported the presence of a lump in the
breast (both potentially symptoms of malignant disorders).
 Table 4 Self reported Symptoms for NCDs among the
participants
Variable Age 30-39 40-49 >50 p-value
Gender n=171 n= 311 n=21 n=122 n=3 n=54 chi- 2
Male(n=195) Male Female Male Female Male Female Test
Female(n=487) n% n% n% n% n% n%
NCD Hypertension 9(5.3) 7(2.3) 3(14.3) 15(12.4) 0(0) 9(17) .266
Diabetes 6(3.6) 9(2.9) 2(9.5) 10(8.3) 0(0) 4(7.5) .926
Oral Symptoms Difficulty in opening mouth 3(1.8) 3(1.0) 0(0) 3(2.5) 0(0) 0(0) .956
Non-healing ulcers 1(.6) 5(1.6) 0(0) 2(1.6) 0(0) 1(1.9) .449

Change in voice 3(1.8) 4(1.3) 0(0) 2(1.6) 0(0) 1(1.9) .810

Female Lump in the breast 15(4.8) 6(4.9) 1(1.9) .719
participants Nipple discharge 3(1.0) 0(0) 0(0) .693
only-Breast Change in breast shape &size 9(2.9) 1(.8) 0(0) .277
symptoms
Cervical Intermenstrual bleeding 17(5.5) 5(4.1) 0(0) .204
symptoms Post coital bleeding 3(1.0) 1(.8) 1(1.9) .628
Post menopausal bleeding 0(0) 0(0) 1(1.9) .111
Foul smelling discharge 7(2.3) 6(4.9) 0(0) .162
• Table 5 presents the unadjusted OR together with the corresponding

significance level for the statistically significant factors predictive of a score in

the high risk range obtained from the univariate analysis.

• Table 5 also presents the results of multivariable logistic regression analysis,

indicating those variables that were statistically significantly linked to high-risk

scores along with their corresponding adjusted OR's and 95% CIs.
Study variables Univariate analysis Multivariable logistic regression P-value
analysis
Unadjusted odds P-value Adjusted odds 95% confidence
ratio ratio limits
Age groups (ref) 3.99 8.77 <0.001 <0.001 (ref)4.58 12.25 2.29–9.16 4.45– <0.001<0.001
(years)30–39 40–49 33.70
≥50

Marital statusSingle (ref)1.14 2.38 0.7970.061

Unmarried Married
Working experience (ref)1.09 1.89
(years)≤5 6–10 11–15 2.92 6.24 0.7540.012<0.00
16–20 >20 1<0.001

Waist circumstance (ref)6.92 <0.001 1.0 (ref)8.61 5.15-14.37 <0.001

(cm)<90 ≥90
Smoking statusNever 1.0(ref)3.03 <0.001 1.0(ref)5.31 2.65-10.66 <0.001
Yes
Alcohol consumption 1.0(ref)10.22 0.034 1.0(ref)18.74 1.72-204.17 0.016
statusNeverYes
Physical activity 1.0(ref)2.13 <0.001 1.0(ref)18.74 2.17-4.91 <0.001
(walking time
[minutes/week])>150
≤150
Family history of 1.0(ref)13.0 <0.001
NCDsNil Present
• The study findings indicate that several variables, including
age, years of work experience, marital status, tobacco use,
alcohol consumption, waist circumference exceeding 90
cm, insufficient physical activity (<150 min of walking per
week) and a family history of NCDs are noteworthy risk
factors for high-risk NCD scores.
• The results of the age-adjusted analysis indicate that several factors,
including smoking habit, alcohol consumption habit, waist
circumference exceeding 90 cm and physical activity, are
significantly associated with an increased risk of NCDs.

• The ORs for these factors range from 3 to 19, with corresponding
95% CIs indicating the precision of the estimates.
 DISCUSSION
• The present study investigated the prevalence and risk factors
for NCDs among nursing personnel, revealing that most
participants have never undergone screening for any NCDs.
• Among the respondents, many were affected by NCDs. The
possible explanation for the participation of nurses affected
by NCDs could be the acquired awareness of NCDs and their
pre-existing NCD condition.
• Similar findings on nurses' low awareness concerns are reported in
other studies conducted in Australia and India (Perry et al., 2018;
Singh et al., 2012).

• This scenario reflects the nursing staff's need for more NCD
prevention awareness.

• Nurses in this study reported high-risk habits: tobacco use and

alcohol consumption, especially male nurses aged 30–49 years
compared with female nurses in the same age group.
• Many research studies have described that the use of tobacco products
predisposes to cardiovascular diseases and hypertension, vascular diseases,
pulmonary diseases and even cancers of organs in the digestive system (oral,
stomach, oesophagus, pancreas, liver, colorectum), excretory system (kidney,
bladder), respiratory system (larynx, pharynx, lung) and cancer in the uterine
cervix in women (Islami et al., 2018; Li & Hecht, 2022).
• Findings of this study align with the conclusions of another study conducted
among nurses in India by Kayaroganam et al. (2022) and a study conducted
among Iranian nurses (Jahromi et al., 2017).

• The reasons for low/no tobacco and alcohol use among female nurses in the
study could be due to cultural restrictions for the use of tobacco and alcohol in
India, strict hospital policies against substance abuse at the workplace or under-
reporting of substance use by the participants.
• However, the prevalence of tobacco and alcohol consumption
among nursing staff in the research is less than their counterparts
in other study (Abou Elalla et al., 2019).

• The measurements of waist circumference of >90 cm (abdominal

obesity) was high, especially among male nursing staff.
• Obesity leads to NCDs like diabetes and hypertension and is also a
risk factor for at least 13 cancers, including colorectal cancer and
breast cancer (Pati et al., 2023).

• Research studies around the globe have expressed

obesity/overweight as a significant health concern among nurses
(Aslam et al., 2018; Fair et al., 2009; Harsimran et al., 2020;
Jahromi et al., 2017; Kayaroganam et al., 2022; Miller et al., 2008
• The study findings were similar to the results of the study conducted by Jharomi
et al. where abdominal obesity was much less frequent among female nurses
(Jahromi et al., 2017).

• On the contrary, earlier studies in India reported high abdominal obesity among
female nursing staff (Aslam et al., 2018; Harsimran et al., 2020; Kayaroganam
et al., 2022; Singh et al., 2012).
• This contrary finding could be due to recruitment in different
geographical regions, with food and cultural diversity among the
study participants.

• Furthermore, among the study participants, the minimum

requirement for physical activities (150 min per week) was met by
high numbers of the male nursing staff.
• On the contrary, Kayaroganam et al. report less physical activity

among male nursing staff (Kayaroganam et al., 2022).

• Nonetheless, a key finding of the study was that male nursing staff

aged 30–39 were at overall higher risk for NCDs than their

female counterparts.
• Another observation of the study was that married nurses had
higher NCD risk factor scores compared with their unmarried
counterparts.

• The plausible explanations could be that married individuals may

have different lifestyle habits, like dietary patterns and physical
activity, compared with unmarried individuals.

• Marriage may be a surrogate for increased age, a risk factor for

NCDs.
• The study shows a correlation between the increase in age among married
women.

• However, it is essential to note that a complex interplay of multiple variables

influences individual health outcomes, and these observations may not apply
universally.

• Similarly, nurses with increased work experience had higher risk factors for
NCDs.

• The increase in risk factors could be because work experience and age can
independently influence these scores, and their effects may be interrelated.
• More experience among nurses could also mean more
responsibilities and increased work stress.

• Work stress and advanced age increase NCD risk among

experienced nurses.

• However, the multivariate logistic regression analysis results did not

indicate that employment experience was a significant influence.
• The overall study findings suggest that individuals who engage in smoking,

and alcohol consumption, have a waist circumference of >90 cm or have low

levels of physical activity and are more likely to experience an elevated risk of

NCDs.

• Other factors, including age and a family history of NCDs, were also found to

be significant risk factors for high-risk NCD scores, which is in line with

another study findings (Monakali et al., 2018).

• It is imperative to acknowledge that maintaining a health-conscious lifestyle as
a nurse can be arduous.

• The occupation entails physical and emotional strain, requiring nursing staff to
work extended hours, irregular shifts and high-stress positions.

• Consequently, emphasis on personal health and wellness can prove to be a

challenging endeavor.

• Nursing staff may have some knowledge regarding NCDs and prevention
measures in their nursing practice.
• The reduced inclination towards health-seeking behaviour among nursing staff

may stem from excessive workload, lack of motivation and inadequate NCD

knowledge.

• The current prevalence of NCD risk factors among nursing personnel

underscores the urgent need for implementing strategic measures for NCD

control.
 STRENGTH AND LIMITATIONS

• The overall participation rate was less than 20% of those eligible to
take part although we cannot know what proportion of those eligible
actually received information about the study.

• The study involved nursing staff from different hospitals in the

Delhi-National Capital Region of India making the findings more
generalizable.
• In addition, the nursing staff in the study are members of a
professional nursing association, which may help in planning
education programmes on NCD prevention and organizing routine
screening programmes

• However, nursing staff who are less motivated to respond to online

surveys may not have participated, which may be the reason for
non-response bias and poor response rate.
• Further, participants’ self-reported data using the CBAC form may
have resulted in underreporting of risk behaviours.

• We had a limited representation of male nurses in the study. In

addition, the study design was cross-sectional, which prevented the
ability to follow up on NCD prevalence. Therefore, a longitudinal
study is necessary to investigate this topic further.
 CONCLUSION

• The study findings suggest that the nursing staff have suboptimal self-

health concerns on NCDs.

• This situation warrants continued health education, awareness campaigns

on adopting a healthy lifestyle and health promotion.

• However, a longitudinal study may be required to further the research in

this area.
 REFERENCES
1. Abou Elalla, E., Awaad, M. I., Elhabiby, M., Khalil, S. A., & Naguib, M. S.
(2019). Substance abuse among nursing staff: Prevalence and
sociodemographic and clinical characteristics. Addictive Disorders & Their
Treatment, 19, 107–199.
2. Aslam, M., Siddiqui, A. A., Sandeep, G., & Madhu, S. V. (2018). High
prevalence of obesity among nursing personnel working in tertiary care
hospital. Diabetes & Metabolic Syndrome, 12(3), 313–316.
https://doi.org/10.1016/j.dsx.2017.12.014
3. Fair, J. M., Gulanick, M., & Braun, L. T. (2009). Cardiovascular risk factors
and lifestyle habits among preventive cardiovascular nurses. The Journal of
Cardiovascular Nursing, 24(4), 277–286. https://doi.org/10.
1097/JCN.0b013e3181a24375