Association between Caloric Intake and Work Related Stress among Nurses in Two District Level Hospitals in Mampong-Akuapem of the Eastern Region of Ghana

Abstract

Background: Stress has often been related to a multitude of negative human behaviours and many health conditions including cardiovascular diseases. In recent times, several harmful dietary practices such as unhealthy eating patterns have been associated with issues of stress. Work-related stress (WRS) is experienced when the demands of the work environment exceed the employees’ ability to cope with (or control) them. Nursing is generally perceived as a stressful and demanding profession. A review of employee stress in healthcare settings across 17 countries found that nurses in the majority of countries experience high levels of occupational stress. Aim: This study assessed the association between WRS and caloric intake among nurses in two district level primary care hospitals in Mampong-Akuapem of the Akuapem North Municipality of the Eastern Region, Ghana. Methods: The study was cross sectional with a convenient selection of 85 nurses from the two hospitals, Tetteh Quarshie Memorial Hospital (public) and Bryan Lowe Orthopedic Hospital (private). Stress levels for both on and off duty periods were measured. Physiological level of stress using the Salimetrics cortisol assay in saliva and psychological levels of stress using the Cooper’s Life-Stress Inventory were measured. Caloric intake was determined by a food frequency questionnaire (FFQ) as well as a four day (two week days and two weekends) 24-hour recall. The body mass index (BMI) of the nurses was also determined. Stress levels were compared to caloric intake and BMI using the Pearson’s correlation test. Variations in stress levels among various ranks of nurses was also analysed. Results: The average age of the nurses was 34.86 ± 6.27 years. Their BMI ranged from 17.96 – 34.82 kg/m2 with a mean of 26.11 ± 2.96 kg/m2. Majority of the nurses (52.9%) were in the WHO classification of overweight.

The nurses consumed animal source proteins daily, more frequently than any other food group (4 days out of 7) but also consumed soft drinks 3 three days out of 7. Mean caloric intake off duty (2368.74 ± 259.67 kcal) was significantly higher (p˂ 0.0001) compared to that on duty (1784.80 ± 402.84 kcal). The nurses also recorded significantly higher (all p < 0.001) mean physiological stress scores (61.18 ± 7.42 versus 17.12 ± 7.15) and salivary cortisol levels (11.79 ± 1.06 g/l versus 5.10 ± 1.02 g/l) when on duty compared to when off duty. However, significantly positive correlations were observed with total caloric intakes and salivary cortisol levels whether the nurses were on duty (R = 0.5850, 95% confidence interval 0.4248 to 0.7096, p<0.0001) or off duty (R = 0.3185, 95% confidence interval 0.1130 to 0.4978, p<0.003). Stress levels were highest among staff nurses. Conclusion: Nurses of the two hospitals encountered a high stress whiles on duty and this affected their caloric intake both on duty and off duty. High caloric intake could influence their nutritional and health outcomes.