1. Sarah Ku & Natalia Rosario
Promoting Healthy Food Options in Hospitals to Benefit Staff During All Shifts
Sarah Ku & Natalia Rosario
Dr. Rose Lach
DePaul University
BACKGROUND
METHODS
DISCUSSION
Obesity is an ever growing epidemic that does not discriminate between patients or hospital employees. The CDC reports that more than one-third or 35.6% of the U.S adults are obese.
Hospital employees are often limited to access of healthy foods and choices especially when they are working the night shift.
The reported annual cost of obesity in the U.S was $147 billion dollars in 2008 (CDC, 2016).
.Obesity is defined as having a Body Mass Index (BMI) of greater than 30 kg/m2 and is the leading cause of preventable death (CDC, 2016). A healthy individual is considered to have a BMI between 18.5 to 24.9 kg/m2 (CDC, 2016).
With the increase of chronic illnesses related to obesity, it is important to promote healthy food options in hospitals. “By modeling food environments that limit access to high-calorie, low-nutrient foods in hospitals, the healthcare sector has the opportunity to decrease the costs and burdens of chronic disease” (Bellini & Spelman, 2015).
Many of the options available in the hospitals are fast food or considered unhealthy and do not meet the recommended dietary guidelines (Reed, 2010). Hospitals, often times, oppose changes to a healthier menu because they fear poor or low patient satisfaction scores which in turn may be reflected in revenue generated (Reed, 2010).
Cafeterias are closed at night and as a result, availability of healthy options are limited and contribute to poor decision making which may contribute to the obesity epidemic.
DESIGN
This study used the integrative literature review method to examine the impact of healthy food options in hospitals. This method is beneficial when evaluating healthy food options because it clearly defines that a problem in food selection exists. An integrative literature review evaluates the strengths of scientific evidence, identifies gaps and need for further research, bridges gaps between related work, identifies central ideas, and generates questions. The integrative review process includes problem formulation, data collection or literature search, evaluation of data, data analysis and interpretation and presentation of results (Russell, 2005).
LITERATURE SEARCH
Primary and qualitative journals were used. Search strategies included: Cumulative Index of Nursing and Allied Health (CINAHL), ProQuest Nursing & Allied Health Source and PubMed. Search words included: “food options,” “healthy food,” “food choice,” “food habits,” “work site,” “work place,” and “hospitals.” All articles chosen were included or excluded to address the research question.
LITERATURE SEARCH LIMITATION & INCLUSION AND EXCLUSION CRITERIA
The inclusion characteristics discussed healthy food options in regards to health care environment; such as a hospital. There was also mention of relevance to promoting healthy eating and lifestyle whether it be diet or exercise or both. Articles used were written in English and were within the last ten years. The exclusion articles were those that were written more than ten years ago. There were not stringent restrictions or exclusions in groundwork because it is a limited research topic that needs further investigation. The initial search databases produced 266 articles. Of the 266 articles, 8 articles met the inclusion criteria and were used for further review as seen in figure 1.
FIGURE 1
Literature Search: PubMed CINAHL ProQuest
Number of Studies found using keywords:
Number of Studies meeting inclusion criteria:
Number of Studies after using exclusion criteria:
Number of Studies selected based on total content:
The successful incorporation and promotion of healthy food option availability will better improve the overall health of the hospital community.
The research concluded that the strategic methods used to influence healthier food choices do in fact make a difference in the decision making process.
The “traffic light label system” that was implemented reflected that the proportion of sales of unhealthy (Red labeled foods) decreased as Green (healthy) items increased.
The conclusion of this study indicates that changes in eating behaviors are possible and sustainable when food environments promote healthy choices.
LIMITATIONS
The strongest limitation to the implementation of healthier food options are a direct link to the profitability of the hospitals.
Many hospitals rely on the earnings from the cafeteria and/or vending machines.
Because the hospital needs evidence of financial gains with
the implementation of change, it is important to conduct an
extensive cost-benefit analysis in successful systems utilized by
such hospitals as Massachusetts General Hospital.
NURSING IMPLICATIONS
Cafeterias are only open during certain hours and vending machines supply limited, unhealthy snacks. A vending machine that includes healthy options such as fruits and salads would be beneficial, especially for night shift nurses; however, vendors tend to avoid these options because these items are perishable within days.
Hospitals have tried to motivate change through incentive programs in which employees sign up for charters, healthy tips, and receive expert advice on healthy portions and eating. It is vital to provide healthier options especially for nurses, because nurses provide patients with education and teaching; therefore, providing nurses with a healthier, positive environment has the potential to impact the obesity epidemic.
RESULTS
The main findings that support the research question were supported by a study done in Boston that included food labelling, incentive programs, and financial aspects related to implementation of healthy food options.  
Food Labelling: Massachusetts General Hospital introduced the notion of traffic light labelling (using the colors red ,yellow, & green indicating the amount of fat, saturated fat, sugar, and salt that are in a particular food). This did in fact alter the choices of hospital staff (in favor of the healthier choice) when provided caloric value of the food options available in the hospital cafeteria.
Food items were labelled; Green (healthy), Yellow (less healthy); and Red (unhealthy). The healthier items in green were rearranged to be more accessible.  The results indicated that the system was successful.
Incentive Programs: Hospitals have tried to motivate change through incentive programs that provide opportunities for healthy tips & expert advice on healthy portions and eating.
Other studies did encompass healthcare worker’s shifts. In particular, nurses who worked the night shift reported to eat healthier due to bringing their own lunch when compared to their day shift colleagues who reported more snacking during the day. The daytime nurses also had access to the cafeteria which was often closed during night shift.  
The research indicates that the lack of healthy food options available to nurses during most shifts compounded by the lack of allotted time for a “real” break has contributed to the obesity epidemic (Dean, 2014).
Financial Aspects: The proportion of sales of unhealthy or red labelled foods decreased from 24% to 20% in 24 months and Green (healthy) items increased from 41% to 46% .
The conclusion of this study indicates that changes in eating behaviors are possible and sustainable when food environments promote healthy choices
PURPOSE
The purpose of this integrative literature review is to assess successful strategies of promoting and integrating healthy food options in hospital cafeterias to benefit staff during all shifts.
CONCLUSIONS
RESEARCH QUESTION
Hospital employees should have the option to make healthy decisions during all hours of the day. Studies have shown that when given nutritional facts of whether an item is healthy or not, employees made the healthier choice.
Furthermore, studies should be conducted to determine whether hospitals can be incentivized to promote healthy options at the governmental or legislative levels in order to be successfully implemented.
What active strategies are found to successfully be implemented into hospitals to benefit hospital staff for promoting healthy food options?