Nurses as role models in health promoting behaviour: concept development and analysis

There are national and international expectations for nurses to be role models in health promoting behaviour despite little existing research exploring or defining the concept within nursing theory. This study aimed to i) promote theoretical clarity for the concept of the nurses being role models in health promoting behaviour and ii) investigate student nurses, nurse educators and registered nurses’ experiences and perceptions of the concept. A hybrid, concept analysis and development framework was developed for this study which involved a theoretical, fieldwork and final analytical phase. The theoretical phase of the study firstly involved analysis of multi-disciplinary literature to determine uses of the term ‘role model’ and secondly, analysis of nursing literature to identify antecedents, attributes and consequences to the concept of nurses as role models in health promoting behaviour. The fieldwork phase involved a qualitative study of six focus groups and one interview, which included participants from a range of NHS Trusts and independent organisations across London and South East England. Student nurses, nurse educators and registered nurses’ (RNs) were recruited to capture opinions and experiences about being healthy role models from across the profession and to explore their understanding of what the concept actually means. Thematic analysis of qualitative data contributed to further identification of antecedents, attributes and consequences and identification of model, contrary, borderline and related cases. The final analytical phase involved integrating findings from fieldwork and theoretical phases and considering: i) the relevance of the concept, ii) if the selection of the concept seems justified, and iii) to what extent the theoretical and empirical analysis support the presence and frequency of the concept within the population under study The adapted hybrid framework developed for this study went beyond analysis of literature to provide the following definition: Being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being: caring, 8 non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self- confident, innovative, professional and having a deep sense of self. Thematic analysis of qualitative data provided insight into factors perceived to affect the ability or desire to act as healthy role models. Thus qualitative data highlighted perceived personal, educational, societal and organisational complexities surrounding the requirement to be role models. Many participants in this study were unaware of the NMC requirement to be role models in health promoting behaviour and did not understand what is meant by the concept. Although most participants perceived being a healthy role model as important to their role as a nurse many considered that working as a nurse did not support their own health and considered working environments unhealthy. Some participants disagreed with the requirement to be a healthy role model and many felt undervalued by their organisations, which they considered a barrier to being a healthy role model. If nurses continue to be expected to act as healthy role models, understanding of the complexities identified in this study can help inform nurses, nurse educators, health care organisations and policy makers to support the profession to meet that expectation