Quebec Nurses’ Perceptions of the Integration of Sustainable Diet Promotion Into Clinical Appointments: A Qualitative Study

Main Article Content

Stéphanie Larente-Marcotte
https://orcid.org/0000-0001-7979-5616
Laurence Guillaumie
https://orcid.org/0000-0003-1138-8285
Thierno Diallo
https://orcid.org/0000-0002-0168-2299

Abstract

Introduction: A sustainable diet is a diet that is respectful of ecosystems, culturally acceptable, accessible and healthy. It is considered as a promising avenue for optimizing health and reducing the impacts of food on the environment. Several nursing associations have demonstrated a growing concern for nurses’ involvement in environmental and climate change issues, including in promoting sustainable diet. However, the literature reveals a lack of data on why and how nurses could address sustainable diet in their clinical practice.


Objective: The aim of this study was to explore clinical nurses’ perceptions of their role in the promotion of sustainable diet.


Methods: A descriptive qualitative study was conducted based on 6 focus groups involving 20 nurses from 7 regions of the province of Quebec, Canada. Computer-assisted thematic analysis was conducted on verbatim transcripts.


Results: The discussions revealed 3 major themes. First, some dimensions of sustainable eating are already implicitly addressed and nurses were theoretically open to make further. However, it was difficult to see how nurses could translate this interest into concrete action due to a lack of time and their other clinical priorities. Lastly, in order to do this, nurses need support from health organizations as well as clear guidelines, training and tools.


Discussion and conclusion: Despite experts’ recommendations, many barriers and inadequacies between experts’ recommendations and nurses’ reality prevent the implementation of concrete initiatives toward the promotion of sustainable diet among nurses. Nurses are invited to get involved and contribute to the promotion of sustainable diet with a “bottom-up” approach.

Article Details

How to Cite
Larente-Marcotte, S., Guillaumie, L., & Diallo, T. (2022). Quebec Nurses’ Perceptions of the Integration of Sustainable Diet Promotion Into Clinical Appointments: A Qualitative Study. Science of Nursing and Health Practices / Science infirmière Et Pratiques En Santé, 5(2), 70–88. https://doi.org/10.7202/1095200ar
Section
Empirical research articles

References

Afshin, A., Sur, P. J., Fay, K. A., Cornaby, L., Ferrara, G., Salama, J. S., Mullany, E. C., Abate, K. H., Abbafati, C., Abebe, Z., Afarideh, M., Aggarwal, A., Sutapa, A., Akinyemiju, T., Alahdab, F., Bacha, U., Bachman, V.F., Badali, H., Badawi, A.,… Murray, C. J. L. (2019). Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The lancet, 393(10184), 1958-1972. https://doi.org/10.1016/S0140-6736(19)30041-8

Álvarez-Nieto, C., López-Medina, I. M., Abad, M. L., Grande-Gascón, M. L., & Álvarez-García, C. (2017). Curriculum nurse and strategies training on environmental sustainability and climate change. Enfermería Global, 16(3), 665-678. http://dx.doi.org/10.6018/eglobal.16.3.243151

Ballet, M., Dotsey, C., & Martin, D. (2015). La coopération entre élus et porteurs d’initiatives au service d’une alimentation durable et locale. Le cas de la Communauté de Communes du Pays de Bourgueil-5. Tours, Polytech Tours. http://memoires.scd.univ-tours.fr/EPU_DA/2015PFE_Ballet_Dotsey_Martin.pdf

Benton, D., & Shaffer, F. (2016). How the nursing profession can contribute to sustainable development goals. Nursing Management, 23(7), 29-34. https://doi.org/10.7748/nm.2016.e1534

Bérard, C. (2013). Les démarches participatives en matière de politiques publiques: le cas de la propriété intellectuelle des innovations biotechnologiques. Politiques et management public, 30(1), 51-73. http://journals.openedition.org/pmp/6555

Bilodeau, A., Allard, D., Francoeur, D., & Chabot, P. (2004). L’exigence démocratique de la planification participative: le cas de la santé publique au Québec. Nouvelles pratiques sociales, 17(1), 50-65. https://doi.org/10.7202/010573ar

Bommert, B. (2010). Collaborative innovation in the public sector. International public management review, 11(1), 15-33. https://journals.sfu.ca/ipmr/index.php/ipmr/article/view/73

Branca, F., Lartey, A., Oenema, S., Aguayo, V., Stordalen, G. A., Richardson, R., Arvelo, M., & Afshin, A. (2019). Transforming the food system to fight non-communicable diseases. BMJ, 364, 24-29. https://doi.org/10.1136/bmj.l296

Burlingame, B., & Dernini, S. (2012). Sustainable diets and biodiversity directions and solutions for policy, research and action. The Food and Agriculture Organization. https://www.fao.org/3/i3004e/i3004e.pdf

Canadian Institute for Health Information. (2019). Registered nurses. https://www.cihi.ca/fr/infirmieres-autorisees

Canadian Nurses Association. (2008a). Climate Change and Health Position Statement. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/ps100_climate_change_e.pdf

Canadian Nurses Association. (2008b). The Role of Nurses in Greening the Health System. file:///C:/Users/Proprio/Downloads/kipdf.com_the-role-of-nurses-in-greening-the-health-system_5ab73bb91723dd339c8160a5.pdf

Casagrande, G., LeJeune, J., Belury, M. A., & Medeiros, L. C. (2011). Registered dietitian's personal beliefs and characteristics predict their teaching or intention to teach fresh vegetable food safety. Appetite, 56(2), 469-475. https://doi.org/10.1016/j.appet.2011.01.020

Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches (4th ed., Vol. 1). Sage publications. https://books.google.ca/books?hl=fr&lr=&id=DLbBDQAAQBAJ&oi=fnd&pg=PP1&dq=Creswell,+J.+W.,+%26+Poth,+C.+N.+(2016).+Qualitative+inquiry+and+research+design:+Choosing+among+five+approaches+&ots=-hu01eJWPB&sig=jjxWBVx9WLnBgyC3dKC2Ix1xAh4#v=onepage&q=Creswell%2C%20J.%20W.%2C%20%26%20Poth%2C%20C.%20N.%20(2016).%20Qualitative%20inquiry%20and%20research%20design%3A%20Choosing%20among%20five%20approaches&f=false

Cristel, R. T., Demesh, D., & Dayan, S. H. (2020). Video conferencing impact on facial appearance: looking beyond the COVID-19 pandemic. Facial Plastic Surgery & Aesthetic Medicine, 22(4), 238-239. https://doi.org/10.1089/fpsam.2020.0279

Dagenais, B., & Mercille, G. (2021). L’alimentation durable dans les établissements de santé : est-ce réaliste? Nutrition Science en évolution. La revue de l'Ordre professionnel des diététistes du Québec, 19(1), 11-16. https://doi.org/10.7202/1084184ar

de Coninck, H., Revi, A., Babiker, M., Bertoldi, P., Buckeridge, M., Cartwright, A., Dong, W., Ford, J., Fuss, S., & Hourcade, J.-C. (2018). Strengthening and implementing the global response. In University of groningen (ed.), Global warming of 1.5° C: Summary for policy makers (pp. 313-443). IPCC-The Intergovernmental Panel on Climate Change.

Dekker, S. C., Kraneveld, A. D., van Dijk, J., Kalfagianni, A., Knulst, A. C., Lelieveldt, H., Moors, E. H. M., Muller, E., Pieters, R. H. H., Pieterse, C. M. J., Rosenkranz, S., Voesenek, L. A. C. J., & van Westen, A. C. (2020). Towards Healthy Planet Diets—A Transdisciplinary Approach to Food Sustainability Challenges. Challenges, 11(2), 21. https://doi.org/10.3390/challe11020021

Drake, D., Hayden, A. M., & Delkoski, S. (2021). Love the Food That Loves You Back: A Planetary Health and Women's Heart Health Partnership. Creative Nursing, 27(4), 262-266. https://doi.org/10.1891/cn-2021-0016

Ducak, K., & Keller, H. H. (2011). Menu planning in long-term care: toward resident-centred menus. Canadian Journal of Dietetic Practice and Research, 72(2), e126-e133. https://doi.org/10.3148/72.2.2011.83

Duncan, K., & Bergman, E. A. (1999). Knowledge and attitudes of registered dietitians concerning vegetarian diets. Nutrition Research, 19(12), 1741-1748. https://doi.org/10.1016/S0271-5317(99)00127-X

Fraser, C., Grundy, A., Meade, O., Callaghan, P., & Lovell, K. (2017). EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user‐involved care planning. Journal of psychiatric and mental health nursing, 24(6), 367-376. https://doi.org/10.1111/jpm.12361

Gonzalez Fischer, C., & Garnett, T. (2016). Plates, pyramids, planet. Oxford, Angleterre : Food and Agriculture Organization of the United Nations and The Food Climate Research Network at The University of Oxford. https://www.fao.org/3/i5640e/i5640e.pdf

Government of Canada. (2019). Canada's food guide. https://food-guide.canada.ca/en/

Grosso, G., Mateo, A., Rangelov, N., Buzeti, T., & Birt, C. (2020). Nutrition in the context of the Sustainable Development Goals. European journal of public health, 30(Supplement_1), i19-i23. https://doi.org/10.1093/eurpub/ckaa034

Guillaumie, L., Boiral, O., Baghdadli, A., & Mercille, G. (2020). Integrating sustainable nutrition into health-related institutions: a systematic review of the literature. Canadian journal of public health = Revue canadienne de sante publique, 111(6), 845–861. https://doi.org/10.17269/s41997-020-00394-3

Guillaumie, L., Boiral, O., Gagnon, M.-P., Bernard, J., & Baghdadli, A. (2020). Rapport de recherche intermédiaire. https://www.fsi.ulaval.ca/sites/default/files/documents/laurence-guillaumie/rapport_complet_-_projet_pados.pdf

Gysels, M., Richardson, A., & Higginson, I. J. (2005). Communication training for health professionals who care for patients with cancer: a systematic review of training methods. Supportive care in cancer, 13(6), 356-366. https://doi.org/10.1007/s00520-004-0732-0

Hanley, F., Pilote, B., & Belleau, J. (2021). Les changements climatiques et les soins infirmiers : de la connaissance à la pratique. Perspective infirmière, 18(2), 8. https://www.oiiq.org/w/PI/PI-vol18-no-2.pdf#page=66

Harmon, A., Lapp, J. L., Blair, D., & Hauck-Lawson, A. (2011). Teaching food system sustainability in dietetic programs: Need, conceptualization, and practical approaches. Journal of Hunger & Environmental Nutrition, 6(1), 114-124. https://doi.org/10.1080/19320248.2011.554272

Hawkins, I. W., Balsam, A. L., & Goldman, R. (2015). A survey of registered dietitians’ concern and actions regarding climate change in the United States. Frontiers in nutrition, 2, Article 21. https://doi.org/10.3389/fnut.2015.00021

Hawkins, I. W., Balsam, A. L., & Graves, D. (2015). A qualitative study of how registered dietitians made the connection between diet, climate change, and environmental degradation. Journal of Hunger & Environmental Nutrition, 10(1), 47-59. http://doi.org/10.1080/19320248.2015.1004213

Hege, A., Giddens, J., Bergquist, E., Stadler, D., Gayer Campbell, C., Cummings, J., Goetze, A., Steinmetz, J., Combs, E., Schwartz, A., Prange, N., Brown, K., Sauer, K., & Spiker, M. (2021). Integration of a Sustainable Food Systems Curriculum in Nutrition and Dietetics Education: Assessment from the First Year of Implementation. Journal of the Academy of Nutrition and Dietetics, 121(12), 2536-2548. https://doi.org/10.1016/j.jand.2021.02.001

Heidelberger, L., Smith, C., Robinson-O’Brien, R., Earthman, C., & Robien, K. (2017). Registered dietitian nutritionists’ perspectives on integrating food and water system issues into professional practice. Journal of the Academy of Nutrition and Dietetics, 117(2), 271-277. https://doi.org/10.1016/j.jand.2016.06.380

Holguera, J. G., & Senn, N. (2021). Co-bénéfices santé-environnement et changement climatique: concepts et implication pour l’alimentation, la mobilité et le contact avec la nature en pratique clinique. La Presse Médicale Formation, 2(6), 622-627. https://doi.org/10.1016/j.lpmfor.2021.10.009

Jones, M., Dailami, N., Weitkamp, E., Salmon, D., Kimberlee, R., Morley, A., & Orme, J. (2012). Food sustainability education as a route to healthier eating: evaluation of a multi-component school programme in English primary schools. Health education research, 27(3), 448-458. https://doi.org/10.1093/her/cys016

Kellogg, W. (2004). Logic model development guide. WK Kellogg Foundation. https://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/KelloggLogicModelGuide_161122_162808.pdf

Khan, A. R. (2016). Policy implementation: Some aspects and issues. Journal of Community Positive Practices(3), 3-12.

Kinney, L. M. (2010). Environmental sustainability in healthcare. The Journal for Quality and Participation, 33(2), 23-26.

Kitzinger, J. (1994). The methodology of focus groups: the importance of interaction between research participants. Sociology of health & illness, 16(1), 103-121. https://doi.org/10.1111/1467-9566.ep11347023

Knoblock-Hahn, A., & Medrow, L. (2020). Development and Implementation of a Sustainable, Resilient, and Healthy Food and Water Systems Curriculum for Dietetic Interns. Journal of the Academy of Nutrition and Dietetics, 120(1), 130-133. https://doi.org/10.1016/j.jand.2019.04.016

Lange, J. K. (2002). Review: Richard A. Krueger & Mary Anne Casey (2000). Focus Groups. A Practical Guide for Applied Research (3rd edition). Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 3(4). https://doi.org/10.17169/fqs-3.4.791

Légaré, F., Politi, M. C., Drolet, R., Desroches, S., Stacey, D., Bekker, H., & SDM-CPD Team (2012). Training health professionals in shared decision-making: an international environmental scan. Patient education and counseling, 88(2), 159-169. https://doi.org/10.1016/j.pec.2012.01.002

Linton, E., Keller, H., & Duizer, L. (2018). Ingredients for success: Strategies to support local food use in health care institutions. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada, 79(3), 113-117. https://doi.org/10.3148/cjdpr-2018-008

Liquori, T., Koch, P. D., Contento, I. R., & Castle, J. (1998). The cookshop program: outcome evaluation of a nutrition education program linking lunchroom food experiences with classroom cooking experiences. Journal of Nutrition Education, 30(5), 302-313. https://doi.org/10.1016/S0022-3182(98)70339-5

Marshall, C., & Rossman, G. B. (2014). Designing qualitative research (6th ed.). Sage publications.

Maskell, K., McDonald, P., & Paudyal, P. (2018). The usefulness of health education materials in GP waiting rooms: A cross-sectional study. British Journal of General Practice, 68 (suppl 1): bjgp18X696845. https://doi.org/10.3399/bjgp18X696845

Mason, P., & Lang, T. (2017). Sustainable diets: how ecological nutrition can transform consumption and the food system (1st ed.). Routledge. https://doi.org/10.4324/9781315802930

McGuire, S. (2013). WHO, World Food Programme, and International Fund for Agricultural Development. 2012. The State of Food Insecurity in the World 2012. Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition. Rome, FAO. Advances in Nutrition, 4(1), 126-127. https://doi.org/10.3945/an.112.003343

Moerenhout, T., Borgermans, L., Schol, S., Vansintejan, J., Van De Vijver, E., & Devroey, D. (2013). Patient health information materials in waiting rooms of family physicians: do patients care? Patient preference and adherence, 7, 489-497. https://doi.org/10.2147/PPA.S45777

Morgan, D. L. (1996). Focus groups as qualitative research (2nd ed.). Sage publications.

Morgan, D. L. (1997). Planning and research design for focus groups. In The Focus Group Kit 2 (ed.) Focus groups as qualitative research (2nd ed.). Sage publications. https://dx.doi.org/10.4135/9781412984287

Murphy, B. M., Higgins, R. O., Shand, L., Page, K., Holloway, E., Le Grande, M. R., & Jackson, A. C. (2017). Improving health professionals’ self-efficacy to support cardiac patients’ emotional recovery: the ‘Cardiac Blues Project’. European Journal of Cardiovascular Nursing, 16(2), 143-149. https://doi.org/10.1177/1474515116643869

O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245-1251. https://doi.org/10.1097/ACM.0000000000000388

Ogbeide, G. C. A., & Harrington, R. J. (2011). The relationship among participative management style, strategy implementation success, and financial performance in the foodservice industry. International Journal of Contemporary Hospitality Management. 23 (6), 719-736. https://doi.org/10.1108/09596111111153448

Päivärinta, E., Itkonen, S. T., Pellinen, T., Lehtovirta, M., Erkkola, M., & Pajari, A. M. (2020). Replacing Animal-Based Proteins with Plant-Based Proteins Changes the Composition of a Whole Nordic Diet-A Randomised Clinical Trial in Healthy Finnish Adults. Nutrients, 12(4), 943. https://doi.org/10.3390/nu12040943

Ranke, T. D., Mitchell, C. L., George, D. M. S., & D’Adamo, C. R. (2015). Evaluation of the Balanced Menus Challenge: a healthy food and sustainability programme in hospitals in Maryland. Public health nutrition, 18(13), 2341-2349. https://doi.org/10.1017/S1368980014002936

Rose, D., Heller, M. C., & Roberto, C. A. (2019). Position of the Society for Nutrition Education and Behavior: the importance of including environmental sustainability in dietary guidance. Journal of nutrition education and behavior, 51(1), 3-15. e11. https://doi.org/10.1016/j.jneb.2018.07.006

Springmann, M., Clark, M., Mason-D’Croz, D., Wiebe, K., Bodirsky, B. L., Lassaletta, L., De Vries, W., Vermeulen, S. J., Herrero, M., Carlson, K. M., Jonell, M., Troell, M., DeClerck, F., Gordon, L. J., Zurayk, R., Scarborough, P., Rayner, M., Loken, B., Fanzo, J., … Willet, W. (2018) Options for keeping the food system within environmental limits. Nature, 562, 519-525. https://doi.org/10.1038/s41586-018-0594-0

Strotmann, C., Friedrich, S., Kreyenschmidt, J., Teitscheid, P., & Ritter, G. (2017). Comparing food provided and wasted before and after implementing measures against food waste in three healthcare food service facilities. Sustainability, 9(8), 1409. https://doi.org/10.3390/su9081409

Sulda, H., Coveney, J., & Bentley, M. (2010). An investigation of the ways in which public health nutrition policy and practices can address climate change. Public health nutrition, 13(3), 304-313. https://doi.org/10.1017/S1368980009990334

Swinburn, B. A., Kraak, V. I., Allender, S., Atkins, V. J., Baker, P. I., Bogard, J. R., Brinsden, H., Calvillo, A., De Schutter, O., Devarajan, R., Ezzati, M., Friel, S., Goenka, S., Hammond, R. A., Hastings, G., Hawkes, C., Herrero, M., Hovmand, S., Howden, M., … Dietz, W. H. (2019). The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. The lancet, 393(10173), 791-846. https://doi.org/10.1016/S0140-6736(18)32822-8

The EAT-Lancet Commission on Food, Planet, Health brief for health professionals. (2019). https://eatforum.org/lancet-commission/healthcare-professionals/

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042

Van den Hove, S. (2001). Approches participatives pour la gouvernance en matière de développement durable: une analyse en termes d’effets. Gouvernance et développement durable, Bâle/Genève/Munich, Helbing & Lichtenhahn, 53-89. http://psychaanalyse.com/pdf/APPROCHES%20PARTICIPATIVES%20POUR%20LA%20GOIUVERNANCE%20EN%20MATIERE%20DE%20DEVELOPPEMENT%20DURABLE%20UNE%20ANALYSE%20EN%20TERMES%20D%20EFFETS%20(38%20Pages%20-%20156%20Ko).pdf

Ward, K., & Hawthorne, K. (1994). Do patients read health promotion posters in the waiting room? A study in one general practice. British Journal of General Practice, 44(389), 583-585.

Williams, C. P., Elliott, K., Gall, J., & Woodward-Kron, R. (2019). Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study. Journal of public health research, 8(1), 1476. https://doi.org/10.4081/jphr.2019.1476

World Health Organization. (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines 2013. https://www.who.int/publications/i/item/transforming-and-scaling-up-health-professionals%E2%80%99-education-and-training

World Health Organization and United Nations Development Programme. (2019). Non-communicable disease prevention and control: a guidance note for investment cases. https://apps.who.int/iris/bitstream/handle/10665/311180/WHO-NMH-NMA-19.95-eng.pdf