Eating Healthy Even on The Night Shift

1. Eating Healthy Even on The Night Shift Desiree Hensel PhD, RN,CNS, CNE Assistant Professor Indiana University School of Nursing dehensel@indiana.edu

2. The Nurse Personality*(from Fit Nurse) • Type E • We do Everything • For Everybody • Except ourselves • Develops in 3 stages • `As a child you get satisfaction comforting others • Others recognize you making you feel significant • You get paid for sacrificing your needs

3. The Boss’s Dream Nurse

4. Florence Nightingale Said • “The martyr sacrifices themselves entirely in vain. Or rather not in vain; for they make the selfish more selfish, the lazy more lazy, the narrow narrower.” • She also said “To understand God's thoughts one must study statistics... the measure of his purpose.”(okay maybe she was off there)

5. The baccalaureate generalist graduate is prepared to engage in care of self in order to care for others*   *AACN Essentials for Baccalaureate Education

6. The Challenges

7. Top 5 Signs of a “Nurse’s Diet • You ask your colleagues “Isn’t it time for your kids to be selling candy bars again?” • You call for clarification on a Vitamin C order because you don’t think your patient needs Caffeine • You define a balanced meal as one that can be balanced it in your arms while eating on the run • You classify chocolate as a vegetable because it started as a bean. • Instead of using alcohol, you accidently try to clean an IV port with the Sweet & Low packet in your pocket.

8. Break Room Temptations

9. Hazards of Shift Workers* • Sleep pattern changes • Higher accident rates • Increased alcohol and drugs to help them sleep • Fatigue and burned out • Higher divorce rate • *Canadian Health Worker

10. Shift Work Eating Habits Lead To*: • Higher rates of GI problems • Constipation • Diarrhea • Gas • Indigestion • Reflux • ulcers • Altered appetite • Changes in body weight • *Canadian Health Network

11. The Bad Habits • Eating in a rush (not time to feel full) • Eating alone (make less healthy choices) • Eating poorly during day then overeating at night • Consuming too much caffeine to stay awake (Moderate intake ≤300mg/day) • Eating high fats foods (contributes to weight gain and GI problems)

12. Starbucks and Caffeine From http://www.energyfiend.com/the-complete-guide-to-starbucks-caffeine

13. Why is Caffeine Such a Problem? • Consumption tends to be highest at the end of shift! • Levels peak 5-45 minutes, but can linger 8 hours • Makes falling asleep hard when you get home • Methylxanthines increases heart rate, blood pressure and renal blood flow • Dehydration & Fatigue • Remember it takes about a 5% water loss before you feel thirst!!!

14. Signs of Mild to Moderate Dehydration • Dry, sticky mouth • Sleepiness or tiredness • Thirst (a later sign) • Concentrated urine • Dry skin • Headache • Constipation • Dizziness or lightheadedness (remember Hillary Clinton’s blackout)

15. From Canadian Health Network and Fit Nurse Tips for Healthy Night shift Eating

16. Eating Tip 1 • Eat to stay awake!! • Whole grain, carbohydrate-based, food make you sleepy!!!! • Eat these before bed • Good choice whole grain toast with fruit spread • Protein-rich foods keep us alert • Good choice for meals and snacks on night shift • Hard boiled eggs and nuts • Large meals decrease alertness • Keep meals small at night! • Aim for about 300 -400 calories

17. Some of my favorite light meals • Low carb tortilla wrap, spread with peanut butter, and wrapped around a banana • 385 calories • Salad greens topped peach or apple slices and almonds with a carton of lemon or peach Greek yogurt as the dressing- (fresh mint on top is extra yummy) • 400 calories • Canned salmon mixed with ranch dressing on top of spinach • 300 calories

18. Eating Tip 2 • Night shift workers should eat their main meal before their shift starts • Make this your regular dinner time! • Between 5 pm and 6:30 pm • If you work 7p-7a • Eat a small meal around midnight • Snack lightly during shift • Suggest 100cal type snacks around 9p and 3a if you eat at midnight

19. Eating tip 3 • Fight the 3AM-4AM sleepiness with a pick me up snack • Avoid caffeine • Avoid diet sodas • They may increase the desire for sweets • Role in weight gain is unclear (Fakhouri, 2012) • Choose protein with a small amount of carbs • Greek yogurt • Energy bar/mix with nuts • Still hungry? • Have some fruit

20. Alternative Meal Schedule • If you can’t eat at main meal at midnight • Snack at Midnight (and maybe 9p) • Eat small meal around 2am-3am • Snack before going home.

21. Eating tip 4 • Drink 6-8 glasses of water/day • Take a refillable water bottle • Plan to get half your daily intake at work

22. Eating Tip 5 • DO Bring food from home. • It offers the most variety • Best chance to control quality • Remember many hospitals only offer grill food at night! • DON’T Indulge in • High-fat vending machine foods • Greasy foods that slow digestion • Leads to reflux • Caffeine

23. About hospital cafeteria food!

24. Eating Tip 6 • After your shift but before you sleep • DON”T go to bed hungry • You are more likely to wake up • DO eat small carbohydrate-rich, low protein snack or meal • Carbs help you sleep • Good choice: cereal and juice • Bad choice: omelet

25. The Sleep-Diet Link • Sleeping <6hrs a day was associated with increased general obesity, abdominal obesity & calorie intake (Haghighatdoost et al, 2012) • Experimental data thus far shows a probable link between shortened sleep and altered glucose metabolism (diabetes, prediabetes, & metabolic syndrome) as well as appetite dysregulation (Killick et al.,2012). • Alcohol intake was significantly higher in men and women who slept <6hrs a night than those who slept>7hours (Chaput et al., 2012).

26. General Sleep Help for Night Shift • Don’t go to bed hungry • Avoid caffeine, alcohol, and sleeping pills • Follow a relaxing routine- • like a warm bath before bed • Allow enough time for sleep • Try to keep a regular schedule • Consider dark curtains for your room • No electronics 30 minutes before sleep • Be active during the day

27. Sleep Cycles Sleep cycles last about 90 minutes Sleep becomes progressively lighter each cycle Waking in stage 3&4 leaves you feeling tired! From http://www.brainmaintenanceacademy.com

28. Alcohol affects second half of sleep period Fromm http://adcaps.wsu.edu/campaigns/sleep-alcohol/

29. Tips to Maintains Social Life • Plan quality time with spouse, family, friends • Involve family in activities • Eat at least 1 meal a day with your family or friends • Participate in group activities • Exercise with your family

30. https://www.youtube.com/watch?v=zWvnfdgEOcA And laugh daily!!!!

31. References • American Colleges of Nursing (October 20, 2008). The essentials for baccalaureate education for the professional practice of education. Retrieved from http://www.aacn.nche.edu/education/pdf/baccessentials08.pdf. • Canadian Health Network(n.d.) Shift work and eating healthy. Retrieved fromhttp://www.gov.ns.ca/psc/v2/pdf/employeeCentre/healthyWorkplace/healthyEating/03_16_ShiftWork.pdf • Chaput, J. P., McNeil, J., Després, J. P., Bouchard, C., & Tremblay, A. (2012). Short sleep duration is associated with greater alcohol consumption in adults. Appetite. DOI: 10.1016/j.appet.2012.07.012 • Fakhouri, T.H.I. (2012) Consumption of Diet Drinks in the United States, 2009‒2010 • www.cdc.gov/nchs/data/databriefs/db109.pdf • Haghighatdoost, F., Karimi, G., Esmaillzadeh, A., & Azadbakht, L. (2012). Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran. Nutrition. Doi:10.1016/j.nut.2012.04.015    • Killick, R., Banks, S., & Liu, P. Y. (2012). Implications of Sleep Restriction and Recovery on Metabolic Outcomes. Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/jc.2012-1845    • Scholar, G. (2010). Fit nurse. Indianapolis, IN: Sigma Theta Tau International