The term ‘health’ is familiar in everyday language but defining what it means is problematic. Lay perspectives of health reflect opinions of non-medical individuals. Herzlich (1973) presents health as a combination of the individual's perspective, lifestyle and society, a view that is endorsed in research by Macintyre et al (2006). Lay perspectives about the sense of control over health are influenced by social, economic and cultural factors (Prochaska and DiClemente, 2017).
Theoretical definitions focus on health as ‘the freedom from medically defined disease and disability’ (Prochaska and DiClemente, 2017). The biomedical approach to health predominates, focusing on scientific knowledge as the basis of medical, surgical and biological management of illness to restore health (Giddens and Sutton, 2017). The body is considered akin to a homeostatic machine that adapts to change in the environment. If the body cannot adapt, then health is compromised (Blaxter, 2010). This view disregards the fact that many individuals live long, full lives despite having long-term health conditions.
Social theories define health as more than freedom from illness. Engel (1977) created the holistic and humanistic biopsychosocial model that takes into account biological, psychological, social and spiritual factors that influence health. Whitehead and Dahlgren (1991) developed the rainbow model, which focuses predominantly on the influence of an individual's socioeconomic conditions on their health. The social definition of health presents a dynamic viewpoint, with health inequalities at the heart, since these have wide implications for every individual.
My personal perspective is that health is constructed by individuals based on social, biological, geographical and metaphysical factors. This article analyses the impact of my experiences of moving away from home to study nursing at university on my health and wellbeing.
Personal reflection about my health and wellbeing since starting university
Becoming a student nurse meant giving up a full-time job and moving from a rural location with plentiful exercise spaces to an urban setting with limited green space. My new location meant I was away from my community, friends and family. These factors had a spiritual and social impact on my health and wellbeing. The new challenge of balancing university work, part-time work and a social life resulted in stress and anxiety that negatively affected my emotional health and, ultimately, caused the cessation of exercise, which considerably influenced my physical and mental health.
Analysing my experiences in the context of a theoretical model has supported me to understand my response to the health and wellbeing challenges that presented and to take control of my health and wellbeing. This has clear benefits for my own nursing practice when supporting patients to make lifestyle changes.
It also helps me to support peers and colleagues who have been affected by lifestyle changes arising from the COVID-19 lockdown restrictions; these may have included the closure of leisure facility and increased workloads and caring responsibilities. More generally, my experience demonstrates how universities can support student nurses to develop self-awareness about their health and wellbeing and take action to enhance this.
Benefits of exercise for health and wellbeing
Regular exercise is a major contributor to good health and wellbeing, endorsed by the World Health Organization (1995) and, more recently, championed by the New Economics Foundation within the five ways to wellbeing model (Government Office for Science, 2008). NHS guidelines recommend that adults do 150 minutes of moderate activity per week to prevent the onset of chronic conditions and reduce the risk of early death by up to 30% (NHS website, 2019). Exercise improves not only cardiovascular performance but also self-efficacy, cognitive decision-making and all-round quality of life (Derakhshanpour et al, 2018). Ersöz (2017), in a study involving 552 university students, found that those who did not exercise displayed more symptoms of stress and depression, concluding that exercise is strongly correlated with positive wellbeing.
The benefits of exercise support medical theories (proposing that it reduces the risk of chronic physical conditions developing) and social theories (that it has a positive impact on social and psychological health and wellbeing).
Whitehead and Dahlgren's (1991) rainbow model and the New Economics Foundation's dynamic model of wellbeing (Government Office for Science, 2008) highlight the impact of external forces on an individual's ability and capacity to exercise. Many social determinants affect exercise patterns within society; for example, people on a low income may have less access to leisure centres and sports clubs, which reduces their opportunities to exercise, negatively impacting on their health in the longer term (Kelly et al, 2016). In addition, during the COVID-19 pandemic, restrictions placed on leisure providers and altered working hours reduced access to exercise for many people who usually use such facilities.
Analysis of my experience of stopping exercising in the context of the transtheoretical model of behaviour change
My personal reflection, constructed within the transtheoretical model (Prochaska and DiClemente, 2017), considers the impact of my cessation of exercise since starting university on my health and wellbeing. Although dating back to 1979, this model remains widely accepted, having been adapted to consider behaviour change and individual attitudes (Manchaiah et al, 2018).
The five steps of behaviour change proposed by McConnaughy et al (1983)—precontemplation, contemplation, decision-making, action and maintenance—are used to frame my analysis.
Before starting university, I was very active and participated regularly in team sports. At the time I started university, I was at the maintenance stage of the model. I was still exercising, and my attitude and self-efficacy were still high, supporting my positive mental health. I quickly noted a change when I moved to university, with my whole routine disrupted. My withdrawal from team sports had a negative impact on my physical and mental health. The irregular shift patterns I was working as a nursing student made it difficult to put an exercise routine in place. I began to feel extremely frustrated, more agitated and more negative in my outlook, which resulted in me stopping all exercise within a month of starting university.
After 4 weeks without exercise, my holistic health started to deteriorate. I considered this as neglect of my health and wellbeing. I noticed physical changes in myself. Psychologically, I experienced low moods and struggled to concentrate. I did not initially link this to my lack of exercise, but the work of Morgan et al (2018) informed me how the cessation of exercise increases depression-related symptoms. Although I was experiencing a poor attention span, fatigue and mood swings, I was unaware of their basis, meaning that I was in the precontemplation stage of the transtheoretical model. At this stage, it is common to have low self-efficacy and to discredit the effects of change. I have always been an advocate of exercise but I was in denial of the physical and psychological changes I had experienced in body and mind. My self-efficacy was low and I was not making time to exercise.
As my self-awareness increased, I experienced a period of contemplation. I recognised discrepancy when I started placement, where I was advocating exercise to patients to improve their health and wellbeing yet, hypocritically, I was not exercising myself. Bandura's (1977) social learning theory, endorsed by Hwang (2019), proposes that learning arises when observing and later replicating behaviour viewed in others. Working as a student nurse, I noticed the positive impact of physiotherapy on patients' emotions and attitudes and realised that a change could be positive for me.
My analysis of my feelings and observations fuelled me to the preparation stage of the model, where self-liberation occurs, and realistic, manageable goals start to be set. After preparing, I engaged in action, taking purposeful steps to modify my behaviour. After sustaining the behaviour change for 6 months or longer, I reached the maintenance stage once again (Fidanci et al, 2017), engaging happily in exercise as I had been before starting my university course and experiencing positive health and wellbeing.
The transtheoretical model continues to be endorsed in healthcare practice, supporting individuals to review their behaviour and to consider the psychosocial benefits to their health and wellbeing from changing this (Manchaiah et al, 2018). While the model is useful, one limitation is that the criteria for each stage of change appear arbitrary, making its application subjective. Having used the model, I am better equipped to support others to understand and use it to support their own behaviour change.
Although my experience is specific to starting university, over the past 18 months many people have experienced a deterioration in their health and wellbeing as a result of COVID-19 restrictions, which reduced opportunities to exercise (Faulkner et al, 2021). The lifting of restrictions provided the perfect time to foster self-awareness and to support others to make lifestyle changes around exercising to improve their health and wellbeing.
Conclusion
Critically analysing the impact of stopping exercising on my health and wellbeing has reinforced my view that ‘health’ is a concept that is personal and that it is influenced by the relationship between physical, social, psychological and spiritual factors.
Developing self-awareness about factors that affect my health and wellbeing as a student nurse has supported me to take positive action to enhance my own wellbeing, building my sense of self-efficacy. It has helped me to manage during the COVID-19 pandemic. The understanding gained from my personal analysis and experience of taking action enables me to better support patients in practice, as well as to support peers.
KEY POINTS
- Exercise has a strong correlation with positive health and wellbeing, with its absence linked to the onset of physical illness and to higher levels of stress and depression in university students
- The transtheoretical model supports people to understand the impact of their lifestyle choices/behaviours, and to consider how making changes has psychosocial benefits for health and wellbeing
- Developing self-awareness through reflection can strengthen student nurses' understanding of health and wellbeing, enabling them to better support lifestyle changes with those they care for
- Sharing experiences about health and wellbeing creates a dialogue within which strategies for change can be shared and where support from and for others can be developed
CPD reflective questions
- Using the transtheoretical model, can you identify a lifestyle choice or behaviour that is affecting your psychosocial health?
- What aspect would you change and how?
- How do you think you could use the transtheoretical model to start dialogue with colleagues about aspects of the work environment that affect on your physical and/or psychosocial health?