Date of Award

Fall 2020

Document Type

Open Access Dissertation

First Advisor

Robin M. Dawson


Though nurses may have knowledge about the health promoting benefits of a healthy diet, many do not consume enough fruits or vegetables. For hospital shift nurses to achieve healthy eating while at work, environmental barriers were reportedly the most challenging to overcome. To better understand the hospital food environment from the nurses’ perspective, two mechanisms for workplace food acquisition were studied: 1.) hospital consumer food environment, which includes cafeterias, vending machines, and gift shops; and 2.) free food at work.

Through observations of 31 South Carolina hospitals using the Hospital Nutrition Environment Scan (HNES), descriptive data was collected to illuminate the healthfulness of hospital consumer food environments across the state. The presence of health promoting practices and environmental barriers of importance to nurses were observed and aggregated to provide an overall assessment. Scores and observations were also compared between groups according to hospital size, urbanization, and teaching status.

Free food at work was investigated through a concept analysis and an exploratory electronic survey of hospital nurses from across the United States. Prevalence, consumption, location, and sources of free food were the primary areas of interest for quantifying the problem of free food at work for hospital nurses. Additionally, personal, nursing, and hospital demographics; self-efficacy for diet; and regular fruit and vegetable intake were also measured and used to compare differences in free food availability and consumption.

Findings revealed that hospital food environments from the nurses’ perspective needed additional health-promoting practices implemented. Specifically, the hospital consumer food environment lacked 24/7 access to fruits and vegetables but had an overabundance of access to unhealthy foods. Similarly, free food at work was provided often and nearby but typically consisted of high energy, low nutrient density foods. Even though nurses recognized free food as a less healthy option, they regularly consumed it when available. This study adds to our knowledge on the health status of hospital food environments as experienced by nurses.


© 2020, Cynthia Elaine Horton Dias

Included in

Nursing Commons