The Physical and Emotional Benefits of Social Support: Application to Obesity, Smoking, and Alcoholism

Stages of change theory and the nicotine-dependent client: direction for decision making in nursing practice

Clinical practice is the basic purpose of nursing. Nursing's evolving professional development calls for the application of theory to direct decision making in nursing practice. Therefore, in an attempt to bridge what has been described as the "theory-practice gap," the author demonstrates how Prochaska and DiClemente's stages of change theory is relevant to nursing practice. According to Prochaska and DiClemente, behavioral change, such as smoking cessation, involves a process of five identified stages: precontemplation, contemplation, preparation, action, and maintenance. The author discusses each stage of change and the framework it provides for decision making in nursing practice. The concept of relapse is described and highlighted as a valuable learning experience. Finally, using the criteria set by Chinn and Kramer, systematic evaluation of the stages of change theory pinpoints strengths and discusses integration of the theory into nursing practice.

Evaluation of a nurse-delivered smoking cessation intervention for hospitalized patients with cardiac disease

OBJECTIVE

To determine the effect of a nurse-delivered smoking cessation intervention for hospitalized smokers on smoking cessation rates and smoking cessation self-efficacy at 6 months after enrollment.

DESIGN

A quasi-experimental design was used; specifically, a nonequivalent control group design was implemented.

SETTING

A 450-bed major teaching and research tertiary care hospital, serving patients from across the province of British Columbia, Canada.

SUBJECTS

Smokers with a cardiac diagnosis (n = 102) who were admitted to 1 of 2 inpatient cardiac units for medical or surgical treatment.

OUTCOME MEASURES

Self-reported smoking status and self-reported smoking cessation self-efficacy.

INTERVENTION

Two structured, in-hospital contacts, followed by 3 months of telephone support. The interventions focused on problem-solving and reinforcing the patient's self-efficacy.

RESULTS

Of the patients enrolled, 86 completed 6-month follow-up questionnaires. When subjects who were lost to follow-up were assumed to be smokers, 46% of the intervention group, compared with 31% of the control group, were nonsmokers. When key variables were controlled, we found that those subjects in the control group were 3 times more likely to relapse and begin smoking than those who received the intervention. There were no significant differences in follow-up smoking cessation self-efficacy scores in the treatment and control groups. When background variables were controlled, self-efficacy related to positive/social situations and habit/addictive situations were noted to be significantly higher in the intervention group.

CONCLUSION

The findings of this research are encouraging; they suggest that a nurse-delivered smoking cessation intervention improved the smoking cessation rate in patients with cardiac disease.

Maintaining smoking abstinence after myocardial infarction

Maintaining smoking abstinence after a myocardial infarction (MI) greatly reduces risks of recurrent disease morbidity and of mortality. Although post-MI patients appear to have better long-term rates of smoking abstinence compared with healthy groups, studies employing biochemical verification of smoking status generally indicate that only about one third of previously smoking post-MI patients remain abstinent at follow-up. Factors which may accompany the occurrence of a MI and which may be associated with maintenance of smoking abstinence include environmental changes aiding cessation (e.g., decreased exposure to smoking cues), increased social support from family, and stronger belief in the harmful effects of continued smoking. The usefulness of these factors in developing new treatments for maintaining abstinence in post-MI patients is discussed, and commonalities between efforts to maintain smoking abstinence in post-MI patients and avoidance of substance abuse in other groups at risk for serious health consequences are briefly noted.

Perceived helpfulness of messages on a community-based telephone support service for ex-smokers

Callers to a community-based telephone support service for ex-smokers evaluated the perceived helpfulness of six categories of taped messages. These categories were: behavioral coping, cognitive coping, negative health, positive health, informational, and supportive. Supportive messages were rated as significantly more helpful than negative health, informational, and behavioral coping. The implications of these findings are discussed.

Social support and compliance: a selective review and critique of treatment integrity and outcome measurement

The paper presents a selective review and critique of the literature on social support as a factor in the enhancement of patient compliance with medical regimens. The review highlights several studies that measure the correlation between social support and compliance. The manner in which studies operationalize social support is discussed. Several research recommendations suggest ways social support could be studied as a clear and strong independent variable, such as utilizing measures of compliance with the social support manipulation and considering several different variates of social support. Greater attention to methods for measuring compliance is also suggested.