Beliefs, knowledge, and self-efficacy of nursing students regarding tobacco cessation

Smoking Prevalence, Attitude, and Cessation Training among Nursing Students in Bhubaneswar, India—A Cross-sectional Study

Introduction The smoking habit of health professionals including nursing students may prevent them from providing cessation advice and counseling to their patients as one cannot persuade others to quit if he/she is smoking himself/herself.

Objective The study aimed to assess the smoking prevalence, attitude, and tobacco cessation training among nursing students.

Materials and Methods During January to April 2019, we conducted a cross-sectional study among 432 third-year nursing students of eight graduate nursing colleges of Bhubaneswar using the Global Health Professional Student Survey (GHPSS) questionnaire.

Results Overall, 38 (8.8%) were current smokers. Majority of participants agreed that health professionals should receive specific training on smoking cessation techniques (91%), serve as role models for their patients and the public (94%), advise their patients to quit tobacco (96.1%). Current smokers were more likely to be males (adjusted OR [aOR]: 6.53, 95% confidence interval or CI: 2.61–16.36), those not supporting a smoking ban in discos/bars/pubs (aOR: 2.82, 95% CI: 1.13–7.05), those lacking knowledge about dangers of smoking (aOR: 2.48, 95% CI: 1.10–5.60), and those not discussing the reasons of smoking (aOR: 2.49, 95% CI: 1.05–5.93).

Conclusion Sincere efforts must be undertaken in the nursing colleges to design and implement strategies to discourage tobacco use among nursing students and adequately train them on tobacco cessation techniques.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers

AIM

The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students.

BACKGROUND

Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves.

DESIGN

Longitudinal comparative study.

MEASUREMENTS

We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed.

RESULTS

There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake.

CONCLUSION

Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

Prevalence of smoking in nursing students worldwide: A meta-analysis of observational studies

BACKGROUND

Smoking is common among nursing students worldwide, but the reported prevalence is inconsistent across epidemiological studies. This is a meta-analysis of the prevalence of smoking in nursing students worldwide.

DESIGN

Meta-analysis of observational studies.

SAMPLE

A total of 46 studies were included in this meta-analysis.

METHOD

Electronic databases (PubMed, Medline, PsycINFO, EMBASE and Web of science) were independently and systematically searched by two investigators from their commencement date up to 12 May 2018. Studies that reported the smoking rate of nursing students were included and analyzed using random-effects model.

RESULTS

The pooled prevalence of current smoking was 26.6% (95% CI: 22.9-30.4%), while pooled prevalence of previous smoking was 15.5% (95% CI: 11.8-19.3%). Subgroup analyses showed that smoking rate was higher in male compared with female students (39% vs 25.2%, P < .001), while survey time, sample size, age, study design and academic year did not moderate the smoking rate (all P > .05).

CONCLUSION

This meta-analysis confirmed that smoking is common in nursing students. Considering the negative impact of smoking on health, appropriate smoking cessation measures for nursing students should be developed.

The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I² 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I² 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I² = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.

The Perception and Intervention of Internship Nursing Students Helping Smokers to Quit: A Cross-Sectional Study in Chongqing, China

Background: Smoking is among the most preventable causes of death globally. Tobacco cessation can lessen the number of potential deaths. The China Tobacco Cessation Guidelines encourage medical staff to perform the 5As (Ask, Advise, Assess, Assist, Arrange) when delivering tobacco dependence treatments to patients. Nursing students will develop to be nurses in the future and they have to finish 9 months of clinical practicum study in the last year at hospitals or care centers. However, the frequency of behaviors used to help smokers quit among Chinese nursing internship students is unclear. This study analyzed the rate of nurse interns' performance of the 5As and which demographic characteristics, perceptions of smoking and knowledge predicted higher performance of the 5As. Methods: The cluster sampling method was used to select 13 teaching hospitals among 29. All nursing intern students were expected to finish the questionnaire about their 5As behaviors to help patients quit smoking. Their 5As performances were scored from one to five with 5 being the best and scores were summed. A multivariate linear mixed-effect model was employed to test the differences between their 5As. Results: Participating in the survey were 1358 interns (62.4% response rate). The average scores were as follows-Ask-3.15, Advise-2.75, Assess-2.67, Assist-2.58 and Arrange-2.42. A total of 56.3% students perceived that medical staff should perform the 5As routinely to help patients quit smoking. On the other hand, 52.1% viewed clinical preceptors as role models of the 5As. School education regarding tobacco control, smoking dependence treatment, self-efficacy and positive intentions were predictors of higher performance of the 5As (p < 0.001). Conclusions: Nursing internship students seldom administered tobacco dependence treatments to patients. It is essential to improve the corresponding education, skills and self-efficacy of the 5As. Meanwhile, clinical preceptors should procure more training in the responsibilities and skills related to tobacco cessation. In this way, clinical preceptors can be role models of the 5As and impart positive influences on interns.

Smoking Perceptions and Practice among Nursing Students in Kabupaten Kupang, Indonesia

Objective:

Several studies have offered evidence of the importance of nursing-led interventions in smoking cessation. However, other studies have found that negative perceptions and smoking among nurses were barriers to them providing such interventions. The purpose of this study is to investigate smoking prevalence among nursing students and the demographic predictors of smoking, as well as perceptions about their roles with regard to smoking behaviour.

Methods:

A cross-sectional, self-administered, anonymous survey was conducted with all nursing students of the Maranatha School of Health Science in Indonesia. Smoking status, individual and familial characteristics including socio-economic status, and smoking cessation-related knowledge and attitudes were examined.

Result:

From the population of 313 students, 197 (62.9%) completed questionnaires were included in the analysis. The prevalence of current smoking for participants overall (25.9%) and males (52.4%) were similar to general population smoking rates in East Nusa Tenggara Province (25.9% overall and 52% for males) but lower than national rates (39% and 75.2%). However, the smoking rate among female participants (7%) was higher than national (2.9%) and regional (0.8%) female smoking rates. The majority of participants were aware of smoking health-related risk (87.3%) and supportive of giving smoking cessation advice (96.4%). In terms of seeing themselves as role models by not smoking at all, approximately 97% non-smokers agreed whereas only 60.8% of smokers agreed. Gender and being supportive of being role models by not smoking at all were significant predictors of the smoking status.

Conclusion:

This study suggests that smoking prevalence among nursing students is high. Despite most of the students having good smoking-related knowledge and having supportive attitudes towards providing smoking cessation services, high smoking prevalence is known to be an impediment to being effective in delivering cessation services. Personal smoking behaviour among nurses needs to be addressed to encourage critical nursing-led smoking cessation interventions.

A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing

Opt-out HIV testing (in which patients are offered HIV testing as a default) is a potentially powerful strategy for increasing the number of people who know their HIV status and thus limiting viral transmission. Like any change in clinical practice, implementation of opt-out HIV testing in a health service requires a change management strategy, which should have theoretical support. This paper considers the application of three theories to the implementation and evaluation of an opt-out HIV testing programme: Behavioural Economics, the Health Belief Model and Normalisation Process Theory. An awareness, understanding and integration of these theories may motivate health care providers to order HIV tests that they may not routinely order, influence their beliefs about who should be tested for HIV and inform the operational aspects of opt-out HIV testing. Ongoing process evaluation of opt-out HIV testing programmes (based on these theories) will help to achieve individual health care provider self-efficacy and group collective action, thereby improving testing rates and health outcomes.

Smoke-free hospital site conversations: how nurses can initiate change

Smoking tobacco continues to be the world's most preventable cause of death and disability with over six trillion cigarettes sold each year. Patients, visitors and health professionals who smoke on hospital sites present a challenge to the effectiveness of public health messages. Health professionals who ignore 'No smoking' hospital/clinic signage, and avoid smoking-cessation activity, help to sustain the perception that smoking is tolerated. Case studies, with a focus on lung cancer and chronic obstructive pulmonary disease (COPD), are used to illustrate how nurses can 'seed' the idea of hospitals becoming smoke-free, provide brief interventions and support patients, carers and colleagues to make that change.

Effectiveness of tobacco intervention education in health professional students' practice: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to examine the effectiveness of entry-level education on smoking cessation or prevention and tobacco-dependence interventions on health professional student practice in promoting client health and on client smoking cessation behaviors.The specific review question to be addressed: what is the effect of entry-level tobacco dependence education on: (1) health professional students' knowledge and skills and self-efficacy, (2) performance of tobacco prevention and cessation interventions, and (3) client smoking cessation behaviors?

Smoking cessation support: Indian nursing students' practices, attitudes and perceived barriers

BACKGROUND

Tobacco use is a significant global health issue. Studies that examined nursing students' attitudes towards smoking cessation support were limited from India.

AIM

To assess undergraduate nursing students' practices, beliefs, attitudes and perceived barriers towards smoking cessation support.

METHODS

A cross-sectional descriptive design was adopted among undergraduate nursing students (n=178) using self-reported questionnaires.

RESULTS

Findings revealed that a majority (68.5%) of the students inquire about their clients' smoking habits and 78.1% of them advise patients who are smokers about the health effects of smoking. Although student nurses hold positive attitudes in the enthusiasm domain (28.8 ± 7.29), the majority of them lack self-efficacy towards smoking cessation support (14.2 ± 4.70). 'Patient's lack of motivation' (89.3%), 'lack of training/knowledge' (88.2%) and 'lack of communication skills' (77.5%) were the major barriers encountered by the participants during tobacco counselling.

CONCLUSION

The findings suggest that there is an urgent need to include a tobacco-control curriculum at undergraduate level to improve their competency in giving smoking cessation support.

Impact of a smoking cessation educational program on nurses' interventions

PURPOSE

To evaluate a brief educational program about smoking cessation on the frequency of nurses' interventions with smokers, and impact of nurses' smoking status on outcomes.

DESIGN

Prospective, single group design with prestudy and 3 months post-study data.

METHODS

Nurses in the Czech Republic attended hospital-based 1-hr educational programs about helping smokers quit. They completed surveys about the frequency (i.e., always, usually, sometimes, rarely, never) of their smoking cessation interventions with patients using the five A's framework (i.e., ask, advise, assess, assist, arrange), and their attitudes prior to and 3 months after the course. Demographic data included smoking status.

FINDINGS

Among the 98 nurses with prestudy and post-study data, all were female, mean age was 43 years, 33% were current smokers, and 64% worked in a medical or surgical or oncology settings. At 3 months, compared to baseline, significantly (p < .05) more nurses assessed patients' interest in quitting, assisted with quit attempts, and recommended the use of the quitline for cessation. At 3 months after the program, nurses who smoked were less likely to ask about smoking status (odds ratio [OR] = 4.24, 95% confidence interval [CI; 1.71, 10.53]), advise smokers to quit (OR = 3.03, 95% CI [1.24,7.45]), and refer patients to a quitline (OR = 2.92, 95% CI [0.99, 8.63]) compared to nonsmokers, despite no differences in delivery of interventions at baseline.

CONCLUSIONS

Three months after attendance at an educational program focused on the nurses' role in supporting smoking cessation efforts, more nurses engaged in interventions to help smokers quit. However, the program was less effective for nurses who smoked.

CLINICAL RELEVANCE

This program demonstrated promise in building capacity among Czech nurses to assist with smoking cessation, but nurses' smoking poses a challenge.

Knowledge, attitudes and beliefs about tobacco use after an educative intervention in health sciences' students

PURPOSE

To examine the effectiveness of a tobacco control course on the improvement of knowledge, attitudes and beliefs about smoking among health sciences' students.

METHODS

This was a quasi-experimental study of community intervention carried out during the years 2005-2008, at 2 university health science centres in northwest Spain. A total of 290 students on the intervention and 256 on the control campus took part in the study. The intervention consisted of a course on the prevention and control of tobacco use offered only on the intervention campus. Data were collected before the intervention and 6 months afterwards.

RESULTS

After the course, significant differences between groups were observed in the improvement of knowledge, attitudes and perceived ability to act in tobacco control.

CONCLUSIONS

The introduction of training concerning smoking through active methodologies had a positive impact on the knowledge, attitudes and beliefs about tobacco of students.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

Smoking health professional student: an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Tobacco use, exposure to secondhand smoke, and cessation counseling among health professions students: greek data from the global health professions student Survey (GHPSS)

We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students' smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients' smoking habits.

How healthy are our nurses? New and registered nurses compared

This study examined the health behaviour of nursing staff, comparing registered and pre-registered nurses in terms of their self-reported health and lifestyle behaviour. In total, 325 pre-registered nurses and 551 registered nurses, based at the same university teaching hospital and located within an acute NHS trust, completed a self-administered health and lifestyle questionnaire survey. With the exception of smoking behaviour, registered nurses generally had a healthier lifestyle compared with pre-registered nurses. However, when examining the overall health profile of the sample, the study reveals that there is room for improvement in the health and lifestyle behaviour exhibited by both registered and pre-registered nurses. Almost half of the sample failed to meet public health recommendations for levels of physical activity, almost two-thirds did not consume five portions of fruit or vegetables daily and almost half ate foods that were high in fat and sugar content on a daily basis. These findings are alarming given the current government emphasis on the health of NHS staff and the important role that nurses play in influencing lifestyle choices among their patients. There is an urgent need to target education and support services to improve the diet and exercise habits of nursing professionals.

Nursing education and beliefs towards tobacco cessation and control: a cross- sectional national survey (GHPSS) among nursing students in Greece

BACKGROUND

Within the healthcare system, nurses have the ability to influence their patients' smoking habits through counselling. Therefore, it is of great importance to appropriately train health professionals on smoking cessation strategies with the aim to help them provide advice to their patients. In light of the above, the objective of this study was to assess the association between Greek nursing students' beliefs towards tobacco control/smoking cessation and the professional training received.

METHODS

During February 2009, we conducted a cross sectional national survey among all 3rd year nursing students of the two university based nursing departments in Greece (University of Athens, University of the Peloponnese). The Global Health Professional Student Survey (GHPSS) questionnaire was applied and following written informed consent 73% provided a completed questionnaire (n = 192/263 enrolled students).

RESULTS

Overall, 33% were current active smokers, while 74% reported ever to experiment smoking. In regards to their beliefs towards tobacco control policies, non smokers were more positive in regards to banning smoking in restaurants (94% vs. 61%, p < 0.001), in bars and cafes (82% vs. 34%, p < 0.001), and all public places (93% vs. 51%, p < 0.001) when compared to current smokers. In comparison with students who had not received training on the importance of asking patients about their smoking habits, those that did were more likely to believe that nurses should have a role in smoking cessation and should act as role models for their patients.

CONCLUSIONS

Resources should be invested in improving the quality of undergraduate education in nursing departments in Greece with respect to tobacco control and smoking cessation.

Tobacco use, exposure to secondhand smoke, and training on cessation counseling among nursing students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2009

The Nursing Global Health Professions Student Survey (GHPSS) has been conducted in schools in 39 countries and the Gaza Strip/West Bank (identified as “sites” for the remainder of this paper). In half the sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 22 sites. Over 60% of students reported having been exposed to secondhand smoke in public places in 23 of 39 sites. The majority of students recognized that they are role models in society, believed they should receive training on counseling patients to quit using tobacco, but few reported receiving any formal training. Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train health professionals in effective cessation-counseling techniques.