Implementation of a Smoking Cessation Education Program in the Emergency Department

Public health messaging during disasters: A qualitative study of emergency department key informants

BACKGROUND

Patient education is a professional obligation for all nurses. Public health messaging in emergency departments during disasters can help prevent further risk or illness for affected communities. In this study, Australian emergency nurse Key Informants share their perceptions and experiences of preventative messaging provided in their departments during disasters and the governance and processes in place to support this practice.

METHODS

The qualitative phase of a mixed methods study, where semi structured interviews were utilised, and data analysed using a six step Thematic analysis.

RESULTS

Three themes were identified: (1) Part of the Job; (2) It's all in the delivery; and (3) Preparation is the key. These themes include concepts involving the confidence and competence of nurses providing messages, what, when and how messages are being given and how prepared both the department and staff are regarding patient education during disaster events.

CONCLUSIONS

Nurse confidence is a key factor in the delivery of preventative messages during disasters, potentially resulting from a lack of exposure, a junior workforce and minimal training. Leaders agree that departments are not preparing or supporting messaging practice, with an absence of specific training, formal guidelines, and patient education resources; and that improvement is needed.

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.

Public health education by emergency nurses: A scoping review and narrative synthesis

OBJECTIVE

To identify the extent, range, and nature of the evidence on public health education provided by emergency nurses.

METHODS

A scoping review, using the methodological guidance of Joanna Briggs Institute, was conducted to scope and map the literature and research activity. Using predetermined criteria, databases, grey literature, and reference lists were searched for eligible sources. At least two authors reviewed each article. A narrative synthesis methodology was utilised to analyse and report the findings.

RESULTS

There was significant methodological heterogeneity between sources (n = 6). Three themes were identified: 1) Benefits of the system: An opportunity to inform the public, 2) The barriers: Time pressures and being prepared and 3) The strategies: Plan for structured and created teachable moments CONCLUSION: Limited research is being conducted in this area. Further research is needed to understand emergency nurse's practice and attitudes towards providing public health messages.

PRACTICE IMPLICATIONS

Emergency nurses need to utilise the 'teachable moment' for every emergency admission, providing opportunistic preventative education to improve health outcomes and reduce demand on the healthcare system.

Effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of behavior in delivering smoking cessation counseling

INTRODUCTION

Despite the effectiveness of smoking cessation counseling, participation of nurses in delivering smoking cessation advice has been far from satisfactory in practice. Training nurses is considered to be important for increasing self-efficacy and skills for routine delivery of smoking cessation counseling. The aim of the present study was to evaluate the effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of their behavior in delivering smoking cessation counseling, three months later.

METHODS

We ran a 6-hour smoking cessation educational program for nurses recruited from the Nursing Associations of 13 prefectures in Japan between May 2019 and February 2020. Surveys were conducted by questionnaire before the start of the program and 3 months thereafter. The successful implementation of smoking cessation counseling behavior was evaluated according to the 5As of the Clinical Practice Guidelines for Treating Tobacco Use and Dependence (Ask, Advise, Assess, Assist, Arrange).

RESULTS

We received 289 responses 3 months after the program finished (response rate 46.0%). At that time, 43% of participants had increased the frequency of ‘Ask’ and 42.1%, 50%, 39.3%, and 28.6%, respectively, had also increased their frequency of ‘Advise’, ‘Assess’, ‘Assist’, and ‘Arrange’. We found that smoking cessation counseling was significantly more frequently delivered after the educational program for those participants who had routinely delivered ‘Advise’ before the program as measured by increased delivery of ‘Assess’ and ‘Assist’ afterwards (OR=2.39; 95% CI: 1.00–5.69, OR=2.54; 95% CI: 1.16–5.60 and OR=3.68; 95% CI: 1.40–9.65, OR=2.77; 95% CI: 1.10–7.01, respectively).

CONCLUSIONS

The program successfully increased the frequency of nurses providing smoking cessation advice to patients. Readiness to deliver smoking cessation counseling before the program and continuing self-efficacy after the program are important for changing the behavior of nurses in delivering smoking cessation counseling.

Preventing COVID-19 Infection in Mental Health Units: Recommendations for Best Practices

Mental health facilities should be equipped to care for patients while preventing spread of COVID-19. Peer-reviewed literature and guidelines for government and health organizations were reviewed to guide best practices. Gunderson's five therapeutic functions of a milieu are used as a conceptual framework. Patients should be screened for infection according to local or national policy prior to admission to an inpatient mental health unit. While interacting with one another in a therapeutic milieu, patients should be encouraged to practice physical distancing and hand hygiene. Clinicians may need to alter therapeutic groups to prevent COVID-19 infection. Additionally, clinicians should monitor patients for emerging symptoms and conduct rapid testing and isolation of patients suspected of COVID-19. Recommendations are made for patients unable to adhere to physical distancing or hand hygiene policies.

Behavior change counseling training programs for nurses and nursing students: A systematic descriptive review

OBJECTIVES

(1) To systematically review the literature on behavior change counseling (BCC) training programs targeting nurses and nursing students; (2) to characterize these training programs according to their content (i.e., targeted health behavior[s], BCC approaches taught, BCC techniques taught), structure, and modes of delivery.

DESIGN

A systematic, descriptive literature review.

DATA SOURCES

PubMed, CINAHL and Embase were searched with no time limitation in August 2018.

REVIEW METHODS

A systematic, descriptive literature review structured according to Paré et al.'s methodology and the PRISMA guidelines. Primary studies were included if they evaluated a BCC training program with nurses or nursing students. Review authors screened studies, extracted data, and assessed study quality using the MERSQI. Data was synthesized through narrative synthesis, descriptive statistics, and content analysis.

RESULTS

From a pool of 267 articles, we included 25 articles published between 2003 and 2018. Two studies scored as low quality (8%), 18 as moderate quality (72%), and 5 as high quality (20%). Physical activity (n = 14; 56%) and smoking (n = 11; 44%) were the most frequently targeted health behaviors. Eleven BCC approaches were cited (e.g., motivational interviewing), and 48 BCC techniques were identified (e.g., eliciting and scaling change talk). The median number of training sessions was 3 (interquartile range [IQR] 5), the median training program duration was 3 h (IQR 6.25 h), and median training period was 24.5 days (IQR 110 days). Programs were most often delivered as seminars and workshops.

CONCLUSIONS

High-quality studies reporting the assessment of BCC training programs with nurses and nursing students are scarce. There was significant heterogeneity in terms of the BCC approaches and techniques taught. Current evidence suggests nurses and nursing students learn BCC mainly through active, realistic practice. However, computer-based training programs are rapidly gaining ground. Further research emphasizing theory-based BCC training programs is warranted.