Nurses' opportunistic interventions with patients in relation to smoking

Health education for hospitalized patient in nursing care: a conceptual analysis

OBJECTIVES

to define the concept of Health Education of Hospitalized Patient.

METHODS

the study used the conceptual analysis based on Walker and Avant strategies: Derivation, Synthesis, and Analysis of the concept. Researchers conducted 35 interviews with nurses who worked in direct care to patients admitted to a Hospital-School, and a bibliographic search on the CINAHL, Medline/PubMed®, Scopus, Web of Science, LILACS, and BDENF databases.

RESULTS

the study identified the antecedents, attributes, and consequences of the concept and defined the concept of Health Education of Hospitalized Patient as "the action of sharing knowledge about the promotion, prevention, recovery and rehabilitation concerning to health based on reciprocity between nurses and patients, family members and companions, in a systematized or unsystematic way".

FINAL CONSIDERATIONS

the identification of antecedents, attributes, consequences, and empirical references enabled the theoretical definition unprecedented of this concept and its applicability in practice, contributing to science and hospital nursing care.

Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings

Background: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting.

Methods: A systematic literature search was conducted specific to hospital-based healthcare workers’ perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework.

Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequently.

Conclusion: Healthcare workers report a plethora of barriers to providing smoking cessation interventions in hospital settings, which cover all aspects of the COM-B framework. These impediments need to be addressed in a multidisciplinary approach, at clinical, educational, and administrative levels, to improve intervention provision.

Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?

INTRODUCTION AND AIMS

Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice.

DESIGN AND METHODS

Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered.

RESULTS

Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later.

DISCUSSION AND CONCLUSIONS

Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120].

Nursing interventions for smoking cessation in hospitalized patients: a systematic review

AIM

This study aimed to clarify the role of nurses in planning and implementation of nursing interventions related to smoking cessation.

BACKGROUND AND INTRODUCTION

Nearly half of all smokers die from smoking-related illnesses. Quitting smoking can reduce these problems. Smoking cessation interventions include various types helping smokers successfully quit. Studies suggest that hospitalization can be a golden opportunity for nurses helping patients to quit smoking because of No Smoking regulations.

METHOD

A systematic review of the literature was carried through Web of Knowledge, ProQuest, Medscape, MedlinePlus, Ovid SID, Magiran, PubMed, and Science Direct databases between 1990-2015 on the subject of interest by keywords: role of nursing in smoking cessation, nursing intervention in smoking cessation, smoking cessation, smoking quitting and interventions planned by nurse.

RESULT

Nineteen papers were systematic examined, dealing with smoking cessation interventions by nurses. Totally, 17 studies used counselling for quitting smoking. Most studies involved other methods such as manuals, pamphlets, brochures training or printed educational materials, audio and video file. Some studies used nicotine replacement methods for patients such as nicotine skin tags, chewing nicotine or bupropion. Moreover, 17 studies were conducted by telephone at patients' follow-up after hospital discharge.

CONCLUSION

Nurses' interventions for smoking cessation play an important role in helping patients quit smoking successfully. There are a variety of interventions that nurses can employ according to the patient's condition and diagnosis of different diseases.

IMPLICATION FOR NURSING AND HEALTH POLICY

Quitting smoking can reduce lung cancers and other health problems. Nurses play an important role in helping patients to quit smoking.

Supporting smoking cessation in older patients: a continuing challenge for community nurses

Tobacco smoking continues to pose negative health consequences for smokers and their families, and is the single greatest cause of health inequalities in the UK. Older people are particularly vulnerable to the negative health impacts of smoking and therefore, supporting older smokers to quit remains an important public health goal. Community nurses are required to help patients to lead healthier lifestyles and have ideal opportunities to encourage smoking cessation in older people who are affected by smoking-related health conditions, or whose existing conditions may be exacerbated by continued smoking. This paper discusses how community nurses can support their older patients to quit smoking by fostering a patient-centred partnership through good communication and empathy. The newly developed 'Very Brief Advice on Smoking' (VBA) interventions can provide a useful tool for community nurses who experience time constraints to advise older people that psychosocial support with treatment is the most effective method of smoking cessation, while respecting the health decisions of patients.

Faculty-perceived barriers and benefits to teaching tobacco cessation

AIM

The study explored nurse faculty beliefs regarding patient tobacco use and the promotion of patient tobacco cessation.The second aim explored perceived barriers and benefits in teaching baccalaureate students about patient tobacco use and cessation.

BACKGROUND

Nurse faculty have a role in ensuring that graduates entering the nursing profession are knowledgeable, skillful, and have the self-efficacy needed to take action regarding patient tobacco use and cessation.

METHOD

Four 90-minute focus group interviews were taped, transcribed, and analyzed.

RESULTS

Two major themes were identified: barriers and opportunities. Barriers included a knowledge deficit about patient tobacco use and cessation, which lagged behind published evidence. Opportunities included perceptions that providing patient tobacco cessation should occur throughout the nursing process during nurse-patient interactions.

CONCLUSION

Nursing faculty development regarding patient tobacco use and cessation needs to occur as well as the development and dissemination of curriculum resources.

Tabagismo em universitários de ciências da saúde: prevalência e conhecimento

OBJETIVO: Determinar a prevalência de tabagismo e o nível de conhecimento acerca do tabagismo entre estudantes universitários da área de saúde. MÉTODOS: Estudo transversal. Um questionário estruturado e autoadministrado foi respondido em sala de aula por universitários do último ano dos cursos da saúde de Cuiabá e Várzea Grande (MT). Foram avaliados alunos de uma universidade pública e de duas universidades particulares. Cinco variáveis foram analisadas: idade, sexo, curso de graduação, status tabágico e noções sobre o tabagismo. A variável "conhecimento" foi dividida em cinco partes: tabagismo como doença; tabagismo e nicotina como causa de dependência; treinamento específico sobre tabagismo; fatores dificultadores da cessação tabágica; e formas de tratamento do tabagismo. Os últimos dois itens somente foram respondidos pelos alunos dos cursos de medicina. RESULTADOS: A prevalência do tabagismo variou de 9,3% na universidade pública a 21,1% em uma das universidades particulares. Aproximadamente 30% dos entrevistados não souberam identificar a nicotina como causadora da dependência, 20,8% não consideravam o tabagismo como doença, e 47,2% responderam não terem recebido nenhum treinamento sobre o tabagismo. Os alunos de medicina da universidade pública mostraram maior conhecimento sobre as diversas formas de tratamento do tabagismo. CONCLUSÕES: A prevalência do tabagismo entre os universitários estudados foi alta. O conhecimento sobre tabagismo foi deficitário, o que poderia refletir uma inadequação da grade curricular dos cursos dessas universidades

Smoking cessation for older people: neither too little nor too late

Community nurses are uniquely placed to facilitate smoking cessation with older people. Older people who smoke in the home expose not only themselves to the many health risks associated with tobacco use but also partners, children and grandchildren through second-hand smoke. Yet research has found that community nurses have several concerns about raising the issue of smoking in the home with older people including taking away one of their few pleasures; fear that the damage is done; damaging the professional relationship and a lack of knowledge about smoking cessation advice and services. In this article the authors acknowledge and challenge these concerns to encourage community nurses to embed smoking cessation in their daily practice with older people.

'It's not worth stopping now': why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study

AIM

This study aims to explore the experience of cigarette smokers with Chronic obstructive pulmonary disease (COPD) who have received smoking cessation support and describe their personal decision-making processes regarding their smoking behaviour.

BACKGROUND

Previous studies have demonstrated poor smoking cessation rates in people with COPD, despite this being the primary intervention for disease management. There is limited research exploring the reasons why this population continues to smoke.

DESIGN

Retrospective qualitative interviews were conducted and analysed using Giorgi's (1985) process of analysis.

METHOD

Following a randomised controlled trial to evaluate national smoking cessation guidelines, semi-structured interviews were conducted with a purposive sample (n = 6) of those patients who were unable to stop smoking.

RESULTS

Six themes that typified patients' decision-making were identified during six interviews; too late to stop now, finding motivation, guilt about continued smoking, bargaining/contemplation, need to stop and reduced quality of life.

CONCLUSION

The reasons why smokers with COPD continue to smoke despite poor health and following support are complex. Cigarettes are regarded as friends, despite the knowledge that they are contributing to severe disability and poor quality of life. Owing to their inability to stop smoking, many patients avoid healthcare opportunities, further contributing to their poor health.

RELEVANCE TO CLINICAL PRACTICE

Smoking cessation is associated with ambivalence in this population. Health professionals need to understand the volatility of patients' decision-making and tailor advice and support to achieve more realistic goals such as reduced consumption.

Scolders, carers or friends: South African midwives' contrasting styles of communication when discussing smoking cessation with pregnant women

OBJECTIVE

to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics.

DESIGN

a qualitative study using individual, in-depth interviews for data collection.

SETTING AND PARTICIPANTS

24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa.

FINDINGS

three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders.

KEY CONCLUSIONS

the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation.

IMPLICATIONS FOR PRACTICE

smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers.

Smoking prevalence among qualified nurses in the Republic of Ireland and their role in smoking cessation

BACKGROUND

Smoking is the leading preventable cause of premature mortality, killing approximately 6000 people in Ireland each year. On 29 March 2004, the Republic of Ireland became the first country in the world to ban smoking in all workplaces, including bars and restaurants. This study took place after the introduction of this smoking ban. An admission to hospital provides an opportunity to help people stop smoking. Nurses' role and wide availability puts them in a prime position to encourage people to quit smoking.

AIM

To examine the smoking prevalence among qualified nurses at a large university teaching hospital in Cork Southern Ireland and their role in smoking cessation.

METHODS

This was a descriptive cross-sectional study using a calculated sample of 430 qualified nurses (with a 70% response rate). A structured questionnaire was used.

FINDINGS

It was found that 21% (n = 63) of nurses were smokers, 23% (n = 70) were ex-smokers and 56% (n = 167) were non-smokers. The highest prevalence of smokers was found in the age groups 20-25 years (28%, n = 17) and 26-30 years (34%, n = 21). Nurses working within psychiatric care (47.4%) and coronary care (33.3%) had the highest smoking prevalence among the nurses who smoked. The study found that there was a significant difference between the attitudes of smokers and non-smokers, 89% (n = 211) of non-smokers strongly agreed that cigarette smoke represents a major risk to health in comparison with only 65% (n = 41) of smokers. Only 14% (n = 43) of the nurses surveyed had received training in smoking cessation. Lack of time (74%) and lack of training (65%) were the two main reasons given by nurses for not giving smoking cessation advice to patients.

CONCLUSION

Nurses' potential in preventive health care has been largely under-utilized. Lack of time and training are major factors inhibiting nurses' role in smoking cessation with their patients.

Qualitative case study methodology in nursing research: an integrative review

AIM

This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research.

BACKGROUND

Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology.

DATA SOURCES

In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria.

METHODS

Whittemore and Knafl's integrative review method guided the analysis.

RESULTS

Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research.

CONCLUSION

Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.