Evaluating the effectiveness of the coronary care nurses' role in smoking cessation

The balancing act: patient care time versus cost

BACKGROUND

With demands to improve patients' clinical outcomes and decrease the escalating costs of inpatient care, nurse executives are focusing on how nurses spend their time rather than just raising staffing levels to positively impact patient outcomes. Because nursing wages constitute a high proportion of a hospital's budget, understanding the costs of nursing activities is critical to managing them.

METHODS

An activity-based costing approach was used in 14 medical-surgical nursing units to study nursing activities and their related costs. Time use for 4 patient care activities (assess, teach, treat, provide psychosocial support) and 2 support activities (coordinate care and manage clinical records) including the percent of non-value-added (NVA) time for each of these activities was identified through focus groups, interviews, and timed observations. Annualized wage costs were assigned to these activities to determine average wage-related costs of each activity as well as NVA-related costs.

RESULTS

More than one-third of nurses' time was considered NVA, averaging dollars 757,000 per nursing unit in wage costs annually. Nurses spent more time on support activities (56%) than in providing patient care (44%), with the least amount of time being spent on patient teaching and psychosocial support.

CONCLUSION

Findings indicate a huge opportunity to both improve clinical outcomes in these units and, at the same time, reduce costs by focusing on processes to reduce the high amount time spent performing NVA and support activities and increase patient care time, particularly patient teaching and psychosocial support.

Promoting smoking cessation in adults

There is a wealth of opportunities for nurses to facilitate smoking cessation with their patients. Nurses have shown to have a modest but positive effect on cessation rates when they deliver brief or intensive counseling. Because nurses work in a multitude of clinical settings, they can impact both prevention and treatment of nicotine addiction associated with cigarette use. More nurses need to be educated about their role in reducing the morbidity and mortality of tobacco-related diseases.

Gender differences and fears in patients awaiting coronary artery bypass grafting

The study aimed at ascertaining the gender differences and fears among patients awaiting coronary artery bypass grafting. Data were collected using a mailed questionnaire from patients (n=207) scheduled for coronary artery bypass grafting at one hospital. Intensity of fear was measured on a 10-point scale including 12 objects of fear. The results showed that demographic data, lifestyle and functional capacity differed between the sexes. Patients' fears differed with respect to their objects and intensity, with women reporting more intense fears. Men also had fears, but the objects of fear differed from those in women. Apart from gender, the intensity of fear was associated with physical exercise, emotional problems and depression. Nursing interventions could be developed to meet the different needs for information and support, especially among women but also among men, to relieve their fears during the wait for coronary artery bypass grafting.

Developing realistic treatment standards in today's economic climate: stroke survivor education

Teaching people about the risk factors and early symptom identification of stroke significantly decreases the incidence of both first time and recurrent strokes. Patient teaching has traditionally been a nursing responsibility. However, in the fiscal constraints of today's health care delivery system, nurses' time for teaching is highly restricted. This pilot study was designed to evaluate the impact of a short 1(1/2) hour stroke education programme in a population of hospitalized stroke survivors prior to their discharge. The first session focused on the disease process of stroke and its warning signs. A second session addressed risk factors and behavioural strategies for exercise, stress management, or smoking cessation. Responses to the teaching programme were evaluated through patient interviews immediately following the teaching session and 3 weeks later. Responses indicated that short-session patient teaching, in and of itself, is not always successful in changing behaviour but is successful for knowledge attainment. The findings from this pilot study suggests a need to consider new teaching strategies and a need to identify opportunities for reinforcement, support and encouragement that will meet the realities of today's time constraints while still meeting our professional responsibilities for patient education.

Smoking habits among Finnish middle-aged men: experiences and attitudes

The purpose of this study was to explain smoking habits amongst middle-aged men in Finland by describing their experiences of smoking and their attitudes towards smoking. As a pilot survey for a major health campaign targeted at 40-year-old men, the data for this study were collected using two questionnaires in connection with voluntary medical examinations. The first questionnaire was based on Prochaska's theory of stages of change in health behaviour. The second instrument was an attitude scale developed specifically for this study on the basis of Green and Kreuter's theory of factors influencing health behaviour. According to the results 31% of males aged 40 were regular smokers. Men with a lower level of education and out of work smoked more often than others. Non-smokers reported a better self-perceived health than smokers. Smoking cessation is a process in which men gradually proceed from one step to the next. In this study 12% of the men were in the contemplation stage and 11% in the preparation stage. One-quarter of the men had recently given up the habit and were in the action stage, while 2% had quit smoking over 6 months ago and were in the maintenance stage. One-quarter of the men regarded smoking as an integral part of their way of life and felt that public opinion towards smoking is hostile.

Community nurses and health promotion: ethical and political perspectives

This paper brings together ideas from two perspectives on ethics and health promotion. A discussion of the ethical dimension of the health promotion practice of community nurses is set in the wider context of health policy, with particular reference to health gain and individual responsibility. It is widely held that nurses have a key role to play in health promotion and that this is particularly the case for nurses working in primary health care. This assumption is reinforced by policy documents from the World Health Organization, the Department of Health and statutory bodies such as the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The approach of many nurses to health promotion has tended on the one hand to be somewhat naive and on the other to be authoritarian and didactic; there has been little discussion in the nursing literature of the ethical aspects of health promotion. However, recent developments in nurse education, such as Project 2000 and the consequent changes to preregistration programmes, have resulted in increased attention to both ethics and health promotion within the curriculum.