Hazel Watson

A study of minimal interventions for problem drinkers in acute care settings

This article reports an investigation of three minimal interventions for potential problem drinkers in general hospital wards. The interventions were: (a) brief advice; (b) the provision of health education literature; (c) a combination of both the advice and literature. One year after recruitment the mean levels of alcohol consumption and the number of alcohol-related problems reported by the cohort was significantly reduced. These reductions were supported by reductions in the mean levels of GGT and AST, but not in mean MCV. No statistically significant treatment effects were found. The results are presented and implications for nursing are discussed.

Breaking the habit: a qualitative exploration of barriers and facilitators to smoking cessation in people with enduring mental health problems

BackgroundSmoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group.MethodsFollowing a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54).ResultsThere was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals’ own smoking status also appeared to influence their health promoting role.ConclusionsMany opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.

Developing and evaluating training for community pharmacists to deliver interventions on alcohol issues

Objective To evaluate community pharmacists’ readiness to provide brief interventions on alcohol and to use study findings to develop training to enable them to screen for hazardous or harmful drinking and intervene appropriately. Setting Community pharmacies in Scotland. Method Eight community pharmacies in Greater Glasgow, Scotland were purposively selected on the basis of pharmacy (independent, multiple), population deprivation index, location (rural, urban, suburban), and local level of hospital admissions for alcohol misuse. Baseline pharmacist telephone interviews covered: current practice; attitudes towards a proactive role; and perceived training needs. A two-day course was designed focusing on: consequences of problem alcohol use; attitudes; sensible drinking; familiarity with client screening using the Fast Alcohol Screening Tool; brief interventions and motivational interviewing. Main Outcome Measures Knowledge of problem alcohol use and brief interventions; attitudes; competence. Results Participants felt it was feasible for trained pharmacists to provide brief interventions. Core training needs centred on communication and alcohol related knowledge. The training course was positively evaluated and led to increases in knowledge, attitudinal scores and self related competence. Conclusion A training programme for pharmacists to deliver brief interventions to problem drinkers was successfully delivered resulting in enhanced knowledge, attitudinal scores and self related competence.

Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies

Objective The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention.

An exploration of the knowledge, attitudes and practice of members of the primary care team in relation to smoking and smoking cessation in later life

Smokers aged 65 and over have been identified as a priority group for smoking-cessation interventions. However, despite confirmation of the benefits of cessation in later life and compelling evidence that interventions can be effective, studies have shown that members of the primary care team often fail to target this population. If these professionals are to be encouraged to broach the subject of smoking cessation with older people, it is important that barriers to the effective provision of interventions are uncovered. This article reports findings from a qualitative study that sought to do this by exploring the knowledge, attitudes and practice of members of the primary care team in relation to smoking/smoking cessation in later life. A purposive sample of health visitors, district nurses, practice nurses and general practitioners ( n = 41) working in the west of Scotland was recruited. Data were collected during face-to-face interviews using a semi-structured interview schedule. The interviews were transcribed and then analysed using content analysis procedures. While the participants were generally convinced of the benefits of cessation many believed that few older people manage to stop smoking successfully. A pessimistic view of the success rate of older smokers appeared to negatively influence practice. In addition, a number of the participants lacked confidence in their own counselling skills and/or had limited awareness of smoking cessation resources and specialist services. These factors also appeared to preclude the provision of effective smoking-cessation interventions. Finally, there was little awareness of the content of the UK Smoking Cessation Guidelines. The findings from this study, and a parallel study that explored the health beliefs of older smokers, have been used to develop smoking cessation training designed specifically for members of the primary care team who have contact with older people who smoke. The efficacy of the training is currently being evaluated.

Minimal Interventions for Problem Drinkers

Asking patient/clients how much alcohol they drink is the easiest way of determining risk.Minimal interventions for problem drinkers are brief treatments, such as the provision of advice or health education literature about sensible drinking and health risks associated with heavy drinking. Evidence suggests that they can be delivered by non-specialist health care workers and are less intensive than traditional methods of treatment. This article describes such interventions and provides information about how potential drinkers can be identified and treated in a variety of health care settings.

Screening and brief intervention delivery in the workplace to reduce alcohol-related harm: A pilot randomized controlled trial

AIM To explore the feasibility and cost effectiveness of screening and delivery of a brief intervention for hazardous drinking employees. METHODS A pilot randomised controlled trial of a brief intervention delivered by an Occupational Health nurse versus no delivery of brief intervention (control group) conducted in a Local Authority Council (LCA) in the United Kingdom. Changes in quality of life and economic indicators were measured by the EQ-5D. RESULTS 627 employees were screened of whom 163 (26.01%) fulfilled the inclusion criteria with a total of 57 (35%) agreeing to participate. No significant differences were found between the groups for baseline demographics or levels/patterns of alcohol consumption. A statistically significant effect was found in the mean AUDIT scores over time (F=8.96, p=0.004) but not for group (F=0.017, p=0.896), and no significant interaction was found (F=0.148, p=0.702). The cost of each intervention was calculated at £12.48, the difference in service costs was calculated at £344.50 per person; that is there was a net saving of health and other care costs in the intervention group compared to the control group. The QALYs fell in both intervention and control groups, the difference -0.002-(-0.010) yields a net advantage of the intervention of 0.008 QALYs. CONCLUSION The main results from this pilot study suggest that alcohol brief interventions delivered in the workplace may offer the potential to reduce alcohol-related harm and save public sector resources. A fully powered multi-centre trial is warranted to contribute to the current evidence base and explore further the potential of alcohol brief interventions in the workplace. In a full trial the recruitment method may need to be re-considered.

Necesidades psicosociales de los cuidadores informales de las personas con esquizofrenia: exploración del rol del profesional de enfermería

Resumen Introduccion En Espana y el Reino Unido mas del 80% de las personas con esquizofrenia vive a cargo de cuidadores informales, y todos son vulnerables al estres cronico que, si no es valorado, podria desembocar en algun trastorno El articulo pretende contribuir a la exploracion del rol profesional de enfermeria con el referido grupo de cuidadores y responder a la pregunta: –en que medida la vision de los profesionales sobre su rol afecta a la atencion del cuidador? Diseno del estudio Cualitativo, enmarcado en la teoria fundamentada; se analiza 4 entrevistas Conclusiones Los participantes ven a los cuidadores como colaboradores y como un recurso para atender al paciente, no como potenciales clientes. Sin embargo, se encuentran en un proceso de cambio en sus actitudes desde un enfoque centrado en el paciente y su patologia hacia otro que tendria en cuenta las necesidades del cuidador y su estado de salud. Para corroborar y profundizar en lo expuesto deben recogerse mas datos

How do we increase problem drinkers' self‐efficacy? A nurse‐led brief intervention putting theory into practice

Aims: The work undertaken aimed to develop an alcohol‐related brief intervention based on the theoretical concepts of the self‐efficacy construct. The brief intervention was to be administered by general nurses in a general hospital setting for patients who were identified as potential problem drinkers. Background: Alcohol‐related brief interventions use methods such as booklets, verbal advice, counselling and behaviour change techniques in an attempt to change alcohol consumption behaviour with the aim of reducing levels of alcohol consumption. Miller and Sanchez () identified self‐efficacy as one of six elements typically included in brief interventions. Nurses have been identified as being in a prime position to administer interventions (Arthur, ). This work provides essential information relating to the specific content of interventions and the processes involved for nurses to fulfil this role. Methods: The intervention was developed following a review of existing related literature. Findings: Using the theoretical concepts of the self‐efficacy construct a single session nurse administered minimal intervention was developed. The brief intervention comprised of nine stages. Discussion: The development of a nurse‐administered intervention with a sound theoretical basis demonstrates the ability to link theory to practice. The intervention was implemented within a general hospital setting following identification of potential problem drinkers.

Screening for hazardous/harmful alcohol consumption amongst general hospital in-patients: establishing concurrent validity of the Alcohol Use Disorders Identification Test in the UK

Aim The study aimed to establish the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for use in the identification of potential problem drinkers amongst general hospital in-patients in the UK. Design Survey/correlational. Setting General medical, surgical, otolaryngology and dermatology wards of a general hospital. Participants One hundred and eighty-three male and thirty-two female, general hospital in-patients aged between 18 and 75 years. Measurements Self-reports of weekly alcohol consumption (WAC), AUDIT, and Short Alcohol Dependence Data (SADD) questionnaire. Findings Correlations were computed using Spearmans rank correlation coefficient. The linear relationship between the scores obtained from the AUDIT and SADD indicated a good concurrent validity (r = 0.87, P < 0.001). The correlations between the AUDIT and WAC also suggested a significant correlation (r = 0.76, P < 0.001). Conclusions The data presented in this study can be interpreted as important in supporting evidence for the concurrent validity of the AUDIT in the UK, for the given setting and subjects described. The efficacy of the AUDIT as a screening instrument within the UK amongst both similar and diverse samples and settings merits future research.