Karen Chalmers

Smoking behavior and patient education practices of oncology nurses in six countries

Worldwide, tobacco is the leading cause of preventable death, resulting in approximately 5 million deaths annually. Nurses are keenly positioned to work toward reducing tobacco-related illness and deaths. Therefore, guided by the health belief model, the purpose of this study was to explore the smoking behavior, beliefs, smoking cessation education practices, and existing smoking policies at the institutions of a sample of practicing oncology nurses in Canada, Japan, Korea, Taiwan, United Kingdom, and the United States. A 27-item structured survey, designed for this study in English and translated and reverse translated by the Asian countries, was distributed to a convenience sample of nurses attending oncology meetings in each country. Totally 759 surveys were completed and analyzed using descriptive statistics. Principle findings indicate that 4.5% of these nurses currently smoke, although 23.3% reported smoking previously. While many nurses (74%) reported frequently assessing the smoking status of patients, only 50% reported discussing cessation with their patients that smoke. Although the majority (80%) reported feeling comfortable with asking their patients about smoking, only 23% felt it was the nurses role. The findings indicate that while internationally oncology nurses recognize the importance of smoking cessation, significant room for improvement exists in translating this into practice.

Public health nurses' decision making in Canada, Finland, Norway, and the United States

The purpose of this study was to describe the decision-making processes of 369 public health nurses in Canada, Finland, Norway, and the United States, and to discuss any differences observed among these countries. The results indicate that public health nurses used different decision-making models on the job and that these models varied considerably. Five different decision-making models were identified, each exhibiting features of different decision-making theories. The differences between decision making of public health nurses in different countries were statistically significant. The differencies in decision making appear to be due to differences in health care systems in the 4 countries and the nature of the nursing task and context.

The Changing Environment of Community Health Practice and Education: Perceptions of Staff Nurses, Administrators, and Educators

Historically, baccalaureate nursing programs in Canada have prepared graduates to practice in the community. Two recent trends-the move to prepare all registered nurses in degree programs and the changing climate in which community nursing is practiced-made it timely to explore the educational preparation required for community health practice. This article reports on one part of the study, i.e., on findings that explicate the nature of community health nursing practice in a western Canadian province, as it has changed during the past decade, as it is currently practiced, and as it is expected to develop in the future. What, in other words, is the nature of the community practice for which nursing students should be prepared? An action research design guided the study. Participants were recruited from all major urban, rural, and northern settings in which baccalaureate nurses practice throughout the province. The perspective of relevant people was considered important, i.e., nurses practicing in the community, administrators, and educators of future community nurses. One hundred eighteen (118) participants were interviewed in 27 focus groups. Data were tape recorded, transcribed, and analyzed for content. Among the themes identified were those that captured changes community health nurses experienced in their nursing practice. Nurses also described how they thought practice would evolve in the years to come. These themes are discussed within a primary health care framework in which nurses can be expected to play a more active role in shaping community health nursing practice.

Patient experiences of nurse-led telephone follow-up following treatment for colorectal cancer.

PURPOSE Colorectal cancer is the third most prevalent cancer worldwide, although mortality rates across most of Europe have decreased in recent years. Historically, patients are asked to return to hospital outpatient clinics following treatment to monitor for disease progression. However, new approaches are being called for that focus on meeting the information and support needs of patients. Telephone follow-up (TFU) by specialist nurses is an alternative approach; this study aimed to explore patient views of TFU. METHODS Qualitative interviews were conducted with 26 colorectal cancer patients who had received TFU. One interview was also conducted with the specialist nurse who had used a structured intervention to provide TFU. Data were analysed using content analysis. RESULTS All patients found TFU to be a positive experience and all stated a preference for continuing with TFU. Three main themes emerged from the patient interviews; 1) accessible and convenient care, 2) personalised care, and 3) relationship with the specialist nurse. The themes from the specialist nurse interview were 1) knowing the patient, 2) the benefits of TFU and 3) the challenges of TFU. CONCLUSIONS TFU was well received by patients; it was perceived as highly convenient and had distinct advantages over hospital follow-up. Continuity of care was an important factor in building a trusting relationship between patient and nurse. Training in the use of the intervention is recommended and it may be useful for specialist nurses to initially meet eligible patients face to face to establish rapport before implementing TFU.

Specialist community nurses: a critical analysis of their role in the management of long-term conditions.

The aim of this narrative review is to identify strategies in use by specialist community and public health nurses in the prevention, care and management of individuals with long-term conditions, specifically chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders. These conditions have been selected as they are highly prevalent; a burden on health services globally and a major public health issue. From a UK policy perspective, specialist community nurses have been placed at the forefront of taking a lead role in the coordination and delivery of more responsive services for individuals with long-term conditions; whether this has been an effective use of skills and resource is questionable. We systematically searched relevant databases between 1999–2009 to identify interventions used by specialist community nurses and critically appraised the studies. This review reports on impact and value of interventions used by specialist community nurses in the prevention and management of COPD and musculoskeletal conditions, and makes recommendations for improving services.

Issues related to delivering an early childhood home-visiting program.

PurposeTo describe the issues related to delivering an early childhood home visiting program, BabyFirst, from the perspective of public health nurses and lay home visitors (paraprofessionals). Study Design and MethodsThis descriptive, qualitative interpretive study had a sample of 24 public health nurses and 14 lay home visitors. One in-depth, semi-structured, audio-taped interview was conducted with each participant. Transcribed data were analyzed using content analysis techniques. ResultsPublic health nurses and lay home visitors identified several issues associated specifically with the use of lay home visitors and more broadly with the delivery of the BabyFirst program. These are discussed in the following categories: issues related to (a) the lay home visitors, (b) the BabyFirst families, and (c) the general administration of the program. Clinical ImplicationsFindings from this study provide information about the issues related to providing home-visiting services delivered by lay home visitors that can be applied to policy and practice development. The findings suggest that in addition to careful selection of prospective applicants, considerable resources should be provided in preparing public health nurses and home visitors for their respective roles. The concerns identified by nurses and home visitors suggest the need to target the following three areas: (a) training and retention of nurses and home visitors, (b) program delivery, and (c) enrollment of families. Attention to the issues discussed in this article has implications for improving the BabyFirst home-visiting program and other similar early childhood programs.

Nursing interventions for health promotion.

Selected nursing interventions for health promotion in well individuals are described. Over a two-year period, two clinical nurse specialists developed and used client record keeping, role playing, audio and video feedback, imagery, visual mapping and experimentation as health promotion interventions. Clinical examples and client outcomes are discussed. Health promoting interventions are clearly distinguished from disease prevention approaches as described in the literature.

Commentary: Intensive behavioural counselling interventions are effective for smoking cessation in patients admitted to hospital

N Rigotti Correspondence to: Professor N Rigotti, Massachusetts General Hospital, Boston, MA, USA; nrigotti@partners.org What is the effectiveness of various interventions for smoking cessation in patients admitted to hospital? ### Data sources: Medline, EMBASE/Excerpta Medica, PsycINFO, Cochrane Tobacco Addiction Group register (all to January 2007); CENTRAL (Issue 4, 2006); CINAHL (to August 2006); conference abstracts; bibliographies of relevant studies; and experts. ### Study selection and assessment: randomised controlled trials (RCTs) or quasi-RCTs comparing any behavioural, pharmacological, or multicomponent intervention (started in hospital) with control (included brief advice or usual care) for smoking cessation in patients admitted to hospital, who were current smokers, had quit >1 month before admission, or planned to quit after discharge. Studies of secondary prevention or cardiac rehabilitation in patients who were not …