Patricia M. Smith

Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs

BACKGROUNDSmoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups, while inpatient cessation programs have not been widely implemented.OBJECTIVEThe objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA.METHODSThis is a pre-/post-non-randomized control study initially designed to teach inpatient staff nurses on general medical units in the Ann Arbor and Detroit VAs to deliver the Tobacco Tactics intervention using Indianapolis as a control group. Coupled with cessation medication sign-off, physicians are reminded to give patients brief advice to quit.RESULTSApproximately 96% (210/219) of inpatient nurses in the Ann Arbor, MI site and 57% (159/279) in the Detroit, MI site have been trained, with an additional 282 non-targeted personnel spontaneously attending. Nurses’ self-reported administration of cessation services increased from 57% pre-training to 86% post-training (p = 0.0002). Physician advice to quit smoking ranged between 73–85% in both the pre-intervention and post-intervention period in both the experimental and control group. Volunteers made follow-up telephone calls to 85% (n = 230) of participants in the Ann Arbor site. Hospitalized smokers (N = 294) in the intervention group are reporting an increase in receiving and satisfaction with the selected cessation services following implementation of the program, particularly in regards to medications (p < 0.05).CONCLUSIONA large proportion of inpatient nursing staff can rapidly be trained to deliver tobacco cessation interventions to inpatients resulting in increased provision of services.

National survey of clinical placement settings across Canada for nursing and other healthcare professions—who's using what?

BACKGROUND The types of pre-licensure clinical placements being used and by what health professions are becoming an important and pressing issue as concerns about clinical placement shortages and competition for placements increase. OBJECTIVE This study was designed to address a gap in the literature by quantifying the range and specific types of pre-licensure clinical placements being used by nursing and other health professions. METHOD This was a Canadian national online cross-sectional survey designed to create an inventory of the types of hospital, community, long-term care, and innovative settings being used for pre-licensure clinical placements by schools of nursing, licensed practical nursing, registered psychiatric nursing, midwifery, occupational therapy, physiotherapy, and medicine. RESULTS The response rate was 70% (113/162). There was no difference in nursing vs. other professions in the general types of placements used-hospitals (97%), community (93%), and long-term care (93%), or travel out of the academic community for placements (85%) which was primarily intra-provincial and rural. Medical and surgical inpatient units were the specific types of placements most commonly used by all respondents (93%). The significant differences included more nursing schools using inpatient maternal/child (p<0.001), mental health (p=0.006), and pediatric (p=0.006), and community public health (p<0.001), and more other healthcare professions using hospital outpatient orthopedic (p=0.002) and research placements (p=0.001). The innovative placements reported by respondents were all community-based and quite diverse (e.g., summer camps, businesses, etc.). CONCLUSIONS This inventory of pre-licensure clinical placements fills a gap in the literature and revealed a broad and diverse range of settings being used by nursing and other healthcare professions, especially in the community. The diversity raises questions as to whether the organization of clinical education in the past is the best way to meet the needs of tomorrows healthcare providers, yet it also offers new possibilities for re-contextualizing pre-licensure clinical education.

A review of the evidence for the maximization of clinical placement opportunities through interprofessional collaboration

Interprofessional collaboration has been suggested as a potential solution to clinical placement shortages. This review was designed to compile the evidence on the use of interprofessional and nursing intraprofessional collaboration to maximize clinical placement opportunities for undergraduate/pre-licensure health professional students. A worldwide search of the published and grey literature was conducted, supplemented by 28 interviews across Canada. Results revealed only two articles, both in nursing – one that described an intraprofessional nursing collaboration consisting of a clinical placement consortium for finding placements, and one that described a unique program that provided a seamless transition from a practice nurse program to associate degree nursing program and that included collaboration with clinical placements. The interviews revealed various types of collaborations designed to maximize placements and various mechanisms by which these collaborations served to maximize placements including easing the pressure to find preceptors and increasing the number of placements. The authors concluded that while collaborations exist specifically to maximize placements, at least in Canada, it was neither happening within the context of research nor being formally evaluated. More evaluation is needed in order to clarify the evidence by which collaboration works or does not work to maximize placement opportunities.

Abuse and smoking cessation in clinical practice

AIMS AND OBJECTIVES This discursive paper explores issues of abuse during smoking cessation counselling. BACKGROUND During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. METHODS A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. RESULTS There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress-management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patients decision whether to continue with cessation counselling. CONCLUSION Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. RELEVANCE TO CLINICAL PRACTICE This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention.

Effectiveness of the Tobacco Tactics Program for Psychiatric Inpatient Veterans: An Implementation Study

BACKGROUND The objective of this study was to evaluate the effectiveness of the inpatient, nurse-administered Tobacco Tactics program for patients admitted for psychiatric conditions in two Veterans Affairs (VA) hospitals compared to a control hospital. METHODS This is a subgroup analysis of data from the inpatient tobacco tactics effectiveness trial, which was a longitudinal, pre- post-nonrandomized comparison design with 6-month follow-up in the three large Veterans Integrated Service Networks (VISN) 11 hospitals. RESULTS Six-month self-reported quit rates for patients admitted for psychiatric conditions increased from 3.5% pre-intervention to 10.2% post-intervention compared to a decrease in self-reported quit rates in the control hospital (12% pre-intervention to 1.6% post-intervention). There was significant improvement in self-reported quit rates for the pre- versus post-intervention time periods in the Detroit and Ann Arbor intervention sites compared to the Indianapolis control site (P=0.01) and cotinine results were in the same direction. CONCLUSION The implementation of the Tobacco Tactics intervention has the potential to significantly decrease smoking and smoking-related morbidity and mortality among smokers admitted to VA hospitals for psychiatric disorders.

It’s Not That Simple: Tobacco Use Identification and Documentation in Acute Care

This environmental telephone interview scan was designed to identify: (1) how hospitals in one Canadian province incorporated tobacco use identification/documentation systems into practice; and, (2) challenges/issues with tobacco identification/documentation. Participants included 36/139 hospitals previously identified to offer cessation services. Results showed hospitals aided by researchers monitored and tracked tobacco use; those not aligned with researchers did not. The wording of tobacco items most commonly included use within the last 6-months (42%), 30-days (39%), or 7-days (33%), or use without reference to time (e.g., “Do you smoke?”; 39%); wording sometimes depended on admitting form space limitations. The admission process determined where the tobacco item appeared, which differed by hospital—75% included it on an admitting form (75%) and/or nursing assessment (56%); the item sometimes varied by unit. There were also different processes by which the item triggered delivery of cessation interventions; most frequently (69%), staff nurses were triggered to provide an intervention. The findings suggest that adding a tobacco use question to a hospital’s admitting process is potentially not that simple. Deciding on the purpose of the question, when it will be asked and by whom, space allotted on the form, and how it will trigger an intervention are important considerations that can affect the question wording, form/location, systems required, data extraction, and resources.

Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review

Introduction The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. Aims and Methods A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Results Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. Conclusions This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. Implications This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).