Effectiveness of Educational Programs for Clinical Competence in Family Nursing: A Systematic Review.

Evidence shows that applying family nursing theory to practice benefits the patient, the family, and nursing professionals, yet the implementation of family nursing in clinical practice settings is inconsistent and limited. One of the contributing factors may be related to insufficient or inadequate educational programs focused on family nursing. This article presents a systematic review of the research that has examined the effectiveness of family nursing educational programs aimed at promoting clinical competence in family nursing. Six databases were systematically searched and 14 studies met the inclusion criteria, generating three themes: general study characteristics, educational program components, and outcome measures. These educational programs reported effectiveness in developing family nursing knowledge, skills, and attitudes, but did not evaluate the nurses' actual acquisition and implementation of family nursing clinical competencies. This review offers relevant implications for research and for family nursing education, especially when designing and evaluating future educational programs. Future research must more closely address the process and outcomes of best educational practices in family nursing education and how these are applied and evaluated in actual practice settings.

Health education: A Rogerian concept analysis.

OBJECTIVES: The concept of health education has traditionally focused on enabling people to change unhealthy behaviours and lifestyles. Although, at the theoretical level, there exist definitions of the concept, it remains complex and ambiguous. Furthermore, nurses often confuse the concept with other related terms, such as health information or health promotion. The aim here is to report a concept analysis of health education and elucidate a current definition. DESIGN: Rodgers' evolutionary concept analysis. DATA SOURCES: A systematic search was conducted using PubMed and CINAHL for articles written in English or Spanish, published between 1986 and 2017. A manual search was performed, and grey literature was also reviewed. A pre-determined template of study inclusion-related questions assisted the process. REVIEW METHODS: Rodgers' evolutionary method guided the narrative analysis. The attributes of health education, as well as its antecedents, consequences, related terms and contextual bases were extracted and synthesized. RESULTS: Based on the review of 31 studies on health education, the attributes are a learning process, health-oriented, multidimensional, person-centred and partnership. The antecedents are professional awareness of health education, training of health professionals, available resources, individual's willingness to act, and health as an individual's priority in life. The consequences are the increase in knowledge, skills and/or attitudes; change in health-related behaviours, individual capability and empowerment; positive health outcomes; and positive social/economic impact. The related terms are health information, patient education, counselling, health coaching and health promotion. Health education is defined as a continuous, dynamic, complex and planned teaching-learning process throughout the lifespan and in different settings that is implemented through an equitable and negotiated client and health professional 'partnership' to facilitate and empower the person to promote/initiate lifestyle-related behavioural changes that promote positive health status outcomes. Health education takes into account individuals'/groups' internal and external factors that influence their health status through potentially improving their knowledge, skills, attitudes and beliefs in relation to their health-related needs and behaviour, within a positive health paradigm. CONCLUSIONS: The theoretical definition and conceptual framework provided in this study contribute to and extend the current knowledge base among nurses and other health care providers. The findings elucidate the clinical role of health educators, enabling them to identify the realities of its practice, building a common reference point, and highlighting the main recommendations for its use at the clinical, education, policy and research interface.

Predictors of Smoking Cessation Among College Students in a Pragmatic Randomized Controlled Trial.

An effective strategy to quit smoking should consider demographic aspects, smoking-related characteristics and psychological factors. This study examined potential predictors of smoking cessation in Spanish college students. A total of 255 college student smokers (18-24 years old), recruited to a cessation trial (Spain, 2013-2014), comprised an observational cohort. The main outcome was biochemically verified (urine cotinine) abstinence at the 6-month follow-up. Baseline potential predictors included socio-demographic, smoking-related and psychological variables (Fagerström Test for Nicotine Dependence (FTND), expired monoxide level (CO), intention to quit, previous quit attempts, participation in previous multicomponent programmes and confidence in quitting). Logistic regression models were used to identify potential predictors, the area under the ROC curve (AUC) was used to discriminate the capacity of the predictors and the Hosmer-Lemeshow goodness-of-fit test was used to assess model calibration. After 6 months of follow-up, variables related to high nicotine dependence, FTND and expired CO levels were associated with lower odds of quitting smoking (OR = 0.69 [95% CI 0.54-0.89] and 0.84 [0.77-0.92], respectively). Furthermore, being prepared to change (OR = 3.98 [1.49-10.64], p = 0.006) and being confident to quit (OR = 4.73 [2.12-10.55], p < 0.001) were also potential predictors of smoking cessation. The model that combined all these variables had the best predictive validity (AUC = 0.84 [0.78-0.91], p = 0.693) and showed good predictive capacity (χ2 = 10.36, p = 0.241). Findings highlight that, in this population of college student smokers, having a lower level of nicotine dependence, being prepared to quit and having the confidence in the ability to quit were associated with smoking cessation, and these factors had good predictive capacity.

Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial.

Although beliefs, self-efficacy, and intention to quit have been identified as proximal predictors of initiation or quitting in young adults, few studies have studied how these variables change after a smoking cessation intervention. To evaluate the changes in the beliefs, self-efficacy, and intention to avoid smoking and determine if these are potential mediators in quitting, following a smoking cessation intervention, aimed at tobacco-dependent college students. Single-blind, pragmatic randomized controlled trial with a 6-month follow-up. A total of 255 smoker students were recruited from September 2013 to February 2014. Participants were randomly assigned to intervention group (n = 133) or to control group (n = 122). The students in the intervention group received a multicomponent intervention based on the Theory of Triadic Influence (TTI). The strategies of this program consisted of a 50 min motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. The smoking-related self-efficacy, belief, and intention scale was used to assess outcomes. Intention to quit smoking is partial moderator explaining 36.2% of the total effects in smoking cessation incidence. At 6 month follow-up, the differences in the mean scores of self-efficacy and intention related to stopping smoking were significantly higher in the intervention than in the control group. A multicomponent intervention based on the TTI, tailored to college students, positively increased the self-efficacy to avoid smoking and the intention to quit, suggesting intention as potential mediator of quitting.

Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial.

AIM: To evaluate the effectiveness of a nurse intervention aimed at helping college student smokers quit smoking. DESIGN: Single-blind, pragmatic randomized controlled trial which compares a multi-component intervention, tailored specifically to college students, with a brief advice session with a 6-month follow-up. SETTINGS: This study was conducted at the University of Navarra, Spain. PARTICIPANTS: A total of 255 college student smokers (age range = 18-24 years) were randomized to an intervention group (n = 133) or to a control group (n = 122). INTERVENTION: A multi-component intervention based on the Theory of Triadic Influence of Flay was developed. The intervention consisted of a 50-minute motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. MEASUREMENTS: The primary outcome was self-reported abstinence, with biochemical verification at 6 months. The secondary outcomes consisted of the mean number of cigarettes smoked per day, self-reported attempts to quit smoking and stage of change at 6 months. FINDINGS: At the 6-month follow-up, the smoking cessation incidence was 21.1% in the intervention group compared with 6.6% in the control group (difference = 14.5 confidence interval = 6.1-22.8; relative risk = 3.41, 95% confidence interval = 1.62-7.20). The difference in the mean number of cigarettes at 6 months was significantly different (difference = -2.2, confidence interval = -3.6 to -0.9). CONCLUSIONS: A multi-component intervention tailored to college students and managed by a nurse is effective in increasing smoking cessation among college students.