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 patient's 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.

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 tomorrow's healthcare providers, yet it also offers new possibilities for re-contextualizing pre-licensure clinical education.