New Brunswick nurses' views on nursing research, and factors influencing their research activities in clinical practice.

New Brunswick became the first province in Canada to require a baccalaureate degree in nursing as the entry to practice, yet nursing research in hospital settings remains quite low. This study examined clinical nurses' views on nursing research, and identified some contributing factors to the research-practice gap. This descriptive, cross-sectional multicenter study involved 1081 nurses working in the Francophone Regional Health Authority in New Brunswick, Canada. Nurses were eager to identify nursing-care problems to improve patient care (92.9%), and to be involved in collecting data for nursing research studies (95.2%). However, without research supervision, few had engaged in basic research activities, such as formulating or refining research questions (24.5%), presenting at research conferences (6.9%), or changing their practice based on research findings (27.2%). Younger, more educated nurses, nurse managers, and educators participated more readily in research. Sharing research and clinical expertise, as well as infrastructures between academic and clinical institutions is the key to enduring successful patient-centered nursing research in clinical settings. Concrete actions are proposed to build clinical nursing research.

Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease.

BACKGROUND: Several authors have questioned the transtheoretical model. Determining the predictive value of each cognitive-behavioural element within this model could explain the multiple successes reported in smoking cessation programmes. The purpose of this study was to predict point-prevalent smoking abstinence at 2 and 6 months, using the constructs of the transtheoretical model, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. DESIGN: The study follows a predictive correlation design. METHODS: Recently hospitalized patients (n=168) with cardiovascular disease were pooled from a randomized, controlled trial. Independent variables of the predictive transtheoretical model comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. RESULTS: Compared to smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-re-evaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy and stages of change at baseline were predictive of smoking abstinence after 6 months. Other variables found to be predictive of smoking abstinence at 6 months were an increase in self-efficacy; an increase in positive social support behaviour and a decrease of the pros within the decisional balance. CONCLUSIONS: The results partially support the predictive value of the transtheoretical model constructs in smoking cessation for cardiovascular disease patients.

Balance self-efficacy and its relevance to physical function and perceived health status after stroke.

OBJECTIVES: To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status. DESIGN: Secondary analysis of baseline, postintervention, and 6-month follow-up data from a randomized trial. SETTING: General community. PARTICIPANTS: Ninety-one subjects with a first or recurrent stroke, discharged from rehabilitation therapy with a residual walking deficit. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Activities-Specific Balance Confidence (ABC) Scale, Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale, and the EQ-5D visual analog scale of perceived health status. RESULTS: Average balance self-efficacy was 59 out of 100 points on the ABC scale (95% confidence interval, 55-64; n=89). After adjusting for age and sex, functional walking capacity explained 32% and 0% of the respective variability in physical function and perceived health status scores obtained 6 months later. After adjustment for age, sex, and functional walking capacity, balance self-efficacy explained 3% and 19% of variation in 6-month physical function and perceived health status scores, respectively. CONCLUSIONS: Subjects living in the community after stroke experience impaired balance self-efficacy. Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement, primarily in perceived health status, but also in physical function, than the enhancement of functional walking capacity alone.

The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease.

BACKGROUND: Smoking is an important risk factor for cardiovascular disease (CVD), and quitting is highly beneficial. Yet, less than 30% of CVD patients stop smoking. Relapse-prevention strategies seem most effective when initiated during the exacerbation of the disease. OBJECTIVE: A nurse-delivered inpatient smoking cessation program based on the Transtheoretical Model with telephone follow-up tailored to levels of readiness to quit smoking was evaluated on smoking abstinence and progress to ulterior stages of change. METHOD: Participants (N = 168) were randomly assigned by cohorts to inpatient counseling with telephone follow-up, inpatient counseling, and usual care. The inpatient intervention consisted of a 1-hr counseling session, and the telephone follow-up included 6 calls during the first 2 months after discharge. The nursing intervention was tailored to the individual's stage of change. End points at 2 and 6 months included actual and continuous smoking cessation rates (biochemical markers) and increased motivation (progress to ulterior stages of change). RESULTS: Assuming that surviving patients lost to follow-up were smokers, the 6-month smoking abstinence rate was 41.5% in the inpatient counseling with telephone follow-up group, compared with 30.2% and 20% in the inpatient counseling and usual care groups, respectively (p = .05). Progress to ulterior stages of change was 43.3%, 32.1%, and 18.2%, respectively (p = .02). Stage of change at baseline and intervention predicted smoking status at 6 months. DISCUSSION: This tailored smoking cessation program with telephone follow-up significantly increased smoking cessation at 6 months, and progression to ulterior stages of change. The telephone follow-up was an important adjunct. It is, therefore, recommended to include such comprehensive smoking cessation programs within hospital settings for individuals with CVD.

The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial.

OBJECTIVES: To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific, influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity. DESIGN: Secondary analysis of a two-center, observer-blinded, randomized, controlled trial. SETTING: General community. PARTICIPANTS: Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke. INTERVENTION: Task-oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks. MEASUREMENTS: Activities-specific Balance Confidence Scale, Six-Minute Walk Test, 5-m walk, Berg Balance Scale, and Timed "Up and Go" administered at baseline and postintervention. RESULTS: The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention. Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practiced. In the walking group, change in balance self-efficacy correlated with change in functional walking capacity (correlation coefficient=0.45, 95% confidence interval=0.16-0.68). Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age, sex, comorbidity, time poststroke, and functional mobility on change in self-efficacy. CONCLUSION: Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke. Benefits may be partially the result of improvement in walking capacity. The influence of baseline level of self-efficacy, depressive symptoms, and prognostic variables on treatment effects are of clinical importance and must be verified in future studies.

Knowledge level and coping strategies according to coagulation levels in older persons with atrial fibrillation.

The present study examined the knowledge level and the coping strategies of older persons with atrial fibrillation, who were on oral anticoagulant therapy. The relationship among knowledge level, problem and affective-oriented coping strategies, and the level of anticoagulant effectiveness were examined. We also compared differences between subjects who were within a therapeutic range for International Normalized Ratio levels with those who were not. The research design was descriptive and correlational. One hundred older persons completed the Jaloweic Coping Scale (a knowledge questionnaire) and socio-demographic, contextual and clinical characteristic questions. The findings suggested that the knowledge levels were low (53%), and problem-oriented coping strategies were most often used (32.62%) compared to affective-oriented coping strategies (18.96%). Other than praying and putting one's trust in God (P = 0.05), it appeared that no other significant coping strategies differentiated the subjects regarding their level of anticoagulant effectiveness. It is recommended that further examination of the reasons for older persons' low knowledge level, in regard to their oral anticoagulant therapy, occurs and that use of problem-oriented coping strategies, to improve self-care measures, be encouraged.

[Social support contribution to health and the adoption and maintenance of health behaviors]. / La contribution du soutien social à la santé et à l'adoption et au maintien de sains comportements de santé.

Social support refers to the presence of individuals providing emotional or material resources. Its four components are: integration, structure, function, and quality. This article presents empirical and theoretical data, as well as criticism of studies which examine the relationship between social support, global health and cardiovascular health, also evaluating direct or moderating contributions to the adoption and maintenance of health behaviours in persons with cardiovascular disease. Concrete implications for nursing practice are reviewed.

[Adaptive strategies and adaptation after participation in a education program after a first coronary event]. / Stratégies adaptatives et adaptation selon la participation à un programme d'enseignement suite à un premier évènement coronarien.

This descriptive correlational study compares adaptive strategies and adaptation according to participation to an outpatient education program "A vous de jouer". Participants more frequently use seeking social support strategies, and eating less fat, participating in physical activity, managing stress behaviors and returning to work. Distancing/escape avoidance strategies are negatively correlated with healthy life style habits, whereas positive reappraisal/problem solving, and seeking social support strategies are positively associated. Positive reappraisal/problem solving, program participation, and the non-use of distancing/escape avoidance strategies, predict adaptation. The use of these adaptive strategies and behaviors is therefore advantageous to coronary patients.

[Expected and received assistance from informal social support for aged people in heart surgery]. / Aide attendue et reçue du réseau de soutien social informel par des personnes âgées subissant une chirurgie cardiaque.

This study describes and compares the importance and availability of expected and received types of assistance, during the convalescence period at home, from the informal social support network, as perceived by older persons undergoing heart surgery. The research design is descriptive and comparative. Barrera's conceptual framework has been integrated to Roy's model of adaptation. The 45 participants, 31 men and 14 women with a mean age of 74 years (SD = 3.37 years), underwent myocardium revascularisation, valve replacement, or a combination of both surgeries. The day before the heart surgery and one month following the hospital discharge, the participants completed a French modified and adapted version of the "Inventory of Socially Supportive Behaviors" (Lepage, 1984) to identify perceived importance and availability of expected and received types of assistance (material, physical, emotional, guidance, and feedback) while at home on convalescence. Repeated-measure MANOVAs result in significant interactions between importance and availability of assistance, and between the day before heart surgery and one month following hospital discharge in three categories of assistance (emotional, p = 0.002; guidance, p = 0.003; feedback, p = 0.001). ANOVAs indicate that older persons perceive, one month after hospital discharge, the received assistance as important as anticipated the day before their surgery, but its availability is less. It is therefore important for nurses to reevaluate and adapt their pre-operative teaching program for older persons, especially as pertaining to the significant 15 types of assistance, and according to available resources from the informal social support network, and to mobilize the formal support network before hospital discharge.