Screening, brief intervention and referral to treatment (SBIRT) by nurses to college students who use electronic cigarettes.

OBJECTIVE: To examine how screening, brief intervention and referral to treatment (SBIRT) influenced nurses' knowledge, attitude, responsibility and confidence when caring for college students using electronic cigarettes (EC). PARTICIPANTS: Nurses (n = 8) in an urban university campus in the US. METHODS: Training sessions included classroom instruction on SBIRT and EC, and practice with a standardized patient. Surveys administered pre and post training, and at conclusion. Measurement included nurse's knowledge of SBIRT and EC; and attitude, confidence and responsibility when using SBIRT. Students with past 90-day EC use were administered SBIRT by nurses and referred to health educator on request. RESULTS: Over 6 weeks, 103 students reported EC use, 80 received SBIRT and 36 were referred to health educator. Nurses gained knowledge, supported using SBIRT, and reported that skills increased. CONCLUSIONS: SBIRT is a motivational interviewing skill that nurses can learn to use to engage with college students who use EC.

A Lifestyle Intervention Program to Improve Knowledge and Health Behaviors in Women.

OBJECTIVE: To improve health knowledge, facilitate healthy behaviors, and provide social support for a high-risk population of women by implementing a culturally tailored, gender-specific lifestyle intervention program. DESIGN: Evidence-based practice project. SETTING/LOCAL PROBLEM: A Chicago neighborhood in Cook County, Illinois, where there are increased rates of diabetes, heart disease, cancer, stroke, hypertension, obesity, preterm birth, and violent crime. PARTICIPANTS: Female residents of the community, ages 19 to 45 years; 12 participants registered for the program, and 11 participants completed the entire 2-month program. INTERVENTIONS/MEASUREMENTS: The BE WISE Lifestyle Intervention, a culturally tailored, gender-specific behavior change curriculum, was used for this project. An interprofessional team was used to enhance participant experience, and neighborhood collaborations were established to create sustainability of efforts. Pre- and postintervention measures of diet, physical activity, social support, and knowledge acquisition were used to evaluate outcomes. RESULTS: Improvement was noted for knowledge in most of the content areas, as well as for dietary and physical activity behaviors. All participants rated the program highly and responded positively to the social support experienced in the group. CONCLUSION: Culturally tailored lifestyle interventions can be effective in improving knowledge and encouraging behavior change, especially when delivered in group settings to enhance social support. Community-level collaborations enhance interventions by providing local support and resources for participants. Because behavior change takes time, follow-up at the 6-month and 1-year intervals is recommended to determine longer-term outcomes.

Pharmacologic Management of Acute Migraines in the Emergency Department.

Migraine headaches account for approximately 1.2 million emergency department (ED) visits annually. Despite the prevalence of this condition, there is little consensus on the best pharmacotherapeutic interventions to use in the ED setting. Guidelines published by the American Headache Society and the Canadian Headache Society offer some direction to ED providers but are not widely utilized. This article reviews the best evidence behind some of the medications frequently used to treat acute migraines in the ED setting, including dopamine receptor antagonists, serotonin receptor agonists, anti-inflammatory medications, opioids, magnesium, valproate, and propofol. The evaluation of patients presenting to the ED with an acute headache, the diagnostic criteria for migraines, and implications for advanced practice are also discussed.

What the Advanced Practice Nurse in the Emergency Department Needs to Know About the Health Risks and Hazards of Electronic Cigarette Use by Youth.

Despite the decline in traditional tobacco use among teens and young adults, the rapid increase in electronic cigarette (EC) use has filled the gap, raising concern that this will usher in a new generation of tobacco users. Although long-term effects have not been clearly established, EC use is not without risks or hazards that may be encountered by the advanced practice nurse in the emergency department (ED). The ED presents an opportune moment for health promotion and risk reduction education for patients and families, but there are also dangers to EC use that the practitioner should be aware of and prepared to manage. Nicotine, found in most EC liquids, is well known to be a neurotoxin that affects brain development in young people. It is important to inform young people and families that EC products may contain not only nicotine but also other harmful chemicals and are not just harmless water vapor. Other toxins found in EC liquids and vapors raise questions about the health impact of long-term EC use and add additional concerns for secondhand exposure for children and pregnant women. The EC is also used by youth to inhale concentrated forms of cannabis, which could be a precursor to EC use for other illicit drugs. Hazards to be prepared for in the ED are accidental ingestion of EC liquids by children and intentional overdose of concentrated liquids. Severe injuries have been reported from explosions of EC devices as well. The ED is a starting point for EC screening and education of young people and families. Advanced practice nurses must also anticipate and be prepared to handle any other untoward effects from exposures to devices and liquids. The purpose of this article is to inform and prepare advanced practice nurses with the latest information to manage these patient encounters.

Emergency Nurse Implementation of the Brief Smoking-Cessation Intervention: Ask, Advise, and Refer.

PROBLEM: Smoking is the single most avoidable risk factor for many health problems such as cardiovascular disease and pulmonary dysfunction. Emergency departments provide care for many patients who smoke. Patients who smoke and are discharged to home from emergency departments do not customarily receive smoking-cessation information. This project explored the feasibility and acceptability of a brief smoking-cessation intervention as part of emergency nursing practice. METHODS: This practice improvement project was conducted in a large midwestern emergency department. A review of data from 12 months before the project revealed a 17.6% prevalence of smoking among patients discharged from the emergency department with no patient having received smoking-cessation information, confirming the need for intervention. A survey of emergency nurse attitudes and learning needs indicated that nurses believed offering advice to quit was appropriate but that they had limited smoking-cessation training. A total of 83 nurses received training on an "Ask, Advise, Refer" protocol. RESULTS: Evaluation after training indicated that emergency nurses gained knowledge about brief smoking-cessation intervention methods, and 75.7% (n=74) felt adequately trained. During the 12-week intervention, data were collected on 7,465 emergency visits. Nurses advised all smokers to quit using the protocol, and 6.3% of patients accepted smoking-cessation referrals. IMPLICATIONS FOR PRACTICE: Emergency nurses felt comfortable performing the smoking-cessation intervention, suggesting that training was effective. Data indicated that patients were consistently advised to quit smoking. Results suggest that brief smoking-cessation interventions are feasible and acceptable in emergency settings. The training and protocol could be used in other emergency departments, and lessons learned can guide future efforts by emergency nurses to help patients quit smoking.