Models for Access to Maternal Smoking cessation Support (MAMSS): a study protocol of a quasi-experiment to increase the engagement of pregnant women who smoke in NHS Stop Smoking Services.

BACKGROUND: Maternal smoking is a key cause of poor outcomes for mothers, babies and children and Wales has higher rates of smoking in pregnancy than any other UK country. Despite various improvements within the NHS Stop Smoking Service to strengthen the intervention for pregnant women, referrals and successful quit attempts for this group have continued to remain extremely low. A key element of UK national guidance for smoking cessation during pregnancy is to provide a flexible and tailored service to help increase levels of engagement. This study aims to test the effectiveness of three different models of service delivery to address the gap in the evidence base about how to deliver a flexible, tailored smoking cessation service to pregnant women. METHODS: This study will adopt a quasi-experimental design over a 12 month period. The setting is four of Wales' seven Health Boards using an integrated approach between maternity services, local public health teams and the NHS Stop Smoking Service. Core recommendations from UK public health guidance are being implemented across intervention and usual care sites. Stop smoking support for pregnant women in intervention sites is being delivered more flexibly than in usual care sites. Both qualitative and quantitative approaches will be adopted to capture important contextual information and consider multiple perspectives. A health economic analysis will be undertaken using a cost-consequences analysis approach. The primary outcome measure is engagement with stop smoking services (defined as having at least one face-to-face therapeutic contact with a clinician). DISCUSSION: Supporting pregnant women to stop smoking is a challenging area of public health. The proposed study will address several areas where there are key evidence gaps relating to smoking cessation interventions for pregnant women. Specifically, how best to encourage pregnant women to attend a specialist stop smoking support service, how to deliver the service and who should provide it.

Emotional and informational needs of women experiencing outpatient surgery for breast cancer.

This article reports a qualitative study about informational and emotional needs of women who had surgery for breast cancer on an outpatient basis. Nineteen women volunteered for the study. The interviews, lasting approximately 60 minutes, were audio taped and transcribed verbatim. Data were analyzed using content analysis outlined by Hsieh and Shannon (2005). Findings are organized according to: 1) emotional and informational needs prior to and immediately after surgery; 2) emotional and informational supports while recovering at home; and 3) emotional responses to the outpatient surgery experience. Overall, women were satisfied with the experience of surgery for breast cancer on an outpatient basis, but there were several aspects that warrant closer attention, such as the amount and timing of information delivery, discharge care, and the need for consistent community nursing support and follow-up.

Adolescent depression: meeting therapeutic challenges through an integrated narrative approach.

TOPIC: The adolescent period is a time of transition and change often associated with losses and adjustment issues at the family, school, and individual levels. When this normal developmental transition is interrupted and compounded by depressive illness, treatment needs and nursing therapeutic challenges can be daunting. PURPOSE: This clinically based article explores the clinical process and progress in work with a 14-year-old adolescent boy who was diagnosed with a major depressive episode. Core clinical features, distinguishing characteristics of depression in youth, as well as specific therapeutic issues and challenges are discussed. The value of an integrated clinical approach with special emphasis on narrative methods both for achievement of clinical goals and for establishing a therapeutic alliance is highlighted. SOURCES USED: The study used published literature and the author's professional and clinical experiences. CONCLUSION: Nursing therapeutics with adolescents experiencing depression must embrace a holistic integrated approach to adolescent recovery with an emphasis on what works with each unique clinical situation. Special attention to the nurse-adolescent therapeutic alliance not only facilitates achievement of therapeutic goals related to the depressive illness, but in addition, supports the shaping of a new self-narrative, wholeness, and healthy adolescent development and well-being.

The sickle cell crisis. Interview by Stephanie Northen.

Lack of awareness of sickle cell disease has led to poor treatment and deaths. However, a centre in London is leading change with a holistic approach.

Narrative methods and children: theoretical explanations and practice issues.

TOPIC: The Narrative approach is an innovative way of working with children and adolescents experiencing mental health problems. This approach can be effectively integrated with the expressive arts and other nonverbal ways of accessing the life world of children. In addition, the approach promotes respect for and collaboration with the child in working towards healing and growth. PURPOSE: In this paper core features of the narrative approach are described; the theoretical and philosophical and evidence base for this approach as well as its congruence with the special nature and needs of children will be explored. Finally, the benefits and challenges of this approach in relation to a specific clinical situation will be highlighted. SOURCES USED: Published literature and the author's clinical experiences. CONCLUSION: Narrative methods are ideally suited for addressing needs of children experiencing mental health problems and can enhance therapeutic effectiveness. Some of the challenges associated with its use include: finding creative ways to apply specific narrative concepts and methods with diverse clinical issues/problems; learning to collaborate with children and respect them as experts in their own lives; and shifting the nursing focus from a problem-focused orientation to a strength-oriented and child-centered approach.

Promoting safe drinking water.

Ensuring access to safe drinking water is a major public health concern. The outbreaks of disease from water-borne pathogens in communities like Walkerton and North Battleford alerted the federal government to the need for a standardized multi-barrier approach to managing public drinking water distribution systems. Although many provinces and territories have adopted such an approach, there are problems with water quality throughout Canada. Between 1997 and 2004, the authors conducted a community health needs and resources assessment study in Newfoundland and Labrador to assess health beliefs and practices, satisfaction with health and community services and concerns in relation to community health. The data collection methods used were a random household survey (N = 2,842), key informant interviews (N = 86) and focus group sessions (N = 22). The results indicated that the quality of drinking water was of serious concern. In this article, the authors discuss the study findings and the implications for nursing practice in relation to developing healthy public policy and population health initiatives.

Using Theraplay in shelter settings with mothers & children who have experienced violence in the home.

This article describes a group program for women and children exposed to violence in the home. The program is primarily based on Theraplay, an attachment-based intervention approach for working with both adults and children who have a variety of emotional and behavioral difficulties. The theoretical and research bases, as well as the guiding principles of Theraplay, will be outlined and discussed, and the rationale for its application to a shelter setting will be highlighted. Finally, the benefits of and challenges to implementing such a program and the implications for practice and further evaluation will be explored.

Having a sibling with schizophrenia: a phenomenological study.

Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen's (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.

Understanding sickle cell disorders.

More than 12,500 people in England have sickle cell disorders. This article explains how these disorders call be inherited and discusses the associated clinical problems. The author focuses on social, psychosocial and cultural aspects, and the implications for nursing practice are examined.

The client as educator: learning about mental illness through the eyes of the expert.

Increasingly, educators are asking clients who have a mental illness to make a contribution to nursing students' learning as a way of informing their attitudes towards persons experiencing mental illness and thus enhancing care delivery. The nature of clients' involvement in the classroom and the quality of learning by students through this approach has rarely been questioned. This paper discusses a model of client/nurse educator collaboration in a mental health course with undergraduate nursing students. It draws on the nursing education experiences of the first author, and the personal views of the second author, a user of mental health services. Specifically, it addresses positive features of collaboration as perceived by students, client, and nurse educator and analyzes some of the challenges/issues for the nurse educator. In addition, it outlines helpful aspects of the collaborative process for both nurse educator and client, in particular, its impact on the client's personal well being. This kind of analysis is essential if we are to develop education models of such collaboration that are beneficial for all partners in the learning process.