It's not that simple: tobacco use identification and documentation in acute care.

This environmental telephone interview scan was designed to identify: (1) how hospitals in one Canadian province incorporated tobacco use identification/documentation systems into practice; and, (2) challenges/issues with tobacco identification/documentation. Participants included 36/139 hospitals previously identified to offer cessation services. Results showed hospitals aided by researchers monitored and tracked tobacco use; those not aligned with researchers did not. The wording of tobacco items most commonly included use within the last 6-months (42%), 30-days (39%), or 7-days (33%), or use without reference to time (e.g., "Do you smoke?"; 39%); wording sometimes depended on admitting form space limitations. The admission process determined where the tobacco item appeared, which differed by hospital-75% included it on an admitting form (75%) and/or nursing assessment (56%); the item sometimes varied by unit. There were also different processes by which the item triggered delivery of cessation interventions; most frequently (69%), staff nurses were triggered to provide an intervention. The findings suggest that adding a tobacco use question to a hospital's admitting process is potentially not that simple. Deciding on the purpose of the question, when it will be asked and by whom, space allotted on the form, and how it will trigger an intervention are important considerations that can affect the question wording, form/location, systems required, data extraction, and resources.

Nurse case-managed tobacco cessation interventions for general hospital patients: results of a randomized clinical trial.

This randomized clinical trial was designed to test the efficacy of intensive versus brief smoking cessation interventions for hospital patients. The interventions included advice and pamphlets for Brief and bedside counselling, take-home materials, and 7 post-discharge telephone counselling calls over 2 months for Intensive. Confirmed 1-year abstinence was 28% for Intensive (85/301) and 24% for Brief (76/315). Abstinence was significantly higher for patients who did not use pharmacotherapy (36%) versus those who did (16%) and for patients with CVD (40%) versus other diagnoses (20%). Because this was a replication trial, benchmarks for planning can be suggested: 12% to 15% recruitment of identified smokers, 90% plus completion for Intensive, 15% drop-out, and 75% abstinence corroboration. The results consolidate findings for general inpatients, including expected absolute abstinence and treatment outcomes, the effect of CVD patients on outcomes, the reproducibility of high abstinence in a universal health-care system, and the need for more research to inform practice.

The perennial struggle to find clinical placement opportunities: a Canadian national survey.

Pre-licensure clinical placements are becoming increasingly difficult to obtain due to healthcare restructuring, workforce shortages, and increased student enrollment. This cross-sectional study was designed to nationally quantify the issues related to finding placements in this changing environment. A survey was developed based on the literature and key informant interviews, and a mailing list was developed to include clinical coordinators at all Canadian schools of nursing, licensed practical nursing, registered psychiatric nursing, midwifery, occupational therapy, physiotherapy, and medicine. The response rate was 70% (113/162). Results showed that although 87% (SD=13%) of placements were based on the previous year, 58% of the respondents reported difficulty finding a sufficient number of appropriate placements. The most frequent reasons for finding new placements were also the main reasons for the difficulty in finding sufficient appropriate placements-student requests, increased enrollment, and agency changes. Traditional methods for finding placements (historical use and faculty) remained the most common. Interagency/interschool collaborations, web-based registries, and innovations (such as schools developing their "own" placements) were evident but were still not the norm and used more by nursing than others. Given these results, it is suggested that consideration be given to expanding the repertoire of emerging and innovative methods for finding placements.