Knowledge, attitudes and practices of primary healthcare professionals regarding smoking and smoking cessation among the elderly in France.

INTRODUCTION: Smoking remains a leading cause of preventable death in France, even among the elderly. Although smoking prevalence has decreased overall, it still affects a significant portion of older adults. This study investigates the knowledge, attitudes, and practices of primary healthcare professionals regarding smoking and smoking cessation among the elderly in France. METHODS: A cross-sectional study involved 300 primary care professionals (general practitioners, pharmacists, nurses) in the Ile-de-France region. Data collection occurred via telephone interviews in September and October 2019. The study employed a questionnaire focusing on knowledge (10 questions), attitudes (12 statements), and clinical practices (7 questions) related to tobacco dependence in older adults. Responses were scored based on correctness for knowledge and appropriateness for attitudes and practices. RESULTS: The surveyed professionals were predominantly female (57.7%), with a mean age of 53.0 years, and most were non-smokers or former smokers (85.3%). While 66.7% believed older smokers had lower cessation rates, only 64.3% knew it was safe to prescribe nicotine replacement therapy for the elderly. Attitude scores averaged 8.8/12, with pharmacists scoring highest (9.9) and nurses lowest (8.2). Practices scores averaged 2.8/7, with physicians scoring highest (3.8) and pharmacists lowest (1.9). CONCLUSIONS: Primary healthcare professionals have a relatively good knowledge of the management of tobacco dependence in the elderly and consider it to be part of their mission. However, their confidence in their abilities needs to be strengthened, and many opportunities to counsel and assist this population to quit smoking are still being missed. Preventive approaches to older smokers are essential, in keeping with the concept that 'every contact with the healthcare system counts'. Improving practice will require education and training that will not only build knowledge but also change perceptions, leading to better attitudes and practices in the management of smoking cessation among older adults.

[Therapeutic alliance between sectorial psychiatry inpatients and nurses and aides: A prospective, observational and cross-sectional study]. / Alliance Thérapeutique Entre Les Patients Hospitalisés En Psychiatrie De Secteur Et Les Infirmier(e)s Et Aide-Soignant(e)s: Une Etude Prospective, Observationnelle Et Transversale.

BACKGROUND: Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization. OBJECTIVE: The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry. METHOD: This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients. RESULTS: The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up. CONCLUSION: Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place.

CONTEXTE: L'alliance thérapeutique représente un objet très peu étudié quand il concerne les infirmiers et les soins prodigués par une équipe infirmière et dans le cadre de l'hospitalisation en soins aigus. OBJECTIF: L'objectif était d'étudier l'influence de facteurs sur l'alliance thérapeutique construite entre les infirmier(e)s et les aides-soignant(e)s et les patients adultes hospitalisés dans un service de soins aigus en psychiatrie générale de secteur. MÉTHODE: Il s'agit d'une étude prospective, observationnelle et transversale utilisant une échelle de mesure de l'alliance thérapeutique. Le score d'alliance thérapeutique (AT) a été mesuré à l'aide de l'échelle STAR-P sur un échantillon de 240 patients. RÉSULTATS: Le score moyen obtenu est de 33,4 (±7,8) sur un score maximum théorique de 48. Le score global d'AT des patients âgés de 60 ans ou plus, est significativement plus élevé que celui des patients ayant entre 18 et 29 ans (p = 0,021). L'absence de suivi ambulatoire au cours des trois mois suivant la sortie d'hospitalisation n'est pas associée au score global d'AT (p = 0,73). Si les patients hospitalisés, quelques soit leurs troubles et les différentes formes de soins, sous obligation légale ou non, jugent plutôt bonne l'AT à l'issue de leur hospitalisation. Seuls des facteurs sociaux-démographiques comme, l'âge, les conditions d'hébergement (précaire ou durable), avoir ou non un emploi, vivre seul ou avec un partenaire influent sur l'AT et le suivi. CONCLUSION: Les résultats convoquent les concepts d'anomie et d'attachement, qui semblent jouer un rôle important dans l'absence de suivi post-hospitalisation, ce qui indiquent la nécessaire approche globale des soins et une implication des professionnels de santé mais aussi du social où l'empathie doit trouver sa place.

Promotion de la santé en psychiatrie et santé mentale : l'exemple du syndrome métabolique et des pratiques infirmières.

Introduction : Life expectancy in psychiatric patients is reduced by 15 to 20 years due to the presence of comorbidities and the lifestyle of these patients. Metabolic syndrome, also a side effect of antipsychotic drugs, is an aggravating factor of this phenomenon, which is why health promotion is essential. The objective of this study is to describe the knowledge, attitudes, and practices of psychiatric nurses with regard to metabolic syndrome, using N. Pender's health promotion model as a framework.Methodology : A multicenter descriptive study using a « knowledge, attitude, practice ¼ survey was conducted in 16 psychiatric departments in the Ile-de-France region. 70 nurses were interviewed via online questionnaires.Results : The results show partial knowledge. A gap exists between attitudes and nursing practices. The nurses' actions mainly involve counseling. The type of nursing knowledge is discussed, as well as the need for reflection on the nurse-patient relationship. Nursing interventions need to be further developed to better manage metabolic syndrome.Conclusion : Training is needed to carry out preventive measures and promote health more effectively.

Living with chronic obstructive pulmonary disease in Lebanon: a phenomenological study.

Background: Lebanon has the fastest growing older adult population in the Arab region but few social resources to address their needs. No studies have explored the experience of patients with chronic obstructive pulmonary disease (COPD) in Lebanon. Aims: Exploring the experiences of individuals living with COPD in Lebanon. Method: Using a descriptive phenomenological research design, qualitative individual semi-structured interviews were conducted with COPD patients living in Lebanon, between May 2019 and September 2019. Results: Fifty participants agreed to be interviewed. The majority were men (56%) and had moderate COPD (40%). Mean age was 71.5 (standard deviation 9.0) years. We found that COPD affects three dimensions of patients' lives: educational, organizational and psychosocial. Conclusion: The results highlight the need for multidisciplinary strategies to address the needs of people with COPD in Lebanon, including their caregivers. Strategies include patient education and the development of new methods to facilitate and promote partnership between health care professionals, COPD patients and their caregivers.

Defining an enabling environment for those with chronic disease: an integrative review.

BACKGROUND: Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management. METHODS: An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used. RESULTS: A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment. CONCLUSION: This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

[From relationship to therapeutic alliance with adolescents and young adults at risk of psychotic transition: The perspective of mental health professionals. An exploratory study]. / De la relation à l'alliance thérapeutique auprès d'adolescents et jeunes adultes présentant un risque de transition psychotique : le point de vue de professionnels de santé mentale. Une étude exploratoire.

Introduction : Psychotic disorders usually begin during adolescence or early adulthood. The first psychotic symptoms are said to be attenuated in their prodromal phase. It is essential to identify them and initiate follow-up as early as possible to limit the severity of symptoms or even prevent a psychotic transition. However, there is still some uncertainty about the progression of symptoms. The aim of this exploratory study was to show the difficulties that surround the construction of a therapeutic alliance in this context.Methodology : The method adopted was a field survey.Results : Uncertainty about the development of disorders and their worsening and the fact that they are assessed by evaluating the patient's functional weaknesses led professionals to develop a relationship based on knowledge that is acquired empirically and that is in line with a phenomenological approach. Thus, professionals mobilized dynamic and interactive communication techniques to try to forge a therapeutic alliance.Conclusion : It has been shown that professionals seek to build a therapeutic alliance with young people presenting an uncertain evolution toward psychosis using a phenomenological, personalized, and pragmatic logic.

De la relation à l'alliance thérapeutique auprès d'adolescents et jeunes adultes présentant un risque de transition psychotique : le point de vue de professionnels de santé mentale. Une étude exploratoire.

Introduction : Psychotic disorders usually begin during adolescence or early adulthood. The first psychotic symptoms are said to be attenuated in their prodromal phase. It is essential to identify them and initiate follow-up as early as possible to limit the severity of symptoms or even prevent a psychotic transition. However, there is still some uncertainty about the progression of symptoms. The aim of this exploratory study was to show the difficulties that surround the construction of a therapeutic alliance in this context.Methodology : The method adopted was a field survey.Results : Uncertainty about the development of disorders and their worsening and the fact that they are assessed by evaluating the patient's functional weaknesses led professionals to develop a relationship based on knowledge that is acquired empirically and that is in line with a phenomenological approach. Thus, professionals mobilized dynamic and interactive communication techniques to try to forge a therapeutic alliance.Conclusion : It has been shown that professionals seek to build a therapeutic alliance with young people presenting an uncertain evolution toward psychosis using a phenomenological, personalized, and pragmatic logic.

Characteristics of the skills of caregivers of people with dementia: observational study.

BACKGROUND: Due to demographic change within an aging population as announced by the WHO, the involvement of caregivers is essential. Caregivers are required to change their roles within the family unit. Such life transitions experienced by caregivers to people confronted with dementia-type pathologies are sometimes difficult, necessitating the acquisition and development of certain skills. Few studies have shown that caregivers develop specific and essential skills to promote quality care and safety. To characterize their skills, there is a need to identify the abilities, knowledge, resources, obstacles and constraints that contribute to caregivers' transitions. The research question for this study was: What skills do caregivers use to care for their loved one with dementia? METHODS: Qualitative observational research based on the epistemological paradigm of socioconstructivist knowledge was conducted. The study was carried out in the canton of Geneva and recruitment was carried out through the participation of the Alzheimer's association and the association for the support and assistance of elderly people in medical and social institutions and their families (APAF). Observations and semi-structured interviews were conducted in the homes of 14 family carers caring for their loved one with dementia. The observations were transcribed on observation grids and the interviews were recorded. Subsequently, according to the classic distinction of Denzin (Interpretive interractionism, 2001), we analysed the observation notes and verbatims, then as recommended by Miles et al. (Qualitative data analysis: a methods sourcebook, 2014), two researchers triangulated the results. RESULTS: The results identified five types of situations regularly experienced by caregivers. The study characterized 11 skills that caregivers use to cope with their daily lives. The learning process and maladaptive behaviours in caring for their loved ones with dementia were also highlighted. CONCLUSION: This study was able to point out that today's caregivers have developed more competency than their predecessors. This evolution can be explained by new paradigms of care requiring caregivers to be more involved. Although some caregivers need training, others through their experiences can act upon and provide knowledge. To improve the quality and safety of care for people with dementia, this expertise can be the subject of partnerships between caregivers and health care staff.

Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study.

Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.

Enfermeros prescribiendo medicamentos en centros geriátricos: mapeo Internacional / Nurses prescribing medications in geriatric centers: international mapping

OBJETIVO: La meta de este estudio fue identificar la percepción de los enfermeros y médicos con respecto a los centros de atención de largo plazo, al mismo tiempo, explicar la intervención de los enfermeros en la prescripción médica. METODOLOGÍA: estudio multinacional transversal en el que participaron enfermeros y médicos en centros de cuidado geriátrico durante las fechas de abril y octubre de 2017. Se utilizaron tres cuestionarios en línea en idiomas francés e inglés. RESULTADOS: un 78.7% de médicos discutieron la relevancia que existe entre las prescripciones y enfermeros competentes. El mapeo demuestra la relación entre el nivel de evidencia que existe en el rol de enfermería y las prescripciones médicas, y enfermeros autorizados en los 51 países participantes. CONCLUSIONES: La relacion interpersonal entre médicos y enfermeros es esencial para facilitar el rol de enfermería en el manejo de tratamientos eficientes

OBJECTIVE: the aim of this study was to identify the perceptions of nurses and physicians and describe the involvement of nurses in medical prescription in general and that of antibiotics in particular, in geriatric institutions. METHODS: a cross-sectional multinational study was conducted among nurses and physicians in geriatric institutions between April and October 2017. Data was collected using three online questionnaires in both French and English. RESULTS: in total, 78.7% of doctors discussed the relevance of the prescription with competent nurses. A map shows the relationship between the evidence level of nursing role in medical prescription, and prescriptive authorization nurses in the 51 participating countries. CONCLUSIONS: interpersonal physician-nurse relationships are essential in facilitating the nursing role of effective treatment management

[Intellectual disabitily, challenging behavior, and care: A systematic literature review]. / Déficience intellectuelle, « comportements défis ¼ et soins : une revue systématique de littérature.

Introduction and background : People with intellectual disabilities present difficult behaviors, also called problem behaviors or challenging behaviors.Objective : The objective of this study was to describe the state of knowledge in nursing about challenging behaviors in people with intellectual disabilities.Methodology : We performed a systematic literature review based on the use of the keywords "challenging behavior," "intellectual disability," "nurs*," and "problem behavior" on the PubMed and Web of Science websites between 2008 and 2018.Results : Individuals with intellectual disabilities frequently present challenging behaviors, which can give rise to the abuse of psychotropic medication. These behaviors are also stressful for staff. Solutions in terms of staff training exist, as well as assistance in the identification of associated diagnoses that may sometimes be responsible for challenging behaviors. No publications in French on this topic were found.Conclusion : Nurses who work with people with intellectual disabilities should be encouraged to become involved in research so that they can contribute to developing knowledge on challenging behaviors and improve the quality of their care. This will also enable them to further develop their collaboration within the multidisciplinary team in order to promote good practice in terms of the management of challenging behaviors and in particular in terms of promoting a move away from prescribing psychotropic drugs.

Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance.

INTRODUCTION: This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV. METHODS: This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method. RESULTS: Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance. CONCLUSION: Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.

[Care, the caring, the cure and the caregiver]. / Le care, le caring, le cure et le soignant.

Due to the multiple meanings of the concept of care and its diverse cultural meanings, the purpose of this article is to address this concept, starting with clarification of its etymological origins. In addition to this clarification, the objectives of this paper are to highlight the rapport between care and cure, the implications of care in health care team management. The etymological analysis is made starting from encyclopaedic writings, to discuss the original meaning of the concept. The results of this analysis show that the original meaning of care is anchored on affects and feeling, lead to caring. Therefore, a personal dimension is inherent to it. This reflection tries to show that care does not oppose to cure, but that it is imperative to incresae nurses to the personal dimension in care to become caring with the management support. The conclusion reveals that a personal dimension of caring, supported by human values associated, participate to the professional dimension of the nursing role. Thus, these two dimensions that must grow together, are unavoidable for nursing pratice.