Abuse and smoking cessation in clinical practice.

AIMS AND OBJECTIVES: This discursive paper explores issues of abuse during smoking cessation counselling. BACKGROUND: During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. METHODS: A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. RESULTS: There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress-management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patient's decision whether to continue with cessation counselling. CONCLUSION: Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. RELEVANCE TO CLINICAL PRACTICE: This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention.

National survey of clinical placement settings across Canada for nursing and other healthcare professions--who's using what?

BACKGROUND: The types of pre-licensure clinical placements being used and by what health professions are becoming an important and pressing issue as concerns about clinical placement shortages and competition for placements increase. OBJECTIVE: This study was designed to address a gap in the literature by quantifying the range and specific types of pre-licensure clinical placements being used by nursing and other health professions. METHOD: This was a Canadian national online cross-sectional survey designed to create an inventory of the types of hospital, community, long-term care, and innovative settings being used for pre-licensure clinical placements by schools of nursing, licensed practical nursing, registered psychiatric nursing, midwifery, occupational therapy, physiotherapy, and medicine. RESULTS: The response rate was 70% (113/162). There was no difference in nursing vs. other professions in the general types of placements used-hospitals (97%), community (93%), and long-term care (93%), or travel out of the academic community for placements (85%) which was primarily intra-provincial and rural. Medical and surgical inpatient units were the specific types of placements most commonly used by all respondents (93%). The significant differences included more nursing schools using inpatient maternal/child (p<0.001), mental health (p=0.006), and pediatric (p=0.006), and community public health (p<0.001), and more other healthcare professions using hospital outpatient orthopedic (p=0.002) and research placements (p=0.001). The innovative placements reported by respondents were all community-based and quite diverse (e.g., summer camps, businesses, etc.). CONCLUSIONS: This inventory of pre-licensure clinical placements fills a gap in the literature and revealed a broad and diverse range of settings being used by nursing and other healthcare professions, especially in the community. The diversity raises questions as to whether the organization of clinical education in the past is the best way to meet the needs of tomorrow's healthcare providers, yet it also offers new possibilities for re-contextualizing pre-licensure clinical education.

Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment.

BACKGROUND: This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. METHODS: This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269) via mail to the researchers. RESULTS: Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent < 10 minutes. The most frequently performed activities tended to take the least amount of time, while the more complex activities (e.g., teaching coping skills and pharmacotherapy education) were seldom performed. Patient-related factors (quitting benefits and motivation) encouraged nurses to intervene and work-related factors discouraged them (time and workloads). There were significant rural-urban differences--more rural nurses perceived intervening as part of their role, reported having more systems in place to support cessation, reported higher confidence for intervening, and more frequently assisted patients with quitting and arranged follow-up. CONCLUSIONS: The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.