Provider feedback improves adherence with AHCPR Smoking Cessation Guideline.

BACKGROUND: This study evaluated the effect of primary care providers' adherence with the AHCPR Smoking Cessation Guideline after receiving a multicomponent intervention. METHODS: A quasi-experimental study with one intervention and one control team was conducted in a southeastern Veterans Affairs Medical Center primary care setting. During phase I, chart reviews were conducted to measure baseline provider adherence and documentation of the four A's (ask, advise, assist, arrange). In phase II, the intervention team received a single educational session on the AHCPR Guideline, four A's, and tobacco dependence treatment. This was followed by chart reviews of patients seen 4 to 8 weeks after the educational intervention to measure provider adherence and documentation of the four A's. During phase III, the intervention team received individual and team feedback from the chart reviews in phases I and II and booster education on the AHCPR Guideline. Chart reviews were conducted from patient visits 4 to 8 weeks after the feedback and booster education to determine provider adherence and documentation of the four A's. RESULTS: A nested repeated measures two-factor analysis of variance was performed for each of the following outcomes: ask, advise, assist, and arrange. Data analyses revealed that both the control and the intervention teams had 100% compliance in asking the patient about smoking status. There was a prestudy implementation of the vital sign stamp that included smoking status in this setting. Education on tobacco dependence and the AHCPR Guideline had no significant impact on provider performance with the advisement, assistance, and arrangement of follow-up. However, significant improvements occurred in the intervention team in the advisement (P = 0.05), assistance (P = 0.001), and arrangement of follow-up (P = 0.001) phase after individual and team feedback was provided. This research supports the fact that feedback impacts individuals and team performances and facilitated positive system changes to improve provider adherence with the AHCPR recommendations in treating tobacco dependence.

The impact of tobacco use in women: exploring smoking cessation strategies.

The incidence of lung cancer in women has escalated during the last several decades. Lung cancer death rates in women also have risen and now exceed the number of deaths from breast cancer. Tobacco use accounts for more than 30% of all cancer deaths. Currently, 22 million adult women smoke, and more than 1.5 million adolescent females are smokers (American Cancer Society, 2000a). The use of tobacco by young female adolescents is on the rise, and those who are current smokers typically began smoking prior to high school graduation. Oncology nurses have an opportunity in inpatient and outpatient settings to impact the smoking habits of females, regardless of age. This article presents the guidelines for assisting women in smoking cessation. Clinical implications are presented that all oncology nurses should consider implementing in their practice setting.

Barriers to prostate cancer screening.

The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.

A model nurse practitioner-managed smoking cessation clinic.

PURPOSE/OBJECTIVES: To describe an intensive nurse practitioner (NP)-managed smoking cessation clinic that evolved from a primary-care quality-management initiative. DATA SOURCE: Published articles, abstracts, books, clinical experience, and clinical data. DATA SYNTHESIS: Smoking continues to be the leading cause of preventable deaths in the United States and accounts for 87% of all lung cancers. Although smoking is responsible for nearly 30% of all cancer deaths, smoking prevalence rates remain stagnant in adults and are continuing to increase in adolescents. Twenty-five percent of all Americans smoke. An NP-managed clinic was developed within a large teaching hospital located in the southeastern United States based on the Agency for Health Care Policy and Research guideline for smoking cessation. The clinic provided effective smoking cessation interventions that can be replicated by experienced nurses with a smoking cessation background. All nurses have opportunities to assist patients to stop smoking through brief counseling and minimum interventions. CONCLUSIONS: Nurses can effectively manage an intensive smoking cessation clinic that is utilized by the interdisciplinary team to treat referrals. Cessation rates were high because therapies combined intensive behavioral sessions and pharmacologic approaches rather than either single modality. IMPLICATIONS FOR NURSING PRACTICE: Nurses can replicate this practice in a variety of healthcare settings. Innovations in clinical practice often facilitate research studies to further define effective approaches for smoking cessation. Nurses need to identify and target smoking as the serious health problem it is and conduct much-needed research on cessation approaches within the inpatient and outpatient settings.

Multiple paradigms of nursing science.

Of the many controversies that have accompanied the growth of nursing as a discipline, few have been debated as long and as vigorously as the question of which paradigm should guide nursing science. Despite more than 20 years of discussion, the question remains unresolved. This article discusses the concept of paradigm, explores the paradigms that influence nursing science, and presents a comparison of the advantages and disadvantages of theoretical unification and mutiparadigmism. Additionally, the implications and consequences of multiparadigmism for the present and future development of nursing as a science within a practice discipline are presented.

Implementing the Agency for Health Care Policy and Research smoking cessation guidelines: a call to action.

Smoking is the single most preventable cause of death in our society. Each year, cigarettes kill more Americans than AIDS, alcohol, car accidents, fires, illegal drugs, murders, and suicides combined. An estimated 46 million adults in the United States smoke--28% of all men and 23.5% of all women. Seventy percent of Americans who smoke say that they would like to quit. Additionally, 70% who smoke visit a healthcare provider each year. Unfortunately, half of these who seek health care each year say they have never been advised to quit smoking or provided specific strategies to be successful at quitting. In 1996, the Agency for Health Care Policy and Research (AHCPR) published smoking cessation materials in several formats that target different audiences. This article describes the significant health problems of smoking and the AHCPR publications for smoking cessation. Providers are encouraged to identify smoking cessation as a priority and incorporate the AHCPR guidelines into routine health care for all patient encounters.

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

Nursing care for diabetic patients with alcohol-induced hypoglycemia.

The combination of diabetes and alcohol poses a potentially serious threat for 16 million persons in the United States. With the prevalence of diabetes increasing, health care providers working in acute care settings need to be prepared to recognize alcohol-induced hypoglycemia quickly and respond with appropriate treatment. Prompt recognition of the problem and rapid implementation of appropriate therapies may help decrease the current cost of diabetes for the nation, which exceeds $100 billion a year, and also contribute toward the U.S. Department of Health and Human Services Healthy People 2000 goal of decreasing diabetes-related deaths and complications.