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CORK Bibliography: Nurses

39 citations. January 2010 to present

Prepared: June 2011

Abu-Baker NN; Haddad L; Mayyas O. Smoking behavior among coronary heart disease patients in Jordan: A model from a developing country. International Journal of Environmental Research and Public Health 7(3): 751-764, 2010. (32 refs.)

The purpose of this study was to compare the frequency of cigarette smoking before and after diagnosis of Coronary Heart Disease (CHD), detect the reasons that discourage quitting smoking and resources of advice about quitting, and investigate the relationship between smoking behaviors and demographic variables. A convenient sample of 300 CHD patients from cardiac outpatient clinics participated. Before disease occurrence, nonsmokers composed 40% of all participants, former smokers 11.7%, and current smokers 48.3%. Surprisingly, after disease occurrence only 29.7% of the patients quit smoking, while 60.7% continued smoking, and 9.6% relapsed. The most frequent reasons given by smokers for not quitting smoking were "do not incline to stop smoking" (25.6%) and "craving for a cigarette" (25%). Doctors were cited most frequently as the reason individuals quit smoking (19.0%). The Jordanian health care system needs to implement systematic intensive smoking cessation programs to maintain and promote CHD patients' motivation to quit smoking.

Ahern NR; Sole ML. Drinking games and college students part 2: nursing implications. Journal of Psychosocial Nursing and Mental Health Services 48(4): 15-18, 2010. (14 refs.)

In Part 1 of this article, published in the February 2010 issue, the problem of drinking game participation by U.S. college students was described. College students may play these games for reasons of peer acceptance and social interaction. Unfortunately, approximately two thirds of U.S. college students participate in this risky binge drinking behavior, from which serious consequences and harms can result. In this article, implications for community and mental health nurses are discussed. Nurses in a variety of settings have unique opportunities to educate, counsel, treat, and refer these students regarding the risks and protections of this behavior.

Ahern NR; Sole ML. Drinking games and college students. Part 1: Problem description. Journal of Psychosocial Nursing and Mental Health Services 48(2): 17-20, 2010. (18 refs.)

College students seek peer acceptance and opportunities for social interaction. For many, it may be the first time away from home, away from the supervision and watchful eyes of parents and other family members. Whether for fun, thrill, competition, or the need to socialize with others, approximately two thirds of U.S. college students participate in the risky binge drinking behavior called drinking games. Regardless of the game type, the goal of this behavior is to become intoxicated in a short period of time. Significant consequences and harm can result from this dangerous social behavior. This article, the first of two parts, will describe the problem; Part 2 will discuss the implications for community and mental health nurses.

Chen YH; Chen PL; Huang WG; Chiou HY; Hsu CY; Chao KY. Association between social climate for smoking and youth smoking behaviors in Taiwan: An ecological study. International Journal of Nursing Studies 47(10): 1253-1261, 2010. (39 refs.)

Background: Social acceptance of smoking is associated with smoking prevalence. Higher smoking rates and ETS exposure might be considered as important indicators for protobacco social norms or social climate. Among studies indicating the association between youth smoking and adult smoking behaviors, most were from individual-level study designs. Objectives: An ecological study was conducted to determine the role of social climate, i.e., adult smoking behaviors and exposure to environmental tobacco smoke (ETS), on youth smoking behaviors. Methods: Data on the smoking behavior and ETS of 16,688 Taiwanese adults were collected in 2004 by telephone administration of the Taiwan Adult Smoking Survey. Similar data on 22,339 junior high school students were collected in 2004 by school-based administration of the Taiwan Youth Tobacco Survey. City/county-level data were analyzed across 25 counties by descriptive statistics, Pearson's correlation, and hierarchical multiple regression. Results: In both adult and youth populations, overall or gender-specific smoking prevalence and ETS varied widely across counties/cities. The current youth smoking rate within counties was significantly positively correlated with the current adult smoking prevalence as well as home ETS exposure in adults or youth. For male youth, a 1% increase in the rate of home ETS exposure reported by youth increased the current male youth smoking rate by 0.20% after controlling the female youth smoking rate and home ETS exposure reported by adults (p = 0.0197). For female youth, male youth smoking prevalence was the only variable that contributed significantly (Beta = 0.46, p < 0.001). Conclusions: Community health nurses should develop tobacco-control interventions that are tailored to support smoke-free environments by decreasing the social acceptability of smoking.

Desy PM; Howard PK; Perhats C; Li SL. Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: An impact evaluation. Journal of Emergency Nursing 36(6): 538-545, 2010. (30 refs.)

Introduction: In a quasi-experimental study, control and intervention group outcomes were compared following implementation of alcohol screening, brief intervention, and referral to treatment (SBIRT) by emergency nurses. The primary hypothesis was: Trauma patients who participate in nurse-delivered ED SBIRT will have greater reductions in alcohol consumption and fewer alcohol-related incidents than those who do not. Methods: Patients were screened for alcohol use and those with risky drinking were randomly assigned to either the intervention or usual care group. Those in the intervention group received a brief motivational intervention and referral to appropriate follow-up services. Using medical and driving history records, subjects' alcohol consumption, alcohol-related traffic incidents, repeat injuries, and repeat ED visits were compared between groups at baseline and three-month follow-up. Results: Alcohol consumption decreased by 70% in the intervention group compared to 20% in the usual care group. Drinking frequency also decreased in both groups. Fewer patients from the intervention group (20%) had recurring ED visits compared to patients in the usual care group (31%). Discussion: The SBIRT procedure can impact alcohol consumption and potentially reduce injuries and ED visits when successfully implemented by staff nurses in the emergency department environment. Further research is needed to improve follow-up methods in this hard to reach, mobile patient population.

Duffy SA; Karvonen-Gutierrez CA; Ewing LA; Smith PM. Implementation of the tobacco tactics program in the Department of Veterans Affairs. Journal of General Internal Medicine 25(Supplement 1): 3-10, 2010. (41 refs.)

Smoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups, while inpatient cessation programs have not been widely implemented. The objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA. This is a pre-/post-non-randomized control study initially designed to teach inpatient staff nurses on general medical units in the Ann Arbor and Detroit VAs to deliver the Tobacco Tactics intervention using Indianapolis as a control group. Coupled with cessation medication sign-off, physicians are reminded to give patients brief advice to quit. Approximately 96% (210/219) of inpatient nurses in the Ann Arbor, MI site and 57% (159/279) in the Detroit, MI site have been trained, with an additional 282 non-targeted personnel spontaneously attending. Nurses' self-reported administration of cessation services increased from 57% pre-training to 86% post-training (p = 0.0002). Physician advice to quit smoking ranged between 73-85% in both the pre-intervention and post-intervention period in both the experimental and control group. Volunteers made follow-up telephone calls to 85% (n = 230) of participants in the Ann Arbor site. Hospitalized smokers (N = 294) in the intervention group are reporting an increase in receiving and satisfaction with the selected cessation services following implementation of the program, particularly in regards to medications (p < 0.05). A large proportion of inpatient nursing staff can rapidly be trained to deliver tobacco cessation interventions to inpatients resulting in increased provision of services.

Epstein PM; Burns C; Conlon HA. Substance abuse among registered nurses. AAOHN Journal 58(12): 513-516, 2010. (23 refs.)

The stressful conditions under which nurses work, due in part to the nursing shortage, are among the risk factors that contribute to nurses' abuse of illicit drugs. Nurses differ from the general population in that they work in an environment where they not only have access to controlled substances, but also are exposed to death and dying, the stress of which can increase the risk of drug abuse. However, practicing while impaired places patients' lives at. risk and decreases staff morale.

Fernandez D; Martin V; Molina AJ; De Luis JM. Smoking habits of students of nursing: A questionnaire survey (2004-2006). Nurse Education Today 30(5): 480-484, 2010. (40 refs.)

Aim: To determine changes in the prevalence of tobacco use among students of nursing and associated factors. Background: The prevalence and distribution of smokers among nursing students varies according to the country and period of study. Method: Transversal descriptive study by self-answered questionnaire. Eight hundred and fifty four subjects (94.9%) were questioned in the period 2004-2006. Findings: Twenty eight percent of the students declared themselves to be smokers. The habit began before the students started university. The tendency of prevalence by year of survey and by graduation year was downward. The students shown a low nicotine dependency according to Fagerstrom and little motivation to give up. The average age at the onset of consumption was 14.6 (1.8) years. From the logistical regression analysis, the model best explaining the prevalence of tobacco consumption included the variable of year surveyed and academic background, those coming from the baccalaureate showing a lesser prevalence and tendency to smoke. Conclusions: Tobacco consumption among students of health sciences was less than in the general population of the same age but high given their future profession. The tendency to smoke is decreasing and most started smoking before joining the university. We recommend an intensification of actions directed at teenagers and the promotion of anti-tobacco campaigns in universities.

Ford R. An analysis of nurses' views of harm reduction measures and other treatments for the problems associated with illicit drug use. Australian Journal of Advanced Nursing 28(1): 14-24, 2010. (48 refs.)

Objective: To analyse nurses' views of harm reduction measures and other treatments for the problems associated with illicit drug use. Design and setting: The study, a cross-sectional survey, sampled the entire registered nurse population of the ACT. A self-complete survey was posted to home or workplace addresses. The views of all nurses registered in the ACT were sought. Subjects: The study sample (n = 1,605: 50% response rate), was predominantly comprised of nurses working outside specialist drug and alcohol fields (94%), with a small group from specialist fields. Main outcome measures: A 6-point Likert scale comprising 7 items (illicit drug treatments). Comparison with the Australian population was achieved through use of the National Drug Strategy Household Survey database. Results: Nurses mirrored the views of the Australian population, being strongly supportive of two abstinence-based measures (naltrexone for the maintenance of abstinence - 82% and rapid detoxification therapy 77%) and one harm reduction measure (the needle and syringe program - 76%). Nurses' lower support for the methadone maintenance program (66%) was statistically significant. Conclusions: Nurses reported high approval for the needle and syringe program but were mistakenly optimistic about abstinence-based measures for problems associated with illicit drugs. They reported significantly less support for important harm reduction measures - the methadone maintenance program and safe injection rooms. Nurses' low approval rating for these harm reduction measures is at odds with the evidence. This study highlights the need for education on the evidence base for the various illicit drug treatments.

Fornili K; Burda C. Overview of current federal policy for substance use disorders. (editorial). Journal of Addictions Nursing 21(4): 247-251, 2010. (16 refs.)

Substance use disorders (substance abuse and addiction) impose enormous costs on society and are responsible for thousands of deaths each year. Nurses play an increasingly valuable role in the addictions prevention and treatment workforce; they can increase both access to care and the quality of services. Traditionally, drug control efforts in the United States have directed more resources toward "supply reduction" (law enforcement and interdiction) than on "demand reduction" (substance abuse prevention and treatment efforts), forcing the latter to work overtime to make an impact on rates of these disorders. Particularly as the field moves toward health care reform and improved integration of somatic and behavioral health, nurses are strongly encouraged to learn more about available national substance abuse prevention and treatment policies, strategies and evidence-based interventions (EBPs). This column provides a brief overview of current federal priorities, policy and EBPs for the prevention and treatment of substance use disorders.

Gardiner C; Ingleton C. Commentary on Green AJ & De-Vries K (2010) Cannabis use in palliative care - an examination of the evidence and the implications for nurses. (editorial). Journal of Clinical Nursing 19(21-22): 3253-3255, 2010. (13 refs.)

Gill JS; Gibson C; Nicol M. Healthcare and medical graduates of 2009: Their reactions to four key proposals in the Scottish Government's strategy for tackling alcohol misuse. Alcohol and Alcoholism 45(2): 200-206, 2010. (26 refs.)

Aims: This study compares the views of final year medical, and nursing and allied health professional (NAHP) students in relation to four governmental proposals impacting on the sale and purchase of alcohol. Methods: Against a background of political will to address alcohol abuse in Scotland and moves within the National Health Service promoting a shifting of professional roles, self-completed questionnaires were administered in spring 2009 through course websites and lectures to final year medical and NAHP students. Results: Questionnaires were returned by 406 NAHPs and 121 medical students. Over three quarters of all students agreed with the proposed change to reduce the drink driving limit to 50 mg/100 ml blood. Less support was evident for the raising of the minimum legal purchase age for off-sales (37%), the banning of below cost price promotions of alcohol (47%) and minimum retail pricing (37%). However, there were differences between the NAHP and medical students in the case of the final two proposals; over 60% of the medical students agreed they would have a positive impact. For NAHPs, figures were 41% and 31%, respectively. Conclusions: Support for four key proposals outlined by the Scottish Government to address alcohol misuse varied. Only the suggestion to lower the drink driving limit received backing overall and within students in these professions. Effectiveness of proposed restrictions on the price of alcohol was less well regarded except by medical students. Evident gaps in knowledge around health guidelines, and the finding that almost half of NAHPs disagreed that they had the appropriate knowledge to advise patients about responsible drinking advice and alcohol misuse problems, suggest a need for improved undergraduate education and continued professional development with respect to public health aspects of alcohol use.

Go F; Dykeman M; Santos J; Muxlow J. Supporting clients on methadone maintenance treatment: A systematic review of nurse's role. Journal of Psychiatric and Mental Health Nursing 18(1): 17-27, 2011. (42 refs.)

Accessible summary Nurses, regardless of where they practice need to play a major role in providing holistic care for persons who participate in methadone maintenance treatment programmes. Nursing tasks that were found to rank as the most important when caring for clients on methadone maintenance treatment were: to administer methadone, to observe the patient's general condition, to provide counselling, and offer ongoing support as needed. Nurses should be prepared to assess for drug dependency, screen for opiate use when high index of suspicion is present and assess for psychosocial factors. Furthermore, nurses should be also knowledgeable about appropriate dosage of methadone and its efficacy, as well as support case management and outreach interventions. Nurses need to know enough about addiction and methadone maintenance therapy to be able to gain an understanding of the client's attitude and perceptions regarding addiction and the treatment process. Abstract This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.

Goebel JR; Sherbourne CD; Asch SM; Meredith L; Cohen AB; Hagenmaier E et al. Addressing patients' concerns about pain management and addiction risks. Pain Management Nursing 11(2): 92-98, 2010. (36 refs.)

Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high. Regarding addressing addiction concerns, 66% of nursing staff were very likely, 16% somewhat likely, 9% unsure, 6% somewhat unlikely, and 2% very unlikely to take action. Health technicians were less likely to address addiction concerns than registered or licensed vocational nurses (odds ratio [OR] 0.116; p=.004). Nursing staff with more years' experience (OR 1.070; p=.005) and higher levels of self-efficacy/confidence (OR 1.380; p=.001) were more likely to engage in discussions related to addiction risks. Targeted efforts to improve pain management activities should focus on retaining experienced nursing staff in initial assessment positions and improving the skills and confidence of less experienced and less skilled staff.

Green AJ; De-Vries K. Cannabis use in palliative care: An examination of the evidence and the implications for nurses. Journal of Clinical Nursing 19(17-18): 2454-2462, 2010. (57 refs.)

Aim and objective: Examine the pharmaceutical qualities of cannabis including a historical overview of cannabis use. Discuss the use of cannabis as a clinical intervention for people experiencing palliative care, including those with life-threatening chronic illness such as multiple sclerosis and motor neurone disease [amyotrophic lateral sclerosis] in the UK. Background: The non-medicinal use of cannabis has been well documented in the media. There is a growing scientific literature on the benefits of cannabis in symptom management in cancer care. Service users, nurses and carers need to be aware of the implications for care and treatment if cannabis is being used medicinally. Design: A comprehensive literature review. Method: Literature searches were made of databases from 1996 using the term cannabis and the combination terms of cannabis and palliative care; symptom management; cancer; oncology; chronic illness; motor neurone disease/amyotrophic lateral sclerosis; and multiple sclerosis. Internet material provided for service users searching for information about the medicinal use of cannabis was also examined. Results: The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care. Relevance to clinical practice. Questions and dilemmas are raised concerning the role of the nurse when caring and supporting a person making therapeutic use of cannabis.

Indig D; Copeland J; Conigrave KM; Arcuri A. Characteristics and comorbidity of drug and alcohol-related emergency department presentations detected by nursing triage text. Addiction 105(5): 897-906, 2010. (30 refs.)

Introduction: This study used nursing triage text to detect drug- and alcohol-related emergency department (ED) presentations and describe their patient and service delivery characteristics. Methods: Data were reviewed for all ED presentations from 2004 to 2006 (n = 263 937) from two hospitals in Sydney, Australia. Each record included two nursing triage free-text fields, which were searched for more than 100 drug-related and more than 60 alcohol-related terms. Adjusted odds ratios were used to compare the characteristics of drug and alcohol-related ED presentations with all other ED presentation types. Results: Just over 5% of ED presentations were identified as alcohol-related and 2% as drug-related. The most prevalent drug-related ED presentations specified were related to amphetamines (18%), heroin (14%), cannabis (14%) and ecstasy (12%), while nearly half (43%) were drug unspecified. Polydrug use was mentioned in 25% of drug-related and 9% of alcohol-related ED presentations, with the highest rate of polydrug use among ecstasy-related (68%) presentations. Drug- and alcohol-related ED presentations were significantly more likely than other ED presentations to have a mental health diagnosis, with the highest rates found among cannabis-related (OR = 7.6) or amphetamine-related (OR = 7.5) presentations. Conclusion: The ED provides an opportunity for early intervention for patients presenting with comorbid drug and alcohol and mental health problems. Further research is needed to assess the prevalence of drug and alcohol problems in ED patients with mental health problems and to develop effective interventions in that setting.

Johnson ME; Robinson RV; Corey S; Dewane SL; Brems C; Casto LD. Knowledge, attitudes, and behaviors of health, education, and service professionals as related to fetal alcohol spectrum disorders. International Journal of Public Health 55(6): 627-635, 2010. (27 refs.)

We explored differences in fetal alcohol spectrum disorders (FASD) knowledge, attitudes, and behaviors across six groups of professionals in key position to provide primary and secondary prevention efforts (physicians, educators, correctional staff, social workers, public health nurses, and substance abuse counselors). Achieving a 60.1% response rate, 2,292 professionals returned surveys, providing data on basic knowledge of FAS, FASD-associated risks and cognitive deficits, and willingness to confront and recommend treatment to alcohol-consuming pregnant women. Across groups, findings revealed ample FASD knowledge and willingness to confront and recommend treatment to alcohol-consuming pregnant women that increases as consumption becomes more frequent and severe. However, results revealed significant between-group differences data that provide valuable guidance for targeted future FASD education efforts. Public health initiatives regarding FASD have been effective in increasing knowledge among a broad range of professionals. However, between-group differences indicate the need for targeted, discipline-specific interventions. These differences highlight the need for all professional groups to provide a consistent public health message regarding maternal alcohol consumption.

Matten P; Morrison V; Rutledge DN; Chen T; Chung E; Wong SF. Evaluation of tobacco cessation classes aimed at hospital staff nurses. Oncology Nursing Forum 38(1): 67-73, 2011. (23 refs.)

Purpose/Objectives: To evaluate a three-hour smoking cessation program and its effect on nurse knowledge, counseling behaviors, and confidence in counseling behaviors. Design: Program evaluation. Setting: A Magnet (R)-designated, 500-bed community hospital in Southern California. Sample: 107 nurses. Methods: Program content included behavior counseling and pharmacotherapy along with role playing. Investigator-developed self-report surveys were completed on the clay of the class and at 3, 6, and 12 months. Main Research Variables: Short- and long-term changes in nurse knowledge, attitudes, and behaviors about tobacco cessation efforts. Findings: Knowledge significantly increased from baseline to post-test. Counseling skills improved. Nurses who completed all surveys exhibited no significant changes about asking patients to quit smoking but did demonstrate significant changes at three months regarding advising patients, assessing quit readiness, and providing assistance. Changes were maintained over the year. Nurses' average ability to counsel patients was rated "good or very good" after one year. At 3, 6, and 12 months, most respondents reported providing cessation counseling or referrals to at least one patient. Conclusions: These findings support tobacco cessation programs for bedside nurses as useful in enhancing nurse confidence in patient-counseling skills. Implications for Nursing: Study findings demonstrated' benefits to using the developed curriculum. Additional research is needed on tobacco cessation programs for hospital nurses, particularly with longitudinal outcomes and actual nurse behaviors.

McCreaddie M; Lyons I; Watt D; Ewing E; Croft J; Smith M et al. Routines and rituals: A grounded theory of the pain management of drug users in acute care settings. Journal of Clinical Nursing 19(19-20): 2730-2740, 2010. (67 refs.)

Aim. This study reviewed the perceptions and strategies of drug users and nurses with regard to pain management in acute care settings. Background. Drug users present unique challenges in acute care settings with pain management noted to be at best suboptimal, at worst non-existent. Little is known about why and specifically how therapeutic effectiveness is compromised. Design. Qualitative: constructivist grounded theory Method. A constructivist grounded theory approach incorporating a constant comparative method of data collection and analysis was applied. The data corpus comprised interviews with drug users (n = 11) and five focus groups (n = 22) of nurses and recovering drug users. Results. Moral relativism as the core category both represents the phenomenon and explains the basic social process. Nurses and drug users struggle with moral relativism when addressing the issue of pain management in the acute care setting. Drug users lay claim to expectations of compassionate care and moralise via narration. Paradoxically, nurses report that the caring ideal and mutuality of caring are diminished. Drug users' individual sensitivities, anxieties and felt stigma in conjunction with opioid-induced hyperalgesia complicate the processes. Nurses' and hospitals' organisational routines challenge drug user rituals and vice versa leading both protagonists to become disaffected. Consequently, key clinical issues such as preventing withdrawal and managing pain are left unaddressed and therapeutic effectiveness is compromised. Conclusion. This study provides a robust account of nurses' and drug users' struggle with pain management in the acute care setting. Quick technological fixes such as urine screens, checklists or the transient effects of (cognitive-based) education (or training) are not the answer. This study highlights the need for nurses to engage meaningfully with this perceptibly 'difficult' group of patients. Relevance to clinical practice. The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that they can be prevented and, or addressed.

McKenna B; Thom K; Howard F; Williams V. In search of a national approach to professional supervision for mental health and addiction nurses: The New Zealand experience. Contemporary Nurse 34(2, special issue): 267-276, 2010. (25 refs.)

A competent nursing workforce is crucial for recovery of mental health and addiction service users. Professional supervision is central to facilitating this competency. This article reports on research that scoped the current provision of professional supervision then explores possibilities for developing a standardised national approach to professional supervision for mental health and addiction nurses in New Zealand. The study involved telephone and mail surveys with nurse leaders and current supervisors from district health boards and non-government organisations. The findings indicated that the majority of those canvassed were supportive of a nationally endorsed approach. Standardisation was seen as a means of assisting in the monitoring and quality refinement of the content and provision of professional supervision, and the training of supervisors. It was also recommended that to be successful, a national approach must incorporate partnerships with significant stakeholders in the sector, including service users and Maori.

Merrill RM; Gagon H; Harmon T; Milovic I. The importance of tobacco cessation training for nurses in Serbia. Journal of Continuing Education In Nursing 41(2): 89-96, 2010. (32 refs.)

Background: This study assessed smoking prevalence, attitudes, and perceived patient counseling responsibilities among practicing nurses in Serbia. The need for nurses to receive tobacco cessation training is explored. Methods: Data were collected through a cross-sectional survey of 230 nurses at public institutions in Belgrade, a health care center in Belgrade, and public health care facilities throughout Serbia. Results: The smoking prevalence was 52% for male nurses and 47% for female nurses. Nurses had the greatest mean level of agreement with statements about controlling smoking through policy, followed by statements about being role models. Only 15% (n = 35) of nurses regularly counseled their patients about smoking, and only 16% of nurses (45% of males vs. 12% of females, p < .0001) had received training in counseling patients about smoking. Nurses' training in counseling patients about smoking was positively associated with the nurses' belief that their counseling could help patients stop smoking or never start smoking. In addition, nurses with training in counseling patients about smoking considered themselves significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe that their counseling about smoking could be effective. They also felt significantly less well prepared to assist patients to quit smoking. Conclusion: These findings show that nurses' training in tobacco cessation counseling results in greater self-perceived confidence and frequency of regular tobacco cessation counseling in Serbia.

Merrill RM; Madanat H; Kelley AT. Smoking prevalence, attitudes, and perceived smoking prevention and control responsibilities and practices among nurses in Amman, Jordan. International Journal of Nursing Practice 16(6): 624-632, 2010. (22 refs.)

This study assesses smoking prevalence, attitudes, and perceived patient counselling responsibilities among practicing nurses in Amman, Jordan. It also identifies whether their smoking status or training in counselling patients about smoking is associated with their smoking-related attitudes and counselling practices. Data were collected through a cross-sectional survey of 266 (n = 266) nurses at four public and private hospitals in Amman. Smoking prevalence was 42% for male nurses and 13% for female nurses. Nurses strongly favoured enforcement of anti-smoking policy, but did not strongly agree that nurses should be involved in counselling patients about smoking. Approximately 41% of nurses indicated that they had received training on counselling patients about smoking. Nurse training with respect to counselling patients about smoking was positively associated with the nurses' belief that their counselling could help patients stop or never start smoking. In addition, nurses with counselling training about smoking felt significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe their counselling of patients about smoking could be effective. Finally, smoking status was not significantly associated with how well prepared the nurses felt to assist patients to quit smoking. These findings identify a need for more extensive and better-tailored training programmes for nurses on patient counselling about smoking.

Monroe T; Kenaga H. Don't ask don't tell: Substance abuse and addiction among nurses. Journal of Clinical Nursing 20(3-4): 504-509, 2011. (27 refs.)

Aim. The purpose of this manuscript is to illustrate the challenges faced by nurses who abuse substances and to promote international dialogue about what practitioners, administrators, health care providers and students can do when they suspect someone in the profession is abusing substances, or they may themselves be suffering from addiction. Background. Addiction among nurses has been recognised by professionals in the field for over 100 years, and current estimates place rates of substance misuse, abuse and addiction rates as high as 20% among practicing nurses. Unfortunately, fear of punishment and discipline may keep nurses or students from asking for help for themselves or from reporting a colleague or friend who is in need of help. Design. Discursive paper. Method. This paper synthesises the results of three previous papers conducted on substance abuse policies in the nursing profession. In the first paper, the authors reviewed the history of addiction in nursing and compared disciplinary and alternative-to-discipline policies. The second focused on the development of an alternative-to-dismissal policy for substance abuse in a school of nursing and using telephone and email interviews, and the final paper reported findings of what types of polices seem to be working to retain and rehabilitate nurses who suffer from addiction in the. Lastly, this paper introduces international policy for nurses with addictions. Conclusions. Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions. Relevance to clinical practice. Recognition of a colleague's need of treatment is the important first step in the rehabilitation process. Early intervention and assistance are essential for helping colleagues and students to recover from an addictive disorder and providing a confidential, non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care.

Naegle M; Baird C. Nurses, health and tobacco use. (editorial). Journal of Addictions Nursing 21(2-3): 67-68, 2010. (0 refs.)

Nakata A; Swanson NG; Caruso CC. Nurses, smoking, and immunity: A review. (review). Rehabilitation Nursing 35(5, special issue): 198-205, 2010. (74 refs.)

Nurses regularly are exposed to a variety of occupational hazards. In addition to documented occupational hazards, exposure to smoking remains a major concern. This article reviews the prevalence of smoking among nurses working in the United States and discusses their reasons for smoking. Researchers conducted a state-of-the-art review on the effects of cigarette smoking and exposure to secondhand smoke (Si-IS) on the immune system. Smoking prevalence among nurses working in the United States ranged from 7%-12%, and high work stress, poor work environment, shift work, and peer influence were suspected major risk factors influencing smoking behavior. A review of the effects of smoking on immunity revealed that both active smoking and exposure to SHS negatively affects immune function. When rehabilitation nurses stop smoking, their health improves and nonsmokers are exposed to less SHS. Rehabilitation nurses are encouraged to share knowledge of the immunological benefits of smoking cessation with patients to facilitate nurse-led rehabilitation programs.

Noknoy S; Rangsin R; Saengcharnchai P; Tantibhaedhyangkul U; McCambridge J. RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol and Alcoholism 45(3): 263-270, 2010. (17 refs.)

Aims: To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand. Methods: A randomized controlled trial was conducted in eight PCUs in Ubonratchatanee and Chachoengsao provinces in Thailand. Hazardous drinkers were identified using the World Health Organization-recommended Alcohol Use Disorder Identification Test. Of 117 eligible participants (91% male), 59 were randomized to the intervention group to receive MET in three individual appointments with a trained nurse and 58 to an assessment-only control group. Outcome evaluations were carried out after 6 weeks, 3 months and 6 months. Results: Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group (P < 0.05) after both 3 and 6 months. The groups did not generally differ at 6 weeks. However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study. Conclusion: MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.

Noonan D. Exemptions for hookah bars in clean indoor air legislation: A public health concern. Public Health Nursing 27(1): 49-53, 2010. (29 refs.)

Popularity of waterpipe smoking or hookah smoking in the United States has been growing for some time now among youth and young adults. Currently, many cities and states have exemptions that allow hookah bars to remain in operation despite the passage of clean indoor air legislation. From a public health perspective this is concerning for many reasons. One public health concern with the increase in popularity of this type of tobacco use is the associated health effects. Another concern is that hookah smoke produces a sweet smelling aroma making it less obvious that patrons and employees of hookah bars are inhaling noxious fumes from mainstream smoke, as well as the toxins from the charcoal that is used to heat the tobacco. The purpose of this paper is to discuss smoke-free air legislation in relation to hookah use, the public health implications of exempting hookah bars from current smoke-free legislation, and implications for the public health nurse in protecting the public from the dangers of second-hand smoke, and limiting this new form of tobacco use.

Nyamathi A; Shoptaw S; Cohen A; Greengold B; Nyamathi K; Marfisee M et al. Effect of motivational interviewing on reduction of alcohol use. Drug and Alcohol Dependence 107(1): 23-30, 2010. (47 refs.)

Background: Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population. Objective: To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use. Methods: A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (I) nurse-led hepatitis health promotion group sessions (n=87); (2) MI delivered in group sessions (MI-group: n=79), or(3) MI delivered one-on-one sessions (MI-single, n=90). Results: Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p<.05). In multiple logistic regression analysis controlling for alcohol consumption at baseline and other covariates, no differences by condition were found. Discussion: As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.

Perdikaris P; Kletsiou E; Gymnopoulou E; Matziou V. The relationship between workplace, job stress and nurses' tobacco use: A review of the literature. International Journal of Environmental Research and Public Health 7(5): 2362-2375, 2010. (44 refs.)

The aim of this study was to provide a summary of the existing published knowledge on the possible relationship between the workplace as a stressor factor and nurses' tobacco use. A systematic review of the literature from 1995 to 2009, using the MEDLINE database took place. Studies, that referred to nurses' smoking habit exclusively or as a part of the study, were included in the review. 491 studies were retrieved and their titles/abstracts were examined systematically. Twenty one studies were retrieved for further consideration by a comprehensive literature review. Ten studies fulfilled the eligibility criteria and they were examined further. There is a conflict on the possible relationship between workplace as a stressor factor and nurses' smoking habits, because there is no evidence on if the nurses' work environment causes smoking initiation.

Peterson J. A qualitative comparison of parent and adolescent views regarding substance use. Journal of School Nursing 26(1): 53-64, 2010. (45 refs.)

Substance use is a major cause of adolescent morbidity and mortality. By age 14, 70% of adolescents have consumed alcohol and half of 12th graders report having used marijuana. The purpose of this study was to increase the understanding of parent and adolescent perceptions regarding adolescent use of alcohol, tobacco, and other drugs (ATOD) to enhance the development of effective prevention programs. Six adolescent focus groups and one parent focus group participated. Results were derived following elicitation of adolescents' and parents' beliefs regarding adolescent ATOD use and current prevention programs. Findings indicate that current prevention programs are ineffective; ATOD use is normalized by schools, community, and family; positive adult role models deter use; and programs should involve youth, parents, schools, and community. Focus group discussions can strengthen the development of tailored ATOD prevention programs. School nurses can foster collaboration between families, schools, and communities to reduce adolescent substance use.

Ritchie L; Evans MK; Matthews J. Nursing students' and clinical instructors' perceptions on the implementation of a best practice guideline. Journal of Nursing Education 49(4): 223-227, 2010. (23 refs.)

A university nursing program in Ontario, Canada initiated the process of implementing the Registered Nurses' Association of Ontario best practice guideline (BPG) on smoking cessation into the curriculum. This study explored nursing students' and clinical instructors' perceptions regarding the implementation of the BPG in their practice to support faculty in the development of a curriculum that promotes smoking cessation and the competencies necessary for graduates to implement health promotion skills in practice. Four student nurses and two clinical instructors participated in semistructured interviews. Four major themes were identified through the data analysis process: personal and professional self, health "preaching," developmental perspective, and environmental constraints. This study presents a curricular model for health promotion practice incorporating the components of primary health care, health promotion counseling, smoking cessation BPG, and sociopolitical context.

Sarna L; Bialous SA; Sinha K; Yang Q; Wewers ME. Are health care providers still smoking? Data from the 2003 and 2006/2007 tobacco use supplement-current population surveys. Nicotine & Tobacco Research 12(11): 1167-1171, 2010. (27 refs.)

Introduction: Smoking by health care professionals poses a barrier to interventions with patients. This study reports smoking status changes among health care professionals using the Tobacco Use Supplement-Current Population Surveys (TUS-CPS). Methods: TUS-CPS self-reported smoking status (current, former, and never) identified by occupation (physicians, physician assistants, registered nurses [RNs], licensed practical nurses [LPNs], respiratory therapists, dentists, and dental hygienists), were analyzed for the 2003 (N = 4,095) and 2006/2007 (N = 3,976) cohorts. Quit ratios among U. S. health care professionals were calculated by dividing the number of former smokers by the number of ever-smokers using weighted estimates. Results: In 2006/2007, LPNs (20.55%) and respiratory therapists (19.28%) had the highest smoking prevalence. Physicians (2.31%), dentists (3.01%), pharmacists (3.25%), and RNs (10.73%) had the lowest prevalence. Data from 2006/2007 indicate that physicians, pharmacists, dentists, and physician assistants had the highest quit ratios; all groups had quit ratios higher than the general public, except LPNs (. 52 vs. .46, respectively). Current smoking varied by group but did not significantly decline from 2003 to 2006/2007. The majority of health care professionals were never-smokers. Conclusions: These data indicate that only 4 health care professional groups met the Healthy People 2010 goal of 12% smoking prevalence. LPNs were the only group with quit ratios lower than the general population. The lack of significant decline in smoking rates among health professionals was similar to the "flat" rate seen among adults in the United States. This is of concern as smoking among health care professionals limits their interventions with smokers and their involvement in tobacco control.

Smith DR. Tobacco control and the nursing profession. (editorial). Nursing and Health Sciences 12(1): 1-3, 2010. (42 refs.)

Tong EK; Strouse R; Hall J; Kovac M; Schroeder SA. National survey of US health professionals' smoking prevalence, cessation practices, and beliefs. Nicotine & Tobacco Research 12(7): 724-733, 2010. (35 refs.)

Tobacco dependence treatment efforts have focused on primary care physicians (PCPs), but evidence suggests that they are insufficient to help most smokers quit. Other health professionals also frequently encounter smokers, but their smoking prevalence, cessation practices, and beliefs are less well known. The study included 2,804 subjects from seven health professional groups: PCPs, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. Outcomes included self-reported smoking status, smoking cessation practices, and beliefs. Multivariate regression was used to examine factors associated with health professionals (except pharmacists) self-reportedly performing the "5 A's": asking, advising, assessing, assisting, or arranging follow-up about tobacco. Health professionals have a low smoking prevalence (< 6%), except nurses (13%). Many health professionals report asking (87.3%-99.5%) and advising (65.6%-94.9%) about smoking but much less assessing smokers' interest (38.7%-84.8%), assisting (16.4%-63.7%), and arranging follow-up (1.3%-23.1%). Controlling for health professional and practice demographics, factors positively associated in the multivariate analyses with self-reportedly performing multiple components of the 5 A's include awareness of the Public Health Service guidelines, having had cessation training, and believing that treatment was an important professional responsibility. Negative associations include the health professional being a current smoker, not being a PCP, being uncomfortable asking patients if they smoke, believing counseling was not an appropriate service, and reporting competing priorities. U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.

Tsai YF; Tsai MC; Lin YP; Weng CE; Chen CY; Chen MC. Facilitators and barriers to intervening for problem alcohol use. Journal of Advanced Nursing 66(7): 1459-1468, 2010. (33 refs.)

Aim. This article is a report of a study exploring nurses' perceived facilitators and barriers to conducting brief interventions for problem alcohol use. Background. Excessive alcohol use has been associated with health, social and legal problems. Healthcare providers worldwide need help to detect and intervene with hazardous/harmful drinkers. Methods. For this cross-sectional study, ten hospitals were randomly selected throughout Taiwan during 2007. Nurses (N = 741) were selected from the emergency department, and psychiatric and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. Data collected using facilitator and barrier scales and a demographic information form were analysed by descriptive statistics and stepwise, multiple linear regression analysis. Results. Nurses identified the top facilitator to intervening for problem alcohol use as 'patients' drinking problems are related to their illness'. Top barriers were 'patients lack motivation to change' and 'patients express no interest in receiving intervention'. Perceived facilitators were associated with nurses' work unit, intention to intervene for problem alcohol use, and age. Perceived barriers were associated with work unit, experience in intervening for problem alcohol use, and having attended a training course. Conclusion. Source of perceived barriers reflected cultural influences. Taiwanese nurse education needs to be strengthened in terms of brief interventions for problem alcohol use. Emergency department nurses need to become more aware of their important role in alcohol intervention. Alcohol-related education is needed for the general population and hospital policymakers to enhance facilitators and reduce barriers to intervening for problem alcohol use.

Vourakis C. Tackling tobacco use: The power of nursing. (editorial). Journal of Addictions Nursing 21(2-3): 65-66, 2010. (4 refs.)

Voyer P; Roussel ME; Berbiche D; Preville M. Effectively detect dependence on benzodiazepines among community-dwelling seniors by asking only two questions. Journal of Psychiatric and Mental Health Nursing 17(4): 328-334, 2010. (41 refs.)

Consumption of benzodiazepines (BZDs) is common among seniors. When used over a long period of time, BZDs can induce dependence. The present study aimed to equip nurses with valid screening questions for detecting BZD dependence among seniors, applicable to clinical practice and based on the DSM-IV-TR version. A random sample of 707 BZD users aged 65 years and over was screened for BZD dependence using the DSM-IV-TR criteria for substance dependence. To predict a diagnosis of BZDs dependence, sensitivity and specificity were computed for each pair of items. Results showed that an affirmative answer to 'Have you tried to stop taking this medication?' and 'Over the past 12 months, have you noticed any decrease in the effect of this medication?' led to a sensitivity of 97.1% and a specificity of 94.9% to detect BZD dependence. Asking these two simple questions can be easily integrated into clinical practice and have considerable potential for identifying cases of BZD dependence.

Wang HH; Zhou J; Huang L; Li XH; Fennie KP; Williams AB. Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China. Journal of Clinical Nursing 19(3-4): 380-388, 2010. (32 refs.)

Aims and objectives. This study aimed to examine the effects of nurse-delivered home visits combined with telephone intervention on medication adherence, and quality of life in HIV-infected heroin users. Background. Drug use is consistently reported as a risk factor for medication non-adherence in HIV-infected people. Design. An experimental, pretests and post-tests, design was used: baseline and at eight months. Methods. A sample of 116 participants was recruited from three antiretroviral treatment sites, and 98 participants completed the study. They were randomly assigned to two groups: 58 in the experimental group and 58 in the control group. The experimental group received nurse-delivered home visits combined with telephone intervention over eight months, while the control group only received routine care. The questionnaire of Community Programs for Clinical Research on AIDS (CPCRA) Antiretroviral Medication Self-Report was used to assess levels of adherence, while quality of life and depression were evaluated using Chinese versions of World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-BREF) and Self-rating Depression Scale, respectively. Data were obtained at baseline and eight months. Results. At the end of eight months, participants in the experimental group were more likely to report taking 100% of pills (Fisher's exact = 14.3, p = 0.0001) and taking pills on time (Fisher's exact = 18.64, p = 0.0001) than those in the control group. There were significant effects of intervention in physical (F = 10.47, p = 0.002), psychological (F = 9.41, p = 0.003), social (F = 4.09, p = 0.046) and environmental (F = 4.80, p = 0.031) domains of WHOQOL and depression (F = 5.58, p = 0.02). Conclusion. Home visits and telephone calls are effective in promoting adherence to antiretroviral treatment and in improving the participants' quality of life and depressive symptoms in HIV-infected heroin users. Relevance to clinical practice. It is important for nurses to recognise the issues of non-adherence to antiretroviral treatment in heroin users. Besides standard care, nurses should consider conducting home visits and telephone calls to ensure better health outcome of antiretroviral treatment in this population.

Wye P; Bowman J; Wiggers J; Baker A; Carr V; Terry M et al. Providing nicotine dependence treatment to psychiatric inpatients: the views of Australian nurse managers. Journal of Psychiatric and Mental Health Nursing 17(4): 319-327, 2010. (53 refs.)

The prevalence of smoking in psychiatric settings remains high. This study aims to describe the views of nurse managers in psychiatric inpatient settings regarding the provision of nicotine dependence treatment, and whether there were associations between such views and the provision of nicotine dependence treatment. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales, Australia, for completion by nurse managers. Of the identified 131 service units, 123 completed questionnaires were returned (94%). Patient-related factors were considered to have a high level of influence on the provision of nicotine dependence treatment: patients requesting assistance to quit (58%), patients being receptive to interventions (52%), and patient health improving with quitting (45%). Units where the respondent reported that nicotine dependence treatment was as important as other roles were more likely to provide nicotine dependence treatment compared to units whose respondents did not hold this view (OR = 0.257, d.f. = 1, P < 0.01). While the results indicate strong support for the provision of nicotine dependence treatment, this support appears qualified by perceived patient readiness to quit, suggesting care is provided selectively rather than systematically. Positioning smoking as an addiction requiring treatment within a traditional curative approach may lead to a health service more conducive to the routine provision of nicotine dependence treatment.