Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours

AIM

To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.

RATIONALE

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role.

METHODS

A cross-sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self-administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale.

FINDINGS

Two hundred and seventy-two students (61.9%) responded. Sixty (22.1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91.4% said they wanted to quit, few were actively engaged in the quitting process (16.9%). When comparing the beliefs and attitudes of smoking and non-smoking students, proportionally more of the non-smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non-smoking example. Non-smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management.

CONCLUSIONS

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.

Double agency in clinical research

The current focus on evidence-based practice in nursing may result in nurses playing 2 roles concurrently--that is, acting as researcher and caregiver at the same time and with the same people. Given the fiduciary nature of the patient-caregiver relationship, this double agency can give rise to problems, both real and perceived. In this paper, the issues associated with assuming dual roles in research with humans will be examined, particularly in relation to recruitment and informed consent, data collection, and participant withdrawal from a study. In addition, strategies to prevent or minimize problems related to double agency are identified, with attention to the guidance provided by professional codes of ethics and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.

Women's interest in genetic testing for breast cancer risk: the influence of sociodemographics and knowledge

The objective of this study was to assess women's interest in genetic testing for breast cancer risk. Randomly selected samples of 761 women without breast cancer from the general population of British Columbia, Canada, and 260 women with breast cancer from the provincial cancer registry participated in a telephone survey that assessed interest in genetic testing for breast cancer risk, knowledge of hereditary breast cancer and genetic testing, and sociodemographics. Women with breast cancer did not possess superior knowledge of breast cancer genetics compared with women from the general population. Of the women with breast cancer, 30.8% reported interest in testing or had been tested, compared with 28.5% of women without breast cancer. Controlling for differences in age, education, personal history of breast cancer, and knowledge of genetics, women with at least one relative with breast cancer were 2.3 times more likely to express interest in genetic testing for breast cancer risk than those with no family history. There were significant interactions between breast cancer status and education and between age and knowledge of breast cancer genetics. Women without breast cancer and with a positive family history, who were between 20 and 40 years of age, were most likely to be interested in testing. The women with breast cancer who were interested in testing tended to be approximately 50 years of age, had a positive family history, and had more years of education. Women with a family history of breast cancer, well-educated women with breast cancer, and younger women, particularly those with knowledge of genetic testing, are important target audiences for community-based education on genetic testing for breast cancer risk.

Rural families' perspectives on having a child with cancer

The goal of this study was to explore and describe the experience of being or having a child with cancer in a rural geographic area. An exploratory, descriptive study was conducted that used semistructured, in-depth, tape-recorded interviews as the primary data collection method. Ten rural families who each had a child with cancer formed the sample. Data were analyzed with qualitative analysis procedures. Families' descriptions revealed that their experiences were fraught with challenges that were due to living a great distance from the cancer treatment center. Descriptions of their experiences are presented in this report. Recommendations for health care professionals, particularly pediatric oncology nurses, to assist rural families in coping with their challenges are also offered.

A smoking reduction and cessation program with registered nurses: findings and implications for community health nursing

A smoking reduction and cessation program was implemented with registered nurses in 3 Canadian provinces. Nurses (n = 117) participated in either an 8-week group or self-directed program using a resource specifically designed for nurses. Questionnaires were administered prior to and at the end of the 8-week interventions and at 6 and 12 months postintervention. Statistically significant changes at 8 weeks in nurses' smoking practices were found on the number of nurses continuing to smoke, mean number of cigarettes smoked, and movement in the stage of behavioral change. Attrition and variation in patterns of quitting over the 12-month study period made assessing participants' longer term outcomes difficult. This study highlights the complexity of assisting nurses to quit smoking and of implementing and evaluating a program based on accepted community health models of practice.

An exploratory study of clinical decision-making in five countries

PURPOSE

To identify the cognitive processes nurses use in their decision-making in long- and short-term care settings in five countries, and the demographic variables associated with their decision-making. METHOD AND SAMPLES: The instrument used was a 56-item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States.

FINDINGS

Five models of decision-making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of knowledge were significantly associated with decision-making models as well as with country of residence of the participants. The highest proportion of analytically oriented decision-makers was found among nurses in long-term care, the decision-making of nurses in short-term care was more intuitively oriented.

CONCLUSIONS

The results indicate that decision-making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations.

Falling through the cracks. Women's experiences of ineligibility for genetic testing for risk of breast cancer

OBJECTIVE

To describe experiences of women seeking information about their risk of hereditary breast cancer who fail to meet strict eligibility criteria for genetic counseling and testing.

DESIGN

Qualitative descriptive study.

SETTING

Hereditary cancer program in western Canada.

PARTICIPANTS

Women who had received notification of their ineligibility for referral for hereditary breast cancer risk assessment (n = 20) and some of their referring physicians (n = 10). Of 28 attempted contacts, five women had moved, one declined the invitation to participate, and two could not be interviewed because of scheduling conflicts. Ten of 20 physicians declined the invitation to participate.

METHOD

In-depth, open-ended telephone interviews were conducted. Transcribed interviews were systematically analyzed to identify salient themes.

MAIN FINDINGS

Three themes emerged. The first theme, "It's always on your mind," points to the profound concern about breast cancer that underlies women's experiences in seeking genetic testing. The second theme, "A test is a test," reflects women's beliefs that the test was relatively simple and similar to other medical tests in that it would provide a definitive answer. The third theme, "Falling through the cracks," captures the experience of ineligibility. Women reacted with a range of emotional responses and were left frustrated in their search for more specific information about their personal risk for breast cancer. Although women were encouraged to contact their physicians, few did.

CONCLUSION

These findings point to the psychological consequences in women who seek genetic testing for risk of breast cancer when they are told they are ineligible and they are not given adequate information and support.

Advanced practice nursing in Canada: has the time really come?

Nurse practitioners in Canada have experienced many of the problems facing those in the UK. In this paper, first presented at this year's meeting of the Commonwealth Nurses' Federation, the authors explain the events.

Public health nurses' decision making in Canada, Finland, Norway, and the United States

The purpose of this study was to describe the decision-making processes of 369 public health nurses in Canada, Finland, Norway, and the United States, and to discuss any differences observed among these countries. The results indicate that public health nurses used different decision-making models on the job and that these models varied considerably. Five different decision-making models were identified, each exhibiting features of different decision-making theories. The differences between decision making of public health nurses in different countries were statistically significant. The differences in decision making appear to be due to differences in health care systems in the 4 countries and the nature of the nursing task and context.

Knowledge, skills and experiences for community health nursing practice: the perceptions of community nurses, administrators and educators

Nursing in Canada is committed to preparing all new graduates at the baccalaureate level for entry to nursing practice by the year 2000. This goal has major implications for community health nursing education and practice. Health care reform is also expected to move care out of the hospital and into the community. It was against this backdrop that the researchers mounted a study on the educational preparation needed for graduates to begin to practice community health nursing. In this paper, the knowledge, professional and personal skills, and experiences that graduates need to begin community practice are reported. The study was carried out within an action-research framework. All major groups of stakeholders involved in community health nursing throughout the study province were involved in the project. This included nurses and administrators from two public health agencies (provincial and municipal), home care nurses, home health nurses (i.e. non-governmental visiting nurses), community health centres, provincial health care and nursing consultants, and faculty from two universities. In addition to the generation of relevant research findings for use by the educational institutions, the study was initiated to set the stage for future and ongoing interactions between the researchers and community experts to implement the findings from the project. Data were collected from 118 participants by means of 27 focus groups of community nurses, administrators and educators. Interviews were tape-recorded, transcribed and analysed using latent content analysis and constant comparison techniques. Findings indicated that qualified nurses from university programmes need a wide range of knowledge, skills and experiences to begin to practice community health nursing. Detailed accounts of these requirements are outlined and the implications for practice and education put forward.

Information, support, and communication needs of women with a family history of breast cancer

In this article, the role of information, support, and communication in promoting adaptation to the risk of breast cancer is reported. These variables emerged from an in-depth study of women at risk for breast cancer because of breast cancer in one or more of their primary (first degree) relatives. Fifty-five women with mothers, sisters, mother and sister, or mother and another primary relative were interviewed using in-depth semi-structured, tape-recorded interviews. After transcription, data were analyzed using qualitative analysis procedures. A three-phase process of adaptation to the risk of breast cancer was uncovered, which was subsequently validated with two study participants. Information, support, and communication emerged as important factors in facilitating the adjustment of women throughout the three phases of the process: as women "lived" the breast cancer experience of their relative; as they developed a perception of their personal risk for breast cancer; and finally as they put the risk of breast cancer "in its place." Despite the importance of information and support, most women had difficulty meeting these needs. Also, communication patterns both within the family and with health professionals were generally not helpful for these women. Issues related to the ill relative as "manager" of cancer-related information, the "ownership style" of the woman at risk, and the accessibility and availability of resources influenced women's adaptation to feelings of risk. Women's needs for information, support, and communication and facilitating factors are described in detail, and recommendations for clinical practice and research offered.

Age-sensitive T cell phenotypes covary in genetically heterogeneous mice and predict early death from lymphoma

We have assessed several age-sensitive indicators of immune status in young (i.e., 6 to 11-month-old) mice of a genetically heterogeneous population to see if these varied in parallel and to determine if one or more of the status indices predicted life span or cancer incidence. We report that the number of memory (i.e., CD44hi) T cells within the CD8 subset is correlated with number of memory cells in the CD4 population, and inversely correlated with the number of naive (i.e., CD45RBhi) CD4 cells at both 6 and 11 months of age, suggesting that the conversion of naive to memory cells may occur at similar rates in both T cell subsets. Mice that ranked high in the proportion of memory T cells (within the CD4 and CD8 pools) at 6 months of age tended to retain their ranking at 11 months, suggesting that the pace or extent of memory cell formation may be a consistent trait that distinguishes mice at least within a genetically heterogeneous population. Mice that at 6 months of age exhibited high levels of CD4 or CD8 memory T cells, low levels of naive CD4 cells, or low levels of T cells able to proliferate in response to Con A and IL-2 were found to be significantly more likely than their littermates to die within the first 18 months of life. Cases of follicular cell lymphoma, lymphocytic and lymphoblastic lymphoma, and hepatic hemangiosarcoma were seen within the group of mice dying at early ages.(ABSTRACT TRUNCATED AT 250 WORDS)

Difficult work: health visitors' work with clients in the community

The purpose of this paper is to discuss health visitors' construction of difficult work as uncovered in their descriptions of actual cases. The grounded theory approach was used to uncover the processes by which health visitors work with clients in the community. Forty-five experienced health visitors participated in the research. Data were collected using semi-structured, conversational interviews, field notes, and a short data collection form. Findings identified three types of situations in their work which created difficulty for health visitors: concerns about client safety, inappropriate use of health visitor services, and client denial and blocking. Several approaches to dealing with difficult situations were identified. These were labelled as: "more of the same", "wait for a bit", "withdrawal", "fall back on routine visiting", "try something else", and "open up the problem situation/confrontation". The use of approaches was related to factors in the context in the situation in which the health visitor found herself, and factors related to the health visitor and her particular style of practice. This paper assists in understanding how health visitors work with clients in the community to influence health.

The inheritance of genetic markers in microspore-derived plants of barley Hordeum vulgare L

Biochemical, molecular and morphological markers have been used to monitor the segregation of alleles at major gene loci in microspore-derived lines of four spring barley crosses and their parents. Significant deviations from the expected Mendelian ratios were observed for four of the ten markers studied in the cross. Distorted ratios were associated with loci located on chromosomes 4H and 6H. The differential transmission of alleles was in favour of the responsive parent (Blenheim) used in the anther culture studies. For the α-Amy-1 locus on chromosome 6H, the preferential transmission of Blenheim alleles was most pronounced in the haploid regenerants that were colchicine treated. These results are discussed in relation to the genetic control of androgenetic response in barley and with respect to the exploitation of another culture in barley improvement.

Nurse-client interactions in community-based practice: creating common ground

Although research activity is increasingly aimed at examining health outcomes of community health nursing care, little empirical literature systematically describes the nurse-client interaction. In this pilot study nurse-client interactions were evaluated to describe their detailed elements. Nineteen such interactions occurring in a Canadian public health department were videotaped by a professional filming crew. The clinical situations included home visits, school health interviews and screening, health classes, and clinic work. The audio portion of the nurse-client exchanges were transcribed from the videotapes onto a computer and analyzed using content analysis. Semi-structured interviews were conducted with nurses and clients after the filming to elicit their perceptions of the interactions. Field notes describing nonverbal and contextual data were also collected and analyzed. The central process identified during the interactions was called "creating common ground." This integrating conceptual schema captured the give and take as each participant defined territory and revealed information. The process varied depending on care context, process skills of the nurse, and willingness of the client to engage.

The theoretical basis for nursing at the community level: a comparison of three models

Although literature on community health nursing identifies a nursing role at the community level, there is a lack of clarity about the elements and expected outcomes of this role. In this paper three models of community health practice are presented and discussed in terms of their effectiveness as a basis for nursing practice at the community level. These models are (1) the public health model, (2) community participation model, and (3) community change model. Factors that affect the effectiveness of nursing to work at the community level are also discussed and questions for reflection and debate raised.

The relationship of heart-girth to liveweight of female goats in New Zealand

The correlations between heart-girths (measured as the smallest thoracic circumference) and liveweight were determined for 96 Saanen, 100 Angora and 101 feral female goats all of New Zealand origin. The correlation coefficients were 0.94, 0.94 and 0.90 for Saanens, Angoras and ferals respectively. To facilitate liveweight estimation for calculating doses of non-mineralised anthelmintics and to minimise under-dosing it is suggested that a straight-line equivalent of the upper 95% confidence curve be used. Care should be exercised in using girth measurements in small animals where the error could be high. They are not recommended for use when mineralised drenches or potentially dangerous drugs are being administered.

Lifestyle counselling: the need for diagnostic clarity

Three approaches to changing lifestyle behaviours are hypothesized. The argument that diagnostic accuracy is essential for selection of appropriate nursing interventions is developed and illustrated with clinical examples. The diagnoses of information deficiency, information and behavioural control deficiency, and contextual awareness deficiency guide the interventions for the problem of obesity.

Questioning: an intervention for health promotion

In the health professions, questioning is traditionally viewed as a way of gathering information from a client as well as a way of developing the affective domain or how the client feels. The development of the cognitive domain, or how the client thinks, receives less attention. This article describes a clinical nursing approach using Bloom's Taxonomy to question clients' thinking behavior. Examples from nurses' files are used to clarify this approach.

Nursing interventions for health promotion

Selected nursing interventions for health promotion in well individuals are described. Over a two-year period, two clinical nurse specialists developed and used client record keeping, role playing, audio and video feedback, imagery, visual mapping and experimentation as health promotion interventions. Clinical examples and client outcomes are discussed. Health promoting interventions are clearly distinguished from disease prevention approaches as described in the literature.