A survey of tobacco-related knowledge, attitudes and behaviours of primary care providers in Mississippi

Rationale  Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi.
Methods  The Provider Attitude Survey, an 85-item measure of tobacco-related knowledge, attitudes and intervention behaviours was mailed to all members of Mississippi's Family Medicine, Dentistry and Nurse Practitioner professional organizations ( N  = 2043).
Results  Over one-third ( n  = 802, 39.2%) of eligible providers responded. Just 24.3% had received training in tobacco cessation and 33.7% were aware of the Public Health Service clinical practice guideline. Over 90% indicated that it was their role to prevent tobacco use; felt rewarded when they helped patients quit; and were bothered and upset by the health effects of tobacco. Doctors assisted more patients than nurses or dentists. Doctors and nurses reported more self-efficacy, motivation and preparedness for treating tobacco use than dentists. Providers with training performed more interventions and reported more self-efficacy, preparedness and fewer barriers than those without training. Training was associated with greater increases in self-efficacy, preparedness and intervention behaviours for dentists than for the other groups.
Conclusions  Despite a high prevalence of tobacco use and tobacco-related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.     

Sexuality after stroke: Exploring knowledge,attitudes, comfort and behaviours of rehabilitation professionals

BackgroundSexual dysfunction after stroke is common and is associated with poor health and quality of life outcomes. Clinical guidelines for stroke typically recommend that all stroke survivors have access to support relating to sexuality during rehabilitation. However, the extent to which rehabilitation professionals are prepared to address sexuality after stroke is unclear.ObjectiveTo investigate the knowledge, comfort, approach, attitudes, and practices of rehabilitation professionals toward supporting stroke survivors with their sexuality concerns.MethodsCross-sectional analytic survey design. Data were collected by using an electronic questionnaire that contained the Knowledge, Comfort, Approaches, and Attitudes towards Sexuality Scale (KCAASS) and sexuality-related practice questions. Participants were recruited from Australia, New Zealand, the United States, Canada, United Kingdom, Ireland, Singapore, and South Africa. Multiple regression was used to explore KCAASS scores and sexuality-related practices.ResultsA total of 958 multi-disciplinary, stroke rehabilitation professionals participated in the study. Only 23% (n = 216) of health professionals’ reported directly initiating sexuality discussions with stroke survivors. On regression analysis, professionals’ practices, perception of their role in sexuality rehabilitation, sexuality training, education, age and sex predicted their knowledge of sexuality after stroke (r² = 0.44; p < 0.001). Sexuality training, religious affiliation and provision of sexuality-rehabilitation services predicted comfort (r² = 0.21; p < 0.001). Professionals’ age and provision of sexuality-rehabilitation services predicted approach-related comfort (r² = 0.2; p < 0.001). Professionals’ perception of health professionals’ role in sexuality rehabilitation, religious affiliation and geographical location predicted professionals’ attitudes toward sexuality (r² = 0.11; p < 0.001). Open-ended responses indicated that participants perceived a need to improve their competency in providing sexuality rehabilitation. The timing of training predicted knowledge (t = 3.99; p < 0.001), comfort (t = 3.47; p < 0.001) and the provision of sexuality-rehabilitation services (t = 3.68; p < 0.001).ConclusionFindings confirm that sexuality is neglected in stroke rehabilitation and point to the need for a considered approach to the timing and nature of education.     

Protecting patients, protecting healthcare workers: a review of the role of influenza vaccination

MUSIC T. (2012) A review of the role the role of influenza vaccination in protecting patients, protecting healthcare workers the role of influenza vaccination. International Nursing Review 59 , 161–167 Aim: Many health authorities recommend routine influenza vaccination for healthcare workers (HCWs), and during the 2009 A (H1N1) pandemic, the World Health Organization (WHO) recommended immunization of all HCWs worldwide. As this remains an important area of policy debate, this paper examines the case for vaccination, the role of local guidelines, barriers to immunization and initiatives to increase uptake. Background: Seasonal influenza is a major threat to public health, causing up to 1 million deaths annually. Extensive evidence supports the vaccination of priority groups, including HCWs. Immunization protects HCWs themselves, and their vulnerable patients from nosocomial influenza infections. In addition, influenza can disrupt health services and impact healthcare organizations financially. Immunization can reduce staff absences, offer cost savings and provide economic benefits. Methods: This paper reviews official immunization recommendations and HCW vaccination studies, including a recent International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) survey of 26 countries from each region of the world. Results: HCW immunization is widely recommended and supported by the WHO. In the IFPMA study, 88% of countries recommended HCW vaccination, and 61% supported this financially (with no correlation to country development status). Overall, coverage can be improved, and research shows that uptake may be impacted by lack of conveniently available vaccines and misconceptions regarding vaccine safety/efficacy and influenza risk. Conclusions: Many countries recommend HCW vaccination against influenza. In recent years, there has been an increased uptake rate among HCWs in some countries, but not in others. Several initiatives can increase coverage, including education, easy access to free vaccines and the use of formal declination forms. The case for HCW vaccination is clear, and in an effort to further accelerate uptake as a patient safety measure, an increasing number of healthcare organizations, particularly in the USA, are implementing mandatory immunization policies, similar to other obligatory hygiene measures. However, it would be desirable if similar high vaccination uptake rates could be achieved through voluntary procedures.     

Nurses' knowledge and risk perception towards seasonal influenza and vaccination and their vaccination behaviours: a cross-sectional survey

Background

Seasonal influenza has become a serious public health problem worldwide and vaccination is recognized as the most effective preventative measure. Healthcare workers can be the vectors of influenza outbreaks. Data suggest that nurses’ vaccination remains suboptimal worldwide.

Objectives

To explore the relationship among nurses’ knowledge, risk perception and their vaccination behaviours and the reasons for vaccination uptake.

Design

A cross-sectional survey.

Setting

Participants were recruited from the nurses enrolled on continuing professional education courses at a large university in London.

Participants

A sample of 522 nurses returned completed questionnaires (response rate 77.7%). Most of the respondents were women, worked in hospitals and had direct patient contact. The mean years qualified as a nurse were 11.9 ± 8.75 years.

Methods

The survey instrument examined nurses’ knowledge about influenza and vaccination, risk perception towards influenza and pandemics, vaccination behaviours and reasons for vaccination acceptance or refusal. The survey also collected data regarding gender, age, highest educational qualification, work place, clinical specialty, qualified years as a nurse, and whether they had direct patient contact.

Results

The influenza vaccination rate among the respondents was 36% with about 41% never vaccinated. Nurses with a high knowledge level were more likely to get vaccinated compared to those with a low knowledge level (p < 0.001). Vaccination rates between the high risk perception and low risk perception groups were different (p = 0.019). Sentinel knowledge items were associated with nurses’ vaccination status. Several risk perception items including personal vulnerability to influenza or H1N1, mortality risk of H1N1, and the likelihood of transmitting influenza to patients were also predictors of vaccination uptake. Vaccinated nurses were more likely to recommend vaccination to their patients (p < 0.001). The most frequent reason for vaccination refusal was concern about the side-effects of the vaccination while self-protection was the most frequent reason for vaccination uptake.

Conclusions

This study confirmed a relationship between knowledge, risk perception and vaccination behaviours among nurses. The identified sentinel items of knowledge and risk perception could inform future vaccination campaigns. The clinical specialty of nurses and the importance of accessibility to vaccination as predictors of vaccine uptake require further exploration.     

Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies

BackgroundA critical characteristic of effective teams in any setting is when each member is willing to speak up to share thoughts and ideas to improve processes. In spite of attempts by healthcare systems to encourage employees to speak up, employee silence remains a common cause of communication breakdowns, contributing to errors and suboptimal care delivery. Nurses in particular have reported low confidence in their communication abilities, and cite the belief that speaking up will not make a difference.ObjectiveTo develop an understanding of how nurses and other healthcare workers relate to safety voice behaviors and how this might influence clinical practice. Data Sources: A search of the PubMed, CINAHL, and Academic Search Premier databases was conducted using keywords employee, nurse, qualitative, speak up, silence, safety, voice, and safety voice identified 372 articles with 11 retained after a review of the abstracts. Studies took place in Australia, Bulgaria, Canada, Hong Kong, East Africa, Ireland, Korea, New Zealand, Sweden, Switzerland, and the United States representing 504 healthcare workers including 354 nurses.MethodsThis interpretive meta-synthesis of 11 qualitative articles published from 2005 to 2015 was conducted using a social constructivist approach with thematic analysis.ResultsThe four themes identified are: 1) hierarchies and power dynamics negatively affect safety voice, 2) open communication is unsafe and ineffective, 3) embedded expectations of nurse behavior affect safety voice, and 4) nurse managers have a powerful positive or negative affect on safety voice.ConclusionsHealthcare workers worldwide report multiple social and hierarchy related fears surrounding the utilization of safety voice behaviors. Hesitance to speak up is pervasive among nurses, as is low self-efficacy related to safety voice. The presence of caring leaders, peer support, and an organizational commitment to safe, open cultures, may improve safety voice utilization among nurses and other healthcare workers.     

2017－2018年黑龙江省护士流感认知及流感疫苗接种情况调查

目的了解2017 — 2018年黑龙江省护士流行性感冒（流感）认知及流感疫苗接种情况，并分析其影响因素。方法通过方便抽样、定向投放调查问卷的方式，对在护联网注册的现住址为黑龙江省的护士开展网络在线问卷调查。结果本次调查回收773份有效调查问卷，773名护士对流感相关知识的知晓率较高（＞86.80%），但流感疫苗接种率仅为4.01%（31/773），且仅有24.84%的护士曾向护理对象推荐过接种流感疫苗。 不接种流感疫苗的主要原因是工作太忙，没时间接种（20.75%）。 护士性别、年龄、工作年限、工作机构类型、医疗机构级别、所在科室对流感疫苗接种率均无影响（P＞0.05）。结论黑龙江省护士流感疫苗接种率较低，考虑通过在黑龙江省内探索制定医务人员免费接种政策、创新具体的预防接种形式提高流感疫苗可及性、有针对性地开展健康教育，改善疫苗接种情况。     

A study of nurses' knowledge and attitudes about sexuality in health care

This article discusses a questionnaire study carried out to investigate knowledge and attitudes towards sexuality among 50 trained nurses working in gynaecological and non-gynaecological wards in the U.K. Knowledge levels were low and attitudes were traditional, and the gynaecology nurses' scores showed them to be less knowledgeable and more conservative than other nurses. These findings match those of studies carried out in the U.S.A. in the 1970s. The implications of the study for nurse education are considered, bearing in mind some reservations concerning the research instruments used.     

Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study

BackgroundSelf-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care.Objectives(1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes.DesignSecondary analysis of data from a multicentre cross-sectional study.SettingOutpatient clinics from 29 Italian provinces.Participants1192 adults with confirmed diagnosis of heart failure.MethodsSocio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score <70 indicates inadequate self-care. Multiple linear regression analyses were performed.ResultsOf 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p = 0.12), self-care management (p = 0.21) or self-care confidence (p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p < 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p < 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p < 0.001) were determinants of self-care confidence.ConclusionsSelf-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care.