Smoking: rates and attitudes among nursing staff in central Sydney

The objectives of this study were to determine the prevalence and predictors of smoking and attitudes to smoking-related issues among nurses employed by the Central Sydney Area Health Service in Sydney, Australia. A self-administered questionnaire, was distributed via the internal mail system of the Central Sydney Area Health Service in November 1997 to 610 randomly selected nursing staff. Twenty-one per cent (n = 127) of respondents smoked. Smokers were significantly younger than non-smokers and were more likely to speak mainly English at home. There were clear differences between smokers and non-smokers in response to all attitude statements. Interventions specifically directed at nurses who smoke to assist them to stop and maintain cessation are indicated. Future health service workplace tobacco control programmes should address deficits in knowledge about the health effects of passive smoking, should raise awareness among nurses who smoke about their potential to affect the behaviours of others through modelling, and should provide all nurses with the skills required to be smoking educators and advocates for tobacco control.     

Smoking in a forensic psychiatric service: a survey of inpatients' views

Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.     

Women's views of registered nurses as Papanicolaou smear providers: a pilot study

BACKGROUND: Registered nurse Papanicolaou (Pap) smear providers (RN PSPs) were introduced to improve women's accessibility to Pap smear services through the National Cervical Screening Program. This pilot study assessed women's attitudes towards RNs as providers. METHOD: One hundred women attending a Family Planning Queensland (FPQ) centre for a routine appointment with a doctor or registered nurse were recruited. Participants completed an anonymous questionnaire. RESULTS: A response rate of 86% (n = 100) was achieved. Only 15% of participants indicated they had seen a RN for a Pap test prior to this visit and 67% were unaware that registered nurses provided Pap smear services. Participants reported positive attitudes toward RN PSPs (M = 44.53, SD = 7.85, range 13 - 60). The majority of participants considered RN PSPs would be responsive to their needs (92%) and well-qualified to perform Pap smears (70%). The majority (79%) would not hesitate to see a RN PSP for a Pap smear. Some uncertainty existed about the competence of nurses to provide this service (25% of respondents were uncertain). Older women were more likely to report less positive attitudes toward RN PSP (r = -.267, p <.05). Women reporting previous awareness of the role of nurses as Pap smear providers were more likely to report positive attitudes (Chi-square = 12.96, p < .0001) compared to women with no awareness of this role. DISCUSSION AND CONCLUSIONS: While women are positive about RN PSPs, there is a need for promotion and community education about the role of RNs in providing cervical screening services.     

Hardiness,work support and psychological distress among nursing assistants and registered nurses in Quebec

BACKGROUND: Although nursing assistants (NAs) represent a large segment of Canadian health care providers, little is known about psychosocial factors related to their physical and psychological well-being and how these compare with their registered nurse (RN) counterparts. AIM: Guided by Maddi and Kobasa's theoretical framework of Factors Affecting Health-Illness Status, the purpose of the present study was to examine relationships among hardiness, psychological distress and work support in NAs, and to compare results with those from a sample of RNs. METHOD: A random sample of 171 NAs in Quebec completed self-report questionnaires. The study instruments included validated French-Canadian versions of Kobasa's Hardiness Scale, Ilfeld's Psychiatric Symptom Index, and Moos' Work Relationship Index. RESULTS: As theoretically predicted, statistically significant correlations were found between hardiness and psychological distress (r = -0.42; P < 0.001), hardiness and work support (r = 0.27; P < 0.001), and between work support and psychological distress (r = -0.21; P < 0.001). Using a mediational model and multiple regression analyses, hardiness among NAs was found to be a significant mediator between work support and psychological distress. Comparative analyses revealed that whereas NAs and RNs reported similar levels of psychological distress (P = 0.25) and work support (P = 0.13), NAs reported significantly less hardiness (t = -5.58; P < 0.01). In addition, NAs and RNs reported significantly more psychological distress than the general population of Quebec, Canada (t = 9.07 and 22.84, P < 0.01, respectively). CONCLUSION: Results add support to Maddi and Kobasa's theoretical propositions linking personal and contextual resources to health-related outcomes and offer insights into specific factors that may affect the health and well-being of both NAs and RNs as well as their work climate.     

Lifestyle practices and the health promoting environment of hospital nurses

This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.     

Perceptions of registered nurses working with assistive personnel in the United Kingdom and the United States

This study examines registered nurse perceptions of their role in acute care hospitals that use nursing care assistants (NCA) and unlicensed assistive personnel (UAP). Also studied was registered nurse (RN) satisfaction with nursing care assistants and unlicensed assistive personnel in the United Kingdom (UK) and the United States of America (USA). The purpose of this study is to assist RNs and managers in the re-design of health-care delivery systems by investigating: 1. The differences and similarities of registered nurses in the UK and the USA in the perceptions of changes in the RN role when working with nursing care assistants or unlicensed assistive personnel. 2. The differences between and similarities of registered nurses in the UK and the USA in perceptions of NCA and UAP abilities to perform delegated duties, to communicate pertinent clinical information and to provide more time for professional nursing activities. Registered nurse perceptions in the UK were compared with the findings of a previous study of RN role changes and satisfaction in the USA. Registered nurses in the UK did not perceive a profound change in their role when working with UAP and were more satisfied with their use than were RNs in the USA.     

Nursing staff anxiety versus smoking habits

The aim of this study was to assess smoking habits versus anxiety levels of 114 female nurses. The Spielberger State-Trait Anxiety Inventory Scale (STAI, Questions 21-40) was used. Current smokers (n=52) had the highest levels of anxiety (STAI score: mean+/-SD, 43.04+/-8.48) compared to non-smokers (n=30), and ex-smokers (n=32) (38.94+/-6.45 and 36.56+/-6.62, respectively; P<0.02). Differences in STAI scores were greater between non-smokers and ex-smokers (P<0.01), while the STAI scores of current smokers were positively correlated with their per day quota of cigarettes (Pearson's: +0.65; P<0.002). We concluded that even in people who are well-acquainted with the ill-effects of nicotine abuse, smoking habits persist and are correlated with levels of anxiety. Apparently the (perceived) stress-relieving effects of nicotine outweigh anxiety of nursing staff. Preventive programs, if based exclusively on information on the effects of smoking on health, seem to be ineffective. Alternatively, techniques aimed at the relief of anxiety may yield better results.     

The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.     

Perceptions of physical restraints use in the elderly among registered nurses and nurse assistants in a single acute care hospital

Physical restraint use among hospitalized older adults remains an important issue. Despite evidence indicating that restraints can be harmful and strict regulatory rules restricting the use of restraints, healthcare practitioners continue to utilize physical restraints, often in the name of safety. The purpose of this study was to examine the perceptions regarding physical restraint use among registered nurses (RNs) and nursing assistants (NAs). The Perceptions of Restraint Use Questionnaire (PRUQ) was used to evaluate nursing staff perceptions. The overall mean score for the PRUQ was 2.8 out of a possible 5, indicating a neutral perception. Both RNs and NAs identified treatment interference as the most important reason for restraining a patient and substituting of restraints for staff as the least important reason. This study revealed an overall less favorable perception of restraints than previous studies. NAs favored physical restraint for fall prevention more than RNs. It was also noted that protection from physical abuse and patient combativeness was the most salient reason cited by the emergency department staff.     

Research use in the care of older people: a survey among healthcare staff

Background. Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community‐based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design. The overall aim of this cross‐sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method. Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results. Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions. Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice. There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence‐based practice that involves the EN/NA group.     

The evolving role of nurses in primary care medical settings

The role of nurses in primary care is understudied. The purpose of this study was to describe the current registered nurse (RN) role in three Primary Care Networks (PCNs) in western Canada and to identify opportunities for optimal utilization of RNs in these settings. Case study methodology included interviews and document review. Although the RN role evolved during the study, most RNs focused on chronic disease management. Role ambiguity was evident between nurses and with interprofessional team members. Relationships of RNs to other providers, particularly physicians, impacted the enactment of the nursing role. Other barriers to role enactment included physician fee‐for‐service remuneration, management structures and processes, lack of access to electronic medical records and lack of previous opportunities to apply primary health‐care education in the practice setting. Further work is needed to optimize the RN role in primary care to ensure maximum impact for patients, providers and the health system overall.     

Interrelationship between core interventions and core competencies of forensic psychiatric nursing in Finland

The importance of core competencies (CC) and their relationship to core interventions in clinical practice guidelines on schizophrenia (CPGS), and the abilities to master these competencies were studied among registered nurses (RN) and practical mental nurses (PMN) in a forensic psychiatric setting. Data were collected from RNs, PMNs, and managers of all five forensic psychiatric facilities in Finland. The research material was obtained by using a 360-degree feedback method. The response rate was 68% (N = 428). The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the importance of and ability to master the following CCs: (1) pharmacotherapy, (2) knowledge in forensic psychiatry and violent behavior, (3) the treatment of violent patients, (4) processing patient's and own emotion, and (5) need-adapted treatment of the patient. Overall, RNs exceeded PMNs in mastering the CCs, however the principles of the CPGS were not achieved within the current resources in Finland. In summary, RNs, rather than PMNs, should be recruited for work in forensic psychiatric nursing, although a considerable amount of specific training would still be required to achieve competence. Implications of our research indicate that all nurses working in this area need to receive further education in forensic psychiatry and in forensic psychiatric nursing.     

The Stories of Physicians,Registered Nurses and Enrolled Nurses about Ethically Difficult Care Episodes in Surgical Care

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.     

Strategies for enhancing enrollment in one registered nurse–bachelor of science in nursing program

Associate degree and diploma graduates make up the largest number of registered nurses (RNs) in today's workforce, and only 16% return to school for a baccalaureate degree. The nursing shortage and the rapid expanding changes in the delivery of health care have created the demand for more nurses prepared at an educational level appropriate for the responsibilities required of them as professional nurses. Cost-effective and flexible RN–bachelor of science in nursing (BSN) programs are necessary to meet this need.This article describes strategies implemented in one RN–BSN program to enhance RN enrollment.     

Mental health nursing practice in rural and remote Canada: Insights from a national survey

Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.     

RN refresher courses: hospital-based versus university-based.

Refresher and reentry courses for registered nurses (RNs) are being used to recruit inactive nurses back into practice in the present nursing shortage. Built on models of staff development orientation for newly employed RNs and continuing education for adult learners, two refresher/reentry programs are described. University- and hospital-based RN refresher courses had similar enrollments and positive evaluations, but different curriculum organization; cost and employment outcomes varied. Both employment prior to the class and collaboration among providers greatly enhance positive outcomes.     

Nurse migration and its implications for Philippine hospitals

BACKGROUND: 'Push' and 'pull' factors motivate Filipino registered nurses (RNs) to leave for employment in foreign countries making the Philippines the leading source country for nurses overseas. OBJECTIVE: To assess the current RN-staffing situation in Philippine hospitals. DESIGN: A self-administered survey was mailed to a sample of 200 Philippine hospital chiefs of nurses. RESULTS: According to respondents, the majority of RNs in their hospitals (73%) were aged 40 years and younger and female (85%); government hospital RNs earned higher wages than private hospital RNs; and on average, RN vacancy rates and RN turnover rates were lower in government hospitals than private hospitals. All respondents reported no difficulty recruiting RNs with less than 12 months of work experience. However, recruitment of more experienced RNs was somewhat or very difficult for private hospitals compared with government hospitals. Higher salaries, better benefits and good career opportunities were identified as most effective incentives for both recruitment and retention. CONCLUSIONS: RN staffing in government hospitals is more favourable than in private hospitals as measured by employment tenure, vacancy rates, turnover rates and ability to recruit and retain more experienced RNs. On average, respondents reported over half (59%) of total RN turnover was the result of nurse migration overseas.     

Registered nurses' choices regarding the use of intradermal lidocaine for intravenous insertions: the challenge of changing practice.

After a policy change that required that lidocaine be offered to every patient before an intravenous (IV) insertion, registered nurses (RNs) in this rural acute care hospital were interviewed to determine whether they had changed their practice. This study reports on the percentage of RNs who offered lidocaine before IV insertion and explores the perceived and actual barriers for those nurses who did not routinely offer patients this option. The study sample of 30 represents 8% of the RN inpatient staff. Of the sample, 30.0% said that they always offer intradermal lidocaine and reported a decrease in patients' pain, fear, and anxiety as advantages. Another 23.3% of the RNs indicated they offered lidocaine only in specific circumstances based on patients' behavior and condition and the IV site to be used. The remaining 46.7% responded that they do not offer lidocaine. The reasons for not offering lidocaine included the perception that it made the procedure more difficult, an acknowledgment that it was not a part of their routine, or they did not think of it. Both the RNs who used the lidocaine and the RNs who did not use it referred to the fact that there was poor staff knowledge and skill about how to use intradermal lidocaine successfully. Recommendations are made for addressing the identified barriers.     

Retaining Graduate Nurses Who Experience NCLEX Failure: Recommendations for Supporting Retest Success

Current turbulent times in health care are exacerbated by a shortage of registered nurses (RNs), challenging nurse leaders to explore opportunities for improving RN retention. National Council Licensure Examination (NCLEX) pass rates are declining, and an upcoming change in the NCLEX-RN exam is likely to intensify that decline. On average, 18% of graduate nurses (GNs) fail on their first NCLEX-RN attempt, and less than 43% are successful on retest attempts. Therefore, the GN who fails on the first attempt is likely to not be retained for the RN position for which they were hired. A consideration in supporting the GN who fails to retest success is that the most prevalent demographic among GNs is Generation Z. Individuals in this generation display characteristics that impact their ability to negotiate the high-stakes NCLEX-RN exam. Based on experience coaching Generation Z GNs to NCLEX-RN success, the author provides recommendations for coaching to support NCLEX retest success. Nurse leaders in hospital settings are encouraged to consider adopting these recommendations to improve RN retention among GNs who experience NCLEX failure.     

RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals

BackgroundQuality and safety in health care has been increasingly in focus during the past 10–15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes.ObjectiveTo investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals.DesignThis is a national cross-sectional study.Data sourcesA survey (n = >10,000 RNs); hospital organizational data (n = 67); hospital discharge registry data (n > 200,000 surgical patients).Data collection and analysisRN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009–2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality.ResultsPatients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65–0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60–0.91).ConclusionsRN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables.