The integration of tobacco reduction activities into the practice of acute care registered nurses : a mixed methods research project
Notice bibliographique
Résumé
In light of evidence linking tobacco use with various health issues, hospitals have become viable contexts for tobacco control strategies. Clinicians, in particular nurses, are being challenged to address patients' tobacco use by providing cessation interventions. Emerging evidence indicates that nurses support the idea of encouraging people to stop smoking, perceive an expectation upon them to address patients' tobacco use, and are reluctant to approach patients beyond assessing smoking status. Following this lead a concurrent mixed methods research project investigated acute care registered nurses' integration of tobacco reduction interventions. All nurses working at two hospitals in British Columbia, Canada were included in the project; hospitals were situated in regions that represented diversity in population smoking rates (19.6%- 31.2%). Two hundred and fourteen nurses (58% response rate) participated by completing a survey and ethnographic data collection was completed on the 16 adult inpatient wards, which included 135 hours of field observations, 114 brief conversations, document collection, and photographs of designated smoking areas. This first Canadian investigation of acute care nurses revealed similar views and practice activities related to tobacco use interventions. Beyond assessing smoking status, less than half of the respondents reported consistently advising, assisting, or arranging referrals for patients. Site comparisons demonstrated differences in available tobacco related resources, as well as reported practices of assisting and arranging referrals. Testing of a path model, which hypothesized causal mechanisms influencing nurses' practice, demonstrated nearly half of the variance in nurses' uptake of intervention activities was explained by the role attitude and four measures of perceived barriers. Indirect relationships were noted from perceived tobacco workplace climate factors and smoking status. The ethnographic profile of tobacco use and control in the study sites suggested systemic devaluing concerning support for patients' cessation efforts, a lack of awareness of addiction issues related to tobacco, and several burdens that patients' tobacco use brings to nurses' practice. Findings from each study were integrated into a multi-dimensional ecological behavior system, which emphasized the importance of moving beyond focusing on clinicians as a means to change practice. Rather health care institutions will be required to implement system-wide tobacco control strategies.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,068 | 0,041 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,002 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,007 | 0,003 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,004 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».