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PubMed2007

Challenges for new nurses in evidence-based practice.

AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. BACKGROUND: These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. EVALUATION: This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. KEY ISSUES: The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. CONCLUSIONS: We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Attitude of Health Personnel↗
PubMed1995

Facilitating changes in exercise behavior: effect of structured statements of intention on perceived barriers to action.

Two groups of worksite employees (58 in a control, 53 in an experimental group) underwent three 90-min. educational sessions designed to increase participation in exercise. At the end of the third session, experimental subjects were asked to complete a structured statement of exercise intention which addressed the major barrier to exercise. Two weeks following the program, chi-squared analysis showed that the two groups were proportionately different in changes in frequency and intensity of exercise such that the experimental group in both cases showed greater changes than the control. Experimental subjects showed a twofold increase in frequency and intensity of exercise over the control group. Pearson r indicated a statistically significant association between the completeness of structured statements of intention and an increase in frequency of exercise. We conclude that structured statements of intention are useful for distinguishing between contrived barriers to exercise (excuses) and actual barriers that require practical solutions.

Adult↗
PubMedDate not supplied

Validation evidence for Turkish adaptation of Champion's Health Belief Model Scales.

Instruments using Health Belief Model constructs in breast cancer screening in previous studies were developed and tested by Champion for American women, and since then, these have been revised twice. Champion's Health Belief Model Scale (CHBMS) has been translated and tested in various studies in other countries and cultures. Also, the current study examined the validity and reliability of the Turkish adaptation of the CHBMS among Turkish women. The instrument was translated using a back-translation technique, which includes the use of a panel of experts and interpreters to translate the items from the source language to the target language and then back-translate them to the source language. The study was conducted in Ordu, a city in north Turkey. A total of 266 Turkish women aged 20 and older working as primary schoolteachers were included in the sample. Analyses included internal consistency, reliability, factor analysis, and known group techniques. After the analysis, 3 items from the Barriers domain, 1 from the Seriousness domain, and 2 from the Motivation domain were deleted from the original scale. So, the final Turkish version of the CHBMS (CHBMS-T) consisted of 36 items that were clustered into 6 subscales: susceptibility (3 items), seriousness (6 items), motivation (5 items), benefits of breast self-examination (BSE) (4 items), barriers to BSE (8 items), and confidence/self-efficacy of BSE (10 items). Internal consistency ranged from 0.69 to 0.83. Construct validity was supported by exploring the factor structure of the instrument using factor analysis and testing known-group techniques. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. It can be used in planning and testing interventions to improve BSE beliefs and practice.

Adult↗
PubMed2004

Strategic collaborative model for evidence-based nursing practice.

PURPOSE: To describe a model that has been developed to guide nurses and other health professionals in collaborative efforts toward evidence-based nursing practice. METHOD: A review of literature was conducted using MEDLINE and CINAHL to search for articles on research utilization for evidence-based practice in health care delivery. Empirical studies; reviews; and theoretical, opinion, and information articles were included in the review in order to provide a more comprehensive view of the state of evidence-based nursing internationally. FINDINGS: Findings revealed a number of barriers to evidence-based nursing practice, which have persisted over the last two decades, including inadequate knowledge of research among practicing nurses, lack of administrative support for research activities in clinical settings, lack of empowerment of nurses, and lack of needed mentoring from nursing research consultants. CONCLUSIONS: Barriers in the areas of nursing education and administrative support appear to be major. A need was identified for a pragmatic model that encourages cooperation and collaboration between educators/researchers in academia and the administrative leaders in the clinical facilities if evidence-based nursing practice is to become the norm. FRAMEWORK OF MODEL: The Tyler Collaborative Model is based on an eclectic approach to planned change for creating evidence-based practice. This model identifies a step-by-step process for change, while allowing for the opportunity to integrate any of the previously available methods of critical appraisal to determine the best evidence for practice in each clinical setting.

Attitude of Health Personnel↗
PubMed2005

District nurses' involvement and attitudes to mental health problems: a three-area cross-sectional study.

AIMS AND OBJECTIVES: The main aims of this study were to obtain information on the extent of staff contact and input with mental health problems and to determine their experience, training and attitudes to such problems. BACKGROUND: Historical changes and policy shifts have resulted in primary care providers playing an increasing role in the care of mental health problems. Such problems are common within community settings and a major cause of suffering and disability. District nurses in particular are likely to encounter a high level of psychological co-morbidity in their patients. Information is lacking on their involvement, attitudes and specific training for this area of their work. DESIGN AND METHODS: A cross-sectional study was conducted of the staff of district nursing services in three areas, Jersey (Channel Islands), Lewisham and Hertfordshire, using a postal questionnaire. RESULTS: Questionnaires were sent to 331 staff; 66% responded. Community and district nurses estimated a 16% prevalence of mental health problems among their patients, most commonly dementia, depression and anxiety disorders. Staff noted participation in a wide range of psychological care activities, but identified a lack of training for this aspect of their role (three-quarter of nurses had received no such training during the past five years). They reported a willingness to develop their understanding and skills by means of educational programmes. Attitude measures revealed generally optimistic views concerning depression treatment, a rejection of deterministic attitudes about this condition and confidence in the role of district nursing staff in managing such problems. CONCLUSIONS: The need for primary care mental health training is widely noted and based upon consistent evidence of the limited detection and treatment of these problems. This study has employed quantitative methods to clarify the extent and nature of district nursing staff involvement in this area of practice and indicates that training needs are acknowledged by community nurses from geographically distinct settings. RELEVANCE TO CLINICAL PRACTICE: Staff are interested in developing knowledge and skills pertinent to the psychological problems of their patients and their views reveal a consensus that the most important areas for learning are recognition of mental disorders, anxiety management, crisis intervention and pharmacological treatments for depression.

Adult↗
PubMed2003

An evaluation-based model for palliative care education: making a difference to practice.

It has been recognized that education may be one way of improving the provision of palliative care to patients and their families. This article is the culmination of a multi-phase evaluation project that aimed to investigate the effectiveness of palliative care education provided by a hospice education network in the north west of England. Results from a study of 46 students over a three year period indicate that in order for education to be deemed effective, there are certain fundamental requirements. These include responding to the changing and individual needs of participants, competent teaching in theory and practice, and enabling students to make a difference to practice. This paper describes a model for providing palliative care education, which encompasses these fundamental requirements. It also meets the needs of stakeholder and provides evidence of improvements in clinical practice. In particular, it focuses on the challenges of implementing this model in the current climate of clinical effectiveness, evidence-based practice and value for money.

Attitude of Health Personnel↗
PubMedDate not supplied

Barriers to healthy eating in the nursing profession: Part 2.

AIM: This is the second of two articles that report on work commissioned by the NHS Executive North West, to explore the perceived barriers to healthy eating within the nursing profession. METHOD: Observations were made of catering facilities within eight healthcare sites (six acute hospitals, an NHS walk-in centre and an NHS Direct site) across the North West region. Twenty four unstructured interviews were conducted with nurses and three were sampled from each healthcare site. RESULTS: Four main themes emerged as barriers to healthy eating: availability; variety; distance from catering facilities; and breaks/staffing levels/workload issues CONCLUSION: Respondents in this study do not consider their working environments to be conducive to healthy eating practices.

Attitude of Health Personnel↗
PubMed1996

Barriers to contraceptive use in Kenya.

This study was designed to identify and to better understand the barriers to contraceptive use among Kenyan-couples. Data were collected through structured interviews and focus group discussions among couples not planning for pregnancy and not using any effective contraceptive method. The study was conducted in the Baba Dogo urban slum area of Nairobi, and Chwele, a rural sub-location in Bungoma, western Kenya. Some important barriers to contraceptive use were identified in couples wishing to space or limit further births. Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husband's attitude on his role as a decision maker; perceived undesirable side effects, distribution and infant mortality; negative traditional practices and desires such as naming relatives, and preference for sons as security in old age. There were also gaps in knowledge on contraceptive methods, fears, rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied. This paper recommends that information and educational programmes should be instituted to increase contraceptive knowledge, to emphasise the value of quality of life over traditional reproductive practices and desires, and to improve availability and quality of services.

Adolescent↗
PubMed1999

Patterns and characteristics of repeat mammography among women 50 years and older.

Whereas efforts encouraging women to obtain initial mammograms are laudable, the importance of returning for subsequent routine mammograms cannot be minimized. The purpose of this study was to measure the timing, patterns, and characteristics of repeat screening mammography over time in a defined population of health maintenance organization members for whom mammography was a fully covered benefit. We identified all women ages 50-74 years who were enrolled in a southeastern Michigan health maintenance organization, assigned to a large medical group, and received at least one screening mammogram with a normal result between January 1, 1989 and December 31, 1996. Using administrative and radiology data, we calculated the proportion of women who received a subsequent mammogram within 2 years and the time to subsequent screening, both overall and stratified by demographic characteristics. We also examined screening patterns over a 5-year period. Of the 8749 women included in this study, 66.0% [95% confidence interval (CI), 65.0-67.0%] were subsequently screened within 2 years. We found slightly higher rates among Caucasians and married women. The proportion of women who received repeat mammography increased with estimated household income [9.5% difference between the highest and lowest categories (95% CI, 6.5-12.5%)]. The median time to subsequent screening was 17.7 months, and the probability of repeat screening was higher for women whose initial mammogram was between January 1992 and December 1994 compared to those receiving an initial mammogram between January 1989 and December 1991 (9.6% difference; 95% CI, 7.5-11.7%). Repeat mammography has improved over time; however, socioeconomic status could contribute to longer-than-intended intervals between screening when translated into real-world clinical practice. In a setting where most physicians recommended annual screening, we found that the median time to subsequent screening was delayed by 6 months. If annual mammography is the goal, recommendations should be made with the understanding of how the timing of repeat screening occurs in clinical practice.

Aged↗
PubMed2001

The impact of the basic skin cancer triage curriculum on provider's skin cancer control practices.

OBJECTIVE: To evaluate the effect of a 2-hour, multicomponent educational intervention on provider skin cancer control practices. DESIGN: Nonrandomized intervention study. The intervention was a 2-hour curriculum designed to augment provider skin cancer control practices through instruction in basic skin cancer triage (BSCT) and a brief summary of skin cancer epidemiology, prevention, and counseling. SETTING: Five staff-model health maintenance organizations in southeastern New England. PARTICIPANTS: Convenience sample of primary care providers. Providers older than age 75, individuals in practice for less than 1 year, or individuals planning to retire in the next 2 years were excluded from the study. Twenty-two of 28 participants completed the study. RESULTS: Providers completed preintervention and postintervention surveys asking them to rate their attitudes towards skin examination and skin cancer counseling and to rate the frequency of their skin cancer control practices, using 5-point Likert scales. We independently assessed provider behavior through surveys of their patients, eliciting information on provider practices before and after BSCT participation. Following participation in the curriculum, there was significant improvement in provider attitudes towards the total body skin examination but not towards skin cancer prevention counseling. Significant increases in provider self- reported skin cancer control practices during an initial visit with a new patient (2.17 to 3.21, P <.0001) and a routine visit with a patient at high risk for melanoma (2.15 to 3.00, P <.0001) were demonstrated. Analysis of the patient exit interviews independently confirmed these changes in practice patterns. CONCLUSIONS: The study results suggest that the BSCT curriculum may be a useful tool in increasing the practice of skin cancer control measures by primary care providers.

Curriculum↗
PubMed2005

Social marketing in public health.

Social marketing, the use of marketing to design and implement programs to promote socially beneficial behavior change, has grown in popularity and usage within the public health community. Despite this growth, many public health professionals have an incomplete understanding of the field. To advance current knowledge, we provide a practical definition and discuss the conceptual underpinnings of social marketing. We then describe several case studies to illustrate social marketing's application in public health and discuss challenges that inhibit the effective and efficient use of social marketing in public health. Finally, we reflect on future developments in the field. Our aim is practical: to enhance public health professionals' knowledge of the key elements of social marketing and how social marketing may be used to plan public health interventions.

Attitude to Health↗
PubMed2001

Survey of smoking knowledge, attitudes and practice in school children in Honduras.

OBJECTIVE: The aim of this study was to survey Honduran pre-adolescent knowledge, perceptions and experience regarding smoking. METHODS: A 12-item survey was administered in the classroom to fifth and sixth grade students. The main outcome measures were a description of demographic factors, personal smoking experience, knowledge of health risks, attitudes about tobacco use and perceived sources of information. RESULTS: A total of 225 students were surveyed. The majority were aware that smoking is bad for health, and most reported never having smoked. Most viewed smoking as ugly. Friends and family were selected as the major source of information. CONCLUSIONS: School children in this area of Honduras are aware of the health risks of smoking and view smoking as unattractive.

Adolescent↗
PubMed2005

Using action research in nursing practice with older people: democratizing knowledge.

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.

Activities of Daily Living↗
PubMed2000

Acute-care nurses' attitudes towards older patients: a literature review.

With increases in life expectancy and increasing numbers of older patients utilising the acute setting, attitudes of registered nurses caring for older people may affect the quality of care provided. This paper reviews recent research on positive and negative attitudes of acute-care nurses towards older people. Many negative attitudes reflect ageist streotypes and knowledge deficits that significantly influence registered nurses' practice and older patients' quality of care. In the acute setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications, little consideration of their ageing-related needs, limited health education and social isolation. Available instruments to measure attitudes towards and knowledge about older people, although reliable and valid, are outdated, country-specific and do not include either a patient-focus or a caring perspective. This paper argues for the development and utilisation of a research instrument that includes both a patient focus and a caring dimension.

Aged↗