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ABSTRACT: To explore the views of patients and specialist breast care nurses on telephone follow-up after treatment for breast cancer.
A recent randomised controlled trial demonstrated that nurse-led telephone follow-up led to high levels of patient satisfaction with no physical or psychological detriment. This study aimed to explore in more detail the views of patients randomised to telephone follow-up and the nurses who conducted telephone appointments.
Qualitative.
Individual interviews with 28 patients and four specialist breast care nurses. Content analysis was used to analyse the interview data.
Telephone follow-up was convenient for patients and provided continuity of care. Speaking on the telephone was perceived as a more 'normal' activity than attending hospital outpatient clinics. A structured approach was appreciated, instilling feelings of confidence that all questions had been asked and no errors had been made. Specialist nurses emphasised the high level of skill required to deliver the intervention and perceived that the telephone approach was well able to meet the individual needs of patients.
Positive views on telephone follow-up were reported. An experienced and skilled practitioner, with effective communication skills, is required to deliver the intervention and a period of training is recommended. Nurse-led telephone interventions have a broader applicability to other disease conditions, although more work is needed to develop appropriate interventions and evaluate their effectiveness.
Nurses at advanced levels of practice are uniquely placed to deliver such complex interventions. However, a period of initial training with effective peer support and channels for ongoing feedback are essential for administering an intervention that relies on audio rather than visual cues.
Journal of Clinical Nursing 10/2010; 19(19-20):2916-24. · 1.12 Impact Factor
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ABSTRACT: The aim of this study was to generate in-depth insights into patients' and family members' understanding of the causation, progression and prevention of chronic obstructive pulmonary disease and the role of health promotion with this population. In particular, we were interested in identifying the ways patients and family members considered that they could maximise their (patients') health, in the presence of this disease.
Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is, therefore, an important consideration. There are few examples in the literature of health promotion programmes for this population, including those directed at smoking cessation, which also focus on the family or significant others.
An exploratory, descriptive design was employed.
Semi-structured, audio-recorded interviews were conducted with 14 patients and 12 family caregivers. Interviews were transcribed verbatim and thematically analysed using content analysis procedures which captured the meaning of the data.
The three main themes were 'health promotion: what's that?', 'community resources for health promotion' and 'it wasn't just the smoking'. Many participants seemed unaware that their health might benefit from a healthier life style and provided little spontaneous information on any activities they carried out to maintain or improve their health.
This study highlighted a dearth of health promoting activity amongst people affected by chronic obstructive pulmonary disease. The reality for most patients was to manage the day-to-day demands that the symptoms of the disease imposed on them. Our data suggest that a more wide-ranging approach, encompassing aspects of health promotion, might be welcomed by many patients and their family carers.
The findings from this study highlight gaps in patients' and carers' understanding of the potential role of health promotion in chronic obstructive pulmonary disease and areas for intervention by health professionals. With the increase in smoking rates of women and predicted future increases in chronic obstructive pulmonary disease, it is imperative that health professionals find effective ways to provide support and health promotive care for patients and families.
Journal of Clinical Nursing 02/2010; 19(3-4):564-73. · 1.12 Impact Factor
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ABSTRACT: Most reports of cancer caregivers' needs focus on information and psychosocial needs. Less is known about practical knowledge and support carers need to provide physical care in the home. This review aimed to identity and critique studies of the development and/or evaluation of interventions to enable family carers to provide physical/practical care to a family member with cancer.
Narrative review.
Studies which included adult carers who provided care to a family member with cancer (any stage). Search sources included Psych Info., Cochrane Central Register of Controlled Trials, Embase Ovid, Embase, Ovid Medline, CINAHL, other databases, systematic and other reviews.
All types of study designs were included. Initially, multiple and broadly defined search strategies and terms were used to capture the range of potential studies; later more refined procedures were applied.
In total, 19 studies were included in the review. Interventions focused on skills development (n=1), managing symptoms (n=9), problem solving (n=5) and learning (n=4). Few studies were identified with well-defined and evaluated interventions to assist carers to provide physical care for their family member with cancer.
Future research is needed to develop well-defined interventions on practical skills and evaluate the outcomes for patients and caregivers.
International journal of nursing studies 05/2009; 46(11):1516-27. · 1.91 Impact Factor
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Karen Chalmers
Evidence-based nursing 02/2008; 11(1):18.
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ABSTRACT: A significant component of the work of public health nurses and paraprofessional home visitors who provide home visits to families with young children involves establishing relationships to effectively deliver the visiting program. The purpose of this qualitative and descriptive study was to describe the relationships among participants in a home visiting program in one regional health authority in the Canadian province of Manitoba. Interviews were carried out with 24 public health nurses, 14 home visitors, and 20 parents. The findings related to establishing, maintaining, and terminating relationships as well as factors influencing relationship work are described. Public health nurses and home visitors put significant effort into the work of establishing relationships with each other and their clients and require adequate training, sufficient human resources, and support from the program's administration to sustain these relationships.
Journal of Pediatric Nursing 09/2007; 22(4):319-30.
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ABSTRACT: Community matrons have a key role to play in the management of patients with long-term conditions. With the expected increase in prevalence of Chronic Obstructive Pulmonary Disease (COPD), largely due to cigarette smoking, the management and care of patients with COPD is a priority for the NHS. This paper examines the current and future role of community matrons in the management of patients with COPD. Community matrons have a potential role in providing evidence based care and could fill a gap in the implementation of effective interventions to help patients and family members stop smoking. A family focused approach to assessment and case management are important to achieving quality care and management of these patients. Recommendations are made with respect to the improvement of service provision for individuals and families with COPD.
British journal of community nursing 06/2007; 12(5):219-22.
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ABSTRACT: This paper reports a study of the factors that public health nurses, home visitors and parents consider important for the success of an early childhood home visiting programme.
The primary aim of early child home visiting programmes is to promote healthy and safe growth and development of infants and children in at-risk families. Few studies have focused on actual programme components which foster this outcome.
The research was a descriptive, qualitative evaluation. Success of the programme was defined as positive changes in families which were seen as directly related to participation. The 58 participants were 24 public health nurses, 14 home visitors and 20 parents. One in-depth semistructured audio-taped interview was conducted with each participant between October 2003 and February 2004. All interviews were transcribed and analysed using open coding; themes and categories were developed and reviewed for congruence of coding.
Participants discussed several factors that they considered important for the success of the programme: its particular characteristics, the programme activities and the healthcare providers.
Components contributing to the success of early childhood home visiting programmes include a strength-based philosophy, voluntary enrollment of parents, regularly scheduled home visits, a curriculum to structure the home visitor's interventions, and careful attention to the selection, training, and supervision of home visitors.
Journal of Advanced Nursing 09/2006; 55(3):291-300. · 1.48 Impact Factor
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ABSTRACT: Prenatal smoking rates vary substantially among racial and ethnic groups. Although prevalence of smoking among Aboriginal people in Canada is higher than in the general population, little is known about smoking rates during pregnancy among Aboriginal women or the characteristics of Aboriginal women more likely to smoke during pregnancy. The study purpose was to describe and compare the prevalence and correlates of smoking during pregnancy among Aboriginal and non-Aboriginal women giving birth in the Canadian province of Manitoba.
Data were obtained from interviews with 684 postpartum women who delivered a live singleton infant in two tertiary hospitals in Manitoba. Stratified analysis was used to describe effect-measure modification for correlates of smoking among the Aboriginal and non-Aboriginal groups. A multivariable logistic regression was conducted for the total sample.
A significantly higher proportion of Aboriginal women (61.2%) than non-Aboriginal women (26.2%) smoked during pregnancy. No correlates of smoking during pregnancy were specific to Aboriginal women, but several maternal characteristics were associated with smoking among non-Aboriginal women. After controlling for other factors, significant correlates of smoking during pregnancy for the total sample included inadequate prenatal care, low support from others, single marital status, illicit drug use, Aboriginal race/ethnicity, and noncompletion of high school among non-Aboriginal women.
The high prevalence of smoking during pregnancy, particularly among Aboriginal women, necessitates coordinated efforts aimed at smoking prevention and cessation.
Birth 01/2006; 32(4):299-305. · 2.18 Impact Factor
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Karen Chalmers,
Annette Gupton,
Alan Katz,
Tom Hack,
Elske Hildes-Ripstein,
Judy Brown,
Diana McMillan,
Diane Labossiere,
Maria Mackay,
Cathie Pickerl,
Yvette Savard-Preston,
Jo-Anne St Vincent,
Heather M Morris,
Beverley Cann
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ABSTRACT: Up to 70% of women who quit smoking while pregnant will relapse during the first postnatal year. In this study, a community-based, ecological approach guided the development and implementation of a smoking cessation intervention for perinatal women.
The aims of this pilot project were to: (1) develop and implement a community-based intervention to assist women to stop smoking or prevent smoking relapse during the pre- and postnatal periods, (2) provide feedback on participants' perceptions of the helpfulness of the intervention, (3) compare perceptions of the helpfulness of the intervention between women who received the intervention during the prenatal vs. postnatal periods, and (4) identify additional components of the intervention which need to be included in future research.
Using a participative process and a detailed review of the literature, researchers, health care professionals and women (pregnant or postnatal) developed a multifaceted intervention. The intervention included four core components, which all women received: home visit by the intervention nurse, follow-up telephone call(s), resource package, and letter of congratulations. Additional optional components included: telephone help line, support groups, referrals and other services. Forty-two women who were pregnant or had recently delivered participated. Descriptive and evaluation data were collected from participants using questionnaires and telephone interviews. The research was approved by the university Research Ethics Board.
Participants found the core components of the intervention to be helpful in their smoking cessation goals, particularly the home visit and resource material. The support groups and smoking help line were not used. There were no differences in how helpful the components of the intervention were perceived to be between women who received it in the prenatal or postnatal periods.
Future research is needed to evaluate the effectiveness of the intervention.
Journal of Advanced Nursing 02/2004; 45(2):162-71. · 1.48 Impact Factor
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Karen Chalmers,
Annette Gupton,
Alan Katz,
Tom Hack,
Elske Hildes‐Ripstein,
Judy Brown,
Diana McMillan,
Diane Labossiere,
Maria Mackay,
Cathie Pickerl,
Yvette Savard‐Preston,
Jo‐Anne St Vincent,
Heather M. Morris,
Beverley Cann
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ABSTRACT: Background. Up to 70% of women who quit smoking while pregnant will relapse during the first postnatal year. In this study, a community-based, ecological approach guided the development and implementation of a smoking cessation intervention for perinatal women.Aims. The aims of this pilot project were to: (1) develop and implement a community-based intervention to assist women to stop smoking or prevent smoking relapse during the pre- and postnatal periods, (2) provide feedback on participants’ perceptions of the helpfulness of the intervention, (3) compare perceptions of the helpfulness of the intervention between women who received the intervention during the prenatal vs. postnatal periods, and (4) identify additional components of the intervention which need to be included in future research.Design/methods. Using a participative process and a detailed review of the literature, researchers, health care professionals and women (pregnant or postnatal) developed a multifaceted intervention. The intervention included four core components, which all women received: home visit by the intervention nurse, follow-up telephone call(s), resource package, and letter of congratulations. Additional optional components included: telephone help line, support groups, referrals and other services. Forty-two women who were pregnant or had recently delivered participated. Descriptive and evaluation data were collected from participants using questionnaires and telephone interviews. The research was approved by the university Research Ethics Board.Findings. Participants found the core components of the intervention to be helpful in their smoking cessation goals, particularly the home visit and resource material. The support groups and smoking help line were not used. There were no differences in how helpful the components of the intervention were perceived to be between women who received it in the prenatal or postnatal periods.Conclusions. Future research is needed to evaluate the effectiveness of the intervention.
Journal of Advanced Nursing 01/2004; 45(2):162 - 171. · 1.48 Impact Factor
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ABSTRACT: This article reports findings about student nurses' understanding of the nursing role in health promotion related to tobacco issues. These findings were derived from the data of a larger project, examining smoking practices of baccalaureate nursing students in Manitoba, Canada. The study was conducted with second-year, third-year, and fourth-year university nursing students studying at several sites throughout the province (N = 272). From the data analysis of the interviews, class forums, and open-ended survey questions, five themes emerged (i.e., who they are-who they are becoming, central beliefs and attitudes, learning the facts, practice world-limited options, role conflict). Students expressed considerable uncertainty and conflict concerning individual autonomy around decisions about tobacco use. This resulted in confusion about themselves as role models and their use of health promotion interventions.
Journal of Nursing Education 04/2003; 42(3):106-12. · 0.86 Impact Factor
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ABSTRACT: To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.
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.
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.
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.
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.
Journal of Advanced Nursing 11/2002; 40(1):17-24. · 1.48 Impact Factor
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ABSTRACT: 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.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 07/2002; 34(1):131-42.
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ABSTRACT: 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.
Cancer Epidemiology Biomarkers & Prevention 02/2002; 11(1):89-95. · 4.12 Impact Factor
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ABSTRACT: To describe the issues related to delivering an early childhood home visiting program, BabyFirst, from the perspective of public health nurses and lay home visitors (paraprofessionals).
This descriptive, qualitative interpretive study had a sample of 24 public health nurses and 14 lay home visitors. One in-depth, semi-structured, audio-taped interview was conducted with each participant. Transcribed data were analyzed using content analysis techniques.
Public health nurses and lay home visitors identified several issues associated specifically with the use of lay home visitors and more broadly with the delivery of the BabyFirst program. These are discussed in the following categories: issues related to (a) the lay home visitors, (b) the BabyFirst families, and (c) the general administration of the program.
Findings from this study provide information about the issues related to providing home-visiting services delivered by lay home visitors that can be applied to policy and practice development. The findings suggest that in addition to careful selection of prospective applicants, considerable resources should be provided in preparing public health nurses and home visitors for their respective roles. The concerns identified by nurses and home visitors suggest the need to target the following three areas: (a) training and retention of nurses and home visitors, (b) program delivery, and (c) enrollment of families. Attention to the issues discussed in this article has implications for improving the BabyFirst home-visiting program and other similar early childhood programs.
MCN The American Journal of Maternal/Child Nursing 32(2):95-101. · 1.12 Impact Factor
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ABSTRACT: The purpose of this study was to compare the results of different measures of interest in genetic testing for breast cancer risk. A telephone survey of a random sample of women without breast cancer was conducted in British Columbia, Canada. Interest in genetic testing for breast cancer risk was measured in three ways: (1) an unprompted assessment of interest, (2) assessment of interest when prompted with a hypothetical offer of testing, and (3) assessment of interest when provided with supplementary information. Substantial differences in reported levels of interest in genetic testing were observed across the different assessment approaches, with the unprompted assessment of interest resulting in lowest levels of interest. The highest levels of interest were observed when the assessment of interest was prompted with a hypothetical offer of testing. Factors predicting interest in genetic testing varied depending on the assessment measure used. These findings suggest that more attention must be given to measurement issues, including complete reporting of measures used in research, development of standardized approaches to assessing interest in genetic testing, and more rigorous psychometric evaluations of measures of interest in genetic testing.
Psycho-Oncology 12(7):720-8. · 3.34 Impact Factor
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ABSTRACT: While intense efforts have been implemented to address the problem of cigarette smoking, the prevalence of tobacco use among adolescents, in particular young women, remains high. Older adolescent girls are joining their younger counterparts in taking up the smoking habit. The literature has examined the reasons for young people starting to smoke; however, little is known about the smoking cessation process in adolescents. This paper reports findings from an in-depth qualitative study of 25 girls ages 18 and 19 which uncovered the struggles young women experience as they attempt to quit smoking. These struggles and losses are referred to as the ‘costs’ of quitting smoking. The ‘costs’ reflect not only their ‘real’ experiences when attempting to quit smoking, but also reflect ‘anticipated’ struggles and losses. The study addressed the ‘costs’ in relation to the social, emotional and physiological domains of the adolescent girl's life. Findings from this research project provide theoretical direction for the development of comprehensive health promotion interventions. If health care professionals are to assist in reducing cigarette smoking among young women, the ‘costs’ which girls see to quitting smoking must be considered.
