Monday, December 21, 2009

Jean Watson's Theory

Jean Watson Theory of Human Caring: Caritas Process Five
The following discussion of Caritas Process Five is from Jean Watson’s newest book: Nursing: The Philosophy and Science of Caring, 2008 edition, published by University of Colorado Press
Carative Factor 5: Promotion and Acceptance of the Expression of Positive and Negative Feelings has evolved into Caritas Process 5: Being Present to, and Supportive of, the Expression of Positive and Negative Feelings

This Caritas Process cannot be discussed without realizing how essential it is to the development of a trusting-caring-healing relationship. Acceptance of another’s feelings, when positive is easy. But, accept even the negative feelings, and a deep trust, an authentic relationship can develop. “When one is able to hold the tears or fears of another without being threatened or turning away, that is the act of healing and caring.” Although we think of positive emotions and negative emotions, there is no right or wrong to our feelings; they just are. Expression of strong emotions may be due to intellectual-emotional dissonance (incongruity or conflict). The Caritas Consciousness Nurse may be the only one to hear and see and accept the person behind the strong emotions that frequently accompany illness, encouraging the patient to release the feelings that were due to fear, anger, and confusion. It is precisely during this time that the nurse’s equanimity (evenness of mind, even under stress) may help them to regain control and stability. This deepens the authentic, caring relationship to enhance healing and become “healthogenic”.
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Monday, December 14, 2009

Podcast on Intro to EBN by Rebecca Kolb, RN, BSN, CEN

Check out this excellent podcast by Rebecca R Kolb, RN, BSN, CEN which provides an introduction to Evidence Based Nursing including a succinct explanation of the Johns Hopkins Evidence-Based Practice Model .

Some viewers may need to download Quicktime in order to view this.

Wednesday, December 09, 2009

Commentary on Report on Nurses' Tobacco Cessation Behaviors

Research Abstract with Commentary

Frequency of nurses’ smoking cessation interventions: Report from a
national survey

Linda Sarna, Stella A Bialous, Marjorie Wells, Jenny Kotlerman, Mary E Wewers and Erika S Froelicher. Journal of Clinical Nursing, 18, 2066–2077.

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control.
Design. Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate).
Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web.
Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy.
Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2,24).
Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions.
Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This timely article describes one in a series of studies done by Sarna and colleagues related to nurses’ roles in international tobacco control efforts. The assumption behind the sample selection (nurses employed at Magnet hospitals) is that this group of nurses may have better tobacco cessation practices compared to nurses at non-Magnet facilities. Specific findings were of interest to those of us at St. Joseph who have been involved in the tobacco cessation education of nurses here (nurses on all units were to have completed the 3-hour classes offered through Clinical Education).
 73% of nurses ask about tobacco use
 62% advise about the risks
 62% assess motivation to quit
 37% assist with patients’ cessation efforts
 19% arrange cessation strategies
 22% refer to resources
Some unpublished data from a year long hospital study of nurses who have taken the St. Joseph class (Matten, Morrison, Rutledge, Chen, Chung, & Wong, 2009) indicate that our class is enhancing these types of nurse behaviors (see table).

Nurses’ Perceptions of their Skills to Counsel Patients

Action* Pre 3 Months 6 months 12 months
(n = 98) (n = 39) (n = 38) (n = 34)
Ask 3.69 (1.1) 4.33 (0.8) 3.87 (1.0) 4.24 (0.7)
Advise 3.06 (1.2) 3.72 (1.0) 3.87 (1.1) 3.85 (0.9)
Assess 2.65 (1.0) 3.28 (1.0) 3.53 (1.2) 3.56 (0.8)
Assist 2.36 (1.2) 3.49 (.9) 3.35 (1.2) 3.59 (1.0)

*Response set: 1= poor; 5 = excellent