Testing an empowerment intervention to help parents make homes smoke-free: a randomized controlled trial.

The objective of this randomized controlled trial was to test if parents' participation in an intervention based on an empowerment ideology and participatory experiences decreased the number of cigarettes smoked in homes. Sixty families were randomized to the intervention (n = 30) or control (n = 30) group. The intervention included three weekly group sessions followed by three weekly follow-up telephone calls over six consecutive weeks. During group sessions, parents shared experiences about environmental tobacco smoke, identified personal strengths and resources, and developed action plans. Data were collected in interviewer-administered questionnaires at baseline and 6 months follow-up. Ninety-three percent of the sample consisted of mothers, 77% of whom smoked during pregnancy. Forty-two percent of the total sample reported a household income of <$15,000. The median number of cigarettes smoked in the home daily decreased from 18 to 4 in the total sample however no statistically significant difference was detected between groups at 6 months follow-up. Participation in the study, independent of group, may have resulted in parents decreasing the number of cigarettes smoked in the home. Valuable lessons were learned about recruiting and working with this group of parents, all of whom faced the challenges of tobacco and almost half of whom lived in poverty.

'Do it for the kids': barriers and facilitators to smoke-free homes and vehicles.

Despite abundant evidence about the adverse effects of secondhand smoke exposure on children's health, few reports describe barriers and facilitators encountered by parents in making their homes and vehicles smoke-free. This article describes perceptions of barriers and facilitators to making homes and vehicles smoke-free among 36 parents with a child five years of age or younger. Qualitative data were collected in interviews with parents in the context of a randomized controlled trial that tested an intervention to empower parents to make their homes and vehicles smoke-free. Themes that emerged in the analysis were congruent with an ecological conceptualization of health. The greatest barriers were intrapersonal factors, and nicotine addiction was the intrapersonal barrier identified most frequently. The most frequently reported facilitators were intrapersonal factors, such as quitting smoking. Parents reported not seeking advice from health care providers. The transition process to make homes and vehicles smoke-free is complex and individualistic; nurses may need to tailor strategies to take the specific contexts of each individual into account.

Advanced practice nursing: unification through a common identity.

Despite the wide variety of advanced practice roles in nursing and the well-documented differences among them [Hamric, A. (2000). A definition of advanced nursing practice. In A. Hamric, J. Spross, & C. Hanson (Eds.), Advanced nursing practice: An integrative approach (pp. 53-73). Philadelphia, PA: W. B. Saunders], the authors suggest that nurses in these roles should adopt a common identity, that of an "advanced practice nurse" (APN). The authors outline the development of advanced practice nursing in Canada and the United States, tracking historical influences and highlighting current issues facing APNs. The authors explore elements that constitute the definable and describable core of advanced practice nursing-knowledge, education, scope of practice, regulatory issues, and outcomes. They conclude that adoption of a common identity for all advanced practice nursing roles may clarify role confusion (which is currently experienced within and outside the profession), reinforce links between knowledge development and nursing practice, and ensure that advanced nursing practice is responsive to the needs of society.

Exploring nursing roles across North American borders.

Professional nurses are challenged by the increasing complexity of their own healthcare delivery systems and by the growing interconnectivity of healthcare systems worldwide. There are increasing calls for practice across boundaries; however, the role and scope of nursing practice within individual countries are often unclear, ill-defined, and misunderstood by nurses from other countries. In this collaborative educational project among six schools of nursing located in Canada, México, and the United States, nursing students and faculty are exploring the role of the nurse within each country's healthcare system while striving to develop their multicultural awareness. Participating faculty describe the process, challenges, and keys to success found in creating and living this international project. They share strategies for addressing challenges, which included meeting deadlines, time differences, differing academic schedules, writing joint documents in two languages, designing and presenting a shared course, and creating an exchange process between the six partner schools. They describe the evolution of their working relationships, the language challenges, and the joy of coming together as newfound colleagues and friends.

Past, present and future of respiratory research: A survey of Canadian health care professionals.

BACKGROUND: The Canadian Respiratory Health Professionals (CRHP) is the multidisciplinary health care professional group of the Canadian Lung Association. Although the CRHP has a growing number of highly qualified researchers, the landscape of their research in Canada has not been described. OBJECTIVES: To describe the level of respiratory research engagement; identify barriers and facilitators to research engagement; describe the experience and interest in developing research skills; and identify priority areas of future respiratory research among health care professionals. METHODS: An online survey of CRHP members was used to collect demographic information; barriers and facilitators to conducting research; future directions in respiratory research; and research funding and mentorship. Experience with and interest in 'upskilling' research skills were also evaluated. RESULTS: A total of 119 surveys were completed (22% response rate), of which 69 (58%) respondents were engaged in respiratory research. Reasons for not being involved in respiratory research were lack of mentorship, support and funding. The top research areas were chronic obstructive pulmonary disease (74%) and asthma (41%). The top facilitators for research engagement were amount of funding (29%) and mentorship (28%). Respondents in research positions rated their experience in research skills as high; those in nonresearch positions as low. However, both groups expressed interest in improving their research skills. CONCLUSIONS: Areas of development, such as research skills, greater funding opportunities and mentorship to increase the research capacity of health care professionals in respiratory health were identified. Health professional researchers have an important role in the national respiratory research strategy to increase interdisciplinary engagement and build collaborative teams.

Understanding the barriers to cervical cancer screening among older women.

Despite the fact that 90% of cervical cancers can be prevented by regular Pap screening, many women are not screened regularly, particularly older women. To understand better the barriers to screening, the authors held five focus groups during April 2000 in Prince Edward Island (PEI), Canada. Of the 32% of women aged 45 to 70 who had not been screened over a 5-year period (1995-2000), 60 randomly selected women participated in this research. The authors analyzed discussions for themes using an inductive approach, with interpretation guided by the population health model. Women who have avoided a Pap test are falling between the cracks created by a complex interaction between personal experiences and the health system's approach to Pap screening.

Empowering parents through asthma education.

Asthma is the most common chronic illness in children and has a significant impact on children and their families. Asthma management requires a multi-faceted approach, including an effective educational component. The purpose of this pilot study was to compare outcomes for parents who participated in empowering and traditional approaches to asthma education. Specific outcomes that were examined included (a) knowledge, (b) sense of control, (c) ability to make decisions, and (d) ability to provide care. The sample consisted of 57 families who participated in a multi-session educational intervention. Twenty-nine families participated in the empowering approach; the remaining 28 families received the traditional approach. Data were collected before, immediately after, and 6 months following the educational intervention. Significant differences were found regarding sense of control, ability to make decisions, and ability to provide care for parents who participated in the empowering approach. Both approaches resulted in increased knowledge. These findings have implications for asthma education and for the education of health professionals.

A systematic review of questionnaires measuring health-related empowerment.

The objective of this systematic review was to identify questionnaires that measure health-related empowerment in adults or families and demonstrated the best evidence of reliability and validity. A search of nine data bases identified 8,269 abstracts that referred to empowerment. Full article review was completed for abstracts that met the inclusion criteria or that could not be excluded with certainty (n = 124). Fifty distinct, modified, or translated questionnaires measuring empowerment were identified in 74 articles. Each was rated in terms of reliability and validity. One questionnaire had good evidence of reliability and validity, four had moderate evidence, and 45 had limited or no evidence. Limited or no evidence for reliability and validity for many questionnaires could relate in part to lack of consensus on the theoretical definition of, and indicators for measuring empowerment. We recommend that researchers use the questionnaire rated as having good evidence and that data on reliability and validity continue to be reported for other questionnaires.

The Joint Venture Model of Knowledge Utilization: a guide for change in nursing.

Knowledge utilization (KU) is an essential component of today's nursing practice and healthcare system. Despite advances in knowledge generation, the gap in knowledge transfer from research to practice continues. KU models have moved beyond factors affecting the individual nurse to a broader perspective that includes the practice environment and the socio-political context. This paper proposes one such theoretical model the Joint Venture Model of Knowledge Utilization (JVMKU). Key components of the JVMKU that emerged from an extensive multidisciplinary review of the literature include leadership, emotional intelligence, person, message, empowered workplace and the socio-political environment. The model has a broad and practical application and is not specific to one type of KU or one population. This paper provides a description of the JVMKU, its development and suggested uses at both local and organizational levels. Nurses in both leadership and point-of-care positions will recognize the concepts identified and will be able to apply this model for KU in their own workplace for assessment of areas requiring strengthening and support.

Emotional intelligence: a primal dimension of nursing leadership?

Emotional intelligence, a concept well known in the world of business, is quickly gain ing recognition in the healthcare arena. Described as the primal aspect of leadership, emotional intelligence refers to the ability to monitor and discriminate among emotions, and to use the information to guide thought and action. This paper will explore the theoretical and empirical basis of emotional intelligence and its linkages to leadership. Readers will be informed of the origins and theoretical perspectives regarding emotional intelligence, evidence related to the existence of emotional intelligence, benefits and limitations of the concept and implications for nursing leadership.