Cessation among state quitline participants with a mental health condition.

INTRODUCTION: Telephone quitlines are an effective treatment option for tobacco cessation in the general population. Many participants who use quitline services have mental health conditions (MHC), yet few published studies have examined the use of quitline services in this population. This study examined the prevalence of MHC among state quitline participants and compared cessation outcomes among those with and without MHC. METHODS: Demographic and tobacco use data were collected at enrollment and 7 months post-enrollment using standardized assessments for 10,720 eligible participants who enrolled in a state quitline between September, 2010 and August, 2012. RESULTS: The prevalence of self-reported MHC was 19.8% (2,086/10,720 callers). The intent to treat quit rate for participants with a MHC was 16.4% compared to 21.5% for those without a MHC (p < .001), and the responder quit rate was 36.9% for those with a MHC compared to 44.4% for those without (p < .001). The adjusted odds ratio describing the association of MHC status and tobacco cessation was identical for both the intent-to-treat and responder populations, and indicated that participants with MHC were 23% less likely to quit (p < .05). CONCLUSIONS: This study identified that participants with MHC accessed a state quitline, but were less likely to quit. The finding was independent of other factors influencing tobacco cessation, such as gender, race, and education. These findings indicate that although quitline services are an option for tobacco cessation among persons with MHC, further research is needed to determine why cessation rates are lower.

Tobacco quitline outcomes for priority populations.

BACKGROUND: Despite declining rates of tobacco use, certain subgroups still experience a disproportionate risk for tobacco-related health issues. The South Dakota QuitLine identifies five priority population subgroups as the following: American Indians, tobacco users receiving Medicaid, youth, pregnant women, and spit tobacco users. The purpose of this study was to describe South Dakota QuitLine use among priority population subgroups and to measure associated cessation rates and service satisfaction. METHODS: Priority population subgroups comprised 22.6 percent (9,558 out of 42,237) of South Dakota QuitLine participants during a six-year period (2008-2013). Of the 34,866 total participants eligible for seven-months follow-up, 15,983 completed a telephone survey that measured tobacco quit status and service satisfaction (45.8 percent overall response). Eligible priority population subgroups had a 41.9 percent response (3,094 out of 7,388). RESULTS: The seven-month tobacco quit rate for the non-priority population group (46.9 percent) was higher than the quit rate for pregnant women (42.3 percent), youth (37.5 percent), American Indians (38.1 percent), Medicaid participants (35.7 percent) and participants with more than one priority subgroup designation (35.1 percent). The quit rate for spit tobacco users was highest overall (57.3 percent). All subgroups were satisfied with South Dakota Quitline services (≥ 3.5/4.0 scale; 4 = very satisfied). CONCLUSIONS: Tobacco users in high risk and underserved population subgroups of the South Dakota QuitLine seek cessation services. Quit rates were overall favorable and varied between population subgroups (35.1-57.3 percent). Health care providers play a vital role in early identification of tobacco use and referral to cessation services for priority populations. Providers should assess tobacco use, advise users to quit, and refer to the South Dakota QuitLine.

A statewide assessment of smoke-free policy in multiunit housing settings.

INTRODUCTION: The prevalence of smoke-free policies in multiunit housing (MUH) in South Dakota was examined. Owner beliefs about smoke-free policies were identified. METHODS: Stratified random sampling included 27 South Dakota counties classified as frontier, large rural, or urban. Data collection with MUH owners in selected counties employed a telephone survey with mailed backup. RESULTS: The owner response rate was 41.5% (324/780). A written smoke-free policy was reported by 175 (54.0%) owners, and 31 (10%) reported a verbal smoke-free policy. Owners in large rural counties (57.4%) had more written smoke-free policies than owners in urban (52.2%) and frontier (53.5%) counties. Only 8.5% of properties had policies covering both buildings and grounds. Owners without policies were more than twice as likely to manage U.S. Department of Housing and Urban Development subsidized units and were three times as likely to be current smokers. Owners without a smoke-free policy anticipated that a policy would decrease maintenance costs but increase turnover and vacancy rates. Nearly one-half (47.9%) of owners with no smoke-free policy had previously considered implementing a policy. Owners self-reported beliefs about smoke-free policies identified perceived benefits such as decreased maintenance and costs, improved tenant safety and health, and conscientious tenants. Perceived drawbacks included increased outdoor maintenance, enforcement problems, concerns about long-term tenants who smoke, and freedom/rights of smokers. CONCLUSIONS: This study provides a baseline assessment of smoke-free polices in MUH settings. Perceptions of owners without smoke-free policies focused on economic concerns that were inconsistent with reports from those owners with smoke-free policies.

Tobacco quitline outcomes by service type.

BACKGROUND: Tobacco use is a burden in terms of mortality, chronic disease, and economic impact. Effective treatments exist to aid tobacco users who are motivated to quit. The South Dakota QuitLine provides coaching to all participants and the option of a cessation product (nicotine replacement therapy [NRT], or the prescription medications, varenicline or bupropion) at no cost. This study describes the types of services requested by South Dakota QuitLine participants and the associated cessation outcomes across service types. METHODS: Data from South Dakota QuitLine enrollees during a four year period (2008 to 2011) were included. Enrollment data (demographics and tobacco use) and outcome evaluation data (30 day point prevalence - abstinence) collected seven months later were accessed (N = 11,603/26,876 enrollees, 43.2 percent response). The frequency of requests for each type of cessation service and associated cessation outcomes are reported. Abstinence at seven months was compared for the different services. RESULTS: Frequencies of cessation services requested were coaching/varenicline (64.6 percent), coaching/bupropion (5 percent), coaching/NRT (22.6 percent), and coaching only (5.4 percent). Overall abstinence at seven months was 47.2 percent. Abstinence rates for service types were the following: coaching/varenicline (49.8 percent), coaching/bupropion (47.3 percent), coaching/NRT (42.9 percent), and coaching only (40.3 percent). Chi-square analysis and confidence interval comparisons identified significantly higher abstinence (p < .05) for varenicline/coaching in comparison to coaching only or coaching/NRT. CONCLUSIONS: All service options available from the South Dakota QuitLine result in cessation rates of 40 percent or greater. Providers should assess tobacco use, advise users to quit, and refer to the South Dakota QuitLine.

Palliative and end-of-life care in South Dakota.

BACKGROUND: Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. METHODS: Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. RESULTS: Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). CONCLUSIONS: The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Evaluation of an intervention to increase self-efficacy for independent exercise in cardiac rehabilitation.

Adherence to independent exercise is an essential outcome of cardiac rehabilitation (CR), yet limited theory-based interventions to improve adherence exist. This study tested the effects of an intervention based on Bandura's conceptualization of self-efficacy. The self-efficacy coaching intervention (SCI), a supplement to standard care, was designed to increase self-efficacy for independent exercise and independent exercise behavior in CR. We examined whether the SCI vs. attention control (AC) resulted in improved exercise self-efficacy (ESE), barriers self-efficacy (BARSE), and minutes of independent exercise for CR participants (n = 65). While between-group differences did not reach significance (p > .10) for any of the outcome measures, significant within-group changes were noted in BARSE scores and independent exercise (p < .001) for the SCI group. Change in independent exercise for the AC group was also significant (p =. 006). Further study is needed to explore whether short-term changes translate into maintenance of independent exercise participation after program completion.

Dual RN-RDN program: Training for the future of health and nutrition.

PURPOSE: Explore the benefits and feasibility of a dual training program for dietetics and nursing to increase nutrition in clinical practice. METHODS: A professional interest survey on the perceived value of a dual program with 222 registered nurses (RN) and registered dietitian nutritionists (RDN) and an in-depth literature review were completed. RESULTS: A majority of RNs indicated the addition of the RDN would be beneficial for supporting patients with diet-related chronic diseases and performing nutritional assessments and interventions. The RDN respondents indicated a dual program approach would also improve the ability to serve a small community or place of employment that is limited in having both a full-time RDN and RN, and rated benefits for performing more medical and laboratory procedures. The RDNs also indicated the dual program could help increase their income potential. Both dual Master's and dual Bachelor's programs were rated as valuable. Of the 18 (8%) of respondents who had both RDN and RN credentials, half indicated personal growth and interest was the incentive for pursuing the dual training; whereas half indicated professional incentives (e.g., no RDN in the area, improving specialty care, job security, lack of opportunities), The literature review indicated no studies on the efficacy of a dual RDN-RN program on health outcomes; however, studies have shown that individualized counseling from RDNs is more beneficial than general nutritional counselling from other health care providers not specifically trained in dietary assessments. Noted barriers to pursuing dual training included time and cost, and some respondents in both specialties were not interested in a dual program. DISCUSSION: These results support providing students with dual program options, although further exploration of the specific approach is warranted, particularly decreasing time-to-degree while not affecting efficacy.

Treatment-related needs of statewide cancer survivors.

INTRODUCTION: Research on surviving cancer treatment is a national priority and there is a need to understand the experiences of survivors from predominantly rural areas. The purpose of this study was to identify the perceptions of treatment and post-treatment issues for cancer survivors living in South Dakota. Multidimensional aspects of cancer-related needs were explored, including: psychosocial, physical, spiritual, health promotion and access to care issues. METHODS: The design was a cross-sectional survey of cancer survivors who completed their course of treatment at five accredited cancer treatment centers in South Dakota two years prior to the study. The survey was derived from a synthesis of other published instruments, with added items that focused on issues of interest to rural dwellers. There were 524 of 1933 mailed surveys returned (27 percent response). RESULTS: Respondents identified needs for help coping with various emotions more frequently than needs related to finding support and taking care of practical issues post-treatment. Specifically, coping with uncertainty and finding hope were priority needs (33 percent and 36 percent, respectively), while accessing counseling services and financial planning were low priority (9 percent and 14 percent, respectively). There were limited numbers of participants who reported that access to care (time, expense, travel) interrupted their cancer treatment. CONCLUSIONS: Perceptions of treatment-related needs of cancer survivors living in South Dakota include broad health promotion, practical and, most commonly, emotional concerns. Health care providers who assess for and identify these needs require a keen awareness of community resources to support South Dakota cancer survivors.

Helping patients to quit tobacco use: integration of South Dakota QuitLine services.

New evidence-based practice guidelines for tobacco cessation recommend that physicians ask their patients about tobacco use and interest in a serious quit attempt at every visit. There are some barriers to integrating comprehensive quit assistance into clinical practice settings. However, there are many research-tested strategies that simplify the process and overcome the challenges to conversations about quitting. The purpose of this manuscript is to showcase one of the resources available to augment clinical-based cessation conversations in South Dakota--the Department of Health QuitLine. Additional tobacco cessation resources are highlighted.

Pearls and Pitfalls of Team Science.

Formidable health problems are often best addressed by teams of scientists with varied expertise. This diversity among team members and complexities in managing teams can lead to challenges in designing, funding, conducting, and reporting research. Team science difficulties can be addressed by sophisticated planning, frequent reassessment and realignment of team strategies with goals, and consistent transparent communication. This article addresses specific strategies to build and sustain research teams, manage team meetings, strategically develop publications and grants, thrive in the midst of disciplinary and individual team member differences, embrace new ideas and change to maintain creativity, and build future team scientists and projects. The potential value in team science justifies the effort required to build and maintain efficient and effective research teams.

Academic nursing leadership in a rural setting: Different game, same standards.

The call for transformation of nursing education and practice continues to be a national priority. The American Association of Colleges of Nursing recommends enhanced partnerships between academic nursing and academic health centers to advance nursing and healthcare. For academic leaders in rural settings, the context of health and healthcare means that these partnerships are vastly different from academic health centers. The purpose of this article is to describe the context of nursing education and practice in regions that are predominantly rural. The challenges and opportunities for rural academic leaders as they respond to calls for transforming the education of the future nursing workforce are described from the perspective of resources, recruitment and retention of faculty, clinical education and faculty practice, scholarship, and fundraising. Meeting rural health workforce needs is a national imperative and a priority of academic nursing leaders in rural settings.

Launching Successful Beginnings for Early Career Faculty Researchers.

Junior faculty follow a research path replete with challenges as they strive to create knowledge in their area of interest while balancing new responsibilities. Unlike graduate school, where students focus inward on personal development, junior faculty must add responsibilities in ways that hold them accountable as members of a university. This special article deals with three themes of interest to new junior faulty launching research programs: personal development, collaboration and team development within university settings, and funding advice. Strategies in these areas provide guidance on navigating early careers and finding success in the academic setting.

Sharing the gift of life: an intervention to increase organ and tissue donation for American Indians.

CONTEXT: Growing waiting lists for organ transplantation require attention to populations with a high demand for organs but a low donation rate. American Indians experience a high demand for kidney transplantation because of an epidemic of type 2 diabetes, yet donation consent rates are low in this group. OBJECTIVE: To design and evaluate an educational intervention to increase the intention to serve as an organ or tissue donor among American Indians. INTERVENTION: Sharing the Gift of Life was designed for reservation-dwelling American Indians living in the Northern Plains area of the United States. The intervention addressed important cultural traditions and was derived from the Transtheoretical Model of behavior change. DESIGN: A 2-stage descriptive evaluation design was used. SETTING AND PARTICIPANTS: Two evaluation groups were included. American Indian members of a project advisory council served as cultural expert evaluators (stage 1). Northern Plains reservation-dwelling American Indian adults were community member evaluators (stage 2). MEASURES: Stage 1 used an Educational Materials Review Form. Stage 2 used an adapted community member evaluation tool. RESULTS: The cultural expert evaluation was strong. All items met the < 3.0 mean acceptability criterion (range 1.93-2.89). Content validity indices met criterion of 0.80 for the overall evaluation and for all items. Cultural specific changes to the materials were suggested. After revision, community member evaluation was favorable. Mean evaluation scores met criterion and content validity indices were acceptable. Pronunciation of traditional language was corrected in the video. Sharing the Gift of Life is a promising intervention that should undergo efficacy testing.

Strategies to Build Authorship Competence Among PhD Students.

Publication in refereed journals is an important responsibility of PhD-prepared nurses. Specialized writing skills are crucial for effective professional publication. The capacity to develop and publish articles is best learned during doctoral education. This Western Journal of Nursing Research Editorial Board Special Article addresses multi-dimensional strategies to develop authorship competence among doctoral students. The article outlines structured PhD program experiences to provide the context for students to develop authorship capacity. The authors identify multi-faceted faculty endeavors and student activities that are essential to foster authorship competence. Students who embrace opportunities to acquire authorship qualifications will be well prepared for their post-graduation role as stewards of the nursing discipline.

Physical activity behavior of American Indian mothers.

BACKGROUND: Mothers of young children who live in low-income households are a population at-risk for sedentary living that could experience important health benefits from improved physical activity behavior. Previous research among Caucasian mothers attending the Women, Infants and Children (WIC) program showed that the Transtheoretical Model of behavior change was an appropriate model for designing interventions for activity promotion. PURPOSE: This study examined the Transtheoretical Model of behavior change in relationship to the physical activity behavior of low-income American Indian mothers. DESIGN: A descriptive-correlational study employed a purposive sample (N = 30) of six American Indian mothers at each of five stages of behavior change. Participants were recruited from a Women, Infants and Children program located on the Pine Ridge Indian Reservation in South Dakota. Instruments included the 7-day Activity Recall, Stages of Exercise Adoption tool, Pros and Cons to Exercise tool, Self-efficacy for Exercise scale, and the Processes of Exercise Adoption tool. FINDINGS: Significant relationships were found between stage of change and energy expenditure indices (r = 0.69-0.74, p < .01), pros (r = 0.62, p < .01), cons (r = -0.58, p < .05), decisional balance (r = 0.59, p < .01), and self-efficacy (r = 0.60, p < .01). Pros and cons were different from a prior study of mothers attending the Women, Infants and Children program. CONCLUSIONS: The Transtheoretical Model is relevant to American Indian mothers and should be tested in future physical activity interventions.

Normalizing Rejection.

Getting turned down for grant funding or having a manuscript rejected is an uncomfortable but not unusual occurrence during the course of a nurse researcher's professional life. Rejection can evoke an emotional response akin to the grieving process that can slow or even undermine productivity. Only by "normalizing" rejection, that is, by accepting it as an integral part of the scientific process, can researchers more quickly overcome negative emotions and instead use rejection to refine and advance their scientific programs. This article provides practical advice for coming to emotional terms with rejection and delineates methods for working constructively to address reviewer comments.

Mediator analysis of Moms on the move.

This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived. Identifying mediator variables is vital for intervention planning. The intervention was derived from the Transtheoretical Model (TTM) of behavior change and promoted moderately intense activities like walking. Sedentary mothers with children enrolled in the Women, Infants, and Children program (N = 44) were randomly assigned to the experimental intervention or attention control. Large effect sizes were reported for improvements in physical activity and changes in TTM constructs. This study examined whether the physical activity improvements were mediated by the behavioral constructs. Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression. These exploratory findings did not support the hypothesis that increased physical activity, which was associated with the experimental intervention, was mediated by the TTM constructs.

Teaching core nursing values.

Nursing is a caring profession. Caring encompasses empathy for and connection with people. Teaching and role-modeling caring is a nursing curriculum challenge. Caring is best demonstrated by a nurse's ability to embody the five core values of professional nursing. Core nursing values essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice. The caring professional nurse integrates these values in clinical practice. Strategies for integrating and teaching core values are outlined and outcomes of value-based nursing education are described. Carefully integrated values education ensures that the legacy of caring behavior embodied by nurses is strengthened for the future nursing workforce.

Managing opportunities and challenges of co-authorship.

Research with the largest impact on practice and science is often conducted by teams with diverse substantive, clinical, and methodological expertise. Team and interdisciplinary research has created authorship groups with varied expertise and expectations. Co-authorship among team members presents many opportunities and challenges. Intentional planning, clear expectations, sensitivity to differing disciplinary perspectives, attention to power differentials, effective communication, timelines, attention to published guidelines, and documentation of progress will contribute to successful co-authorship. Both novice and seasoned authors will find the strategies identified by the Western Journal of Nursing Research Editorial Board useful for building positive co-authorship experiences.