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Aims and objectives. The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers' needs as reported in studies of patients living with COPD in the community. Background. Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital-at-home care and other models of community care to prevent or reduce re-hospitalisations of people with chronic conditions. Understanding carers' needs is important if health care professionals are to support carers in their caregiving role. Design. A narrative literature review. Methods. Thirty five papers were reviewed after searching electronic databases. Results. Few studies were identified which addressed, even peripherally, carers' needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital-at-home/early discharge, self care and home management programmes were identified which included some information on patients' living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer. Conclusions. This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research. Relevance to clinical practice. There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. Background. Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. Methods. All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. Results. Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. Conclusion. No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes. [ABSTRACT FROM AUTHOR]

Food-induced anaphylaxis (FIA) affects an increasing number of children and families encountered in a variety of nursing environments. Sensitive nursing care requires consideration of the psychosocial impact of the condition. The purpose of this phenomenological study was to arrive at an understanding of the mother's lived experience of parenting a child with FIA. Semistructured interviews were conducted with six mothers of children 6 to 12 years old considered at risk for FIA. Data analysis was carried out concurrently with data collection, revealing 'Living with Risk' as the essence of the experience, supported by five themes: 'Living with Fear,' 'Worrying About Well-Being,' 'Looking for Control,' 'Relying on Resources,' and 'It Is Hard But It Is Not.' These findings should assist nurses in meeting families' education and support needs related to FIA. Copyright © 2007 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire Aims of the study. The aim was to develop and pilot test a newly developed measure, The Information and Support Needs Questionnaire (ISNQ), for use with women with primary relatives with breast cancer. Background/rationale. Breast cancer is a major risk to the health of women in the United Kingdom (UK). Increasingly, research is documenting women’s needs for information and support, particularly at the time of diagnosis. However, to date there is little understanding of the information and support needs of women who have a family history of breast cancer. Contributing to the dearth of understanding of female relatives’ needs is the lack of valid and reliable instruments for use in descriptive and intervention research with this population. Design/methods. The ISNQ and survey items documenting family history, sources of information and support for breast cancer risk, breast self-care practices, and other variables were pilot tested for the acceptability of the measures, appropriateness of the data collection methods, initial psychometric properties of the ISNQ, and time and financial costs of administration. Data were collected from 39 women living in the North-west of England who had primary relatives with breast cancer using mailed questionnaires and follow-up telephone interviews. Findings. The items on the ISNQ were reported to be clear, acceptable to women and to yield relevant data. The psychometric properties of the new measure were satisfactory with a high reliability coefficient alpha. Descriptive findings indicate that women had moderate to high needs for information and support, but reported that these needs were not well met. Conclusions. The results of this pilot are guiding the development of a larger study in which the information and support needs of women with a family history of breast cancer are explored. [ABSTRACT FROM AUTHOR]

Little is known about the needs of adolescents of women with breast cancer. The purpose of this study was to describe the perceptions of adolescents (ages 12-20) about the role of the school in assisting them in dealing with the cancer experience. An exploratory, qualitative study was done to elicit detailed descriptions of adolescent's needs for information and support in response to their mother's breast cancer. A convenience sample of 31 adolescents of women in five illness phases participated in semi-structured interviews. In addition, two focus group interviews were conducted. Interviews were tape-recorded, transcribed and analysed using content analysis techniques. Findings specific to the adolescents' perceptions of the role of the school were discussed according to content, type, amount, timing, provider and quality of information. Support needs were discussed as type of support, source of support, amount, timing and focus. Although school personnel attempted to be supportive and adolescents received generic information about cancer, overall the needs of the adolescents were not adequately addressed. Recommendations for schools and health services in assisting adolescents to cope with this major life experience are made. [ABSTRACT FROM AUTHOR]

Although there have been intense efforts to reduce the prevalence of cigarette smoking in the past three decades, smoking continues to be a critical public health problem. An area of particular concern is the increasing number of young women who are smoking. Gender specific research usually does not examine factors affecting smoking behaviours. Information on late adolescent female smoking is not readily found in the literature. The aims of this study were to explore the smoking patterns and processes of late adolescent females and to explore factors which may or may not be helpful in assisting them to stop smoking. A qualitative ethnographic approach was used to uncover the perceptions of 25 adolescent girls of their behaviour. Data were collected using tape-recorded semi-structured interviews and a questionnaire. Items for the questionnaire were derived from the Manitoba Youth Smoking Survey and from the Fagerstrorn Nicotine Tolerance Scale. Qualitative analysis resulted in four stories about smoking: the start story, the smoking story, the quit story, and the looking to the future story. Although many of the findings are congruent with the existing literature, much of the data reflected the purposive nature of smoking in late adolescent girls. Study findings support the need for holistic approaches to health promotion to ameliorate factors affecting smoking behaviour. [ABSTRACT FROM AUTHOR]

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature. This paper provides background information on the historical origins of community development work through an extensive review of the literature. As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science. These include economic development models, education models both formal and informal, confrontational models, and empowerment models. Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health. However, much additional work will be needed to test out models for community development in actual practice. Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population. [ABSTRACT FROM AUTHOR]

Breast cancer is a major threat to the health of women; two-thirds of women diagnosed with breast cancer are likely to die from the disease. In North America one woman in nine will experience breast cancer at some point in her lifetime. In the United Kingdom, the figure is somewhat lower, one in 12, and increasing. Increasing age and a family history of breast cancer are considered major risk factors. With no known primary prevention, early detection measures remain the main hope of decreasing mortality. Despite controversy surrounding the effectiveness of breast self-examination in reducing mortality, breast self-examination or breast self-'awareness' are advocated by health departments and voluntary cancer organizations. In this paper, breast self-care practices of women with a family history of breast cancer are reported. A descriptive study using in-depth semi-structured interviews as the prime data collection procedure was conducted with 55 women who had mothers, sister(s) or mothers and another primary relative with breast cancer. All interviews were tape recorded, transcribed and analysed using latent content analysis and constant comparison techniques. The findings revealed that women constructed their own personal meanings about the benefits and limitations of breast self-examination and their use of this self-care behaviour within their daily lives. Women used breast self-examination as a means of gaining control over their feelings of the threat of breast cancer. Women's earlier involvement with their relative during the cancer experience and their own processing of their personal risk for breast cancer influenced their breast self-care practices. [ABSTRACT FROM AUTHOR]

Searching out health needs and stimulating clients' awareness of health needs are two key principles of health visiting practice. However, there is little empirically based knowledge of how health visitors carry out these functions in their daily work. The purpose of this paper is to describe and analyse health visitors' work in searching for health needs and promoting clients' awareness and actions in response to professionally identified needs. Forty-five health visitors were interviewed by means of semi-structured, conversational interviews. Findings identified that searching for health needs occurred in four types of situations. These were needs that were (a) client initiated, (b) easily seen, (c) 'opened up' by the health visitor, and (d) suspected and hidden. Several processes were involved in searching for needs and stimulating clients' awareness and actions, including: questioning, using illustrations from other client situations, normalizing, assigning homework, assessing and intervening while searching, and responding to cues. Timing played an important part in when and how interventions to search out needs occurred. This study contributes to our understanding of how health visitors work in the community to promote individual and family health. [ABSTRACT FROM AUTHOR]

The aim of this study was to uncover how experienced health visitors conceptualize and evaluate their health visiting work. The grounded theory approach to data collection and analysis was used to develop a beginning midrange substantive theory about health visiting practice. The beginning theory provides an explanation and understanding of how health visitors work with clients in the community during their day-to-day visiting practice. Data were gathered from 45 experienced health visitors from 13 health authorities in the north-west of England by means of the conversational interview. The basic psychosocial problem uncovered in the data was health visitors' need to provide a service and clients' need to fulfil personal needs and goals. The unifying theme of giving and receiving integrated the major categories into the key analytic framework in this study. This key psychosocial process was the pattern of interaction between health visitors and clients, in which both parties control the interactions by regualting what they offer and accept from each other. Each party both selectively 'gives' and 'receives' in order to manage the health visitor-client encounters. What gets offered and how the offer is received and acted on is a complex process involving many factors related to the health visitor, the client, and the context in which the interaction takes place. [ABSTRACT FROM AUTHOR]

This paper examines the issues that nurses experience when entering the family system to work preventively. The theoretical basis of family-centred nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice. Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems. The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined. The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns. The authors support the general structure of public health practice as of value for preventive work with families. However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family-centred nursing. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore the concept of gaining access to clients as it emerged from an in-depth qualitative study of health visiting practice. The study was conducted using a grounded theory approach to data collection and analysis. Forty-five experienced health visitors were interviewed using a semi-structured interview guide. The interviews were tape recorded and later transcribed. A detailed analysis of the processes involved in 'entering' into client situations to begin health visiting work is presented. Entry into the client/family situation is a process which involves both obtaining access to the client in the environment where health visitor and client meet and 'entering' into the client situation more fully to continue the health visiting work. The data from this study would suggest that the work involved in entering client situations involves many strategies to ensure entry and re-entry. This process is influenced by many factors within the client, the health visitor, and the health visitor-client encounter. This paper makes a contribution to our understanding of the processes involved in everyday health visiting practice. [ABSTRACT FROM AUTHOR]

How do mothers of children at risk describe the process of engaging with public health nurses (PHNs) and family visitors (FVs) in a home visiting programme?DESIGNGrounded theory.SETTINGSouthwestern Ontario, Canada.PARTICIPANTSA purposeful sample of 20 English speaking mothers who had received >/=1 PHN visit and >/=3 FV visits after they had been identified as high risk because of social or economic factors.METHODSMothers participated in 1--3 semistructured interviews of 60--90 minutes, which addressed their experiences and expectations of engagement with PHNs and FVs. 29 interviews were conducted (11 by telephone). Interviewer field notes and client records were also reviewed. Data were analysed using open, selective, and theoretical coding. Checks for data credibility included peer debriefing and member checks by 8 participants.MAIN FINDINGSMothers described feeling vulnerable because PHNs and FVs had the power to alter family structure. When mothers risked participating in home visits, they engaged in a social process to limit family vulnerability, which involved 3 phases: overcoming fear, building trust, and seeking mutuality. These phases comprised a circular process, each dependent on the establishment and stability of the other 2 phases. The speed at which the phases were successfully negotiated was influenced by the personal characteristics, values, experiences, and actions of the PHN, FV, and mother. (1) Overcoming fear. Mothers were ambivalent about accepting initial PHN visits, fearing that they would be judged to be inadequate. Strategies to overcome this fear included 'hiding nothing,' 'trying to measure up' (eg, cleaning the house before the visit), and 'protecting self' (eg, having a spouse present to reduce the likelihood of negative comments from the PHN). Successful use of these strategies allowed mothers to redefine the role of the PHN from authority figure to supportive service provider. Consequences of not overcoming fear included mothers cancelling scheduled visits and dropping out of the home visiting programme without explanation. Most mothers were less fearful of engaging with FVs than PHNs. (2) Building trust. As mothers' trust in home visitors increased, they became more willing to discuss personal, sensitive issues. 'Opening up' was easiest if they perceived that the home visitor was reliable, would keep information confidential, and would not react negatively to disclosed information. Mothers who were open to the relationship, motivated to participate, confident in their parenting abilities, and who perceived the PHN as a positive source of support were more likely to immediately trust the PHN or FV. Mothers often tested home visitors, using secondary sources to verify information and assessing how much information visitors would share about other clients. Mothers had more trust in either PHNs or FVs based on individual characteristics, such as reliability and empathy, rather than on role. (3) Seeking mutuality. All mothers wanted to be able to openly share their stories with PHNs and FVs and, in turn, wanted home visitors to share personal experiences, especially those related to child rearing. They promoted sharing by offering refreshments and encouraging brief social exchanges. Mothers observed the verbal and non-verbal language of home visitors and felt comfortable engaging with those who smiled, nodded their heads in encouragement, and allowed adequate time for mothers to speak. When mutual exchanges of information occurred, mothers felt less vulnerable in answering personal questions. Mothers tried to build alliances with home visitors to respond to relatives who were overly critical of their parenting abilities. Mothers wanted to collaborate with home visitors to define common goals for home visits. Generally, FVs were reported to be less likely to collaborate and more likely to lecture mothers.CONCLUSIONMothers of high risk children described engaging with public health nurses and family visitors as a circular process, with the goal of limiting family vulnerability by overcoming fear, building trust, and seeking mutuality. [ABSTRACT FROM AUTHOR]

The aim of this narrative review is to identify strategies in use by specialist community and public health nurses in the prevention, care and management of individuals with long-term conditions, specifically chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders. These conditions have been selected as they are highly prevalent; a burden on health services globally and a major public health issue. From a UK policy perspective, specialist community nurses have been placed at the forefront of taking a lead role in the coordination and delivery of more responsive services for individuals with long-term conditions; whether this has been an effective use of skills and resource is questionable. We systematically searched relevant databases between 1999-2009 to identify interventions used by specialist community nurses and critically appraised the studies. This review reports on impact and value of interventions used by specialist community nurses in the prevention and management of COPD and musculoskeletal conditions, and makes recommendations for improving services.

Worldwide, tobacco is the leading cause of preventable death, resulting in approximately 5 million deaths annually. Nurses are keenly positioned to work toward reducing tobacco-related illness and deaths. Therefore, guided by the health belief model, the purpose of this study was to explore the smoking behavior, beliefs, smoking cessation education practices, and existing smoking policies at the institutions of a sample of practicing oncology nurses in Canada, Japan, Korea, Taiwan, United Kingdom, and the United States. A 27-item structured survey, designed for this study in English and translated and reverse translated by the Asian countries, was distributed to a convenience sample of nurses attending oncology meetings in each country. Totally 759 surveys were completed and analyzed using descriptive statistics. Principle findings indicate that 4.5% of these nurses currently smoke, although 23.3% reported smoking previously. While many nurses (74%) reported frequently assessing the smoking status of patients, only 50% reported discussing cessation with their patients that smoke. Although the majority (80%) reported feeling comfortable with asking their patients about smoking, only 23% felt it was the nurse's role. The findings indicate that while internationally oncology nurses recognize the importance of smoking cessation, significant room for improvement exists in translating this into practice.

Purpose/objectives: To elicit detailed descriptions of adolescents' information and support needs in response to their mothers' breast cancer., Design: Exploratory, qualitative., Setting: Four different outpatient and inpatient oncology settings in western Canada., Sample: 31 adolescent children of women in five illness phases., Methods: 27 semistructured interviews and two focus groups were conducted. Interviews were audiotaped, transcribed, and analyzed using constant comparison techniques. The Communication Subscale of the McMaster Family Assessment Device also was administered to assess family communication patterns., Findings: Information needs were sources of information, information content, degree of helpfulness, and information timing. Support needs were type, degree of helpfulness, form, and source., Conclusion: Most of the adolescents reported that their needs were poorly met., Implications for Nursing: Women with breast cancer have a need for family-focused care. Further research is required to develop interventions that can assist nurses in providing care that meets the needs of adolescent children and other family members of women with breast cancer.

The aims of this study were to assess nursing students' knowledge of and attitudes towards primary health care using a newly developed Canadian instrument, the Primary Health Care Questionnaire (PHCQ). The instrument was refined for use in the UK prior to collecting data from 427 students in degree, Project 2000, health visitor and district nursing courses. Findings indicate that students in all programmes surveyed have been exposed to the concepts of primary health care. Students have acquired knowledge about primary health care and, generally, positive attitudes to the concepts. Significant differences were found between several student groups on both the knowledge and attitude measures. Although further psychometric evaluation of this new measure is recommended, the PHCQ shows promise as a valuable measure for use in assessing the move toward an increased emphasis on primary health care concepts in nursing education.

The purpose of this paper is to explore health visitors' work with men as uncovered in their detailed descriptions of actual cases. The study used the grounded theory approach to data collection and analysis. Forty-five health visitors were interviewed using the conversational interview and 111 cases of their work with young families discussed. Findings indicate that health visitors' work with men was influenced by both their conceptualization of men within family-focused health visiting practice and contextual factors in the actual client-health visitor situation which enhanced or restricted interventions with men. Four approaches to working with men were identified and classified as: (1) high conceptualization and high intervention, (ii) high conceptualization and low intervention, (iii) low conceptualization and high intervention, and (iv) low conceptualization and low intervention. This paper contributes to our understanding of the health visitor's role in family health promotion.

The aim of this paper is to explore the health visitor-client relationship as it emerged in an indepth qualitative study of health visiting practice. Despite the emphasis in health visiting practice on developing relationships with clients, there is little empirically based knowledge as to how health visitors develop relationships with clients and what effect relationships have on clients' health outcomes. Forty-five experienced health visitors were interviewed and asked to discuss cases where they felt they had had a positive effect and cases where they thought they had not had any impact. The interviews were tape-recorded and later transcribed. A detailed analysis of the processes involved in developing relationships is described. The data from this study suggest that health visitors develop relationships with clients in an attempt, not only to provide services to clients, but also to ensure access to clients over time. This study makes a contribution to our understanding of the processes involved in everyday health visiting practice.

The aim of this paper is to explore the concept of referral as it emerged from an in-depth qualitative study of health visiting practice. The study was conducted using a grounded theory approach to data collection and analysis (Glaser and Strauss, 1967). Forty-five experienced health visitors were interviewed using a semi-structured interview guide. The interviews were tape recorded and later transcribed. A detailed analysis is presented of the processes involved in referring. This includes working up the client for referral, working up the agency, third party referrals, and issues of control in the referral process. The outcome of referral in terms of the effect on the client is also discussed. This paper makes a contribution to our understanding of the microprocesses in everyday health visiting practice.

Contemporary concerns in nursing education in Canada suggest that the earlier educational pathways have not always represented progress. The persistence of alternate routes for the preparation of registered nurses, and the continuing divisiveness among nurses with differing educational backgrounds are problem areas that still require resolution. Some problems, such as the development of the nursing curriculum, have been shared across educational settings. Nurse educators in Canada, as in other countries, have vested tremendous energy into this aspect of nursing education. In retrospect, it is recognized that much of this effort has been misdirected. Efforts to strengthen the theoretical underpinnings of the curriculum have resulted in the incorporation of borrowed theory from other disciplines, often without critical examination of the context in which the theory developed, or of its consistency with the philosophical perspectives of nursing. Attempts to build curricula around the major nursing models have also met with limited success. Separation of education and practice, persistence of multiple levels of preparation in nursing, and a continual search for viable curriculum models have led to uncertainty, to detours in the development of nursing education, and to occasional reconsideration of previous approaches.