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AIM: This paper is a report of a concept analysis of adolescent smoking cessation self-efficacy. BACKGROUND: Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self-efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population. DATA SOURCES: The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self-efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied. FINDINGS: Adolescent smoking cessation self-efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified. CONCLUSION: Levels of self-efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population. [ABSTRACT FROM AUTHOR]

QUESTIONIn children with acute asthma or lower airway obstruction attacks, how do home-made and commercial spacers attached to metered-dose inhalers (MDIs) compare for delivering (beta2 agonists?REVIEW SCOPEStudies selected compared rapid-acting beta2 agonists delivered by MDIs attached to home-made spacers with MDIs attached to commercial spacers in children and adolescents <18 years of age presenting to the emergency department (ED) with acute exacerbations of wheezing or asthma. Outcomes included hospital admission, lung function (peak expiratory flow rate [PEFR], oxygen saturation, and respiratory rate), heart rate, clinical score, intensive care unit (ICU) admission, length of ED stay, and need for additional treatment.REVIEW METHODSMedline, CINAHL, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Cochrane Library (Issue 3, 2007), LILACS, and reference lists were searched. Authors and pharmaceutical companies were contacted for randomised controlled trials (RCTs). 6 RCTs (n = 658, age range 2 mo to 18 y) met the selection criteria. Modified Jadad scores ranged from 2 to 4 out of 5.MAIN RESULTSIn 1 RCT, groups did not differ for hospital admission (table). Groups did not differ for changes in PEFR, oxygen saturation, heart rate, clinical scores, or need for additional treatment (table). No studies reported ED length of stay or ICU admission.CONCLUSIONHome-made and commercial spacers attached to metered-dose inhalers did not differ for delivering 13[2] agonists in children with acute asthma or lower airway obstruction attacks. [ABSTRACT FROM AUTHOR]

In young children with acute lower airway obstruction, is response to bronchodilator treatment given using a metered dose inhaler (MDI) with a bottle spacer equivalent to that given using a conventional spacer?METHODSDesign: randomised controlled equivalence trial. Allocation: concealed.Blinding: blinded ({healthcare providers, data collectors},* and clinical outcome assessors).Follow up period: after completion of 3 bronchodilator treatments.Setting: a children's hospital in Cape Town, South Africa.Patients: 400 children aged 2 months to 5 years (median age 12 mo, 39% boys) who presented with clinical signs of acute lower airway obstruction (expiratory wheeze on auscultation or hyperinflation of the chest) and had cough or difficulty breathing within the previous 5 days. Exclusion criteria were bronchodilator use in the previous 4 hours, underlying cardiac or chronic pulmonary disease (other than asthma), stridor, or daily oral corticosteroid treatment for >2 days before presentation.Intervention: salbutamol, 500 microg, 5 puffs given at 1 puff every 10 seconds from an MDI using a modified 500 ml plastic bottle spacer, where the end of the bottle was held in the mouth simulating a mouthpiece (n = 200), or using a conventional spacer (Aerochamber, Trudell Medical, London, Ontario) (n = 200). A facemask was used for children <3 years of age. Children were reassessed 15 minutes after bronchodilator administration; if no improvement, a repeat inhalation was given, and if no improvement after 15 minutes, a third inhalation was given, and condition was reassessed after 15 minutes. If further treatment was required, children received nebulised salbutamol, 5 mg in 2.5 ml normal saline, using a jet nebuliser, and were reassessed after 15 minutes.Outcomes: admission to hospital (criteria for admission: room air oxygen saturation <92% after 3 bronchodilator treatments, persistent subcostal retractions, cyanosis, or social circumstances precluding safe home care of the acute episode). Equivalence was defined as

Competing Interests: Competing interests: None declared.

Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Background: E-learning is a common method of continuing education for nurses that supports professional competencies and learning needs. However, variations in setting, information technology, and quality of the e-learning may impact these experiences., Objective: To explore registered nurses' perceptions of e-learning in a hospital setting., Design: A qualitative study using an Interpretive Description methodology., Setting: A small urban Northeastern Ontario hospital., Participants: Ten registered nursing staff from acute medical and surgical inpatient departments., Method: Face-to-face semi-structured interviews were conducted to explore nurses' e-learning perceptions. Interview transcripts were analyzed for themes., Results: Three key themes were found that described the participants' perceptions of e-learning and how it related to their continuing education: Unsatisfactory, Meaningful, and Enhancing learning experiences., Conclusion: E-learning can be a useful method of continuing education for registered nurses; however, there are challenges in the delivery of e-learning and an ongoing need for quality development., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes., Competing Interests: Competing interests: RH is an Associate Editor for BMJ Evidence-Based Nursing., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team. Evaluation of the extent to which the processes within NPLC model addressed the needs of patients with multimorbidity is warranted. METHODS: Eight nurse practitioners were interviewed to determine their perception of the quality of care provided to patients with multimorbidity at NPLCs. Interpretive description guided the analysis and themes were identified.FindingsThree themes arose from the analysis, each of which has an impact on the quality of care. The level of patient vulnerability at the NPLCs was high resulting in the need to address social and financial issues before the care of chronic conditions. Dynamics within the interprofessional team impacted the quality of patient care, including NP recruitment and retention, leaves of absence and turnover in staff at the NPLCs had an effect on interprofessional team functioning and patient care. Finally, coordination of care at the NPLCs, such as length of appointments, determined the extent to which attention was given to individual clinical issues was a factor. Strategies to address social determinants of health and for recruitment and retention of NPs is essential for improved quality of care. Comprehensive orientation to the interprofessional team as well as flexibility in care processes may also have positive effects on the quality of care of patients with complex clinical issues.

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

Advance care planning (ACP) is a series of discussions in which patient values and wishes for end-of-life care are made known. The purpose of this study was to determine the extent to which registered nurses (RNs) engaged in ACP with their patients and understand the factors associated with this practice decision in Canada. One hundred twenty-five RNs participated in this cross-sectional descriptive survey. Registered nurse participants agreed that end-of-life decision making is an important part of their work; however, the majority of respondents did not participate in ACP, especially those RNs who were employed in community settings. Study respondents cited barriers to implementing ACP into their practice such as limited organizational policy, limited expectations of others to engage in ACP, inadequate educational opportunities to learn about or practice ACP, and a lack of patient and family readiness for the conversation. Study conclusions support recommendations for continuing education topics and the importance of organizational support in ACP.

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research., (© 2017 John Wiley & Sons Ltd.)

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students' self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students' age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics. Methods An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines. Results Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.

It is estimated that the number of people who die of life-limiting illnesses in Canada will double by the year 2056. Advance care planning (ACP) is one way to improve the quality of end-of-life care. ACP is a process of ongoing discussions whereby a person communicates important values and desired outcomes at the end of life prior to healthcare crises. Nurse practitioners (NP) commonly diagnose and plan healthcare for patients who may have life-limiting conditions and thus are in a strategic position to engage patients in ACP. Currently, we have a poor understanding of the extent and nature of NP involvement in ACP. This descriptive study explored Ontario NPs' knowledge, beliefs and level of implementation of ACP. NPs employed in hospital settings were significantly more likely to engage in ACP with patients and to have a policy governing ACP initiation compared with their community-employed counterparts. There were no significant differences between the NPs in these two settings in the beliefs, attitudes or personal comfort in initiating ACP. Implications for education, practice and research are provided.

Pathological accumulation of abnormally phosphorylated tau protein in astrocytes is a frequent, but poorly characterized feature of the aging brain. Its etiology is uncertain, but its presence is sufficiently ubiquitous to merit further characterization and classification, which may stimulate clinicopathological studies and research into its pathobiology. This paper aims to harmonize evaluation and nomenclature of aging-related tau astrogliopathy (ARTAG), a term that refers to a morphological spectrum of astroglial pathology detected by tau immunohistochemistry, especially with phosphorylation-dependent and 4R isoform-specific antibodies. ARTAG occurs mainly, but not exclusively, in individuals over 60 years of age. Tau-immunoreactive astrocytes in ARTAG include thorn-shaped astrocytes at the glia limitans and in white matter, as well as solitary or clustered astrocytes with perinuclear cytoplasmic tau immunoreactivity that extends into the astroglial processes as fine fibrillar or granular immunopositivity, typically in gray matter. Various forms of ARTAG may coexist in the same brain and might reflect different pathogenic processes. Based on morphology and anatomical distribution, ARTAG can be distinguished from primary tauopathies, but may be concurrent with primary tauopathies or other disorders. We recommend four steps for evaluation of ARTAG: (1) identification of five types based on the location of either morphologies of tau astrogliopathy: subpial, subependymal, perivascular, white matter, gray matter; (2) documentation of the regional involvement: medial temporal lobe, lobar (frontal, parietal, occipital, lateral temporal), subcortical, brainstem; (3) documentation of the severity of tau astrogliopathy; and (4) description of subregional involvement. Some types of ARTAG may underlie neurological symptoms; however, the clinical significance of ARTAG is currently uncertain and awaits further studies. The goal of this proposal is to raise awareness of astroglial tau pathology in the aged brain, facilitating communication among neuropathologists and researchers, and informing interpretation of clinical biomarkers and imaging studies that focus on tau-related indicators.

The previous 16 years have seen a number of healthcare reforms meant to increase access to primary healthcare services in Ontario. This included the establishment of an innovative model, the nurse practitioner-led clinics (NPLCs). NPLCs held promise for nurse practitioners (NPs) to practice to their full potential and optimize patient care. A multiple-case study was undertaken to evaluate the quality of care for patients with diabetes and multimorbidity at NPLCs. Five NPLCs, all in underserved areas in the mid-northern region of the province, were part of the study. Data collection included a chart audit, NP interviews and review of organizational information. Multiple-case analysis was conducted and four interrelated themes emerged about the quality of care of patients with diabetes and multimorbidity at the NPLCs. It was confirmed that the NP is the primary care provider at NPLCs. Healthcare policy such as a lack of increase in NP salary for 10 years has contributed to poor NP recruitment and retention. Insufficient healthcare resources in the communities where NPLCs are located and high patient vulnerability have a negative influence on the quality of care. Strategies, including mentoring, offer possible solutions to improve the quality of care at NPLCs.

The literature suggests that effective teamwork among patient care teams can positively impact work environment, job satisfaction and quality of patient care. The purpose of this study was to determine the perceived level of nursing teamwork by registered nurses, registered practical nurses, personal support workers and unit clerks working on patient care teams in one acute care hospital in northern Ontario, Canada, and to determine if a relationship exists between the staff scores on the Nursing Teamwork Survey (NTS) and participant perception of adequate staffing. Using a descriptive cross-sectional research design, 600 staff members were invited to complete the NTS and a 33% response rate was achieved (N=200). The participants from the critical care unit reported the highest scores on the NTS, whereas participants from the inpatient surgical (IPS) unit reported the lowest scores. Participants from the IPS unit also reported having less experience, being younger, having less satisfaction in their current position and having a higher intention to leave. A high rate of intention to leave in the next year was found among all participants. No statistically significant correlation was found between overall scores on the NTS and the perception of adequate staffing. Strategies to increase teamwork, such as staff education, among patient care teams may positively influence job satisfaction and patient care on patient care units., (Copyright © 2015 Longwoods Publishing.)

Advanced access scheduling is a system designed to allow patients to be seen same day or next day or in the future according to their preference. The scheduling system has been associated with patients being seen earlier in the course of illness and patients being hospitalized less often. The advanced access system focuses on timely access to primary healthcare, ideally within 48 hours. A group of Ontario primary healthcare nurse practitioners recently implemented the system at a newly established nurse practitioner-led clinic. The team's experiences with the implementation of the advanced access scheduling system are reviewed. The team's experiences are then compared and contrasted with what has been published on the scheduling system to date. The article approaches the subject matter from the perspectives of primary healthcare providers, clerical staff and administrators. Advanced access has become a timely subject in primary care, given the chronic shortages of service and funding constraints and the need for enhanced effectiveness.