Understanding Dutch practice nurses' adherence to evidence-based smoking cessation guidelines and their needs for web-based adherence support: results from semistructured interviews
Understanding Dutch practice nurses' adherence to evidence-based smoking cessation guidelines and their needs for web-based adherence support: results from semistructured interviews
复制标题
DOI：
10.1136/bmjopen-2016-014154
复制
发表时间：
2017-03-01
期刊：
影响因子：
2.9
通讯作者：
Hoving, C.
中科院分区：
文献类型：
--
作者：
de Ruijter, D.;Smit, E. S.;Hoving, C.
目的：全科护士对戒烟指南的依从性不理想。由于当完全遵守这些指南时，他们的戒烟支持的有效性是最大的，因此需要制定干预措施，以改善执业护士对指南的遵守，例如，通过根据遵守决定因素调整其内容。然而，解释依从性的社会认知决定因素尚未被调查。因此，本定性需求评估旨在探讨执业护士目前的咨询实践，以及他们对戒烟指南依从性的社会认知信念，以及他们对基于网络的依从性支持的需求。环境：初级保健；荷兰的全科医生参与者：19名执业护士，积极参与戒烟辅导。方法：基于I-Change模型和创新扩散理论，于2014年5月至9月进行半结构化的个体访谈。采用框架方法对数据进行系统分析，认为数据可靠（kappa 0.77； %一致性99%）。结果：受访者在戒烟咨询期间感到能够移情和协作。他们还报告了遵守戒烟指南的心理障碍（例如，自我效能低，以提高患者的积极性和安排适当的后续咨询）和实际障碍（例如，关于戒烟支持补偿的信息过时，以及对执业护士缺乏高质量培训）。大多数受访者对基于网络的依从性支持感兴趣，以克服这些障碍。结论：社会认知因素影响执业护士对戒烟指南的依从性。为了提高他们的依从性，基于网络的量身定制的依从性支持可以为执业护士提供针对个人感知的戒烟指南依从性障碍的个人相关反馈。更具体地说，低自我效能水平可以通过同伴建模（例如，介绍同事的叙述）来提高，并且可以在线提供最新信息，使执业护士能够在患者咨询期间使用它，从而与吸烟患者进行更有效的沟通。
Objectives: Practice nurses in general practices suboptimally adhere to smoking cessation guidelines. Since the effectiveness of their smoking cessation support is greatest when full adherence to these guidelines is achieved, interventions need to be developed to improve practice nurses' guideline adherence, for example, by tailoring their content to adherence determinants. However, the sociocognitive determinants explaining adherence have not yet been investigated. Therefore, this qualitative needs assessment aimed to explore practice nurses' current counselling practices, as well as their sociocognitive beliefs related to their smoking cessation guideline adherence and their needs regarding web-based adherence support.Setting: Primary care; general practices in the Netherlands.Participants: 19 practice nurses, actively involved in smoking cessation counselling.Methods: Semistructured individual interviews, based on the I-Change Model and the Diffusion of Innovations Theory, were conducted from May to September 2014. Data were systematically analysed using the Framework Method and considered reliable (kappa 0.77; % agreement 99%).Results: Respondents felt able to be empathic and collaborative during smoking cessation consultations. They also reported psychological (eg, low self-efficacy to increase patient motivation and arranging adequate follow-up consultations) and practical barriers (eg, outdated information on quit support compensation and a perceived lack of high-quality trainings for practice nurses) to smoking cessation guideline adherence. Most respondents were interested in web-based adherence support to overcome these barriers.Conclusions: Sociocognitive determinants influence practice nurses' smoking cessation guideline adherence. To improve their adherence, web-based tailored adherence support can provide practice nurses with personally relevant feedback tailored to individually perceived barriers to smoking cessation guideline adherence. More specifically, low self-efficacy levels can be increased by peer modelling (eg, presenting narratives of colleagues) and up-to-date information can be presented online, enabling practice nurses to use it during patient consultations, resulting in more effective communication with their smoking patients.