Reasons for tobacco use and perceived tobacco-related health risks in an inpatient psychiatric population

People with mental illness (MI) have a disproportionate tobacco-related disease burden and mortality. Tobacco-use rates in people with MI are nearly twice that of the general population. Reasons for tobacco-use in this population may be a result of diminished tobacco-related disease risk perceptions. The purpose of this study was to examine the reasons for tobacco-use and perceived tobacco-related health risks among psychiatric inpatients. A correlational design was employed to survey a convenient sample of 137 patients from a psychiatric facility in central Kentucky. Information obtained from participants included demographics, psychiatric diagnoses, tobacco-use and exposure history, medical illness history, reasons for tobacco-use, and tobacco-related illness risk perceptions. The primary reasons participants endorsed for tobacco-use were for stress reduction, followed by addiction, then boredom, psychiatric symptom control, social, and negative mood. In addition, about 72% of participants used tobacco to cope with MI symptoms and 52% to manage the side effects of their medications. Participants were most likely to endorse that tobacco-use caused lung disease (83.2%), heart disease (79.6%), cancer (77.4%), and premature mortality (79.6%) but were less likely to admit that it may cause addiction to other drugs (39.4%) or MI (23.4%). Given the high endorsement of tobacco-use for stress reduction and psychiatric symptom control, it is important for mental health nurses to properly educate consumers on tobacco addiction and evidence of its effects on mental health. Strategies to incorporate our study findings into routine mental health services may address the tobacco-use disparities experienced by people with MI.

A crosssectional examination of factors associated with compassion satisfaction and compassion fatigue across health care workers in an Academic Medical Center

Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals’ productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work-related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work-related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work-related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers’ health and safety.

The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients with Mental Illness

Background and Objectives:

Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization.



Reliability was tested by examining Cronbach’s α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255).



The reliability analysis yielded a Cronbach’s α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale.



The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.

Factors associated with tobacco cessation attempts among inpatients in a psychiatric hospital


Several effective evidence-based tobacco treatment approaches can optimize cessation attempts; however, little is known about the utilization of such strategies by people with mental illnesses (MI) during their cessation attempts.


To examine methods used during and factors associated with tobacco cessation attempts among people with MI.


Self-administered cross-sectional survey data were obtained from 132 tobacco using inpatients from a psychiatric facility in Kentucky, USA.


Our study found ‘cold turkey’ as the most reported method by inpatient tobacco users with MI in their prior cessation attempts regardless of the psychiatric diagnosis category. Multivariate logistic regression found ethnicity (OR 26.1; 95% CI 2.9–237.1), age at 1st smoke (OR 1.1; 95% CI 1.0–1.1), importance to quit (OR 1.2; 95% CI 1.0–1.4), and receipt of brief tobacco treatment interventions (OR 1.1; 95% CI 1.0–1.3) significantly associated with quit attempt in the past year.


Despite the existence of various evidence-based approaches to enhance tobacco cessation among people with MI, ‘cold-turkey’ was the most preferred method in this sample. In addition, this study highlighted ethnicity, importance to quit, age at 1st smoke, and receipt of brief interventions as important factors to consider when tailoring tobacco cessation in this population. Though ethnicity is a non-modifiable factor, an informed provider may intervene skillfully by addressing socio-cultural barriers specific to an ethnic group. Lower ratings on the motivation ruler and early age of smoking initiation could also inform providers when using motivational interviewing and other evidence-based tobacco-cessation approaches.

Prevalence and factors of compassion fatigue among Chinese psychiatric nurses: A cross-sectional study

Compassion fatigue has emerged as a detrimental consequence of experiencing work-related stress among psychiatric nurses, and affected the job performance, emotional and physical health of psychiatric nurses. However, researches on Chinese psychiatric nurses’ compassion fatigue are dearth. This cross-sectional study aimed to investigate the prevalence and factors of compassion fatigue among Chinese psychiatric nurses.

All participants completed the demographic questionnaire and the Chinese version of Professional Quality of Life Scale (ProQOL-CN). One-way ANOVA, t-tests, Levene test and multiple linear regression analysis were conducted to evaluate factors associated with compassion fatigue.

A total of 352 psychiatric nurses in 9 psychiatric hospitals from the Chengdu, Wuhan, and Hefei were surveyed. The mean scores of compassion satisfaction, burnout and secondary traumatic stress were 32.59 ± 7.124, 26.92 ± 6.003 and 25.97 ± 5.365, respectively. Four variables of job satisfaction, exercise, had children, and age range from 36 to 50 years explained 30.7% of the variance in compassion satisfaction. Job satisfaction, sleeping quality, and marital status accounted for 40.4% variables in burnout. Furthermore, job satisfaction, average sleeping quality, and years of nursing experience remained significantly associated with secondary trauma stress, explaining 10.9% of the variance.

Compassion satisfaction, burnout and secondary traumatic stress among Chinese psychiatric nurses were at the level of moderate. The higher job satisfaction, healthy lifestyle (high sleep quality and regular exercise), and family support (children, stable and harmonious marital status) positively influenced compassion satisfaction and negatively associated with burnout or secondary traumatic stress.

From twisting to settling down as a nurse in China: a qualitative study of the commitment to nursing as a career


The nurse workforce shortage, partially caused by high work turnover, is an important factor influencing the quality of patient care. Because previous studies concerning Chinese nurse work turnover were predominantly quantitative, they lacked insight into the challenges faced by nurses as they transition from university to their career. A successful transition can result in new nurses’ commitment to the career. As such, this study sought to understand how new nurses commit to the career, and focused on identifying facilitators and barriers to such commitment.


This was a qualitative study using a grounded theory design. Through purposive sampling, clinical nurses were recruited from hospitals in Western China to participate in semi-structured interviews. The data was analyzed through coding to develop categories and themes.


Theoretical saturation was achieved after interviewing 25 participants. The data revealed the ‘zigzag journey’ of committing to the nursing career. The emerging core theme was “getting settled”, indicating that new nurses needed to acclimate to the work reality in the nursing career. By analyzing the data provided by the participants, the researchers concluded that the journey to getting settled in nursing compassed four stages:1) “sailing out with mixed feelings”, 2) “contemplating to leave”, 3) “struggling to stay”, and 4) “accepting the role”. For most participants, nursing was described as a way to earn a living for their family, not as a career about which they felt passionate.


Committing to the nursing career is a complicated long-term process. There seems to be a lack of passion for nursing among the Chinese clinical nurses participating in this study. Thus, the nurses may need continued support at different career stages to enhance their ability to remain a nurse for more than economic reasons.

Social Smoking Environment and Associations with Cardiac Rehabilitation Attendance

Purpose: Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients.

Methods: Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up.

Results: Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant.

Conclusion: Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.

Correlates of posttraumatic growth among nursing professionals: A cross-sectional analysis

Aims: Among nursing professionals, our aims were to examine (a) self-reported traumatic experiences, (b) differences in post-traumatic growth (i.e. positive psychological growth after experiencing a traumatic event) by nursing professional level and (c) demographic, work-related, behavioural and traumatic experience covariates of post-traumatic growth.

Background: Trauma experience among nursing professionals is higher than observed in the general population. Due to the nature of their work environment, workplace trauma rates are particularly alarming. Understanding post-traumatic growth among nursing professionals may guide interventions to enhance well-being.

Method: A secondary analysis of cross-sectional survey data from nursing professionals (N = 299). Demographic, work-related, behavioural, trauma experience categories and post-traumatic growth variables were examined.

Results: Advanced practice nurses and clinical nurses reported higher rates of workplace trauma, as compared to nursing assistants. Higher post-traumatic growth scores were associated with having a postgraduate degree, serving the paediatric population and lower frequency of alcohol use. Lower post-traumatic growth scores were associated with being married/widowed, being an advanced practice provider or clinical nurse, working in the intensive care unit and reporting workplace, family/personal stress and undisclosed trauma.

Conclusions: Nursing professionals have several demographic, work-related, behavioural and traumatic experience-related variables associated with and that explain variances in post-traumatic growth.

Implication for nursing management: Targeted screening and individualized treatment based on nursing professional level should be considered to support trauma recovery and post-traumatic growth.