Britton Geraldine Rose, Collier Rosemary, McKitrick Sean, Sprague Lori Marie, Rhodes-Keefe Joyce, Feeney Ann, James Gary D
Geraldine Rose Britton is an assistant professor of nursing at the Decker School of Nursing, Binghamton University, Binghamton, NY, where Rosemary Collier, Lori Marie Sprague, and Joyce Rhodes-Keefe are clinical assistant professors of nursing and Gary D. James is a professor of nursing, anthropology, and bioengineering. Sean McKitrick is vice president in the Office of Provost, Middle States Commission on Higher Education, Philadelphia. Ann Feeney is an assistant professor of nursing at the University of Scranton, Scranton, PA. Contact author: Geraldine Rose Britton,
Am J Nurs. 2017 Jun;117(6):24-34. doi: 10.1097/01.NAJ.0000520228.66868.ae.
: Background: The U.S. Department of Health and Human Services' initiative Healthy People 2020 targets tobacco use, including smoking during pregnancy, as a continuing major health concern in this country. Yet bringing the U.S. Public Health Service's 2008 clinical practice guideline, Treating Tobacco Use and Dependence, into routine prenatal care remains challenging. Our previous nurse-managed intervention study of rural pregnant women found no significant cessation effect and significant discordance between self-reported smoker status and urinary cotinine levels.
The overall purpose of this follow-up study was to increase our understanding of the experiences of pregnant smokers and their providers. No qualitative studies could be found that simultaneously explored the experiences of both groups.
This qualitative descriptive study used focus group methodology. Nine focus groups were held in two counties in upper New York State; six groups consisted of providers and three consisted of pregnant women. Four semistructured questions guided the group discussions, which were audiotaped and transcribed verbatim. Transcripts were read and coded independently by six investigators. Themes were identified using constant comparative analysis and were validated using the consensus process.
The total sample consisted of 66 participants: 45 providers and 21 pregnant women. Most of the providers were white (93%) and female (93%). A majority worked as RNs (71%); the sample included perinatal and neonatal nursery nurses, midwives, and physicians. The pregnant women were exclusively white (reflecting the rural demographic); the average age was 24 years. All the pregnant women had smoked at the beginning of their pregnancies. Four common themes emerged in both the provider and the pregnant women groups: barriers to quitting, mixed messages, approaches and attitudes, and program modalities. These themes corroborate previous findings that cigarette smoking is used for stress relief, especially when pregnancy itself is a stressor, and that pregnant women may feel guilty but don't want to be nagged or preached to.
These results have implications for how smoking cessation programs for pregnant women should be designed. Health care providers need to be cognizant of their approaches and attitudes when addressing the subject of smoking cessation. Specific educational suggestions include "putting a face" to the issue of tobacco use during pregnancy. More research is needed on how best to implement the 2008 clinical practice guideline in specific populations.
背景：美国卫生与公众服务部发起的“健康人民2020”倡议将烟草使用，包括孕期吸烟，列为该国持续存在的主要健康问题。然而，将美国公共卫生服务部2008年的临床实践指南《治疗烟草使用与依赖》纳入常规产前护理仍然具有挑战性。我们之前对农村孕妇进行的护士主导干预研究发现，戒烟效果不显著，且自我报告的吸烟者状态与尿可替宁水平之间存在显著差异。
这项后续研究的总体目的是加深我们对孕期吸烟者及其医护人员经历的理解。尚未发现有定性研究同时探讨这两组人群的经历。
这项定性描述性研究采用焦点小组方法。在纽约州北部的两个县举行了9个焦点小组；6个小组由医护人员组成，3个小组由孕妇组成。4个半结构化问题指导小组讨论，讨论内容进行了录音并逐字转录。6名研究人员独立阅读并编码转录文本。使用持续比较分析法确定主题，并通过共识过程进行验证。
总样本包括66名参与者：45名医护人员和21名孕妇。大多数医护人员是白人（93%）且为女性（93%）。大多数人是注册护士（71%）；样本包括围产期和新生儿重症监护室护士、助产士和医生。孕妇均为白人（反映了农村人口结构）；平均年龄为24岁。所有孕妇在怀孕初期都吸烟。医护人员组和孕妇组都出现了四个共同主题：戒烟障碍、信息混杂、方法与态度以及项目模式。这些主题证实了先前的研究结果，即吸烟用于缓解压力，尤其是当怀孕本身就是一个压力源时，而且孕妇可能会感到内疚，但不想被唠叨或说教。
这些结果对如何设计孕妇戒烟项目具有启示意义。医护人员在处理戒烟问题时需要意识到自己的方法和态度。具体的教育建议包括让孕期烟草使用问题“有血有肉”。关于如何在特定人群中最佳实施2008年临床实践指南，还需要更多研究。
