Abstract Women who are disadvantaged have higher rates of smoking during pregnancy and are at higher risk of tobacco-related harm. Smoking cessation interventions have been developed for pregnant and parenting women who smoke however, improvements to smoking cessation interventions for rural, disadvantaged pregnant and parenting women are needed. A multiple case study design was used to (1) describe the level of implementation of a smoking cessation intervention, Expecting to Quit (ETQ), in five Healthy Baby Clubs (HBC) in western Newfoundland; (2) describe barriers and facilitators to implementing ETQ; and (3) collect preliminary evidence of its effectiveness among rural, disadvantaged pregnant and parenting women. This study describes implementation of ETQ from the perspective of pregnant and parenting women (n=12), managers (n=5), and HBC Mothers (n=6). It offers insight into factors (i.e., training, policies and procedures, acceptability, appropriateness of the program) associated with implementation of ETQ. Data were collected through: (1) in-person one-on-one interviews; (2) focus group interviews; (3) training evaluation questionnaires; (4) knowledge, attitudes and beliefs questionnaires; (5) socio-demographics and smoking behaviour questionnaires; and (6) document review of annual reports, staff meeting minutes, and records of polices and procedures. Inductive analyses of data were undertaken including content analysis, constant comparison, and thematic analysis. Six integrated themes emerged: (1) Stigma and Judgment: Walking a Fine Line; (2) Social Context, Health and Place: Rural Living Affects Women; (3) Social Networks: Supporting Women Like Us; (4) Community Empowerment: A Catalyst to Get the Message Across; (5) Complexities in the Lives of Women: Just Trying to Get Through; and (6) Tobacco Reduction: It is a Success. The integrated themes suggest that cessation interventions in this context must address each of these issues. These findings may prov / RésuméLes femmes désavantagées sont plus à risque de fumer pendant leur grossesse et sont plus exposées aux risques associés à la consommation du tabac. Des interventions visant l’arrêt de la consommation du tabac ont été développées pour les femmes enceintes et les jeunes mères qui fument. Néanmoins, des améliorations doivent être apportées à ces programmes pour les femmes enceintes ou jeunes mères désavantagées en milieu rural. Une étude de cas multiples à été utilisée pour (1) décrire le niveau d’implémentation du programme d’intervention visant l’arrêt de la consommation du tabac « Expecting to Quit » (ETQ), dans cinq clubs « Healthy Baby Club » de la région ouest de Terre-Neuve, (2) décrire les obstacles et les aspects facilitant l’implémentation des « ETQ », et (3) rassembler les preuves préliminaires de son efficacité pour les femmes enceintes ou les jeunes mères désavantagées en milieu rural. Cette étude décrit la mise en place, des interventions « ETQ » du point de vue des femmes enceintes et des jeunes mères (n=12), des responsables du programme (n=5) et des mères, membres du club « HBC » (n=6). Cette étude apporte des éclairages sur certains facteurs (formation, règles et procédures, acceptabilité, niveau de pertinence) associés à la mise en place des interventions « ETQ ». Les données ont été récoltées à travers: (1) des entretiens en personne, (2) des entretiens en groupe, (3) des questionnaires d’évaluation de la formation, (4) des questionnaires de connaissances, d’attitudes et de croyances, (5) des questionnaires socio démographiques sur le comportement des fumeurs, et (6) la lecture de documents tels que: rapports annuels, compte rendu de réunion des employés, règles et procédures. Des analyses inductives des données ont été faites, incluant, l’analyse du contenu, la comparaison des constantes, et des analyses thématiques. Six thèmes intégrés en sont r

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Firstborns' behaviours were examined at different weeks of the mother's pregnancy. Their behaviours were compared to those of preschoolers whose mothers were not expecting. Eighty preschoolers participated: 20 from each trimester of the mother's pregnancy and 20 in a comparison group. At 16 and 20 weeks, first trimester firstborns had fewer difficulties with separation, insecurity, and dependency than at 12 weeks. At 24 and 28 weeks, second trimester firstborns were less dependent than at 20 weeks, and at 28 weeks less insecure than at 20 weeks. At 38 weeks, third trimester firstborns exhibited fewer separation and dependency behaviours than at 28 weeks. First and third trimester firstborns differed from the comparison group, but not in the expected direction. At 16 and 20 weeks, firstborns showed fewer separation problems than the comparison group. At 16 weeks, firstborn boys were less insecure than their counterparts, and at 38 weeks, firstborn boys had fewer separation problems and were less angry than comparison boys. It would appear a mother's second pregnancy does not appear to be particularly distressing for firstborns.

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A stress, appraisal, and coping framework was used to explore the sources of stress for adult children of elderly parents residing in long-term care facilities and their perceived self-efficacy in managing the stressful events of caregiving. Sixty-four daughters and sons of parents in three long-term care facilities completed interviews and questionnaires. Events related to the parents' behaviour and cognitive status were more frequently appraised by their children as stressful and were appraised as more stressful than those related to assisting parents with activities of daily living or to events associated with the long-term care facility itself. Characteristics of the parent were more significantly related to the appraisal of caregiving events as stressful than were those of the adult child or the caregiving situation. In general, adult children were most confident in managing the stress associated with assisting their parents with activities of daily living and least confident in dealing with the stress related to interactions between their parents and the staff and between themselves and the staff. Practice implications for nurses working in long-term care facilities are discussed.

Family members have been observed to cope with the losses inherent in terminal illness by grieving. Little is known, however, about the factors which influence their grieving before the death of a significant other. This paper describes an exploratory, cross-sectional, correlational study designed to examine the relationships among general coping style, hope, and anticipatory grief in a convenience sample of 61 family members of individuals with terminal cancer. The organizing framework for this study was based on grief theory, Lazarus and Folkman's (1984) theory of stress and coping, and Davies, Reimer, and Martens' (1990) transition framework. Data were collected by a four-part questionnaire comprising the Jalowiec Coping Scale (Jalowiec, 1987), the Herth Hope Index (Herth, 1991), the Non-Death Version of the Grief Experience Inventory (Sanders, Mauger, & Strong, 1985), and a background information sheet developed by the researcher. Findings revealed that family members experienced individual anticipatory grief patterns. Women experienced more despair and anger/hostility than men. Adult children, more highly educated family members, individuals not living with the ill person, and non-primary caregivers expressed more anger/hostility. Multiple regression results showed that emotive coping and hope accounted for significant proportions of the variance in despair, somatization, and loss of control. Emotive coping contributed significant variation in anger/hostility, whereas lack of hope accounted for a significant amount of the variation in social isolation. Neither the general coping styles nor hope significantly predicted death anxiety. Suggestions for research and nursing were indicated.

This correlational study examined the relationships among sex role attitudes and role behaviours (traditionality), marital adjustment, caregiving involvement, caregiver satisfaction, psychological distress and psychosocial adaptation in the MI patient and his wife at two months post infarction. The research also aimed to develop explanatory models of patient and spouse adjustment. / A convenience sample of 130 couples was drawn from the cardiac units of four hospitals in a large metropolitan area. Data were collected during home visits using structured interviews and self-report questionnaires. Patients and wives were interviewed separately. Marital and psychosocial adjustment, psychological distress, sex role attitudes, and selected sociodemographic and control variables were assessed in both members of the couple. Husbands were questioned about their cardiac symptoms whereas wives were asked about their role behaviour, caregiving involvement, and caregiver satisfaction. Data were analyzed using Pearson correlations and hierarchical regression procedures. / Correlations indicated that wives' traditionality (attitudes, role behaviour) was directly related to adjustment outcomes in only two instances: worse domestic and marital adjustment in husbands. However, traditionality was found to be associated with the sociodemographic factors (age, education, illness, social support) that were central to adjustment. The results of the regression analyses revealed that the husbands' and the wives' models of adjustment differ. The husband's adjustment is associated primarily with clinical factors while the wife's adjustment is related to both clinical and psychosocial factors. Caregiving enters in the adjustment model of both husbands and wives, but from somewhat different perspectives. Finally, having a previous MI figured prominently in both models and may be a crucial clinical factor for the couple's adjustment. / These results suggest important factors to be considered in identifying couples at risk of poor adjustment outcomes and demonstrates the importance of both patient and spouse assessments during the early post-MI recovery period.

The primary purpose of this randomized controlled trial was to examine the effect of the Webster-Stratton Parents and Children Series, a proven, video-based, modeling, nurse-delivered, group cognitive-behavioural parent program, on the parenting skills and autonomous self-regulated behaviours of children (ages 3-to-8 years) in families on the caseload of child protection. Twenty-eight families on the caseload of one of three child protection agencies were randomly assigned to one of two conditions: the 16-hour weekly intervention group or the 4-month wait-list control group. Twenty-six families completed the study. Results of the statistical analysis showed that mothers in the treatment group had statistically significant improvement in one parenting skill, involvement, and marginally significant improvement in another parenting skill, autonomy-support, during one of two study activities (free-play) compared to the wait-list control group. No significant improvement was found among children in the treatment group when compared to their study counterparts. Further, little but promising support was found for the hypothesized relationship between mothers with a strong parenting profile and children with a strong autonomous self-regulated profile. / Given the small sample size, providing only 30% power to detect a 10% change, further exploratory analyses were conducted. Although not statistically significant, performance was found to vary according to group, activity and behaviour. Several characteristics distinguished mothers, and children whose performance showed most change (improvement, deterioration). The fact that 92% of the mothers attended six or more of the eight parent program sessions and the low attrition rate (7%) indicate that the intervention may have been more successful with this population than statistical evidence demonstrates.

Research has indicated that the adjustment of psychiatric patients is adversely affected by family criticism. The present study elaborated on this theme by focusing on fifty schizophrenic patients who were formally interviewed, using a standard visual analog scale format, about their perception of family criticism. Two important conceptual distinctions were proposed. The first was the extent to which criticism was perceived as "constructive" or "destructive", and the second was the extent to which the criticism was perceived to be "person directed" or "behavior directed". Regression analyses were performed in order to determine the predictive utility of the various dimensions of criticism on patient outcomes. The results indicate first, that criticism is not always perceived as negative and secondly, patients who perceived high levels of negative criticism (destructive, person directed) had relatively poor outcomes. Those who perceived high levels of positive criticism (constructive, behavior directed) had more positive outcomes. The results therefore indicate that criticism is multidimensional. This awareness of different meanings of criticism may lead to early identification of adjustment difficulties and subsequent interventions to prevent them.