Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance
- David A. Katz MD, MSc,
- John Holman MA,
- Skyler Johnson MS,
- Stephen L. Hillis PhD,
- Sarah Ono PhD,
- Kenda Stewart PhD,
- Monica Paez BA,
- Steven Fu MD, MSCE,
- Kathleen Grant MD,
- Lynne Buchanan RN, PhD,
- Allan Prochazka MD, MSc,
- Catherine Battaglia PhD, RN,
- Marita Titler PhD, RN,
- Mark W. Vander Weg PhD
- … show all 14 hide
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A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses’ delivery of the 5A’s (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses’ attitudes toward the intervention.
We conducted a pre-post guideline implementation trial involving 205 hospitalized smokers on the inpatient medicine units at one US Department of Veterans Affairs (VA) medical center. The intervention included: 1) academic detailing of nurses on delivery of brief cessation counseling, 2) modification of the admission form to facilitate 5A’s documentation, and 3) referral of motivated inpatients to receive proactive telephone counseling. Based on subject interviews, we calculated a nursing 5A’s composite score for each patient (ranging from 0 to 9). We used linear regression with generalized estimating equations to compare the 5A’s composite score (and logistic regression to compare individual A’s) across periods. We compared 29 nurses’ ratings of their self-efficacy and decisional balance (“pros” and “cons”) with regard to cessation counseling before and after guideline implementation. Following implementation, we also interviewed a purposeful sample of nurses to assess their attitudes toward the intervention.
Of 193 smokers who completed the pre-discharge interview, the mean nursing 5A’s composite score was higher after guideline implementation (3.9 vs. 3.1, adjusted difference 1.0, 95 % CI 0.5–1.6). More patients were advised to quit (62 vs. 48 %, adjusted OR = 2.1, 95 % CI = 1.2–3.5) and were assisted in quitting (70 vs. 45 %, adjusted OR = 2.9, 95 % CI = 1.6–5.3) by a nurse during the post-implementation period. Nurses’ attitudes toward cessation counseling improved following guideline implementation (35.3 vs. 32.7 on “pros” subscale, p = 0.01), without significant change on the “cons” subscale.
A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses’ delivery of brief cessation counseling in medical inpatients.
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- Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance
Journal of General Internal Medicine
Volume 28, Issue 11 , pp 1420-1429
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- smoking cessation
- guideline-based intervention
- Industry Sectors
- David A. Katz MD, MSc (1) (2) (3)
- John Holman MA (1)
- Skyler Johnson MS (1)
- Stephen L. Hillis PhD (1) (4) (5)
- Sarah Ono PhD (1)
- Kenda Stewart PhD (1)
- Monica Paez BA (1)
- Steven Fu MD, MSCE (7)
- Kathleen Grant MD (8)
- Lynne Buchanan RN, PhD (10)
- Allan Prochazka MD, MSc (9)
- Catherine Battaglia PhD, RN (9)
- Marita Titler PhD, RN (11)
- Mark W. Vander Weg PhD (1) (2) (6)
- Author Affiliations
- 1. Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA, 52246-2208, USA
- 2. Department of Medicine, University of Iowa, Iowa City, IA, USA
- 3. Department of Epidemiology, University of Iowa, Iowa City, IA, USA
- 4. Department of Biostatistics, University of Iowa, Iowa City, IA, USA
- 5. Department of Radiology, University of Iowa, Iowa City, IA, USA
- 7. Center for Chronic Disease and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, USA
- 8. Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- 10. The College of Nursing, University of Nebraska, Omaha, NE, USA
- 9. Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA
- 11. University of Michigan School of Nursing, Ann Arbor, MI, USA
- 6. Department of Psychology, University of Iowa, Iowa City, IA, USA