Journal article
Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance
Journal of general internal medicine : JGIM, Vol.28(11), pp.1420-1429
2013
DOI: 10.1007/s11606-013-2464-7
PMCID: PMC3797327
PMID: 23649783
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Details
- Title: Subtitle
- Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance
- Creators
- David A KATZ - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesJohn HOLMAN - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesAllan PROCHAZKA - Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, United StatesCatherine BATTAGLIA - Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, United StatesMarita TITLER - University of Michigan School of Nursing, Ann Arbor, MI, United StatesMark W VANDER WEG - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesSkyler JOHNSON - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesStephen L HILLIS - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesSarah ONO - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesKenda STEWART - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesMonica PAEZ - Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System , Iowa City, IA, United StatesSteven FU - Center for Chronic Disease and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, United StatesKathleen GRANT - Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, United StatesLynne BUCHANAN - The College of Nursing, University of Nebraska, Omaha, NE, United States
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.28(11), pp.1420-1429
- DOI
- 10.1007/s11606-013-2464-7
- PMID
- 23649783
- PMCID
- PMC3797327
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer; Heidelberg
- Language
- English
- Date published
- 2013
- Academic Unit
- Radiology; Epidemiology; Psychological and Brain Sciences; Biostatistics; Injury Prevention Research Center; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984051777102771
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