Frequency of nurses’ smoking cessation interventions: report from a national survey

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web‐based resources about tobacco control. Design. Cross‐sectional survey of nurses (n = 3482) working in 35 Magnet‐designated hospitals in the USA (21% response rate). Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web. Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1·55, 95% CI 1·27, 1·90) and recommending medications (OR = 1·81, 95% CI 1·45, 2·24). Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence‐based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.     

Factors Influencing Nurses' Smoking Cessation Assessment and Counseling Practices

Nurses are in a strategic position to influence their patients to stop smoking, but factors affecting their likelihood of assessing and counseling are unknown. The purpose of this cross-sectional survey study was to identify predictors of tobacco use assessment and smoking cessation intervention by office-based nurses employed in private physician practices in Kansas. A 43-item questionnaire was mailed to all family practice, internal medicine, and pediatric private practice offices located throughout the state of Kansas with a final sample of 415 completed surveys. Logistic regression was performed to identify predictors of three dependent variables: (1) tobacco use assessment, (2) patient interest in smoking cessation, and (3) delivering smoking cessation counseling. Nurses were more likely to assess patient tobacco use, assess patient interest in tobacco cessation, and provide tobacco cessation counseling if they believed they had the skills, and had attended tobacco-related continuing education in the previous year. Advanced practice nursing and more years of experience were predictors of assessment activities, but not cessation counseling. Nurses with a bachelor (BSN) degree or higher did provide smoking cessation advice more consistently than non-BSN prepared nurses. Nurses must believe they are sufficiently skilled to overcome perceived barriers to assess tobacco use. Continuing education, skills development and improved understanding of tobacco cessation facts may increase self-efficacy.     

Nurses'' Tobacco-Related Knowledge, Attitudes, and Practice in Four Major Cities in China

PURPOSE: To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses. Design: A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003. METHODS: 2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity. FINDINGS: 2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions. CONCLUSIONS: Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives.     

Relationship between nurses'' pain knowledge and pain management outcomes for their postoperative cardiac patients

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.     

Adolescent smoking cessation: development of a school nurse intervention.

The purpose of this study was to examine the feasibility of a range of strategies to engage and to enhance secondary school nurse involvement in teenage smoking prevention and cessation. School nurses were willing to assist students to quit smoking, but they felt unprepared. Information provided by nurses involved in a three-stage review, pilot-testing, and trial design resulted in the development of a resource for nurses. This resource comprised individual student approaches (brief intervention based on motivational interviewing and written activities designed to help students examine their smoking behavior), approaches to assist parents (letter of support for parents of students who smoke), and school newsletter items. Each component of the resource was found by school nurses to be appropriate, useful, and complementary to their other school- wide approaches to assist adolescents to quit smoking. Nurses also reported an interest to expand or to enhance their smoking cessation role in the school.     

Impact of a novel interprofessional dental and pharmacy student tobacco cessation education programme on dental patient outcomes

The dental setting presents a unique opportunity to assist patients with tobacco cessation. Many dental providers do not feel prepared to provide tobacco cessation, particularly with regard to education on pharmacological treatments. An interprofessional practice experience with dental and pharmacy students provides a novel approach to tobacco cessation in the dental setting, but it is not known whether such methods affect patient outcomes. The goal of the study was to examine the impact of a novel dental and pharmacy student tobacco cessation education programme on patient knowledge gained, barriers to utilising cessation medications, quit intentions, and quit behaviours as compared to standard care. Dental patients who were seen at the dental admissions clinic of a dental school on interprofessional care (IPC) days and received tobacco cessation education from the dental-pharmacy student team (N = 25) were compared with dental patients at the clinic seen on Standard Care (SC) days (N = 25). Patients completed a post-appointment survey and a 4-week follow-up survey. IPC patients reported greater perceived knowledge post-appointment and at follow-up regarding tobacco cessation compared with SC patients and had greater intentions to utilise medication to assist with tobacco cessation. At follow-up there were no differences between groups in terms of quit attempts. Among patients who made a quit attempt those in the IPC group were more likely to have set a quit date and contacted a provider for assistance regarding tobacco cessation. Dental-pharmacy student interprofessional tobacco cessation may be an innovative way to provide tobacco cessation education to dental patients and provide students with interprofessional practice experiences.     

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. OBJECTIVES: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. METHODS: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. RESULTS: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. CONCLUSIONS: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.     

Barriers to tobacco cessation in clinical practice: report from a National Survey of Oncology Nurses

This study describes the survey results of a national random sample of members of the Oncology Nursing Society who reported the greatest number of barriers to delivering a tobacco cessation intervention with their patients. Nurses who perceived the greatest number of barriers were more likely to be current smokers and to be young and were less likely to have an advanced degree, to be a nurse practitioner, or to have administrative responsibilities. Those with greater barriers were less likely to deliver tobacco cessation interventions.     

Smoking cessation counseling for parents during child hospitalization: a national survey of pediatric nurses

ABSTRACT Objective: Given the central role played by pediatric nurses in intake assessment, discharge planning, and education for families of hospitalized pediatric patients, a child's hospitalization may provide a unique opportunity for counseling parents about smoking. We sought to determine if hospital policies can support nurses in effectively counseling parents about smoking. Design and Sample: We conducted a national survey of pediatric staff nurses and administrators/educators who were members of the Society of Pediatric Nurses in 2008 (n=888) to explore counseling practices for tobacco control. Measures: Questionnaires included data on demographics, personal and work environment characteristics, hospital policy characteristics, work attitudes and barriers and the main outcome—5As for smoking cessation counseling—Ask, Advise, Assess, Assist, and Arrange. Results: Overall, routine screening for household smokers was most common (43%), followed by advice to quit (25%), assessing willingness to quit (19%), assisting with a quit plan (6%), and arranging follow‐up contact (3%). Nurses working in hospitals with admission assessments specifically asking about household members who smoke were 7 times more likely than those without such assessments to routinely ask about smoking (OR: 7.2, 95% CI: 4.9–10.5). Conclusion: Future research should test the efficacy of developing comprehensive hospital‐wide policies to deliver smoking cessation for parents during a child's hospitalization.     

社区护士控烟服务情况分析

目的：了解社区医院护士控烟知识知晓率及服务态度情况，为实施控烟行动提供依据。方法：分层整群随机抽取六省一市各级社区医院护士,对护士戒烟服务的知识、态度以及提供的服务情况进行调查。结果：共调查1531名护士，其中男性38人（2.03%），女性1493人（93.93%）；年龄在19至96岁，平均年龄34.09±9.85岁；参加过控烟相关培训1070人（69.89%），未参加过相关培训461人（30.11%）。其中愿意参加培训组在主动劝诫、干预和提供戒烟工作明显高于不愿意参加培训组（P<0.01）。其中影响护士提供戒烟服务态度的主要因素为劝诫效果不明显、门诊时间有限、专业技能不够（P<0.01）；影响护士提供戒烟服务信心的主要因素为没有足够的专业知识、专业技能以及不会使用Fagerstorm量表对吸烟者进行尼古丁依赖程度评估（P<0.01）。结论：本调查表明专业的培训较少，护士对于专业戒烟指导知识和技能掌握不够，以致影响提供戒烟服务的态度和信心。     

Participation of Icelandic nurses in smoking cessation counselling

Aims and objectives. The purpose of this study was to investigate the participation and knowledge of Icelandic nurses in smoking cessation counselling and to find barriers to smoking interventions by nurses. Background. Research has shown that clinical intervention as brief as three minutes can substantially increase smoking cessation success. Several studies have revealed that majority of nurses agree that smoking cessation counselling is within their duties. However, the percentage of nurses who report advising and/or counselling patients remains low. Design and methods. An anonymous mail survey of all practicing nurses in Iceland was conducted in September 2004. A self‐administered questionnaire was used, consisting of 74 questions in six sections: asking about smoking behaviour, to advise, to assess/assist/arrange, children and passive smoking, other questions and demographic questions. Results. Of 2453 questionnaires, 868 complete questionnaires were returned, giving a 36% response rate. While the majority of nurses ‘asked’ about smoking behaviour, a minority ‘advised’ or ‘assisted’ their clients with smoking cessation. However, if the clients had no smoking‐related symptoms, less than half of the nurses asked about smoking behaviour. Failure to ask and advise clients about the importance of smoking cessation and assisting with smoking cessation correlated (p < 0·001) with several factors, including: lack of time, insufficient knowledge or training and not considered as a part of daily duty. Nurses who smoked were less likely to advise against smoking (p < 0·05). Conclusions. Nurses frequently neglect to counsel clients about smoking cessation. Common barriers to the delivery of smoking cessation interventions by nurses include insufficient education and training in smoking cessation therapy. Relevance to clinical practice. The number of patients with tobacco‐related illnesses is increasing worldwide. Effective smoking cessation interventions by nurses have the enormous potential of reducing smoking prevalence and improve health.     

Communication barriers perceived by older patients and nurses

This study investigated the communication barriers perceived by older hospitalized patients and nurses in Korea, with the aim of identifying disparities between the two parties. The authors developed a 50-item communication-barrier questionnaire that includes patient, nurse, and environmental factors. One hundred older hospitalized patients and 136 nurses were asked to rate the importance of each communication-barrier item. Nurses and patients were found to perceive the importance of barriers differently: nurses reported higher scores on patient-related communication barriers, whereas patients reported higher scores on the nurse-related barriers. There were significant differences between patients and nurses in 57%, 62%, and 71% of the nurse-, patient-, and environment-related communication barriers, respectively. Based on these findings, it is necessary for nurses to understand older patients' perceptions about communication barriers and acquire better communication skills and attitudes.     

In-hospital smoking cessation programs: what do VA patients and staff want and need?

In preparation for delivering an inpatient smoking cessation intervention, surveys and interviews of general inpatients and staff were conducted in two Veterans Affairs (VA) hospitals to determine the motivation of veterans to quit smoking and to identify facilitators and barriers to inpatient staff delivery of inpatient cessation services. Seventy percent of inpatients were “motivated smokers” (thinking of quitting in the next 30 days), yet only 17% stated that they received cessation services during their hospitalization. Most staff said that VA should do more to assist patients to quit, yet less than half said that they personally provided cessation services due to lack of confidence/training and hesitancy to upset patients. Given the high motivation to quit among hospitalized veterans and the lack of knowledge about providing cessation services among nurses, training health professionals may facilitate and overcome barriers to the provision of these services. As frontline providers, nurses are ideally positioned to deliver inpatient smoking cessation services to hospitalized veterans.     

北京市临床护士实施5A’S戒烟干预的现状调查

目的了解护士在临床工作中实施5A’S戒烟干预的现状,为促进其实施戒烟干预行为提供依据。方法采用方便取样,在北京市城区6家三级医院对230名护士进行问卷调查。问卷主要内容包括：护士实施5A’s戒烟干预的频度及影响因素,护士对自身戒烟干预能力的评价,护士在校期间学习烟草相关知识的情况。结果护士实施5A’s戒烟干预方案中的“建议”和“评估患者的吸烟史及现状”比较频繁,实施其余干预内容的现状均不理想（如评估对尼古丁的依赖程度、提供尼古丁替代疗法的帮助、协助制定戒烟计划等）。“戒烟能改善患者的健康”的信念能促进护士实施戒烟干预,“患者没有戒烟的动机”、“繁重的工作量”、不认为“帮助患者戒烟是护理工作中优先考虑的”,会阻碍护士实施戒烟干预。临床护士对自身进行吸烟危害的健康教育、沟通能力等评价较为理想,但对给予尼古丁替代疗法（NRT）建议和使用一氧化碳检测仪等方面的能力认同较差。护士在校期间学习过的相关内容主要是烟草的危害,且学时有限（1～2h）,很少涉及戒烟技巧、药物疗法等内容,毕业工作后参加过戒烟培训的护士比例也极低（12．8％）。结论临床护士对5A’s戒烟干预的实施、所接受的戒烟相关教育以及实际戒烟干预能力和临床戒烟干预需要之间存在差距。     

Smoking practices among nursing students: a comparison of two studies

Findings of numerous studies that have explored the smoking practices of nurses reveal a high incidence of smoking that is incongruent with the health beliefs of the profession. Nurses who smoke are less likely to teach or positively influence patients who smoke. They may even undermine health teaching efforts of other health professionals. Studies of smoking practices of nursing students also reveal high incidences of smoking. Included among the determinants of this practice are lack of knowledge of the health effects of smoking, the academic setting, and the role that nursing education may play. In this comparison of two independent studies similar in design, smoking rates were similar to that of the female population and to registered nurses. Students who smoke either started smoking or increased their smoking in nursing school. They knew the health hazards of smoking and most had tried to quit in the past. Challenging opportunities exist for nurse educators to study and implement strategies to prevent smoking initiation and encourage cessation among future nurses.     

A national needs assessment of nurses providing health care to adolescents.

Nurses, as the largest group of health providers in the United States, and by virtue of their scope of practice, are in an important position to promote the health of adolescents. A national survey of nurse members of the American Public Health Association, the National Association of Pediatric Nurse Associates and Practitioners, and the National Association of School Nurses was conducted in 1997 (n = 520) and was compared with findings from a parallel survey conducted in 1985 that assessed perceived competence in addressing common adolescent health issues, relevance of those issues to nurses' practice, and leadership skills. Findings provided a hopeful yet cautious picture of nurses' competencies. Strong increases in the proportion of nurses who felt equipped to address common health problems of youth suggest improved adolescent health education among nurses. Yet, at least 25% of nurses indicated a low level of knowledge in half of the adolescent health areas, and, like 1985's nurses, most nurses in 1997 did not feel competent to address the needs of gay, lesbian, and bisexual youth. Several priority areas in Healthy People 2010 were considered by 25% or more of the nurses to be irrelevant to their practice, including smoking cessation, suicide, violence, and pregnancy. The task remains to assure that all nurses who work with adolescents are equipped to respond to their diverse and unique health needs.     

Characteristics of Nurses Who Used the Internet-Based Nurses QuitNet® for Smoking Cessation

ABSTRACT Background: Smoking among nurses is higher than other health care professionals but nurse-specific cessation programs are limited. Nurses QuitNet^®, launched in January 2004, provided an evidence-based online smoking cessation program for nurses and nursing students.
Objectives: To describe Nurses QuitNet^® registrants and relationships among the demographic and smoking characteristics, program dissemination strategies, and site utilization patterns.
Design: Cross-sectional study.
Sample: 1,790 Nurses QuitNets^® registrants.
Measurements: Demographics and smoking characteristics on the Nurses QuitNet^® intake questionnaire.
Results: Most registrants were female (92.5%), 45–54 years old (34.3%), Caucasian (84.5%), and college graduates (57.5%). Over 68% smoked 10–20 cigarettes/day; 66.4% smoked within 30 min of waking. Half of those with previous quit attempts did not use evidence-based methods; 30% had not made a quit attempt in the past year. "Read-only" social support was the most frequently used Nurses Quitnet^® feature.
Conclusions: The Internet can be a viable option to support nurses' cessation and is available to accommodate their work schedules. The sample is similar to the general nursing population, except for higher levels of education. Efforts are needed to assist nurses struggling with nicotine addiction and disseminate cessation resources, particularly targeting nurses with the highest prevalence of current smoking, for example licensed practical nurses.     

A systems change intervention for nurse-led smoking cessation care in hospitals

AimThe aim of this study was to determine the feasibility and acceptability of a systems change intervention on nurses’ inpatient management of tobacco dependence.MethodsA mixed methods study involving an uncontrolled pre and post study design and qualitative methods. The systems change intervention consisted of: tobacco use questions within the routine nursing care admission assessment forms; provision of nicotine replacement therapy (NRT) as a ‘nurse-initiated’ medication; and nurse education. A medical record audit was conducted 4 months before and 1 month after implementation to assess recording of: smoking status, offer of NRT and referral to a telephone tobacco cessation counselling service ‘Quitline’. Focus groups and semi-structured interviews were conducted to ascertain acceptability of the systems change intervention. Chi square analysis compared identification of inpatients’ who smoke and offer of NRT pre and post implementation. Constant comparative analysis was used to analyse qualitative data.FindingsNurse recording of inpatient smoking status (83% to 90%) did not significantly improve. However offer of nurse-initiated NRT significantly increased from 0% to 34% (p = 0.02). Acceptance of NRT increased from 50% to 64% (p = 0.055) and offer of referral to Quitline increased (0% to 4%) but increases were not significantly different. Three themes emerged from the qualitative data: Education for the nurses, nurse leadership and therapeutic alliance.ConclusionThe study results show promise as our intervention increased nurses’ offer of NRT for inpatients’ who smoked. New approaches need to be developed to support patients who do not want to or are not ready to quit.     

Nurses' smoking behaviour related to cessation practice

AIM: To examine the smoking behaviour, knowledge and attitudes of nurses, their willingness to provide smoking cessation support to patients, the accessibility of training in this area and their willingness to undertake future training in this area. METHOD: A randomised sample of qualified nurses (n = 1,074) in statutory, private and voluntary sectors and across a variety of specialties were surveyed by postal questionnaire. Four focus groups were conducted in various settings before and after the survey. RESULTS: Of those who took part in the survey, 55% had never smoked, 19% were ex-smokers and 26% were smokers. Most agreed that nurses have a responsibility to help those who want to quit smoking. However, nurses who smoked rated their ability to help patients and their effectiveness as a role model lower than nurses who were ex-smokers or non-smokers. CONCLUSION: Smoking prevalence among nurses is no greater than in the general female population. Nurses who smoke are less motivated to provide cessation support for patients, have less positive attitudes to the value of smoking cessation, are less likely to have received smoking cessation training and are less likely to want further training. These results have implications for nurses' own smoking status, as well as their attitudes to cessation training, health promotion practice and future research.