Confidence in Smoking Cessation Counseling Skills Key to Nurses’ Providing Effective, Evidence-Based Counseling

INQRI Study Highlights Need for Smoking Cessation Education and Training for Hospital Nurses

Tobacco use is the number one preventable cause of death and disease in the U.S., causing 440,000 deaths per year. Research has shown that not only can health care providers increase the chances of a smoker quitting, but they are uniquely positioned to do that successfully in a hospital setting. Recognizing the important role nurses play in smoking cessation, the U.S. Department of Health and Human Services published guidelines specific to nurses in 2005, to encourage this activity.

A new study published in the current issue of American Nurse Today, finds that nurses who are less confident in their smoking cessation counseling skills are less likely to engage in specific cessation counseling activities that are supported by research. This includes referring patients to smoking cessation resources (such as the toll-free National Quitline or Web sites like the Tobacco Free Nurses Initiative), advising patients on how to handle relapse and recommending quit strategies (including over-the-counter and prescription drugs or behavioral strategies). Nurses who were more confident about these skills were more likely to provide this kind of counseling regardless of level of education, race, age or gender.

The study involved a survey of 591 registered nurses (R.N.s) in 23 rural hospitals. Far more R.N.s reported that they always assessed and documented whether patients smoked (which are part of standard hospital processes), than engaged in cessation counseling activities that require more detailed knowledge of smoking cessation research such as developing individualized quit plans. Results of this study indicate that implementing strategies to improve nurses’ comfort with evidence from research studies (evidence-based practice) can increase their use of evidence in patient care.

Robin Newhouse, Ph.D., R.N., assistant dean for the Doctor of Nursing Practice Program and associate professor in the Department of Organizations Systems and Adult Health at the University of Maryland School of Nursing, is one of the lead investigators of the study, which was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI). She led an interdisciplinary team that included:

• Laura Morlock, Ph.D. and Kevin D. Fick, Ph.D., professors of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health;
• Cheryl R. Dennison, Ph.D., R.N., associate professor in the Department of Health Systems and Outcomes at Johns Hopkins University School of Nursing;
• Yulan Liang, Ph.D., associate professor in the Department of Family and Community Health and biostatistician for the Office of Research of the University of Maryland School of Nursing; and
• Peter Pronovost, M.D., Ph.D., professor in the departments of Anesthesiology and Critical Care Medicine and Surgery at the Johns Hopkins University School of Medicine, and in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, medical director for the Center for Innovation in Quality Patient Care, and director of the Quality and Safety Research Group.

“In many ways, hospitals are the ideal settings for encouraging people to quit smoking,” said Newhouse. “They are surrounded by health professionals, they cannot smoke while in the hospital and if they were admitted for a condition or disease related to smoking, they may be more likely to want to quit. Since that’s the case, we need to ensure that all hospital nurses are prepared and willing to provide the best possible evidence-based smoking cessation counseling. This study shows that we still have work to do.”

While roughly two-thirds (65.7 percent) of the R.N.s surveyed reported assessing patients’ tobacco use “all the time” and nearly as many (61.9 percent) reported advising tobacco users to quit “all the time,” only one in five (20 percent) said they always advise their patients who smoke to set a quit date and even fewer (16.6 percent) always advise patients that drinking alcohol is strongly associated with relapse. More than half of the nurses surveyed (50.9 percent) said they never refer patients to the Tobacco Free Nurses Initiative Web site resources.

The study’s authors suggest that smoking cessation training be included in nursing education coursework and continuing education and that researchers and guideline developers package smoking cessation interventions so that they are easy to implement. They also suggest that rural hospitals work to find creative ways to educate nurses in cessation counseling, possibly through collaboratives or networks.

The full study is available online at http://www.americannursetoday.com/Article.aspx?id=7902&fid=7870.

INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit http://www.inqri.org/, or follow on Twitter at @INQRIProgram.