Commentary on Report on Nurses' Tobacco Cessation Behaviors

Research Abstract with Commentary

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

Linda Sarna, Stella A Bialous, Marjorie Wells, Jenny Kotlerman, Mary E Wewers and Erika S Froelicher. Journal of Clinical Nursing, 18, 2066–2077.

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 the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This timely article describes one in a series of studies done by Sarna and colleagues related to nurses’ roles in international tobacco control efforts. The assumption behind the sample selection (nurses employed at Magnet hospitals) is that this group of nurses may have better tobacco cessation practices compared to nurses at non-Magnet facilities. Specific findings were of interest to those of us at St. Joseph who have been involved in the tobacco cessation education of nurses here (nurses on all units were to have completed the 3-hour classes offered through Clinical Education).
 73% of nurses ask about tobacco use
 62% advise about the risks
 62% assess motivation to quit
 37% assist with patients’ cessation efforts
 19% arrange cessation strategies
 22% refer to resources
Some unpublished data from a year long hospital study of nurses who have taken the St. Joseph class (Matten, Morrison, Rutledge, Chen, Chung, & Wong, 2009) indicate that our class is enhancing these types of nurse behaviors (see table).

Nurses’ Perceptions of their Skills to Counsel Patients

Action* Pre 3 Months 6 months 12 months
(n = 98) (n = 39) (n = 38) (n = 34)
Ask 3.69 (1.1) 4.33 (0.8) 3.87 (1.0) 4.24 (0.7)
Advise 3.06 (1.2) 3.72 (1.0) 3.87 (1.1) 3.85 (0.9)
Assess 2.65 (1.0) 3.28 (1.0) 3.53 (1.2) 3.56 (0.8)
Assist 2.36 (1.2) 3.49 (.9) 3.35 (1.2) 3.59 (1.0)

*Response set: 1= poor; 5 = excellent