ATTITUDES OF EMERGENCY NURSES TOWARD THE DELIVERY OF SMOKING CESSATION COUNSELING

Purpose: The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation guidelines in the emergency department (ED). One strategy to improve the delivery of smoking cessation services in the ED is to involve non-physician staff. As clinicians’ attitudes are important determinants of delivery of preventive care, the aim of this study is to characterize the attitudes of emergency nurses (ENs) toward smoking cessation counseling and to identify factors associated with these attitudes.    

Method:

We administered a written questionnaire to ENs during the pre-intervention phase of a guideline implementation trial in one University ED and one community ED. The questionnaire included an adapted 20-item decisional balance measure that elicits clinicians’ attitudes ("pros" and "cons") toward smoking cessation counseling [Park, 2001]. We also collected background information (e.g., age, gender, prior training, smoking status), perceived effectiveness and role satisfaction in cessation counseling, and perceptions regarding the work environment (respect from other ED team members, adequacy of staffing and time for patient care). We used multivariable linear regression to identify correlates of ENs’ attitudes toward cessation counseling.    

Result: Survey response rate was 82% (95/114). Mean (sd) scores for ENs on the "pros" and "cons" decisional balance subscales were 31(6) and 28(4), respectively (on a scale of 5-50). Overall, ENs demonstrated conflicting views about smoking cessation counseling. For example, 61% of ENs agreed with the statement that advice from a nurse is one of the best ways to help patients stop smoking, whereas 48% agreed with the statement that smoking cessation counseling is a thankless task. Although having an advanced nursing degree (BSN or higher) was associated with a favorable attitude in bivariate analysis, only non-smoking status and perceived effectiveness in cessation counseling were independently associated with higher scores on the "pros" subscale in multivariable analysis (p<0.05). No factors were associated with "cons" subscale scores.    

Conclusion: Like their physician counterparts, ENs show ambivalent attitudes toward smoking cessation counseling. Efforts to engage ENs in the delivery of smoking cessation counseling should focus on building their skills and self-efficacy.