title: Smoking-cessation counseling in the home. Attitudes, beliefs, and behaviors of home healthcare nurses.
abstract: BACKGROUND
  Despite advances in smoking treatment, cessation rates remain stagnant, possibly a function of the lack of new channels to reach heavily addicted smokers. This cross-sectional study examined home care nurses' attitudes, beliefs, and counseling behaviors regarding counseling their home care patients who smoke.
  
  
  METHODS
  Home healthcare nurses (N=98) from the Visiting Nurse Association of Rhode Island were randomly selected to participate in a study helping home-bound medically ill smokers to quit. At baseline, nurses completed a questionnaire that assessed a constellation of cognitive factors (self-efficacy, outcome expectations, perceived effectiveness, risk perception, motivation, and perceived patient adherence) as correlates of self-reported nurse counseling behaviors.
  
  
  RESULTS
  Nurses with higher outcome expectations spent more time counseling their patients about quitting (p<0.04). Nurses' self-efficacy was the only variable associated with consistent counseling (p<0.05). While the majority of nurses "asked and advised" their patients, a minority of nurses "assisted or arranged" follow-up. Perceived importance of counseling was associated with a greater likelihood of asking, advising and assisting (p<0.05). None of the nurses who currently smoked (n=13) provided follow-up to their patients. Nurses who reported higher levels of both risk perception (regarding the harmful effects of smoking) and perceived effectiveness were more likely to recommend the nicotine patch.
  
  
  CONCLUSIONS
  Attitudes and beliefs about smoking are significantly associated with nurse counseling behaviors. Helping nurses to overcome their barriers to smoking counseling may open up new channels for smoking intervention.
authors.affiliation: Centers for Behavioral and Preventive Medicine, Brown Medical School, Providence, Rhode Island 02903, USA. Belinda_Borrelli@Brown.edu
authors.forename: B
authors.initials: B
authors.lastname: Borrelli
authors.forename: J P
authors.initials: JP
authors.lastname: Hecht
authors.forename: G D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: K M
authors.initials: KM
authors.lastname: Emmons
authors.forename: L R
authors.initials: LR
authors.lastname: Tatewosian
authors.forename: D B
authors.initials: DB
authors.lastname: Abrams
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003152:Community Health Nursing / Q000458:organization & administration*; D003376:Counseling; D005260:Female; D018574:Home Care Agencies; D006801:Humans; D016015:Logistic Models; D008297:Male; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires