title: Implementing smoking cessation guidelines for hospitalized veterans: effects on nurse attitudes and performance.
abstract: BACKGROUND
  A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses' delivery of the 5A's (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses' attitudes toward the intervention.
  
  
  METHODS
  We conducted a pre-post guideline implementation trial involving 205 hospitalized smokers on the inpatient medicine units at one US Department of Veterans Affairs (VA) medical center. The intervention included: 1) academic detailing of nurses on delivery of brief cessation counseling, 2) modification of the admission form to facilitate 5A's documentation, and 3) referral of motivated inpatients to receive proactive telephone counseling. Based on subject interviews, we calculated a nursing 5A's composite score for each patient (ranging from 0 to 9). We used linear regression with generalized estimating equations to compare the 5A's composite score (and logistic regression to compare individual A's) across periods. We compared 29 nurses' ratings of their self-efficacy and decisional balance ("pros" and "cons") with regard to cessation counseling before and after guideline implementation. Following implementation, we also interviewed a purposeful sample of nurses to assess their attitudes toward the intervention.
  
  
  RESULTS
  Of 193 smokers who completed the pre-discharge interview, the mean nursing 5A's composite score was higher after guideline implementation (3.9 vs. 3.1, adjusted difference 1.0, 95 % CI 0.5-1.6). More patients were advised to quit (62 vs. 48 %, adjusted OR = 2.1, 95 % CI = 1.2-3.5) and were assisted in quitting (70 vs. 45 %, adjusted OR = 2.9, 95 % CI = 1.6-5.3) by a nurse during the post-implementation period. Nurses' attitudes toward cessation counseling improved following guideline implementation (35.3 vs. 32.7 on "pros" subscale, p = 0.01), without significant change on the "cons" subscale.
  
  
  CONCLUSIONS
  A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses' delivery of brief cessation counseling in medical inpatients.
authors: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA, 52246-2208, USA, david-katz@uiowa.edu.
authors: David A
authors: DA
authors: Katz
authors: John
authors: J
authors: Holman
authors: Skyler
authors: S
authors: Johnson
authors: Stephen L
authors: SL
authors: Hillis
authors: Sarah
authors: S
authors: Ono
authors: Kenda
authors: K
authors: Stewart
authors: Monica
authors: M
authors: Paez
authors: Steven
authors: S
authors: Fu
authors: Kathleen
authors: K
authors: Grant
authors: Lynne
authors: L
authors: Buchanan
authors: Allan
authors: A
authors: Prochazka
authors: Catherine
authors: C
authors: Battaglia
authors: Marita
authors: M
authors: Titler
authors: Mark W
authors: MW
authors: Vander Weg
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003625:Data Collection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic / Q000592:standards; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D012907:Smoking / Q000523:psychology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D014728:Veterans / Q000523:psychology*
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