title: "Let Me Get You a Nicotine Patch": Nurses' Perceptions of Implementing Smoking Cessation Guidelines for Hospitalized Veterans.
abstract: Many hospitalized smokers do not receive guideline-recommended tobacco treatment, but little is known about the perceptions of inpatient nurses with regard to tobacco treatment. We used a sequential explanatory mixed methods design to help explain the findings of an academic detailing intervention trial on the inpatient medicine units of four Veterans Affairs (VA) hospitals. We surveyed 164 nurses and conducted semistructured interviews in a purposeful sample of 33 nurses with different attitudes toward cessation counseling. Content analysis was used to inductively characterize the issues raised by participants. Emerging themes were categorized using the knowledge-attitudes-behavior framework of guideline adherence. Knowledge-related and attitudinal barriers included perceived lack of skills in cessation counseling and skepticism about the effectiveness of cessation guidelines in hospitalized veterans. Nurses also reported multiple behavioral and organizational barriers to guideline adherence: resistance from patients, insufficient time and resources, the presence of smoking areas on VA premises, and lack of coordination with primary care. VA hospitals should train inpatient staff how to negotiate behavior change, integrate cessation counseling into nurses' workflow, develop alternative referral mechanisms for post-discharge cessation counseling, and adopt hospital policies to promote inpatient abstinence.
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: David A
authors.initials: DA
authors.lastname: Katz
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Kenda
authors.initials: K
authors.lastname: Stewart
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Monica
authors.initials: M
authors.lastname: Paez
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: John
authors.initials: J
authors.lastname: Holman
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Adams
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Vander Weg
authors.affiliation: Department of Medicine, VA Eastern Colorado Health Care System and the Denver Seattle Center for Veteran-Centric Value-Based Research (DiSCoVVR), Denver, CO.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Battaglia
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
authors.affiliation: School of Nursing, University of Michigan, Ann Arbor, MI.
authors.forename: Marita G
authors.initials: MG
authors.lastname: Titler
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ono
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D024802:Nurse's Role; D009741:Nursing Staff, Hospital; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires; D061485:Tobacco Use Cessation Devices; D014728:Veterans / Q000523:psychology