Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions

Addiction Science & Clinical Practice

Sarah S Ono¹  John E Holman¹  Laurence J Baker⁵  Andrew S Nugent³  Marita G Titler²  Mark W Vander Weg¹  Meghan T Gillette⁴  Heather S Reisinger¹  Monica W Paez¹  David A Katz¹ 

[1]Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital, Suite 42-151, 601 Highway 6 West, 52246-2208, Iowa City, IA, USA

[2]University of Michigan School of Nursing, Ann Arbor, MI, USA

[3]Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA

[4]Department of Anthropology, Iowa State University, Ames, IA, USA

[5]Department of Emergency Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA

关键词: Content analysis;    Qualitative research;    Attitude of health personnel;    Smoking cessation;    Emergency medical services;   

Others  :  789274
DOI  :  10.1186/1940-0640-9-1

 received in 2013-05-13, accepted in 2014-01-17,  发布年份 2014

【 摘 要 】

Background

The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians’ (EPs) and nurses’ (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A’s framework (Ask-Advise-Assess-Assist-Arrange) in the ED.

Methods

We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts.

Results

The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients’ receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A’s in the ED.

Conclusions

There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies.

Trial registration

ClinicalTrials.gov registration number NCT00756704

【 授权许可】

   
2014 Katz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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