Nurse Survey. We administered a written pre-implementation
and post-implementation survey to staff nurses who provided
direct patient care on the internal medicine units (“float”
nurses and nursing assistants were excluded). The
Figure 2. Schematic of study design.
JGIM Katz et al.: Implementing Inpatient Smoking Cessation Guidelines 1423
questionnaire included a 20-item decisional balance scale,
which includes ten items that reflect positive attitudes (Pros)
and ten items that reflect negative attitudes (Cons) toward the
delivery of smoking cessation assistance.26 The questionnaire
also included two items that asked nurses to rate their selfefficacy
and satisfaction in helping patients to stop smoking on
a 4-point and 5-point Likert-type scale, respectively.27 Based
on the transtheoretical model of change, decisional balance
and self-efficacy are key constructs that predict transitions
across the stages of change.26