don’t think me tellin’ ‘em what their options are
[will help], especially when they first come in.
Although several nurses expressed doubts about whether
they could overcome patients’ resistance to quitting, they
confirmed that the intervention provided them with tools to
help those who were interested in smoking cessation.
Specifically, nurses reported that the modified admission
database, patient education brochures, and quick orders for
smoking cessation pharmacotherapy provided them with an
efficient mechanism for implementing the 5A’s. As one
nurse explained, “I always give ‘em the brochures. I just
think it’s something they can take home and at least look at
if they need to.”
On the other hand, some nurses acknowledged difficulty
in delivering the 5A’s on account of rapid patient turnover
and competing demands on their time. For example, one
nurse explained:
Um, someone could say they wanted to quit smoking
within the next month, and you know they’d be gone
the next day, or we get uh, busy, and you know it
wasn’t done. The referral wasn’t put in or it just
slipped through the cracks…
Nurses also reported difficulty in completing the Quitline
referral despite efforts of the study team to simplify the
referral process. One nurse recalled:
I wasn’t able to do [a Quitline referral] very often. The
biggest part of that is that it was actually a patient who
wanted to stop smoking, so, we actually wrote out the
note, and the Quitline stuff, filled it out, and for a while
they were filling it out wrong, I guess. We got a note
from our boss showing us the right website to use and
blah, blah, blah, and I would have to write a separate
note in order to fill it out correctly.
In spite of these barriers, interview data confirmed the
observed increases in performance of the 5A’s during the postimplementation
period, as demonstrated by the quantitative
data. We also observed statistically significant increases in