Theoretical Framework: This project utilized the theoretical framework of Donabedian’s Healthcare Outcome Measurement Model, which proposes three closely related areas: structure, process, and outcome. Structure has an impact on process, and consequently, process affects outcome. All three areas are considered critical in quality of care evaluation.
Methods: A group of 80 registered nurses working in a local emergency department were invited to participate in the study. Of these 52 agreed to participate in the study. An educational module regarding smoking cessation counseling was provided to instruct nurses in the protocol for tobacco screening and referral. This included identification of patients reporting tobacco use; categorization of level of intervention needed for this client; and education regarding specific resources available such as pharmacological agents, quit-line referral, and outside counseling services. A pre- and post-intervention self-reported confidential survey was administered to evaluate learning outcomes.
Results: According to a comparison of survey data, the number of emergency department nurses who screened for tobacco use most of the time after the intervention remained the same. However, the number of nurses who advised, assisted, and referred services for those patients screening positive for tobacco use increased significantly in the pre-intervention survey to the post-intervention survey.
Conclusion: Through use of appropriate training, nurses can augment their ability to implement tobacco screening and smoking cessation education in at-risk patients. Providing emergency department nurses this instruction can help them to overcome barriers such as time and lack of knowledge. As nurses take an increasingly active role not only screening, but also advising, assisting and referring at-risk patients, these efforts may help to reduce morbidity and mortality secondary to tobacco-related diseases.
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