A Randomized Controlled Trial to Evaluate Rx for Change: Nurse's Response to a Smoking Cessation Intervention

Wednesday, 14 July 2010: 9:10 AM

Laura L. Ochoa, PhD, RN, MSN, ANP-BC
Perioperative Services Professional Practice, Barnes Jewish Hospital, St. Louis, MO

Learning Objective 1: Articulate the three diagnoses, AMI, CHF and CAP, for which nurses are required to document current smoking status and interventions provided to support continued abstinence.

Learning Objective 2: Identify nonpharmacologic and pharmacologic therapy utilized to promote abstinence during and following and acute care hospitalization.

Purpose: A randomized controlled parallel group trial.


The study was conducted between April 2009 and June 2009 at a large Midwestern academic medical center. The participants were RNs providing direct patient care on medicine or surgery floors. Participants had to work at least .66 full time equivalent and spend at least 80% of their time in direct patient care.  Participants were randomized to a control or intervention group.  The control group was given the RX for Change pretest and delayed posttest 45 days later.  The intervention group underwent RX for Change educational session. The class consisted of didactic material and role playing exercises.  Pretest and posttest were given the day of class then a delayed posttest 45 days after intervention.  Primary expected Outcome:  Improvement in skill, knowledge and confidence to intervene with currently smoking patients.


169 participants indicated initial interest in the study, 5 elected not to proceed after randomization but prior to any direct contact.  71 were randomized to the control group with 67 completing both the pretest and posttest. 105 were randomized to the intervention group with 56 completing the educational intervention and the 45 day delayed posttest. The control group showed no increase in their skill, confidence and knowledge or in intent to be active in providing smoking cessation counseling.  The intervention group showed increase in skill (p<0.0005), confidence (p<0.0005), knowledge (p<0.0005) and in the intent to be more active in preventing patients from starting smoking and helping patients quit smoking (p=0.03).  Although these results are significant, post hoc analysis indicates that greater significance may have been achieved with additional subjects.


RX for Change is an effective and efficient way to educate direct care RNs about the harm of continued tobacco use and improve participation in promoting abstinence.