Department of Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
J Cardiovasc Nurs. 2013 Jan-Feb;28(1):35-47. doi: 10.1097/JCN.0b013e318231f424.
Smoking cessation treatment practices described by the 5 A's (ask, advise, assess, assist, arrange) are not well applied at cardiology wards because of various reasons, such as a lack of time and appropriate skills of the nursing staff. Therefore, a simplified guideline proposing an ask-advise-refer (AAR) strategy was introduced in Dutch cardiac wards. This study aimed to identify factors that determine the intentions of cardiac ward heads in adopting the simplified AAR guideline, as ward heads are key decision makers in the adoption of new guidelines. Ward heads' perceptions of current smoking cessation practices at the cardiac ward were also investigated.
A cross-sectional survey with written questionnaires was conducted among heads of cardiology wards throughout the Netherlands, of whom 117 (64%) responded.
According to the heads of cardiac wards, smoking cessation practices by cardiologists and nurses were mostly limited to brief practices that are easy to conduct. Only a minority offered intensive counseling or arranged follow-up contact. Heads with strong intentions of adopting the AAR guideline differed significantly on motivational and organizational attributes and perceived more smoking cessation assistance by other health professionals than did heads with weak intentions of adopting. Positive attitudes, social support toward adoption, and perception of much assistance at the ward were significantly associated with increased intentions to adopt the AAR guideline.
Brief smoking cessation practices are adequately performed at cardiac wards, but the most effective practices, offering assistance and arranging for follow-up, are less than optimal. The AAR guideline offers a more feasible approach for busy cardiology wards. To ensure successful adoption of this guideline, the heads of cardiac wards should be convinced of its advantages and be encouraged by a supportive work environment. Policies may also facilitate the adoption of the AAR guideline.
由于各种原因，例如缺乏时间和护理人员的适当技能，5A（询问、建议、评估、协助、安排）戒烟治疗实践在心脏病病房中并未得到很好的应用。因此，荷兰心脏病病房引入了简化的指南，提出了询问-建议-转介（AAR）策略。本研究旨在确定决定心脏病病房主任采用简化 AAR 指南的意图的因素，因为病房主任是采用新指南的关键决策者。还调查了病房主任对心脏病病房当前戒烟实践的看法。
对荷兰各地心脏病病房的主任进行了横断面调查，采用书面问卷进行调查，其中 117 人（64%）做出了回应。
根据心脏病病房主任的说法，心脏病专家和护士的戒烟实践大多限于易于进行的简短实践。只有少数人提供强化咨询或安排后续联系。与采用 AAR 指南的意图较弱的主任相比，采用 AAR 指南的意图较强的主任在动机和组织属性上存在显著差异，并且认为其他卫生专业人员提供了更多的戒烟援助。积极的态度、对采用的社会支持以及对病房内提供的大量援助的看法与采用 AAR 指南的意图增加显著相关。
心脏病病房已充分开展简短的戒烟实践，但最有效的实践，即提供援助和安排随访，并不理想。AAR 指南为忙碌的心脏病病房提供了一种更可行的方法。为了确保成功采用该指南，应使心脏病病房主任相信该指南的优势，并鼓励其在支持性的工作环境中采用。政策也可以促进 AAR 指南的采用。
