Department of Medicine, University of Iowa, Iowa City, USA.
Acad Emerg Med. 2012 Apr;19(4):409-20. doi: 10.1111/j.1553-2712.2012.01331.x.
The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurse-initiated intervention on delivery of smoking cessation counseling based on the 5As framework (ask-advise-assess-assist-arrange) and 2) assess ED nurses' and physicians' perceptions of smoking cessation counseling.
The authors conducted a pre-post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses' and physicians' self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable logistic regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates.
Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), and assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5) and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians (EPs). ED nurses' self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in "pros" and "cons" attitudes toward smoking cessation in either ED nurses or physicians.
Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.
对急症护理的重视、时间压力和资源缺乏阻碍了急诊科（ED）提供戒烟干预措施。本研究的目的是：1）确定基于 5A 框架（询问-建议-评估-帮助-安排）的急诊护士发起的干预措施对戒烟咨询的提供效果；2）评估 ED 护士和医生对戒烟咨询的看法。
作者在 789 名成年吸烟者（每天 5 支或更多香烟）中进行了一项前后试验，这些吸烟者在两家 ED 就诊。干预措施侧重于提高 ED 护士和医生对 5A 的实施，包括面对面培训和在线教程、使用图表/提醒工具、将有意愿的吸烟者通过传真转介到州烟草戒烟热线进行主动电话咨询，以及向 ED 工作人员提供小组反馈。为了评估 ED 戒烟咨询的效果，在 ED 就诊后不久对受试者进行了电话采访。通过问卷调查评估护士和医生的自我效能感、角色满意度和对戒烟咨询的态度。多变量逻辑回归用于评估干预措施对 5A 实施的效果，同时调整了关键协变量。
在完成 ED 后访谈的 650 名吸烟者中，接受 ED 护士询问吸烟情况的比例更高（68% vs. 53%，调整后的优势比[OR] = 2.0，95%置信区间[CI] = 1.3 至 2.9），评估戒烟意愿的比例更高（31% vs. 9%，调整后的 OR= 4.9，95% CI = 2.9 至 7.9），帮助戒烟的比例更高（23% vs. 6%，调整后的 OR = 5.1，95% CI = 2.7 至 9.5），并安排了随访戒烟咨询（7% vs. 1%，调整后的 OR = 7.1，95% CI = 2.3 至 21），与基线期相比，在干预期间。急诊医师（EP）也观察到类似的增加。ED 护士在戒烟咨询中的自我效能感和角色满意度在干预后显著提高；然而，ED 护士和医生对戒烟的“赞成”和“反对”态度没有变化。
ED 护士和医生可以有效地为吸烟者提供高效的戒烟咨询。这项试验还为专家建议提供了经验证据，即呼吁护理人员在 ED 中发挥更大作用来提供公共卫生干预措施。
