Katz David A, Paez Monica W, Reisinger Heather S, Gillette Meghan T, Weg Mark W Vander, Titler Marita G, Nugent Andrew S, Baker Laurence J, Holman John E, Ono Sarah S
Department of Medicine, University of Iowa, Iowa City, IA, USA.
Addict Sci Clin Pract. 2014 Jan 24;9(1):1. doi: 10.1186/1940-0640-9-1.
The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians' (EPs) and nurses' (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A's framework (Ask-Advise-Assess-Assist-Arrange) in the ED.
We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts.
The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients' receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A's in the ED.
There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies.
ClinicalTrials.gov registration number NCT00756704.
美国公共卫生服务戒烟实践指南特别建议医生和护士强烈建议其吸烟患者戒烟，但在急诊科实现这一目标的最佳方法仍不明确。本研究的目的是描述急诊医生（EP）和护士（EN）对戒烟咨询的看法，并确定在急诊科实施5A框架（询问-建议-评估-协助-安排）的障碍和促进因素。
在两个研究急诊科进行戒烟指南实施前后试验后，我们对11名急诊医生和19名护士进行了半结构化面对面访谈。我们基于他们对书面调查（决策平衡问卷）的回答，采用目的抽样法针对对戒烟咨询态度不同的急诊医生和护士。采用常规内容分析法归纳描述研究参与者提出的问题，并构建编码结构，然后将其应用于研究记录。
本研究的主要发现集中在三个总体领域：1）对干预措施的反应；2）对患者接受戒烟咨询的接受程度的看法；3）对急诊科戒烟咨询和预防保健的看法。急诊科工作人员对实施戒烟指南持矛盾态度。急诊护士和急诊医生都认为提供戒烟咨询很重要，但由于时间限制、急性护理的相互竞争需求以及患者的抵触，在急诊科并不总是可行的。参与者还提请注意在急诊科实施5A框架时需要提高角色清晰度和团队合作。
在急诊科实施戒烟指南存在诸多挑战。急诊护士通常愿意率先提供简短的戒烟咨询，但他们的努力需要得到急诊医生的加强。急诊系统需要解决工作流程、团队合作和实践政策等问题，这些问题有助于开具戒烟药物处方、转介戒烟咨询以及初级保健中的随访。这项定性评估的结果可用于指导未来急诊科干预研究的设计。
ClinicalTrials.gov注册号NCT00756704。
