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American Journal of Critical Care. 2007;16: 284-289
Copyright © 2007 by the American Association of Critical-Care Nurses.
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Evaluation of a Tobacco Cessation Curricular Intervention Among Acute Care Nurse Practitioner Faculty Members

By Janie Heath, PhD, APRN-BC, ACNP, Frances J. Kelley, PhD, APRN-BC, FNP, Jeannette Andrews, PhD, APRN-BC, FNP, Nancy Crowell, MA, Robin L. Corelli, PharmD and Karen Suchanek Hudmon, DrPH, MS, RPh. At the time this study was conducted, Janie Heath was director of the Acute Care Nurse Practitioner and Critical Care Clinical Nurse Specialist Program and an assistant professor in the School of Nursing and Health Studies at Georgetown University; she is now associate dean for Academic Nursing Practice at the Medical College of Georgia, Augusta, Ga. Frances J. Kelley is an associate professor and Nancy Crowell is a research associate with the School of Nursing and Health Studies, George-town University, Washington, DC. Jeannette Andrews is an assistant professor with the Department of Health Environments and Systems Community Nursing, Medical College of Georgia, Augusta, Ga. Robin L. Corelli is a professor in the School of Pharmacy, University of California, San Francisco, Calif. Karen Suchanek Hudmon was an associate professor with the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn; she is now an associate professor with the Department of Pharmacy Practice at Purdue University, West Lafayette, Ind.

Corresponding author: Janie Heath, PhD, APRN-BC, ACNP, Associate Dean, Academic Nursing Practice, Medical College of Georgia, 987 St Sebastian Way (EC-4350), Augusta, GA 30912 (e-mail: jaheath{at}mcg.edu).


   Abstract
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 Abstract
Methods
 Results
 Discussion
 Conclusions
 References
 
Background In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC.

Objective To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs.

Methods Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula.

Results The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (P<.001). Perceived effectiveness in teaching tobacco cessation also increased (P < .001), as did mean scores for the perceived value of using an evidence-based national guideline (P<.001).

Conclusions Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

Although the prevalence of tobacco smoking has been declining during the past 40 years, an estimated 20.9% of all adults in the United States currently smoke.1 In addition to the established health risks that result in 440 000 deaths per year from tobacco use, the estimated economic impact on healthcare costs is $157 billion per year.1–3 A large proportion of these health and economic costs is attributable to the 4.4 million and 1.3 million adults hospitalized annually with heart disease and pneumonia, respectively.4 In response, the Joint Commission on Accreditation of Healthcare Organizations now requires that smoking cessation be addressed in all adults admitted to a hospital who have pneumonia, myocardial infarction, or heart failure.5

Critical care providers, such as acute care nurse practitioners (ACNPs), play an important role in reducing the detrimental effects of tobacco use. Although an estimated 70% of smokers want to quit smoking, only 35% of healthcare providers offer tobacco prevention and tobacco cessation counseling.6 Evidence indicates that healthcare professionals who receive training are more likely than those who do not to intervene with patients who smoke7; however, numerous studies6,8–15 reveal that healthcare professionals are not adequately prepared to perform tobacco cessation interventions.

During the past decade, increased integration of tobacco education curricula in schools of medicine, pharmacy, and dentistry has been reported.16–30 However, no evidence indicates that schools of nursing are integrating tobacco education into their curricula. After a report9 in 2002 about the lack of tobacco-related curricular content in ACNP education, we partnered to implement a state-of-the-science training program at Georgetown University School of Nursing and Health Studies in Washington, DC.

Here we report the findings from the Rx for Change: Clinician-Assisted Tobacco Cessation curricula intervention29,30 used at Georgetown’s first Summer Institute for Tobacco Control Practices in Nursing Education. We examined faculty members’ perceived effectiveness in teaching tobacco education in the ACNP curriculum, perceived value of using an evidence-based tobacco cessation guideline in the ACNP curriculum, and the amount of time devoted to tobacco education in the ACNP curriculum.


Only 35% of healthcare providers offer tobacco prevention and cessation counseling.

 


   Methods
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 Methods
Results
 Discussion
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 References
 
Participants and Program Content
This pilot study was part of a larger study among advanced practice nursing faculty.31 In a previous study with ACNP faculty members,9 respondents were given the opportunity to indicate their interest in participating in the Summer Institute. Those respondents who were interested were recruited to participate in this study. As part of the criteria for participation, faculty members submitted letters of commitment and/or support from their deans, associate deans, or program directors for integrating the Rx for Change curriculum in their schools of nursing.


Although scientific literature was the most valuable tobacco-related reference at baseline, at 12-month follow-up the USPHS Guideline was thought to be most valuable.

 

Study Procedures
A 1-group, pretest-posttest design with a sample of 30 participants attending the Summer Institute was used. Participants completed a baseline survey before attending the 2 days of training. The program, which draws heavily from the evidence-based US Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (USPHS guideline),32 included core and optional Rx for Change modules, an "instructor tool kit" that contained a complete set of turnkey teaching materials, and access to the Rx for Change Web site (http://rxfor-change.ucsf.edu). A total of 16 hours of training was provided. The survey was repeated 12 months after the training.


After the institute, the number of faculty teaching 3 hours or more of tobacco education increased 3-fold.

 

The survey was developed by using items from instruments used in previous research.8,9,31 Content validity for the survey was obtained by 4 faculty members with curricular and/or tobacco research expertise. All study procedures and measures were approved by the Georgetown University Institutional Review Board for the Protection of Human Subjects.

Study Measures
Sociodemographic variables included sex, age, race/ethnicity, employment status (full-time or part-time), final degree (master’s, post-master’s, doctorate, other), academic position or rank (adjunct, instructor, assistant professor, associate professor, professor), and the number of years the respondent had served as an academic teacher.

Perceived effectiveness in teaching tobacco cessation was assessed by using a 12-item scale. The items included self-perceived effectiveness of teaching basic science tobacco topics (cancer risk from smoking, health effects of tobacco-related disease, effects of passive smoking, contents of cigarette smoke, signs and symptoms of withdrawal from nicotine, and teaching high-risk groups or groups who have the most difficulty in quitting or an increased risk to start smoking), clinical core tobacco topics (techniques for using the 5 A’s [ask patients about tobacco use, advise tobacco users to quit, assess readiness to quit, assist patients with quitting, arrange follow-up counseling], behavioral modification, and pharmacological agents for smoking cessation), and teaching tobacco content overall (including both basic science and clinical core topics). Response options for each of the items ranged from 1 (not very effective) to 7 (very effective). Similar to values in a previous study,31 the mean Cronbach {alpha} was .95 for the pretest and posttest scores.

Perceived value of various tobacco-related resources was assessed by using a 6-item scale. Responses ranged from 1 (not very valuable) to 7 (very valuable) about the perceived value of each of the following: Guide to Clinical Preventive Services, the USPHS guideline, volunteer agencies (eg, American Lung Association, American Heart Association, American Cancer Society), private agencies (eg, individual institutions or facilities), review of scientific literature, and Internet resources. The scale was scored as the sum of the 6 constituent items. Similar to the values in another study,31 the mean Cronbach {alpha} for the pretest and posttest scores was .85.

Extent of tobacco education in ACNP curricula was assessed by using survey items similar to those used in other studies.8,9 The total number of curriculum hours allocated for basic science and clinical core topics was assessed from a "total program" perspective. Response options were 0 to 1 hour, 1 to 2 hours, 2 to 3 hours, 3 to 4 hours, 4 to 5 hours, 5 to 6 hours, and more than 6 hours.

Data Analysis
Standard summary statistics were used to characterize the study population. Paired t tests and {chi}2 tests of independence were used, as appropriate, for examining differences between the baseline and follow-up survey responses.


   Results
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 Methods
 Results
Discussion
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 References
 
Study Population
Thirty nursing faculty members from throughout the United States participated in the train-the-trainer program. Of the 30 participants, 29 completed the baseline survey and 27 completed the follow-up survey. Most of the participants were women (93%), with a mean age of 49 years (SD 6.8, range 38–62), and most participants were of non-Hispanic white origin (93%) and worked full-time (73%). A total of 83% reported having a nursing education degree at the master’s or post-master’s level, and 17% had a doctorate. A total of 61% had an academic rank of assistant professor. The mean numbers of years of academic teaching was 11 (SD 8.4, range 1–30).

Perceived Effectiveness in Teaching Tobacco Cessation
For each content area, perceived effectiveness scores were significantly higher (P > .001) at follow-up than at baseline (Table 1Go). In the baseline survey, effectiveness of teaching health effects had the highest scores (mean 4.33, SD 1.41), and behavior modification (mean 2.81, SD 1.52) and effectiveness of current curriculum (mean 2.85, SD 0.97) had the lowest scores. However, in the 12-month survey, the mean scores for each of the tobacco topics were significantly higher than those in the baseline survey, with means in the high 4 or 5 range (mean 12-month scale score 5.37, SD 1.16, t = 6.982, P < .001). The most dramatic change was for overall content (t = 8.350, P < .001); the baseline mean was 3.26 (SD 1.20), and the 12-month mean was 5.44 (SD 1.12).


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  		Table 1 Perceived effectiveness in teaching tobacco topics: mean scores and t test values at baseline and 12 months after training

 
PerceivedValue of Tobacco-Related Resources
At baseline, the scientific literature was perceived as the most valuable tobacco-related resource (mean score 4.07, SD 1.77); the resources perceived as least valuable were private agencies (mean 2.08, SD 1.50) and the USPHS guideline (mean 2.81, SD 1.72). However, at the 12-month assessment, respondents perceived the USPHS guideline as the most valuable (mean 5.35, SD 1.70, t = 6.103, P = .005). Overall, with the exception of Internet resources, scores for the value of each resource improved significantly from baseline to follow-up.

Extent of Tobacco Education in ACNP Curricula
Table 2Go delineates the amount of time devoted to teaching tobacco education in ACNP curricula at baseline and 12 months after training. Overall, the total number of hours increased from baseline to 12 months. Topic areas with the most dramatic increases in allocated time included health effects, the 5 A’s, behavior modification, and pharmacotherapy. Another dramatic increase was noted in the amount of time devoted to tobacco education overall. It increased from 22.2% of participants teaching 3 hours or more at baseline to 74.1% of participants teaching 3 hours or more at 12 months ({chi}2 = 14.54, P < .001). In addition, an estimated 1200 students received either partial or complete training, resulting in a total of 900 hours of education provided by faculty participants.


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  		Table 2 Extent of tobacco education in curricula for acute care nurse practitioners: a comparison of baseline (n = 29) and 12-month (n = 27) surveys

 

Rx for Change, a tobacco cessation summer institute, demonstrated a positive impact and sustainability.

 


   Discussion
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 Abstract
 Methods
 Results
 Discussion
Conclusions
 References
 
As the first to evaluate integration of tobacco education in nursing curricula, we observed a significant improvement in participants’perceived effectiveness in teaching tobacco content, perceived value of the evidence-based USPHS guideline, and amount of time devoted to teaching tobacco education. Despite the small sample size and potential bias from a convenience sample of self-selected participants, the Summer Institute demonstrated a positive impact and sustainability.33,34 However, additional evaluation of the Rx for Change program in nursing education, particularly its impact on clinical outcomes with tobacco cessation, is needed.


   Conclusions
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Despite the known challenges of implementing curricular changes,35–37 we think meeting clinical and academic performance measures/standards5,38,39 can best be accomplished with a standardized evidence-based curriculum, such as the Rx for Change. Obviously, with the rapid advances in acute and critical care practice, curricular priorities must be made. However, because tobacco use is the leading preventable cause of morbidity and mortality, no compromise should exist for tackling the harmful effects of tobacco use.


   ACKNOWLEDGMENTS
 
We thank Bette Keltner, RN, PhD, FAAN, dean of Georgetown University School of Nursing and Health Studies, for her support of the Summer Institute, the American Legacy Foundation and Tau Chapter of Sigma Theta Tau International for partial funding of this study, the Tobacco Free Nurses project (Linda Sarna, DNSc, and Stella Bialous, DrPH), and the Smoking Cessation Leadership Center project (director Steven Schroeder, MD, and deputy director Connie Revell, MA) for partnerships, and Lisa Kroon, PharmD, and Peter Shields, MD, for teaching with Drs Corelli, Heath, and Hudmon during the Summer Institute. Finally, we thank the American Association of Critical-Care Nurses for its support in launching a research program of study for addressing tobacco curricula in education for acute care nurse practitioners.

FINANCIAL DISCLOSURES
None reported.

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   REFERENCES
Top
 Abstract
 Methods
 Results
 Discussion
 Conclusions
 References
 

  1. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2004. MMWR Morb Mortal Wkly Rep. 2005;54:1121–1124.[Medline]
  2. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001. MMWR Morb Mortal Wkly Rep. 2005;54:625–628.[Medline]
  3. US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
  4. DeFrances CJ, Hall MJ. 2002 National Hospital Discharge Survey: Advance Data From Vital and Health Statistics. Hyattsville, Md: National Center for Health Statistics; 2004. No. 342.
  5. Joint Commission on Accreditation of Healthcare Organizations. 2004 Specification Manual for National Hospital Quality Measures: AMI-4, HF-4, PN-4. Available at: http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/default.htm. Accessed February 22, 2007.
  6. Fiore MC, Epps RP, Manley MW. A missed opportunity: teaching medical students to help their patients successfully quit smoking. JAMA. 1994;271:624–626.[Abstract/Free Full Text]
  7. Lancaster T, Silagy C, Fowler G. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2000;(3):CD000214.
  8. Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999;282:825–829.[Abstract/Free Full Text]
  9. Heath J, Andrews J, Thomas SA, Kelley FJ, Friedman E. Tobacco dependence curriculum in acute care nurse practitioner education. Am J Crit Care. 2002;11:27–33.[Abstract/Free Full Text]
  10. Wewers ME, Kidd K, Armbruster D, Sarna L. Tobacco dependence curricula in US baccalaureate and graduate nursing education. Nurs Outlook. March-April 2004;52:95–101.[Medline]
  11. Hornberger CA, Edwards LC. Survey of tobacco cessation curricula in Kansas nursing programs. Nurse Educ. 2004; 29:212–216.[Medline]
  12. Montalto NJ, Ferry LH, Stanhiser T. Tobacco dependence curricula in undergraduate osteopathic medical education [published correction appears in J Am Osteopath Assoc. 2004;104:368]. J Am Osteopath Assoc. 2004;104:317–323.[Abstract/Free Full Text]
  13. Grinstead CL, Dolan TA. Trends in US dental schools’ curriculum content in tobacco use cessation 1989–93. J Dent Educ. 1994;58:663–667.[Medline]
  14. Richmond RL, Debono DS, Larcos D, Kehoe L. Worldwide survey of education on tobacco in medical schools. Tob Control. 1998;7:247–252.[Abstract/Free Full Text]
  15. Hudmon KS, Bardel K, Kroon LA, Fenlon CM, Corelli RL. Tobacco education in US schools of pharmacy. Nicotine Tob Res. 2005;7:225–232.[Abstract/Free Full Text]
  16. Chamberlain RM, Bakemeier RF, Gallagher RE, et al. Cancer prevention education in United States medical schools. Cancer Education Survey II: cancer education in United States medical schools. J Cancer Educ. 1992;7:105–114.[Medline]
  17. Coultas DB, Klecan DA, Whitten RM, et al. Training medical students in smoking-cessation counseling. Acad Med. 1994; 69(10 suppl):S48–S50.[Medline]
  18. Seim HC, Verhoye JR. Comparison of training techniques using a patient-centered approach to smoking cessation. Med Educ. 1995;29:139–143.[Medline]
  19. Kosower E, Ernst A, Taub B, Berman N, Andrews J, Seidel J. Tobacco prevention education in a pediatric residency program. Arch Pediatr Adolesc Med. 1995;149:430–435.[Abstract/Free Full Text]
  20. Chung TW, Lam TH, Cheng YH. Knowledge and attitudes about smoking in medical students before and after a tobacco seminar. Med Educ. 1996;30:290.[Medline]
  21. Boehlecke B, Sperber AD, Kowlowitz V, Becker M, Contreras A, McGaghie WC. Smoking history-taking skills: a simple guide to teach medical students. Med Educ. 1996;30:283–289.[Medline]
  22. Usatine RP, Wilkes M, Slavin S, Wilkerson L. A model smoking-intervention curriculum for medical school. Acad Med. 1996;71(1 suppl):S96–S98.[Medline]
  23. Roche AM, Eccleston P, Sanson-Fisher R. Teaching smoking cessation skills to senior medical students: a block-randomized controlled trial of four different approaches. Prev Med. 1996;25:251–258.[Medline]
  24. Eyler AE, Dicken LL, Fitzgerald JT, Oh MS, Wolf FM, Zweifler AJ. Teaching smoking-cessation counseling to medical students using simulated patients. Am J Prev Med. 1997; 13:153–158.[Medline]
  25. Papadakis MA, Croughan-Minihane M, Fromm LJ, Wilkie HA, Ernster VL. A comparison of two methods to teach smoking-cessation techniques to medical students. Acad Med. 1997;72:725–727.[Medline]
  26. Wadland W, Keefe C, Thompson M, Noel M. Tobacco dependence curricula in medical schools. JAMA. 2000;283:1426–1427.[Free Full Text]
  27. Spangler JG, Enarson C, Eldridge C. An integrated approach to a tobacco-dependence curriculum. Acad Med. 2001; 76:521–522.[Medline]
  28. Geller AC, Prout MN, Miller DR, et al. Evaluation of a cancer prevention and detection curriculum for medical students. Prev Med. 2002;35:78–86.[Medline]
  29. Hudmon KS, Corelli RL, Chung E, et al. Development and implementation of a tobacco cessation training program for students in the health professions. J Cancer Educ. 2003; 18:142–149.[Medline]
  30. Corelli RL, Kroon LA, Chung EP, et al. Statewide evaluation of a tobacco cessation curriculum for pharmacy students. Prev Med. 2005;40:888–895.[Medline]
  31. Heath J, Crowell N. Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty. J Prof Nurs. In press.
  32. US Department of Health and Human Services. Clinical Practice Guidelines: Treating Tobacco Use and Dependence. Rockville, Md: US Department of Health and Human Services; 2000. USPHS Publication No. 00–0032.
  33. Heath J, Andrews J. Using evidence-based educational strategies to increase knowledge and skills in tobacco cessation. Nurs Res. 2006;55(4 suppl):S44–S50.[Medline]
  34. American Association of Critical-Care Nurses. AACN members tackle tobacco cessation at Summer Institute. AACN News. August 2005;22:1.
  35. Hull E, St Romain JA, Alexander P, Schaff S, Jones W. Moving cemeteries: a framework for facilitating curriculum revision. Nurse Educ. 2001;26:280–282.[Medline]
  36. Loving GL, Wilson JS. Infusing critical thinking into the nursing curriculum through faculty development. Nurse Educ. 2000;25:70–75.[Medline]
  37. Short GJ, Ricer RE, Filak AT Jr. Overcoming barriers to creating a tobacco-use curriculum. Acad Med. 1999;74:1158–1160.[Medline]
  38. American Association of Colleges of Nursing. The Essentials of Master’s Education for Advanced Practice Nursing. Washington, DC: American Association of Colleges of Nursing; 1996.
  39. National Organization of Nurse Practitioner Faculties. Domains and Competencies of Acute Care Nurse Practitioner Practice. Washington, DC: National Organization of Nurse Practitioner Faculties; 2004.



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