Tobacco-Cessation Interventions and Attributes of Individual and Organizational Excellence in Acute Care

Am J Crit Care. 2016 Dec;26(1):53-61. doi: 10.4037/ajcc2017373.


Background: Despite years of reducing tobacco use, few studies describe to what extent evidence-based tobacco-cessation interventions are a standard of acute and critical care nursing practice using the US Public Health Service 5 A's framework: ask, advise, assess, assist, and arrange.

Objectives: To identify relationships between the 5 A's framework, attributes of individual and organizational excellence, and intention to integrate tobacco-cessation interventions as a standard of daily practice among nurses.

Methods: Nurses attending the American Association of Critical-Care Nurses National Teaching Institute were invited to complete a 21-item survey. Data were gathered in Boston, Orlando, and Chicago in a 3-year period. Descriptive statistics and logistic regression were used for data analysis.

Results: Among 1773 completed surveys, nurses from organizations with standing orders for tobacco dependence were 5 times more likely to have high confidence in their 5 A's skills (odds ratio, 5.037; 95% CI, 3.429-7.400; P < .001) and 3.4 times more likely to have high intentions to integrate tobacco cessation into their daily practice (odds ratio, 3.421; 95% CI, 1.765-6.628; P < .001). Nurses with certifications were more likely to want to learn how to integrate tobacco-cessation interventions (odds ratio, 1.676; 95% CI, 0.990-2.836; P = .05).

Conclusions: Opportunities abound to create strategies leveraging attributes of nursing and organizational excellence to promote evidence-based approaches to improve health outcomes in acutely and critically ill tobacco-dependent populations.

MeSH terms

  • Adult
  • Aged
  • Certification / standards
  • Clinical Competence
  • Critical Care / methods*
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Middle Aged
  • Nursing Staff, Hospital / organization & administration*
  • Nursing Staff, Hospital / standards
  • Odds Ratio
  • Organizational Objectives*
  • Practice Guidelines as Topic
  • Smoking Cessation / methods*