Improving public health nurses' effectiveness in counseling pregnant patients who smoke

This paper describes an initiative to reduce smoking among pregnant women. A local health department (LHD) partnered with a PhD-prepared nurse to conduct research and design strategies to increase the effectiveness of public health nurses' smoking cessation counseling. Reducing infant mortality has been a consistent concern for this LHD, with smoking cessation among pregnant women as a key strategy to address this need. The researcher studied the interactions of public health nurses and tobacco-using pregnant patients. Patient interviews revealed satisfaction with the nurse-patient interaction and nurse interviews suggested fulfillment with the role of patient educator-counselor. However, nurses expressed skepticism about their effectiveness in tobacco cessation counseling. Patients who admitted using tobacco were advised to quit for the benefit of the fetus, although long-term health consequences for the woman weren't discussed. Nurses hedged from eliciting a specific commitment to quit. Most notable, was the absence of specific strategies on how to quit smoking. Results of this research were presented to the nursing staff followed by three skill-building sessions on smoking cessation counseling. One year after the sessions, the nurse manager from the LHD approached the researcher to audit records for effectiveness of nurse smoking cessation counseling. Improvements were noted in nurse documentation. Some nurses had clearly stepped up their efforts, offering consistent, repeated, messages urging patients to quit and documenting patient progress. Patients seen by these nurses were most likely to report tobacco cessation by the end of pregnancy. Remaining gaps in documentation and inconsistent procedures suggested the need for further staff development, as well as a standard smoking cessation protocol. The researcher supervised nursing students and worked with LHD administrators and staff nurses to develop a standardized smoking cessation protocol. The new system was initiated in fall 2006 with plans for a future record audits to track progress.