Smoking-cessation counseling in the home: Attitudes, beliefs, and behaviors of home healthcare nurses

Background: Despite advances in smoking treatment, cessation rates remain stagnant, possibly a function of the lack of new channels to reach heavily addicted smokers. This cross-sectional study examined home care nurses’ attitudes, beliefs, and counseling behaviors regarding counseling their home care patients who smoke. Methods: Home healthcare nurses (N=98) from the Visiting Nurse Association of Rhode Island were randomly selected to participate in a study helping home-bound medically ill smokers to quit. At baseline, nurses completed a questionnaire that assessed a constellation of cognitive factors (self-efficacy, outcome expectations, perceived effectiveness, risk perception, motivation, and perceived patient adherence) as correlates of self-reported nurse counseling behaviors. Results: Nurses with higher outcome expectations spent more time counseling their patients about quitting (p<0.04). Nurses’ self-efficacy was the only variable associated with consistent counseling (p<0.05). While the majority of nurses “asked and advised” their patients, a minority of nurses “assisted or arranged” follow-up. Perceived importance of counseling was associated with a greater likelihood of asking, advising and assisting (p<0.05). None of the nurses who currently smoked (n=13) provided follow-up to their patients. Nurses who reported higher levels of both risk perception (regarding the harmful effects of smoking) and perceived effectiveness were more likely to recommend the nicotine patch. Conclusions: Attitudes and beliefs about smoking are significantly associated with nurse counseling behaviors. Helping nurses to overcome their barriers to smoking counseling may open up new channels for smoking intervention.