Caring for Pregnant Smokers: Nurses' Views on Cessation Interventions
Spegman, Adele M.
Wary, Andrea A.
Laam, Leslie A.
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Purpose: Smoking during pregnancy is a significant yet modifiable risk that negatively affects maternal and fetal health during pregnancy. Practice standards recommend assessment of tobacco use at each prenatal visit, consistent messages and action plans that relate to women's readiness to quit (ACOG, 2010). Despite public health initiatives and targeted interventions, the 12- 20% of pregnant women who self-report smoking is considered a significant underestimate of the actual prevalence (Shipton, 2009). Little is reported about the outcomes of nursing cessation interventions. This study examined prenatal nurses' views and experiences with smoking cessation. Methods: The observational design drew on Artinian's Intersystem Model (1997) which highlights the individuals within the nurse-client relationship. Data was collected in 3 phases at a largely rural regional health system. Focus groups were conducted to identify nurses' understandings surrounding cessation interventions in prenatal clinics. The findings were used to develop a survey that was accessed electronically by participants at 22 clinics. The characteristics of self-reported pregnant smokers were examined using existing Electronic Health Record data. Results: Twenty-nine staff, primarily RNs, participated in 7 focus groups. Themes repeated across discussions: pregnant smokers' complex life situations, concern and frustration, testing better strategies, and constraints of clinic settings. Completed surveys were submitted by 84% (N=54) staff. Pregnant smokers were portrayed as a vulnerable subgroup for who established cessation strategies were rarely effective. Participant's ratings of cessation counseling skills were related to perceived effectiveness of cessation training. Retrospective data supported nurses' perceptions of pregnant smokers' characteristics and cessation rates during pregnancy. Conclusions: Ineffective cessation outcomes likely reflect a mismatch between interventions and needs. This study has motivated activities to strengthen nurse-physician collaboration and partnerships with community-based resources to promote cessation and smoke-free homes. Our future research will examine the impact of coordinated massages across prenatal, childbirth and pediatric settings.