Multisite Studies Demonstrate Positive
Relationship Between Practice Environments
and Smoking Cessation Counseling
Robin Newhouse, RN, PhD, NEA-BC, FAAN • Ha Do Byon, RN, PhD, MS, MPH •
Emily Storkman Wolf, RN, BSN • Meg Johantgen, RN, PhD
Problem: High-quality smoking cessation counseling guidelines for people who use tobacco are
not fully integrated in acute-care services presenting missed opportunities to improve health
outcomes. The role of the practice environment on enhancing or inhibiting guideline use is
Objective: To examine the relationship between the nurse practice environment and nurses’ use
of smoking cessation counseling practices, and to evaluate the effect of the individual nurse and
organization characteristics on nurse smoking cessation counseling practices.
Design: Cross-sectional secondary analysis of survey data from two multisite studies.
Sample: The sample included responses from registered nurses (N = 844) in 45 hospitals (22
rural hospitals from the Eastern United States and 23 Magnet hospitals across the United States).
Methods: Linear mixed model was used to adjust intradependency among the responses of indi-
vidual nurses nested within hospitals. Data were abstracted from survey responses including nurse
characteristics, the Smoking Cessation Counseling Scale (SCCS), and the Practice Environment
Scale-Nursing Work Index (PES).
Results: Increasing positive relationships exist between PES and SCCS total and subscales scores.
Also, SCCS total scores were signiﬁcantly related with favorable PES total scores (SCCS score
difference of 0.26 between favorable and unfavorable PES scores, SE = .08, p = .002) controlling
for other covariates. Non-White respondents (vs. White) demonstrated a positive association with
SCCS total scores (difference of .18, SE = .07, p = .010), but not in advanced counseling.
Linking Evidence to Action: Nurse practice environments are positively associated with the use of
evidence-based smoking cessation practices by nurses. As practice environments become more
favorable, higher level counseling practices occur more often. Healthcare leaders should focus
on enhancing the practice environment using a quality improvement approach and framework for
evidence translation. Quality improvement initiatives should be prioritized in which high-quality
evidence is available to support nursing processes.
Tobacco use is the most prominent preventable cause of
morbidity and mortality in the United States with an esti-
mated 480,000 annual attributable deaths, including more
than 41,000 deaths resulting from the second-hand smoke
exposure (U.S. Department of Health and Human Services,
2014). In 2015, over 1.1 billion people smoked tobacco glob-
ally (World Health Organization Global Health Observatory,
2017). Nurses’ role and proximity to the patient provide the
opportunity to intervene at the point of care when patients
are receptive to a health promotion message. According to the
Centers for Disease Control, most smokers with awareness of
the risks of tobacco want to quit (Centers for Disease Con-
trol and Prevention, 2011). The chances for successful quit
attempt more than double when counseling and medication
are used (Fiore et al., 2008). When patients are admitted to
acute-care settings, nurses ask if they smoke as a basic ques-
tion on the admission assessment. Yet, when patients respond
afﬁrmatively, often there is little follow-up with counseling
or referral. Much is known about the evidence-based strate-
gies that should be delivered to help smokers reduce or quit
Worldviews on Evidence-Based Nursing, 2018; 15:3, 217–224.
2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.
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