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Table 4 Qualitative information provided during interviews) – Implementation

From: Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals




Put brochure in patient’s admission package

“I handed the brochure to the partner of a patient.”

“I don’t always provide the brochure. It is sometimes inconvenient.”


Patients are usually not interested

“Accessing the DVD is too difficult for patients”

Tobacco Tactics manual

“I really like it.” (5)

“User friendly.”

“Materials make it easy; it’s simple enough for patients with less education.”

“The book saves me a lot of time talking.”

“The book is informative and simple, that is good.”

“The manual is kind of long and wordy.”

Tobacco Tactics training

“I have to admit that I had an attitude when I went to the training, but it was much more interesting than I thought.”

“I liked the training. I feel more comfortable talking to patients now”

“The training gave me more ideas.”

“I complement the program and planning. It is presented well and attainable.”

“The training made me more comfortable talking to patients.”

“I like that I can take this information and apply it to other issues as well.”

“Training was mandatory on our unit.”

“I did not attend the training, but learned the content from other nurses who went.”

“I was too busy at the time to attend training.” (2)

Tobacco Tactics intervention

“This [Tobacco Tactics intervention] is more than we had before.”

“The intervention is more streamlined now.”

“This is a good service, the patients appreciate it; it’s just that we’re too busy with other things, so we don’t always remember to address smoking.”

“I give materials to fathers too.” (nurse on OB/GYN unit)


“Charting is a problem” (11)

What nurses say to patients

“Quitting will improve wound healing and overall health.” (4)

“I say you haven’t smoked this long, it’s a good time to quit.”

“The [quit] day is here.”

“Never quit quitting!”

“Smoking is the #1 modifiable risk factor.”

“I focus on support group and home.”

“Don’t smoke in front of children.”

Asks if spouse smokes.

“I encourage patients to write down how much money they safe each time they don’t smoke for a day.”

“I say: ‘Either it is gas money, or it is cigarette money.’”

“I tell them: ‘direct your brain to [something] else.’”

From an email: … “just a few short hours after I was in your tobacco tactics class on Monday… I was taking care of a patient who smoked a pack a day and had wanted to quit for a long time. I sat down with her and told her how important it was for her health to quit smoking (yes, I used the phrase)! She agreed and said that she really wanted to quit but that she wasn’t ready because she needed help. I reminded her that she wasn’t going to be smoking while she was here (we had her on a nicotine patch) and that now would be a great time to quit. She agreed and said how she has her son’s wedding coming up in December and she would love to be smoke-free by then. I explained how that would be an excellent goal and that she might as well start now! She looked at me, smiled, and said, “let’s do it!” I gave her the Tobacco Tactics book and the 1-800-quit now card and she spent the rest of the evening looking through the book! She told the day shift RN during bedside report that I had convinced her to quit smoking and that she was going to stick with it! YAY!”

Cessation help strategies

“I provide counseling only if patients want to.”

“It is important to keep reminding patients when they are in the hospital, since it is important for their health.”

“Education is the biggest thing; I point out the benefits and provide examples from the patient’s life, e.g., I relate quitting to the grandchildren.”

“Almost always gives support, but not always the brochure, will now.”

“A patient with lumbar fusion will be offered Bupropion or Chantix.”

“We should frame it in the baby’s health framework.”

“Removing cigarettes from home and work is a good implementation strategy for the patient.”

Opinions on smoking and quitting

“Nicotine seems to be more addictive nowadays.”

“Patients don’t mind to hear about quitting from me.”

“Patients with lung issues tend to want to quit.”

“Smoking cessation is like one other thing, something that gets glazed over. I do stress cessation with vascular patients.”

“If they don’t want to quit, I still provide additional counseling.”

“I’m impressed that there is a phone number that they can call.”

“It’s patients with a lower SES who smoke more.”

“I think we have fewer smokers than we used to.”

“Quitting is nothing more than a decision. It’s more psychological than anything.”

“Patients quit at their own time, when they are ready, I don’t push it.”

“Most people don’t want to hear anything about quitting.”

“We have a lot of Alzheimer’s patients. They are too confused for the intervention.”

“Our patients often smoked a long time ago.”

“I’m not uncomfortable talking to patients.”