Neonatal Nurses Preventing Maternal Smoking
- Describe a process for assessing and documenting maternal smoking status, providing advice to quit smoking or remain abstinent, and making a referral to treatment as needed.
- Compare and contrast the advantages of live-instruction versus computer-based training for increasing nurses' knowledge and self-efficacy for providing smoking prevention interventions.
- Formulate a plan for performance improvement in your own practice to involve neonatal nurses in smoking prevention interventions.
Most women who quit smoking during pregnancy relapse within weeks of giving birth. Improvement in the integration of smoking prevention services along the continuum of care may help women quit smoking and remain abstinent. Postpartum and neonatal hospitalization provides an opportunity for neonatal nurses to coordinate services and bridge the gap between the obstetric and outpatient pediatric settings. However, many neonatal nurses lack the knowledge and confidence to provide smoking prevention interventions. A performance improvement program to educate neonatal nurses about effective strategies for maternal smoking prevention during postpartum hospitalization was developed.
Proposed change:
An educational program that focuses on skills for assessing and documenting maternal smoking status, providing advice to quit smoking or remain abstinent, and making a referral to treatment will increase nurses’ knowledge related to smoking prevention strategies and nurses’ self-efficacy for providing interventions.
Implementation, outcomes and evaluation:
Forty-one neonatal nurses from the newborn nursery and NICU (RNs and LPNs) participated in an educational program. Four live-instruction classes were held. The educational program was converted to an interactive computer-based training (CBT) format to increase staff participation. A pre-and posttest design utilized a questionnaire with 9 general knowledge questions and 4 self-efficacy questions. Pre-and posttest results were compared for participants overall and for subgroups (CBT/Live and RN/LPN). A two-proportion test was used for data analysis.
Overall posttest scores were higher than pretest scores after education: knowledge (30.4% vs. 96.8%; p<.001), and self-efficacy (53.7% vs. 85.9%; p<.001). There were no differences in posttest scores between RNs (n=32) and LPNs (n=9) for knowledge (96.9% vs. 96.3%; p=.804) or self-efficacy (85.9% vs. 85.6%; p=.897). Posttest knowledge scores were higher with CBT compared to live-instruction (p=.01), while posttest self-efficacy scores were higher with live-instruction compared to CBT (p=0.41). Modifications were made to the CBT format to incorporate strengths of the live-training format. Participants expressed satisfaction and acceptance of the educational program irrespective of mode of instruction.
Implications for nursing practice:
CBT increased participation rates by 128% and was found to be cost-effective. Nurses currently employed and newly hired neonatal nurses are easily educated via CBT. Maternal smoking status, including quit attempt, is documented on the infant H&P; therefore, pediatric providers have information to continue interventions and support after hospital discharge. The new process includes a state fax referral process which provides information about cessation and relapse rates for mothers referred. The program provides opportunities for additional research and for expanding the program across other settings.
Keywords: postpartum relapse, maternal smoking, postpartum smoking prevention
