Educating Nursing Students On Pregnancy Smoking Issues to Improve Regional Intervention Efforts

Objective: Rates of pregnancy smoking in the rural South are twice national averages and contribute to poor birth and long term outcomes for affected women and children. Efforts to intervene during prenatal care with pregnant women have been hampered by lack of knowledge, skill, comfort, and commitment from prenatal providers and their nursing staff. Regional community providers and staff have been reluctant to participate in available trainings, and even those who do seldom exhibit attitude and practice change long term. Therefore, efforts to educate health care professionals on the dangers of pregnancy smoking, and to provide necessary skills for intervention efforts, may need to occur before they ever enter practice. Thus, the goal of the current project was to implement and evaluate a pregnancy smoking-related training session for baccalaureate nursing students in rural Southern Appalachia.

Design: Nursing students attended training on pregnancy smoking dangers/intervention techniques.

Sample: Third year students beginning clinical rotations in obstetrics.

Methods: 1.5-hour training including pre- and post-tests.

Implementation Strategies: Four months later, follow-up survey assessed gains in knowledge, skill, comfort, and willingness to address smoking.

Results: Over seven semesters, 659 nursing students were trained. Substantial gains in knowledge of pregnancy smoking issues were seen from pre- to post-testing, with knowledge retained at four- month follow-up. The percentage of students who felt they lacked skills to intervene with pregnant smokers dropped from 39% at pre-test to 6% at same day post-test. In addition, the percentage who reported they would be uncomfortable talking with pregnant women about smoking dropped from 10% to 1%, while the percentage who indicated they would always make time to address smoking with pregnant women increased from 54% to 87%. While most students did address smoking with multiple pregnant patients encountered during clinicals, and over half felt the patients benefited from their actions, only 58% were confident in their intervention skills at four month follow-up. Finally, 83% felt the training had been beneficial, and over 90% committed to addressing smoking with pregnant patients once they graduated.

Conclusion/Implications for nursing practice: Training can increase nursing student knowledge, skill, comfort, and willingness to address smoking with pregnant women. However, it appears ongoing education may be needed to promote skills and confidence long term. In the rural South, where smoking rates are high and provider efforts to address pregnancy smoking are inconsistent, educating future nurses could have substantial impact on pregnancy smoking rates and birth outcomes into the future.

Keywords: pregnancy smoking, nursing student training, pregnancy intervention