• Janie Heath, Karen M Butler, Joel G Anderson, Sarah Craig, Claudia Barone, and Jeannette O Andrews.
• is dean and Warwick Professor of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky. Karen M. Butler is an associate professor, an assistant dean, and a faculty associate for BREATHE, University of Kentucky College of Nursing. Joel G. Anderson is an assistant professor, University of Tennessee College of Nursing, Knoxville, Tennessee. Sarah Craig is an assistant professor, University of Virginia School of Nursing. Claudia Barone is a professor, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Jeannette O. Andrews is dean and professor of nursing, University of South Carolina, Columbia, South Carolina. Jheath@uky.edu.
• Am. J. Crit. Care. 2016 Dec 1; 26 (1): 53-61.

BackgroundDespite years of reducing tobacco use, few studies describe to what extent evidence-based tobacco-cessation interventions are a standard of acute and critical care nursing practice using the US Public Health Service 5 A's framework: ask, advise, assess, assist, and arrange.ObjectivesTo identify relationships between the 5 A's framework, attributes of individual and organizational excellence, and intention to integrate tobacco-cessation interventions as a standard of daily practice among nurses.MethodsNurses attending the American Association of Critical-Care Nurses National Teaching Institute were invited to complete a 21-item survey. Data were gathered in Boston, Orlando, and Chicago in a 3-year period. Descriptive statistics and logistic regression were used for data analysis.ResultsAmong 1773 completed surveys, nurses from organizations with standing orders for tobacco dependence were 5 times more likely to have high confidence in their 5 A's skills (odds ratio, 5.037; 95% CI, 3.429-7.400; P < .001) and 3.4 times more likely to have high intentions to integrate tobacco cessation into their daily practice (odds ratio, 3.421; 95% CI, 1.765-6.628; P < .001). Nurses with certifications were more likely to want to learn how to integrate tobacco-cessation interventions (odds ratio, 1.676; 95% CI, 0.990-2.836; P = .05).ConclusionsOpportunities abound to create strategies leveraging attributes of nursing and organizational excellence to promote evidence-based approaches to improve health outcomes in acutely and critically ill tobacco-dependent populations.©2016 American Association of Critical-Care Nurses.

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