Date of Conferral

2017

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Robert McWirth

Abstract

Cigarette use is more prevalent among veterans who have mental disorders than it is in the general population. Rates of tobacco use are also high among individuals who suffer from post traumatic stress disorder, addiction, and human immune deficiency disease. Approximately 22.7 million American veterans and their families are at risk of tobacco-related health problems. Concerned about heavy tobacco use among veterans, the U.S. Department of Veterans Affairs developed a Tobacco-Cessation Guideline to be used nationally. This guideline was updated in 2008 to include the '5A' mnemonic (ask, assess, advise, assist, and arrange) and is recommended for use by physicians, nurses, nurse practitioners, social service providers, and psychologists in Veterans Health Administration facilities when screening veterans for tobacco use. This doctoral capstone project involved evaluation of the Tobacco-Cessation Guideline by deploying a retrospective chart audit to assess implementation by first-line clinicians. Randomization of patient identifiers was used so that 18 Health Insurance Portability and Accountability Act patient identifiers were not recorded. The project was conducted at a Domiciliary and Residential Rehabilitation Treatment Program located in an urban area in the southern United States. Results of this project included raised awareness of first-line clinicians through electronic health record reminders, clinical outcome evaluations, and patient satisfaction surveys. These initiatives improved providers' effectiveness in documenting interventions, in addition to substantially improving the treatment progress made by each veteran. The sustainability of this effort will require long-term organizational commitment that will help to drive a change in practice and encourage positive attitudes toward tobacco cessation in the general population.

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