Date of Award


Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chair

Louise O'Keefe


Lungs--Diseases, Obstructive--Nursing, Smoking cessation, Cigarette smokers--Rehabilitation


PICOT Question: Does educating clinicians in the use of a smoking cessation survey increase the use of the Tobacco Cessation – Nicotine Addiction Questionnaire (NAQ), and the use of smoking cessation interventions including Nicotine Replacement Therapy (NRT) in COPD patients admitted to an Observation Unit (OU)? Background: COPD is the third leading cause of death, affects more than fifteen million Americans, and causes serious long-term disabilities and premature death. Smoking is the most significant risk factor for developing COPD, accounting for as many as eight out of ten COPD related deaths, harming nearly every organ of the body affecting a person’s overall health. COPD in the setting of ongoing smoking causes high utilization of resources to the US’ health care system resulting in substantial economic expenditures with frequent provider visits and recurrent hospitalizations due to acute exacerbations requiring chronic medical therapy. Purpose: To implement an educational intervention to clinicians caring for COPD patients with ongoing tobacco dependence admitted to an OU for acute COPD exacerbation. This intervention should improve clinician awareness on the use of the NAQ to guide in the utilization of smoking cessation interventions during the OU stay and after discharge. Implementation: A convenience sample of six clinicians providing care to smokers admitted to an OU for acute COPD exacerbation was selected to participate. This quality improvement project, using a pre/post-test design based on a retrospective medical chart review over six months, assessed clinicians’ knowledge and education tool effectiveness after the implementation of a 20-minute educational training via a PowerPoint presentation. Pre/post variables included utilization of the NAQ, smoking cessation teaching, NRT utilization during OBS stay, NRT prescribed at discharge, and smoking cessation treatment offered at discharge. Results: A total of 60 charts were abstracted pre- and post-intervention. All (100%) of the participating physicians demonstrated an increase in the utilization of the NAQ, smoking cessation education, and NRT orders during the OU stay. There was statistically significant improvement in the utilization of the NAQ (p = .000) and smoking cessation education (p = .000). Despite an improvement in NRT use during the OU stay following training, there was not statistically significance (p = .203). Adversely, there was a decrease in prescribing NRT at discharge post-intervention. However, there was an increase in smoking cessation resources offered at discharge without statistically significant differences between groups (p = .073). Discussion: Although the benefits of smoking cessation have been identified in many settings, COPD continues to grow at a frightening rate. This project contributes by preparing DNP nurses to focus on COPD prevention strategies and the importance of continuing education among clinicians, particularly in regards to smoking cessation, a known detrimental public health issue in the US. Additionally, this project demonstrates how physicians are receptive of teaching and practice change to promote positive impact in patients. However, this project emphasizes the need for future research to develop tailored smoking cessation interventions to promote smoking abstinence in a chronic population whose behavior changes are essential for their welfare.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.