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Table 4 Selected EN and EP responses to queries about changes in their smoking cessation practices during the study intervention

From: Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions

  EN responses EP responses
Hospital 1 [250] “Well, yeah, because we would never ask about smoking prior to that….The PAs [physicians assistants] a lot of times would ask, the residents…would ask, but not much of the—not much from the nurses.” [105] “I feel like [the intervention] is worth doing…I feel like a really big part of our job is to prevent people from getting sick, instead of just carrying them when they are sick.”
  [261] “Oh no, before the training? We never--I mean, we just wrote ‘em down, yep they smoke, that’s as far as we went, before….No, this has totally brought [smoking cessation] to our attention.” [109] “It really takes a mindset change for emergency physicians to think about any preventative care. It’s sort of drilled into the residents and students that your goal is to get people out the door. To patch ‘em up and get ‘em out, instead of doing anything preventative necessarily. And so, in some ways the training needs to change.”
  [288] “I have found that I’m a lot more comfortable and I can—you know, the first few people that shut me down I was like, ok, that’s nice, I’m gonna just go on to the next question. But I kinda gotten more confident with talking to people and getting the information out, so it’s—it has changed because I think, I’m more willing, maybe, to keep going on the conversation…. I’ve got that back-up information right smack dab in my room. I don’t have to go anywhere, um, forget about it and go, ‘oh shoot, I forgot that person.’ It’s right there and it’s an immediate thing that you can do.” [118] “I think it’s a bit of a change from the way the ERs have operated in the past, I think there was some resistance to this [intervention] from some of the nursing staff primarily. That’s what I remember. Mainly because of the time constraints involved, I mean we’re extremely busy. It’s kind of hard to sit down and talk to patients about tobacco cessation …. the less busy we are, the more we can implement some of these things.”
   [150] “[T]here are so many things that you’d like to address or that would be useful to address, but you have 6 or 8 patients waiting and so we don’t have the leisure of talking about everything that needs to be addressed. You have to identify those things that the patient is going to be most receptive to and talk about those things.”
Hospital 2 [505] “Prior to the study we didn’t do anything. Since the study though, we use the algorithm, and ask the additional questions on the algorithm, and if they show an interest in quitting, then we do make--, have been making referrals to Quitline and providing them with any information that they might need.” [805] “I think [the intervention] was kind of hit and miss. I mean, it depended on the day, it depended on who was doing triage, it depended on the providers that were around, whether or not it got done.”
  [540] “I’m a big anti-smoker. So probably not a whole lot [of change], because I always did ask patients. And I was one of those that sort of lectured. I would you know, ‘really need to quit smoking’ and that kinda thing because I just hate smoking. But as far as being more aware and filling out the form, all that, yeah it has made a difference.” [890] “I’d say most of the time people weren’t very receptive to it. Some got angry--if you’d ask them: think about quitting? or do you wanna quit?--or very defensive, but I would say, if a few people did think it was a good idea and they’d want information on it, even one or two would be, I suppose, successful.”
  [554] “[during intervention] I’d ask them how long they’ve smoked, have they ever tried to quit smoking. That was about it….I never asked them those questions before. And now I kind of, you know, you can tell when a person comes in…[it’s] a gut feeling.” [878] “I do believe that we have opportunities that are perhaps less dramatic than other things that we do, but equally or more important. And this would be one of them.”
  [616] “[Now] when I ask, I go to the extent of asking, ‘Well, do you wanna quit?’ And, [that’s] something I had never done before. ‘Cause I didn’t care.” [927] “I think that a lot of the providers `and] nurses weren’t really on board, it was kind of like, ‘Look, we don’t have time for this, this really is out of the scope of our practice.”