Table 4 Factors influencing clinical behaviors related to tobacco counseling among PED/UC professionals overall and by professional group: skills, social/professional role and identity, and optimism TDF domains
TDF domain | Sub-theme | Professional group | Sample responses | ||
|---|---|---|---|---|---|
Nurse | Physician | Administrator | |||
Skills | Difficulty initiating a discussion with parents and keeping their attention | ✓ | ✓ | ✓ | “What I would need... just a listening ear and their complete attention. That they turn their phone off and don’t look at it for two to three minutes… a visual thing or a stop thing… to break them away from what they’re spending their attention on.” — Nurse |
Ability to ask and advise parents of children who present with a respiratory-related complaint or smell like smoke | ✓ | ✓ | ✓ | “So, I wouldn’t say I’m very consistent, but certainly on the kids that are either repeat asthmatics that are there frequently or kids that are sicker. The parents will often say, well I do smoke but I smoke outside, and so I always will kind of go through and talk about well when you come inside [do] you… wash your hands? Do you take off whatever clothes you were wearing outside? A lot of people are very surprised by the amount of smoke that can come in on clothing...” — Physician | |
Difficulty providing counseling (assess, assist, arrange) due to lack of training and resources | ✓ | ✓ | ✓ | “We don’t really get trained on any ways to help them besides telling them not to do it, so maybe being able to get them an actual resource on quitting or different… outlets that they can look into if they’re really interested in quitting. I don’t feel like we really have any of those resources set up as far as I know right now.” — Nurse | |
Social/professional role and identity | All professional groups should be involved, but need training | ✓ | ✓ | ✓ | “Yes, the physicians and the nurses should have a part in this as long as we’ve been educated and are given the right communication and right resources to offer assistance.” — Administrator |
Professional boundaries of stabilizing acute care first | ✓ | ✓ | ✓ | “Unfortunately, my primary goal at that immediate time is to treat the pediatric patients, and... if I have a lot going on, I might just jump in and jump out without being able to spend the amount of time to appropriately counsel parents about those issues.” — Physician | |
Do not want to pass judgement on parents and make them defensive | ✓ | ✓ | ✓ | “I think it’s really hard when the parents are defensive and they don’t really want to hear it from me, and you kind of feel like you’re overstepping your boundaries a little bit.” — Nurse | |
Optimism | Optimistic that their respective professional group should be involved | ✓ | ✓ | ✓ | “I think anybody who is participating in patient care should be advocating for patients [and] should be involved. I think it can be addressed at multiple levels in their care from triage to disposition or discharge instructions. And so really any nurses, patient care assistants, medics, physicians, [and] students along the way.” — Physician |