Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Chrystyne Olivieri, DNP, FNP-BC, CDCES

Practice Mentor

Hillary Sullivan, DNP, FNP-BC


Significance and Background: Tobacco use is one of the leading causes of preventable death in the United States, greatly contributing to morbidity and mortality. Motivational Interviewing (MI), a counseling style, has been shown to increase motivation for change in people. Successful intervention for behavior modification starts with identifying a person’s readiness for change. The 5 A’s model is an established form of motivational interviewing that addresses the five major steps of intervention: Ask, Advise, Assess, Assist, and Arrange. The Center for Disease Control (CDC) endorses the use of the 5 A’s brief tobacco intervention to protect the public’s health from the harmful effects of tobacco use. At a primary care office, a policy, which reflects the CDC’s endorsed method of smoking cessation, was implemented to encourage consistent provider-patient conversations on smoking cessation.

Purpose: Offer provider education on best practices for assessing nicotine use and the benefits of utilizing motivational interviewing to identify readiness to quit. Focus on the 5 A’s model to increase provider-patient conversations on smoking cessation. Track provider adherence to the use of the 5 A’s model of smoking cessation and correct documentation.

Methods: Plan-Do-Study-Act. Plan – Review evidence and recommendations currently in place at the practice for identifying nicotine users and interventions for cessation. Do – Overview of motivational interviewing with a focus on the 5 A’s model of smoking cessation was presented to three nurse practitioners and the lead doctor of the practice. A new smoking cessation template was created in the charting system. Study – Data on the 5 A’s model use in patients who were using tobacco/nicotine products. Act – present to stakeholders and plan for the next PDSA cycle.

Outcome: Over the twelve-week implementation period there were 264 adult patient encounters with a nicotine dependence diagnosis code. Of these 264 patients, 198 (75%) had documented smoking cessation counseling utilizing the 5 A’s model, 27 patients (10.3%) received counseling with no specific method, and 39 patients (14.7%) received no counseling. Of the 264 patients with nicotine dependence, 177 patients had no desire to quit smoking and made no attempts. In the other 87 patients there was a total of 12 patients (13.8%) who quit smoking entirely, 46 patients (52.9%) made attempts to quit but failed, and 29 patients (33.3%) reduced the amount they smoke each week.

Discussion: The implementation of a smoking cessation policy using the 5 A’s model of smoking cessation through group educational sessions increased the amount in which providers initiated conversations with their patients on smoking cessation. Educational sessions were geared at the risks and impact of smoking on society and benefits of motivational interviewing to encourage patient-led behavioral changes.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

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Available for download on Sunday, January 12, 2025

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