Nursing Staff Attitude, Subjective Norms, Perceived Behavior Control, and Intention to Provide Tobacco Treatment in a Psychiatric Hospital


Although the nursing staff is fundamental in assisting individuals with mental illnesses (MI) to stop tobacco use, they often have mixed feelings about providing tobacco treatment (TT) services to people with MI in inpatient psychiatric settings.


Therefore, this study aimed to understand factors associated with nursing staff’s intentions to provide TT interventions for individuals diagnosed with MI in a psychiatric facility using the constructs of the theory of planned behavior (TPB).


Secondary data analysis was performed using cross-sectional data collected from 98 nursing staff who worked in a state inpatient psychiatric facility. A 15-item questionnaire was used to assess nursing staff intentions to provide TT services based on TPB constructs, including attitudes (four items), subjective norms (four items), perceived behavioral controls (four items), and intentions (three items) toward providing TT. The mean scores of each subscale ranged from 1 to 7. A logistic regression analysis was used to examine the relationship between TBP constructs and nursing staff intentions to provide TT for people with MI.


Nursing staff had an acceptable mean score in the intentions subscale (4.34 ± 2.01). Only two constructs of TPB explained nursing staff intentions to provide TT: subjective norms (OR = 2.14, 95% CI [1.46, 3.13]) and perceived behavioral control (OR = 2.33, 95% CI [1.32, 4.12]).


The constructs of the TPB, the subjective norms, and the perceived behavior control were able to predict nurses’ intentions to provide TT for inpatients in a psychiatric setting. Accordingly, we suggest implementing policies that make TT a normative practice while supporting the confidence and competence of nurses to deliver TT in psychiatric facilities.

Work Learning Program

The Work Learning Program was designed as a way for nurses to further their education and advance their careers, and to prepare these nurses for practice and leadership. The program provides evidence-based support to full-time employees admitted to the Work Learning Program.

The program was designed to:

  1. Create a space in the workplace set aside for learning.
  2. Create a smooth transition from work to work-learning.
  3. Create a sense of belonging by creating work-learning cohorts studying the same content.
  4. Provide program coordination and direct student support.
  5. Offer program commitment to the work-learners.

The program offers extra support such as study room, paid study time, peer tutoring, and bonding activities to full-time health professionals further their education. The program began in Fall 2017 with an RN to BSN cohort. This cohort graduated in August 2019 and participated in the December 2019 graduation ceremony. BH WELL is continuing to partner with the University of Kentucky, UK HealthCare, Eastern State Hospital and the UK College of Nursing on future Work Learning Program cohorts.

                                                     WLP Seminars


Johna's Story

“I felt like getting through the BSN program would be pretty stressful while working full time, but when I heard about the Work Learning Program I thought it would be a great opportunity.  Studying with my peers and discussing the class work with people that were going through the same course load was extremely helpful.”

And what did her work colleagues think of the quality of her work while going through the program?

A colleague of Ms. Arnett’s described Johna and her work team this way: “You are so incredibly inspiring, trying and seeing through a new medication that has allowed this patient to go home to their family! I am incredibly grateful to work with each of you and be a part of this innovative work. Pat yourselves on the back - you deserve it!"

Johna Arnette, BSN, RN, completed her BSN August 2019 as part of the inaugural RN to BSN Work Learning Program (WLP) at Eastern State Hospital. She is currently back in the Work Learning Program as a Doctoral student and will begin year 2 of her studies toward a Doctorate of Nursing Practice. She completed her ADN at Bluegrass Community and Technical College Lawrenceburg campus in 2015. As a WLP RN to BSN student in the UK College of Nursing, she completed a research paper on Staffing Requirements in Psychiatric Facilities to Decrease Staff Injury. Her capstone was Aggressive Behavior in Psychiatric Patients and Nursing Interventions. She wanted to do the WLP program because she wanted to work closely with co-workers and be able to lean on them throughout the process. Her areas of interest are psychiatric nurse leadership. While in the WLP program, Johna was promoted to a Patient Care Manager position. She was also inducted into the Sigma Theta Tau Nursing Honors Society in Spring 2019. Johna has been married to her husband, Jeff, since 2016. They have a 14-year-old Border Collie-Australian Shepherd mix named Harley and a cat named Dora who is 5.