Systems approaches to tobacco dependence treatment.

Nurses have been at the forefront of initiatives to improve patient outcomes through systems change. Nursing research addressing systems approaches to treatment of tobacco dependence has demonstrated increased implementation of evidence-based practice guidelines. Existing health system research conducted by nurse scientists has focused on four strategies: tobacco use identification systems, education and training of nursing staff to deliver tobacco intervention, dedicated staff for tobacco dependence treatment in both acute and primary care settings, and institutional policies to support tobacco intervention. Nursing involvement in multidisciplinary health services research focusing on tobacco treatment has lagged behind advances in clinical nursing research of individual-focused smoking cessation interventions. Health information technology shows promise as part of an integrated approach to systems changes to support tobacco intervention, particularly in light of the current national emphasis on adoption and meaningful use of electronic health records. Future directions for translational research present unprecedented opportunity for nurse scientists to respond to the call for policy and systems changes to support tobacco treatment.