Date of Award


Degree Name

Nursing (M.S.N.)


College of Nursing

First Advisor

Marie Vanderkooi

Second Advisor

Darleen Hoffert


This paper addresses prenatal smoking rates within in a rural northern Michigan district health department (HD) through a Master of Science in Nursing (MSN) quality improvement project. The paper provides a detailed microsystem assessment of the Maternal Infant Health Program (MIHP) at the district HD describing the clinical problem and identifying a practice gap in care of prenatal smokers. The literature review describes the three most effective prenatal smoking cessation interventions: counseling, incentives, and feedback. The literature review also addresses the effectiveness of and barriers to smoking quitlines. The clinical protocol followed the Model for Improvement framework with the completion of one PDSA cycle. Barriers to Michigan Tobacco Quitline use were identified then addressed by modifying the MIHP referral process to include an educational client handout. MIHP team post-surveys indicated the staff members agree it is easier to encourage prenatal smoker enrollment in the Quitline with the modified referral process. The MIHP team agreed to continue revising their Quitline referral process until the desired affect is achieved.

Included in

Nursing Commons