Nursing Supervised Smoking Cessation Plan:

¶ … Nursing Supervised Smoking Cessation Plan: Methodology, Anticipated Acceptance and Anticipated Results. According to the American Cancer Society (2010), smoking causes 419,000 deaths annually. It is the number one most preventable factor that results in deaths and disability from cancer of the lung, mouth, pharynx, esophagus, and bladder In addition it contributes to stroke and heart attacks (2). It is instrumental in respiratory diseases such as chronic obstructive pulmonary disease and bronchitis It may cause a decrease in physical fitness and elevate serum cholesterol levels (2).

It is habit that effects 19.1% of the population according to the CDC (2007) which is decreased in incidence by 1% from previous data collected by the CDC (2004) of %. The prevalence is moving down in the right direction primarily because of increased public awareness of the dangers of smoking, increased cost of cigarettes, laws that govern smoke free areas (airlines, restaurants and other public venues) and intervention by healthcare professionals who are taking a more proactive stance in cigarette cessation (3).

In addition to being a habit, it is also addiction because of the nicotine found in a cigarette. It is as addictive as heroin or cocaine (3). What causes the medical symptoms is the tar in cigarettes which causes cancer, and the ash which causes pulmonary and cardiovascular symptoms. It can be fairly stated that the nicotine addicts the individual and the tar and ash kills the smoker. It is a vicious and almost perfect killing machine.

If it wasn't for the bodies' ability to partially cleanse the lungs, pharynx and sinus passages with cilia and mucus you would not be able to survive and tolerate smoking at all. Because of the bodies' ability to cleanse it allows cigarette smoking to become a long-term chronic ailment with severe consequences at the end of a smoker's life. A life that may be prematurely ended by 10 to 15 years (Andrews & Hearth, 2003). In addition to the primary smoker there are the consequences of second hand smoke to the nonsmoker.

Children exposed to second hand smoke may develop respiratory diseases and stunt their lungs (4) Children may also have a greater risk of developing lung cancer as adults as well as cases of moderate to severe asthma (4,).

It is important to start smoking cessation programs as early as possible as children are one of the most successful groups that can be educated by nurses (4) The national goal is to reduce cigarette smoking to less than or equal to a prevalence rate of 12%.(5) and there are currently groups that meet or beat these national expectations in addition there are studies which confirm the effectiveness of minimal intervention vs. intensive nursing intervention which give us an idea as to the effectiveness of cessation intervention (5).

Literature Review Fritz, Wider, Hardin, & Horrocks (2008) found that school nurse who work with adolescents are in an ideal position to direct the students into early nonsmoking behaviors. Students who begin smoking are prone to be smokers as adults. These students without nursing instruction fail to recognize the harmful nature of cigarette smoking and also don't seem to have concerns about their future health.

With a nurse educator instructing the student smoker they are able to instruct them about the harmful nature of smoking and the long-term effects it may have on the student. In addition the nurse is in a position to recruit facility to help guide the students into better behavior patterns. By participating with the faculty to make a school a nonsmoking environment further student compliance can be raised.

Scanlon, Clark, Mc Guiness (2008) are Australian investigators who have determined that using evidence based assessment of the Australian 5A's smoking cessation program is the most successful way to encourage smoking cessation, but that it was not being generally used by nurses as they were unaware of how to properly implement the program. 87% of all nurses agreed with a study about the importance of a good smoking cessation program, but few knew how to implement such a program.

The reason for this was the poor dissemination of clinical information on smoking while in nursing school which was responsible for this clinical disparity. In this study 87% agreed with the necessity of encouraging people to stop smoking. Of the nurses questioned in the study 22% were already doing so, but only 22% had the necessary information to give useful direction to people who are smokers. The findings of Scanlon suggest that greater emphasis is needed at the undergraduate and in service level to educate nurses about the dangers of cigarettes.

With this information they could properly inform their patients about the compelling impact of cigarettes on their lives so that smokers would want to quit smoking. Scanlon noted that acute care nurses were in a unique position to give information about smoking to their patients. These nurses are with the patients 24 hours a day. They constitute the largest group of health care providers who will be with the patient during their stay in the hospital.

While the patient is in the hospital, they are normally considering ways to improve their health and the acute care nurse is there to provide information that they may be seeking in this area. If the patient is a smoker the best direction that a nurse could guide them would be that of becoming a nonsmoker (Conroy et al. 2005). The 5As of the Australian system are 1. Ask about current and past use of tobacco; 2. Assess a smoker's desire to quit smoking; 3. Advise a smoker to quit 4.

.Assist through education about the dangers and harms of smoking to encourage quitting; 5. Arrange follow up visits to continue counseling and direction either through nursing or other support services (Zewar et al.). Only 22% of Australian nurses were willing to utilize this system. It was felt that this was because of a lack of information about smoking which should have been learned at an earlier level of instruction. An informational gathering paper was produced and given to 162 nurses.

This paper was to determine how much information the nurses had about cigarettes and smoking. It was determined from the answers given by the nurses that as a group they scored a mean score of 54.93 which was failing, as the passing score was 65. The range of scores was 14 -- 87.12. The data confirmed that the reason why nurses were unwilling to speak to the issue of smoking was the lack of factual information needed to effectively instruct the patients.

On the other hand the study also demonstrated that the nurses were willing to learn the information to help them become more effective educators as 87% felt the cessation of smoking was an important public health care issue. Smith & Burgess (2009) examined the Canadian program for smoking cessation for patients admitted into a cardiac unit for acure myocardial infarction and those admitted for coronary bypass procedures. One conclusion they came to was that the smoking cessation program was underutilized. They examined 276 sequentially admitted patients.

They examined patients who received minimal instruction consisting of minimal advice from a nurse or physician along with two pamphlets as compared to the intensive intervention program. The intensive program consisted of the minimal intervention, 60 minutes of bedside counseling, additional educational materials, and 7 nursing follow up calls during the 2 months following discharge. The results were that 12-month abstinence was significantly higher reported in the intensively treated patients 60% versus the minimally treated group 46%.

When confirmed by cotinine assays it was determined that the actual numbers were 57% in the intensively educated group versus 39% in the minimally educated group. The conclusion was that intensive intervention was beneficial to the smoker who was at risk for cardiac complications. Ritchie, Evans & Matthews (2010) examined nursing student and clinical instructors' perceptions during implementation of best use practice guidelines. They determined that there were personal bias and problems associated with the process. These bias and problems could be identified 1. personal and professional self 2. health preaching 3. developmental perspectives 4.

environmental constraints Personal and professional self wrestled with the issue of a past smoker, non-smoker, and current smoker and how they could best relate to the person who was their patient. Some felt that by never smoking you could not understand what the patient was facing but you could tell them to do as you do and not smoke.

Some nurses who smoked didn't feel they should be telling the patients to not do something they were grappling with or they felt they could advise the patient on what not to do just as they knew they shouldn't smoke either. Past smokers felt that they could talk about their own experiences to help a smoking patient be motivated to stop smoking. Other personal struggles among nurses included younger nurses being "preachy" to patients who were participating in a bad, but legal habit.

Health preaching was a perception among some nurses that they would be seen as judgmental or looking down on smokers and lose their confidence and be ineffective in helping them to quit. Developmental perspective was the concept that the nursing students participating in this study were typically younger than they patients they were caring for. This made it difficult for them to ask the "older" patient questions about a lifestyle they had been practicing for many years.

Environmental constraints were noted that prevented the participants in the study from fully implementing best practice guidelines. The primary of which was time. They noted that because of other duties and paper keeping requirements, they had little time to properly present the best practice guidelines. Some noted that they had little time to do expected things such as breathing, much less introduce the patient properly to best practice guidelines. During their third year of training the nurses were introduced to a comprehensive program concerning cigarettes and cessation programs.

In addition they had already been taught more efficient time management training. With these new tools they felt more comfortable with teaching patients about the best practice guidelines to stop smoking. Apparently education of the nursing students and maturation was important in feeling comfortable and competent in teaching patients these guidelines.

Sanders, Fowler, Mant, Fuller, Jones & Marzillier (1989) originally discovered that if a random group of patients was given information one time by a group of nurses telling them not to smoke that it was significantly more effective than in a controlled group told not to smoke but by non-nursing personnel. Those interviewed and who spoke with nurses at the end of one year had a 3.6% smoking cessation rate when compared to a control group with a rate of .9%.

The nurses were 3x more successful rate with just minimal intervention in stopping a patient from smoking. It is important that tobacco use be identified and dissuaded in youth according to the CDC (2010) for the following reasons 1. Daily 4,000 American youth (12-17 years) try their first cigarette 2. 25% become daily smokers 3. youth doesn't understand that nicotine is as addictive as heroin or cocaine 4. unaware of the consequences to future health 5. school programs can have major impact on smoking cessation and long-term health The CDC (2010) recognizes the consequences of tobacco use 1. premature death 2.

heart disease, stroke, chronic obstructive pulmonary disease 3. blood cholesterol elevation, bronchitis, bronchectasis 4. smokeless tobacco unsafe causing oral cancers 5. cigars increase risk of oral cancers 6. secondary smoke affects young children by hindering lung development and increasing risk of respiratory diseases 7. second hand smoke causes new cases of asthma and worsens existing asthma The CDC (2010) recognizes an opportunity to make a significant impact on smoking habits in the general population by focusing on youth because well designed and implemented programs have in schools 1. proven effective in lessoning the use of tobacco 2.

provides a tobacco free environment, establishes none use of tobacco is a norm 3. prevents the use of other drugs School programs that are effective include the following measures 1. prohibit the use of tobacco in the school and all school functions 2. encourage administrators and staff to quit smoking 3. design program appropriate for K-12 that exposes why tobacco is used 4. nurses, teachers, administrators, family, community leaders provide the same health message against tobacco use 5.

community promotes uniform anti-tobacco messages Recommendations and Methodology Recommendations for a nursing directed anti-smoking program would include the training of nurses during their first year of nursing school concerning the affects of being a cigarette smoker. In addition they would be taught time management practices that would allow them to convey the correct information about cigarettes to their patients. Nurses would involve community leaders such as teachers, public health officials and politicians to propose correct methods of limiting smoking.

Programs could be proposed by nurses to schools to have a zero tolerance policy in and around the school and at all school functions. This zero tolerance would include all teachers, administrators and ancillary personnel prohibiting smoking on school grounds or activities as well as students and parents. In addition in schools no tee shirts depicting cigarettes or any type of construed drug.