Smoking Cessation~ For Health Promotion ~

Eureka Hospital In-patient Unit

By Ann Sparks

Megan SchmidtMichelle Whitelow

A bit of history: Remember When…

Smoking was identified as

glamorous?

Medical History: Remember When…

• Cigarettes were provided free to all of our troops during World Wars I & II, & Korea, including the hospitalized soldiers.

• 1933- The Journal of the American Medical Association publishes its first cigarette ad, a practice that would continue for 20 years.

• Some physicians would even advise that their patients start smoking to help deal with anxiety & stress issues.

• Not only could patients smoke in their rooms, but staff could smoke in the nurses station!

(Hinnen, 2008; Tobacco.org, 2008)

Media played a role: But glamour only goes so far…

Beautiful Betty Grable, died of lung cancer aged 56.

Humphrey Bogart, smoking glamour personified, would light up, "One for me and one for my chick." Died at 57 of esophageal cancer.

Lung cancer stopped Lucille Ball and Desi Arnaz in their prime.

Singer, Nat King Cole? He died of lung cancer aged 45.. Yul Brynner and Robert Mitchum — lung cancer. Lana Turner and The Marlboro Man — throat cancer.

~ all died prematurely from smoking.

(Sulzberger & Bates, n.d.)

The truth emerges: Early anti-smoking campaigns

• But, society came to realize through mortality statistics and research that smoking REALLY KILLS! We can’t claim we “didn’t know” anymore!

• Early smoking cessation campaigns were shocking. Unfortunately, they didn’t get to the heart of the problem.

• Smoking cessation education needs to be bold and to the point: face to face.

• While patients are hospitalized is the BEST time to talk to them about quitting smoking. It’s the “window of opportunity,” or “teachable moment,” particularly if they are there for a lung ailment or smoking related illness.

(Barta, 2005, p. 209, Whyte, 2006, p. 569)

Health effects:To name a few… more discovered all the time

Pulmonary Embolism

Blood Clots & clottingdisorders

Depression

Anxiety

High BP

Osteoporosis

Blood vessel weaknesses

BreastCancer

Lowered

Immunity

DecreasedSex Drive

PAIN

Cataracts

Skin ailments

& cancer

PeriodontitisReproductive cancers

Hard core stats:

• The use of tobacco is the single most prevalent preventative cause of mortality in the world today.

• About half of all continuing smokers will die from smoking related diseases.

• Currently 1 in 5 deaths can be contributed to smoking.

• By the year 2020, it is estimated that smoking will be the absolute leading cause of death.

• Continued smoking causes an average loss of 20-25 years life expectancy per smoker!

(Barta, 2005)

Why do nurses smoke more?

• Major paradox: nurses can tend to have a higher prevalence rate of smoking than the general public.

• The National League for Nursing reports overall, nurses’ smoking rates are 18%, with some studies reporting as high as 24%. The general public is only 20.8-22.5% depending on which study you read.

• ECH is certainly no different. The smoking rate among regularly scheduled staff nurses here on the in-patient unit is noted to be 50%.

• Studies say respondents report addiction, enjoyment, peer influence and stress as causes.

• 34.9% of smoking nurses did not wish to quit. What do you think might be the cause? Motivation is a significant predictor of cessation.

Are you ready to quit?

(Halcomb, 2005; McKenna, 2001; Boardman, 2005)

Chronic smoking:It’s an addiction…

• It’s a physical addiction, with denial, justification, and rationalization… Smokers often don’t realize: it’s insidious & cunning.

• There are a vast amount of support and resources available to help.

• Multiple web sites/phone lines. Check the internet! Literature & seminars.

• Insurance and/or flex account for financial assistance.

• Medications (OTC or prescription):

• Nicotine substitutes

• Wellbutrin/Zyban

• Check out www.quitsmoking.com/zyban/index.htm

Real help for quitters!

• CHANTIX – binds with nicotine receptors in the brain to remove the desire. It’s a fairly new prescription medication that has online help, and phone support for all it’s patients!

• Check out www.chantix.com

(Pfizer, 2008)

• Talk to your doctor about your plan to quit!

• There’s a web site just for nurses, to help quit!!! Tobacco Free Nurses: http://www.tobaccofreenurses

• American Heart Association provides guidelines: http://www.americanheart.org

…And, evidence shows that the majority of smokers DO WANT TO QUIT!

Myths about quitting:Just to name a few…

MYTH

• If I quit smoking, I’ll gain too much weight. It’s better to lose the weight first.

• I’ve tried to quit before and failed. I don’t like feeling like a failure.

• It costs too much for the smoking cessation aids that are on the market.

• My spouse smokes; I can’t ask others to quit.

TRUTH

• How much weight have you lost smoking so far? The risks of smoking far exceed the risks of a few pounds of weight gain.

• It usually takes more than one attempt to quit for good.

• Consider the costs of a month of cigarettes, doctor bills, cigarette burn holes in things…

• Smoking in the garage is a great way to start making changes!

Smoking cessation: Why don’t we teach more?

Our Perceptions

• We often feel inadequate to approach smokers with smoking cessation education.

• If the staff member smokes, “How can I ask the patient to quit when I smoke?”

• I don’t want to offend anyone.

• The patient would be more open to listening to his/her own doctor.

Patient’s Reality

• Patients do listen to the advice of health care providers, particularly when hospitalized.

• Consider your reluctance; it’s contributing to shortened lives of smokers you don’t teach.

• Genuine caring isn’t offensive.

• The more people who educate and encourage, the more likely patients will be successful.

Overwhelming evidence:We’ve come a long way baby…

• Devastating effects of tobacco are so extreme that the World Health Organization (WHO) has established a Code of Conduct requiring nurses to: • Act as role models of smoking

cessation.

• Assess clients tobacco use.

• Give advice on how to quit.

• Participate in tobacco-control activities.

• Support tobacco-free public places and refrain from accepting money from tobacco companies.

• Tobacco control must occur at the individual level.

(Halcomb, 2005, p. 209)

Knowing this…

We could soon be required to do all of these things in our facility.

We need to ask ourselves…

Wouldn’t it be worth it?

In Memory of our friend

Jane A. Wertz

~February 21, 1951

to June 23, 2008

References

American Heart Association (2008). Smoking cessation guidelines. American Heart Association. Retrieved October 14, 2008 from http://www.americanheart.org/presenter.jhtml?identifier=4735

Barta, S. K., & Stacy, R. D. (2005). The effects of a theory-based training program on nurses’ self-efficacy and behavior for smoking cessation counseling. Journal of Continuing Education in Nursing, 36(3), 117-123.

Boardman, T., Catley, D., Mayo, M. S., & Ahluwalia, J. S. (2005). Self-efficacy and motivation to quit during participation in a smoking cessation program. International Journal of Behavioral Medicine, 12(4), 266-272.

Halcomb, K. A. (2005). Smoke-free nurses: Leading by example. American Association of Occupational Health Nurses. 53(5), 209-212.

Hinnen, R. (October 14, 2008). Personal communication.

McKenna, H., Slater, P., McCance, T., Bunting, B., Spiers, A., & McElwee, G. (2001). Qualified nurses' smoking prevalence: their reasons for smoking and desire to quit. Journal of Advanced Nursing, 35(5), 769-775.

References

Pfizer (2008). Quitting- CHANTIX official site. Retrieved on October 14, 2008 from http://www.chantix.com

QuitSmoking.com (2008). Zyban quit smoking drug. Retrieved October 14, 2008 from, http://www.quitsmoking.com/zyban/index.htm

Sulzberger, P. & Bates, M. (n.d.) The real story on smoking glamour . The ultimate quit smoking guide. Retrieved October 13, 2008 from, http://www.quitguide.com/smoking-glamour.html

Tobacco Free Nurses (2006). Tobacco free nurses-join nurses quitnet today. Retrieved October 14, 2008 from, http://www.tobaccofreenurses.org/quit.php

Tobacco.org (2008). The tobacco timeline. Tobacco news and information. Retrieved October 14, 2008 from http://www.tobacco.org/History/Tobacco_History.html

Whyte, R. E., Watson, H. E., & McIntosh, J. (2006). Nurses’ opportunistic interventions with patients in relation to smoking. Journal of Advanced Nursing. 55(5), 568-577.