Opportunities for intervention in patients who smoke should never be missed, writes Geraldine O’Donovan
Smoking is the leading preventable cause of premature mortality, killing almost 6,000 people in Ireland each year. Cigarette smoking prevalence in Ireland declined to just under 24% by December 2005 from 31% in 1998 and 27% in 2002.
Irish women are now smoking at similar rates to Irish men despite increased awareness of the risks involved. Estimates from the Irish National Cancer Registry show that lung cancer is increasing by 3% a year in women. From being a predominantly male disease for the past 50 years, lung cancer will be a predominantly female disease by 2020.1
Tobacco is highly addictive and breaking the cycle of addiction is an enormous challenge. Three-quarters of all smokers want to quit with almost two-thirds having tried to give up at some stage. Proven cessation strategies must be pursued to support smokers in their cessation efforts.
An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability and may find it easier to quit in an environment where smoking is prohibited. Nurses are in a prime position both to encourage smokers to think about giving up and to provide them with appropriate information and help to quit.2 However, nurses’ potential in preventive healthcare has been largely under-utilised.
A number of reasons have been put forward to explain the waste of this valuable health promotion resource. These include: poor knowledge of the dangers of smoking, lack of confidence in using this knowledge and a conflict of personal attitude to smoking.
Surveys in the last two decades have found that while nurses appear to believe in their role as a health promoter in smoking cessation,3 they were not using opportunities to carry out this role. It has been found that a lack of time (78%) and lack of training (67.8%) were the two main reasons given by nurses for not giving smoking cessation advice to patients.
The most appropriate way for most nurses to contribute to smoking cessation is through ‘brief interventions’. These can be undertaken as part of the admission procedure, during nursing assessment or while providing general nursing care.
Brief interventions involve opportunistic advice, discussion, negotiation or encouragement. They are commonly used in many areas of health promotion by a range of primary and community-based professionals. For smoking cessation, brief interventions typically take between five and 10 minutes.
Strategies that may help can be summarised into the following five As:
The brief intervention generally involves assessing and recording the patient’s current smoking status. The way to proceed then depends on which of the six ‘stages’ on Prochaska and DiClemente’s Stages of Change model the patient is in. The aim is then to encourage smokers to move on to the next stage towards giving up.
|The stages of change|
Smokers who are thinking about giving up in the future can be encouraged to set a date and offered support and literature; those who are ready to quit can be referred to their local smoking cessation officer/group, and smokers who have relapsed can be encouraged to try again.
Nurses can educate patients on the availability of different smoking cessation aids, such as nicotine replacement therapy. The chance that an unaided effort to give up smoking will succeed has been estimated at less than 3%.5
The most effective methods for treating tobacco dependence combine behavioural and biological, ie. pharmacological nicotine replacement therapy.
Tobacco use is a major cause of morbidity and mortality. Smoking cessation programmes are government priorities to reduce both the human cost and the cost to the health service of smoking-related ill health. According to recommendations from Building Healthier Hearts – the 1999 report of the Cardiovascular Health Strategy group, all health professionals should receive training on how they can support clients to quit smoking and the HSE Heath Promotion Department offers ‘brief intervention’ training for health professionals
However, nurses have received little training in smoking cessation techniques but are more than willing to learn of new techniques. One recent survey found that only 14.4% of nurses had received training in smoking cessation.6
Nurses’ potential in preventive healthcare has been largely under-utilised. Lack of time and training are major factors inhibiting nurses from playing a greater role in smoking cessation. Smoking cessation programmes should be developed as integrated parts of the undergraduate and postgraduate syllabus with every nurse being trained in ‘brief interventions’.
Geraldine O’Donovan is a college lecturer in the Catherine McAuley School of Nursing and Midwifery, UCC, Cork