The effects of a smoking cessation programme on health‐promoting lifestyles and smoking cessation in smokers who had undergone percutaneous coronary intervention

Smoking is a major risk factor for not only the occurrence of myocardial ischaemia but also recurrences of vascular stenosis. This study aimed to evaluate health‐promoting lifestyles and abstinence rate after a smoking cessation programme. Sixty‐two smokers who had undergone percutaneous coronary intervention were randomly assigned to either the experimental or control group. The experimental group (n = 30) received 10 phone counselling sessions and 21 short message service messages for abstinence and coronary disease prevention, whereas the control group (n = 32) received only the standard education. After the intervention, 14 members of the experimental group had switched to a non‐smoking status, confirmed biochemically; moreover, their physical activity and stress management scores increased significantly. However, self‐efficacy of smoking cessation was not reflected in the cotinine levels. Thus, it is necessary not only to increase self‐efficacy but also to determine the factors that affect the success of smoking cessation so that they can be included in the intervention. Our results suggest that phone counselling and short message service messaging might be important tools for the realization of smoking cessation and lifestyle changes among patients who have undergone percutaneous coronary intervention.     

Psychiatric nurses' ethical stance on cigarette smoking by patients: determinants and dilemmas in their role in supporting cessation

It has been argued that psychiatric nurses are ideally placed to provide smoking cessation interventions to patients with mental illness. This assumes that psychiatric nurses actively support smoking cessation. The current paper articulates some of the reasons why this has not occurred, in particular, some of the ethical beliefs held by nurses that may prevent such activity. Such an assumption also discounts the evidence that confirms psychiatric nurses to have among the highest smoking rates in nursing and in the health professions in general. The role and impact of the institution are also considered. In-depth interviews with seven community and inpatient psychiatric nurses were thematically analysed. Extensive individual and group discussions were also held with inpatient nurses from open and locked psychiatric settings during participant observation of the settings. The findings suggest that psychiatric nurses can be more effective in the primary care role of supporting patients' smoking cessation if they receive adequate institutional support to do so.     

5步式叙事护理干预在经皮冠状动脉介入术后病人戒烟护理中的应用

[目的]观察5步式叙事护理干预在经皮冠状动脉介入(PCI)术后病人戒烟护理中的应用效果。[方法]将接受PCI治疗的120例病人随机分为对照组与观察组各60例,对照组接受常规护理,观察组在常规护理的基础上接受5步式叙事护理法干预,对两组干预后各相关观察指标进行比较。[结果]观察组病人干预后吸烟有利决策评分和尼古丁依赖程度评分均显著低于对照组,而吸烟有弊评分和戒烟成功率(近期与中期)均显著高于对照组(P0.05)。[结论]采用5步式叙事护理干预对PCI术后病人实施戒烟护理,能促使其做出戒烟决策,降低尼古丁依赖程度,提高戒烟成功率。     

Smoking habits and predictors of continued smoking in patients with acute coronary syndromes

BACKGROUND: Most patients with acute coronary syndrome quit smoking when hospitalized, although several have been found to relapse and resume smoking within 3 months. AIM: This paper reports a study to identify factors that can predict who will resume smoking after hospitalization for an acute coronary syndrome. METHODS: Patients (n = 1320) below the age of 75 years, admitted to a Swedish university hospital coronary care unit with acute coronary syndromes, between September 1995 and September 1999, were consecutively included. Data were collected from hospital medical records and included information on previous clinical history, former illnesses and smoking. During their hospitalization, an experienced nurse interviewed the patients by using a structured questionnaire to obtain additional information. Patients were followed up 3 months after the discharge. Those who continued to smoke (non-quitters) were compared with those who had stopped (quitters) with regard to age, sex, medical history, clinical course, and intention to quit. To identify factors independently related to continued smoking, a logistical regression in a formal forward stepwise mode was used. RESULTS: Of the patients admitted, 33% were current smokers. Three months after discharge, 51% of these patients were still smoking. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, independent predictors of continued smoking were: non-participation in the heart rehabilitation programme (P = 0.0008); use of sedatives/antidepressants at time of admission (P = 0.001); history of cerebral vascular disease (P = 0.002), history of previous cardiac event (P = 0.01); history of smoking-related pulmonary disease (P = 0.03) and cigarette consumption at index (P = 0.03). CONCLUSIONS: Smoking patients who do not participate in a heart rehabilitation programme may need extra help with smoking cessation. The findings may provide means of identifying patients in need of special intervention.     

The role of the nurse in health promotion: an evaluation of a smoking cessation programme in surgical pre-admission clinics

This paper presents a pilot study evaluating a smoking cessation programme, implemented by a nurse, in surgical pre-admission clinics at The Chesterfield and North Derbyshire Royal Hospital NHS Trust, Chesterfield, England. Using a quasi-experimental design, a convenience sample of 60 subjects who smoked were randomized, 30 to a control and 30 to a treatment group. Those in the treatment group received a variety of educational interventions and self-assessment questionnaires relating to smoking cessation, when attending the clinic. The control group received routine information. Data were collected using the combined interview and questionnaire method. There was a significant increase in positive behaviour on admission to hospital in the treatment group (80% stopped or reduced smoking), compared to a control group (50% stopped or reduced smoking), particularly in subjects who did not intend to reduce or stop before admission. The level of satisfaction with the service and information relating to smoking cessation was also significantly higher in the treatment group. Subjects described the approach of the nurse and a leaflet devised for the study, as the most helpful aspects of the programme. The study highlights how the nurse, using appropriate theory to underpin such a programme, can facilitate smokers' intention to stop or reduce tobacco consumption prior to hospital admission, and help them to prepare for their surgery, anaesthesia, and the hospital's no smoking policy.     

Frequency of nurses’ smoking cessation interventions: report from a national survey

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web‐based resources about tobacco control. Design. Cross‐sectional survey of nurses (n = 3482) working in 35 Magnet‐designated hospitals in the USA (21% response rate). Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web. Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1·55, 95% CI 1·27, 1·90) and recommending medications (OR = 1·81, 95% CI 1·45, 2·24). Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence‐based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.     

Qualified nurses' smoking prevalence: their reasons for smoking and desire to quit

AIM AND RATIONALE: The preventable nature of smoking related diseases places a major responsibility for health promotion on all health professionals. This study used a questionnaire to survey qualified nurses in Northern Ireland as to smoking prevalence and their desire to quit the habit. It also explores their knowledge base relating to smoking related diseases and their motivation to act as health promoters with patients who smoke. METHODS: A random sample (n=1074) of qualified nurses employed by the Health and Social Services Trusts, private, and voluntary organizations in the province were surveyed. RESULTS: Results show that 25.8% were smokers, 19% were ex-smokers and 55.2% were nonsmokers. Three quarters expressed a wish to stop within 6-months. Almost all smokers and half of ex-smokers had taken up the habit prior to commencing nursing. 'Addiction' and 'enjoyment' were given as the principle reasons for continued smoking. Health reasons were paramount in smokers' desire to stop smoking. CONCLUSIONS: These findings suggest that smoking prevalence among qualified nurses in no greater than that reported by females in the general Northern Ireland population. Results also indicate that those nurses who smoke were less willing to take on the role of a health promoter with patients who smoke. Implications and recommendations for practice, education and research are explored.     

Smoking cessation interventions in chronic obstructive pulmonary disease and the role of the family: a systematic literature review

AIM: This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. BACKGROUND: Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. METHODS: All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. RESULTS: Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. CONCLUSION: No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes.     

护理干预在早期慢性阻塞性肺疾病患者戒烟中的应用效果

目的探讨护理干预在早期慢性阻塞性肺疾病患者戒烟中的作用与效果。方法将早期慢性阻塞性肺疾病患者分为实验组102例和对照组110例。对照组给予常规健康教育,实验组给予多种形式的护理干预。比较两组患者的吸烟知识知晓率及吸烟行为。结果实验组患者吸烟知识知晓率高于对照组(P0.01),吸烟行为优于对照组(P0.01)。结论护理干预对提高早期慢性阻塞性肺疾病患者吸烟知识知晓率,降低吸烟率、戒烟后复吸率有重要作用。     

The use of the nicotine inhaler in smoking cessation

PURPOSE: To raise awareness among nurse practitioners (NPs) about the nicotine inhaler by providing clinical and practical information about the use of the nicotine inhaler as a treatment option for smoking cessation. DATA SOURCES: This included data-based and review articles in the medical literature, tobacco use and dependence clinical practice guideline, and Medline and Cinahl search engines. Criteria for search keywords were "nicotine inhaler" and "nicotine replacement therapy." Initial search was done in December 2004. CONCLUSIONS: The nicotine inhaler has been tested as safe and efficacious in the treatment of tobacco cessation. Clinical trials show the nicotine inhaler to be useful alone or as an adjunct to other pharmacological therapies. Current national guidelines recommend that the nicotine inhaler be used in smoking cessation therapy. IMPLICATIONS FOR PRACTICE: The nicotine inhaler is appropriate for many different smokers, including certain types of cardiac patients. NPs can include the nicotine inhaler in a group of nicotine replacement therapies to ensure that smokers are successful in tobacco cessation.     

Abuse and smoking cessation in clinical practice

Aims and objectives. This discursive paper explores issues of abuse during smoking cessation counselling. Background. During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. Methods. A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. Results. There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress‐management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patient’s decision whether to continue with cessation counselling. Conclusion. Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. Relevance to clinical practice. This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention.