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How nurses can help patients quit smoking

Nurses are accustomed to treating the injuries and illnesses that bring patients to the ER or OR, even the chronic conditions that patients in assisted living might exhibit. Treating the primary condition is always the priority in these settings, but nurses also have the underlying duty of being a guide to the health and well-being of their patients. Lifestyle choices heavily factor into a person’s health (i.e. diet, exercise regimen or substance use) and health-care professionals often take on the role of an advocate when treating patients, who, if they continue on unhealthy paths, might face consequences. Smoking is a leading harmful behavior connected to death, cancer and other serious health conditions. This reality makes it all the more important for nurses to intervene and provide guidance when possible. For instance, if a patient who smokes is treated semi-frequently for bronchitis, nurses should be prepared to have a frank conversation with the patient regarding the real reason behind it all.

Woman holding no-smoking sign

This can be easier said than done. Patients can often be sensitive when it comes to discussing their habits, and may, in all likelihood, want to quit but simply don’t know how. It’s a delicate conversation, but an important one considering the position of authority and influence nurses can communicate from. At-risk patients need to be engaged even more so, and there are many strategies nurses can implement. Every effort matters, as nurses are proven to have a measurable impact in helping smoking cessation programs succeed.

Smoking on decline, but still dangerous as ever
According to the U.S. Centers for Disease Control and Prevention, 21 of 100 U.S. adults were smokers in 2005, but that level fell to 15 percent in 2015. Nurses, as will be shown, played a role in this decline. However, even at current levels, smoking is a clear and ever present danger to smokers and those around them. Further, CDC statistics show cigarette smoking causes more than 480,000 deaths every year in the U.S. (1 in 5 is due to smoking annually), with 41,000 resulting from exposure to secondhand smoke. And while the share of smoking is falling in America, it remains stubbornly high and even rising across the globe. The 6 million deaths caused by tobacco may grow to 8 million by 2030.

Given the stakes, it becomes clear just how important nurses are in warning patients against the dangers of smoking: 16 million Americans live with a disease caused by smoking (ranging from cancer, heart disease, stroke, diabetes, chronic obstructive pulmonary disease as well as increased risk of tuberculosis, immune system issues and rheumatoid arthritis). For every death smoking causes, at least 30 more individuals live with a serious smoking-related illness. Some of these losses are preventable, which makes this an even bigger issue to address with those at risk: Smokers die 10 years earlier than nonsmokers, on average. Meanwhile, if current rates of smoking among U.S. teens continue, 5.6 million Americans younger than 18 years old will die prematurely from a smoking-related condition.

Nurses play a key role
The magnitude of such statistics is overwhelming, but the effect nurses have on patients cannot be shortchanged. Almost 7 in 10 adult smokers want to stop, according to the CDC. Many of them require the professional guidance and can benefit from resources that nurses can provide.

A recent study conducted by The Ohio State University found that even a short talk with a knowledgeable nurse can have big outcomes. The researchers tracked 1,528 patients across five community hospitals in Michigan: 16.5 percent who were admitted to intervention hospitals self-reported having quit smoking, compared to 5.7 percent in the nonintervention hospitals. The study defined an intervention as a nurse (previously trained to coach on cessation) meeting with a patient to provide advice and follow-up resources needed to quit.

“Nurses have the greatest access to patients, they have relationships with patients and they can relate the benefits of quitting to the patient’s medical condition,” said Sonia Duffy, a professor of nursing at OSU and a lead author of the study, published in American Journal of Preventivie Medicine.

Nurses can leverage their education, experience and skills when helping patients along the road to quitting. Yet medical expertise on its own is not enough. The ability to forge personal connections is critical, calling the use of soft skills like communication and bedside manner into play. Here are some strategies to help nurses in guiding patients to stop:

Have a structure to follow
Conversations on smoking cessation can be aided by adhering to a specific structure. The talk itself doesn’t have to be scripted, but there are a few key points that nurses will want to address with patients. The CDC has one such protocol that nurses can employ called “The 5As”:

● Ask: Inquire about readiness to quit tobacco use.
● Advise: Raise awareness on the benefits of quitting to the patient. Maybe in context of the dangers of continued smoking.
● Assess: Make a judgment call on whether the patient is responsive or not.
● Assist: If they are responsive, provide advice and resources, which include support groups, relief aids (like nicotine gum) and other references; if not ready, let them know you’re there to help once they are.
● Arrange: Schedule a follow-up meeting for those taking the steps to quit, as well as those who have expressed an interest.

This structure not only helps nurses have a productive conversation, but also helps them and their patients understand that quitting is an ongoing, complex effort that includes action and follow up to help them stay smoke-free. A crucial facilitator to this is connecting patients with materials that assist in quitting, including hotline numbers, product recommendations and advocate group meeting times. Many are already well-aware of the dangers posed by smoking, and instead need someone who can personally help them realize their goals.

Know how to frame the conversation
Structure can only take the conversation so far, but nurses also need to know how to customize their approach to the patient based on their motivations and lifestyle. Smoking affects different aspects of life, the costs of which can manifest in various ways, whether it’s the financial impact or the emotional toll on family and friends when a loved one dies prematurely due to a smoking-related disease. According to Cancer.org, the average cost of a pack of cigarettes is $6.36. Add to that $35 in associated health-related costs with each pack smoked and it becomes a price tag of nearly $15,100 annually. Such stark figures may be a good way to resonate with some patients, while others may respond to the prospect of adding years to their life.

Provide patients with the right resources
Good advice is not enough to get patients to take tangible steps toward quitting smoking. While they may have all the advice and recommendations, they may not actually have the tools to take action, so it’s vital for nurses to have the ability to connect patients with materials and support systems that can help them quit on their own terms.

An informed intervention may call for nurses to provide quitting products (like nicotine gum), prescribe cessation relief medication (which may be needed to counter withdrawal symptoms), distribute brochures and literature, recommend strategies (such as a productive substitute for cravings), as well as offer lines of communication to ensure the patient is enabled and empowered to quit.

“[Patients] were armed with everything they needed when they left [an intervention] – medication, behavioral tactics, a manual to help them stay on track,” said Duffy.

Man taking a drag of a cigarette

Interested in more nursing education? Contact the University of Arizona
Helping patients quit smoking is an enormous responsibility. Nurses need to continually keep up with new strategies and methodologies in cessation efforts, and update knowledge on how to better engage with at-risk individuals. Many pursue continuing education as a means to enhance their nursing knowledge base, and a Master’s of Science in Nursing can help prepare nurses for those tough conversations with patients who are smokers. Learn more about the online MSN program and contact an admissions advisor today to see what this program can do for you.

Sources:

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm

https://www.cdc.gov/tobacco/campaign/tips/partners/health/materials/twyd-5a-2a-tobacco-intervention-pocket-card.pdf

https://www.cancer.org/research/infographics-gallery/tobacco-related-healthcare-costs.html

https://news.osu.edu/news/2016/09/16/nurses-help-smokers/

Recommended reading:

6 Ways to Improve Patient Safety

Study: Patient Mortality Risks Decrease with the Presence of Professional Nurses

3 Ways Nurses Can Set a Health and Wellness Example

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