Impact of a webcast on nurses' delivery of tobacco dependence treatment.

AIMS AND OBJECTIVES: To evaluate an educational programme about nurses' role in tobacco dependence treatment, and its webcast component, on the long-term impact of increasing the frequency of nurses' self-reported changes in practice related to delivery of smoking cessation interventions. BACKGROUND: Healthcare professionals' knowledge about evidence-based tobacco dependence treatment using the 5As framework (Ask about tobacco use, Advise users to quit, Assess willingness to quit, Assist in making a quit plan and Arrange for follow-up, including referral to a quitline) is essential to increase smoking cessation rates in the United States. DESIGN: A 6-month pre-post design. METHODS: A convenience sample of nurses (N = 283) from Kentucky and Louisiana was provided access to the webcast and printed toolkit. Responses from those who completed an online survey at baseline, and at 3 or 6 months postimplementation of the educational programme were included in an analysis of changes in the consistent (always/usually) delivery of the 5As plus referral to the quitline. RESULTS: After 3 months, the intervention had a significant impact on increasing nurses' reports of consistently providing the 5As to patients who smoked, which was largely sustained at 6 months. Nurses who viewed the webcast were three times more likely to refer smokers to a quitline at 3 months; and four times more likely at 6 months than those who did not. CONCLUSIONS: An online educational programme, plus printed toolkit about tobacco dependence treatment increased nurses' delivery of smoking cessation interventions over time. This study provided preliminary evidence that including a webcast in a nurse-targeted educational programme could significantly increase the proportion of nurses who referred smokers to a quitline beyond the benefit of access to printed materials and web-based resources. RELEVANCE TO CLINICAL PRACTICE: Distance learning is a feasible mechanism for enhancing nurses' involvement in tobacco dependence treatment and promoting evidence-based clinical practice.

Nurses' Attitudes toward Intervening with Smokers: Their Knowledge, Opinion and E-Learning Impact.

BACKGROUND: Numbering about 90,000, nurses represent the largest group of health care providers in the Czech Republic. Therefore, nurses can make a significant impact in the treatment of tobacco dependence, particularly in applying brief interventions to smokers. METHODS: During 2014, 279 nurses from the Czech Republic participated in an e-learning education programme consisting of two Webcasts with additional web-based resources about smoking cessation in relation to health and treatment options in daily clinical practice, particularly regarding brief intervention methods. Before viewing the e-learning programme, and three months after viewing it, the nurses completed a questionnaire documenting their interventions with smokers and their knowledge, attitudes and opinions regarding nurses' roles in smoking cessation. RESULTS: The responses in all of the following categories significantly improved: usually/always asking patients about smoking from 58% to 69% (OR 1.62, CI=1.14-2.29, p=0.007); recommendations to stop smoking from 56% to 66% (OR 1.46, CI=1.03-2.06, p=0.03); assessing willingness to quit from 49% to 63% (OR 1.72, CI=1.23-2.42, p=0.002); assisting with cessation from 21% to 33% (OR 1.85, CI=1.26-2.71, p=0.002); and recommending a smoke-free home from 39% to 58% (OR 2.16, CI=1.54-3.04, p<0.001). The increase in arranging follow-up from 7% to 10% did not constitute a statistically significant improvement, however, this finding is understandable in relation to the status of nurses in the Czech Republic. However, nurses' confidence in helping smokers to quit smoking, their senses of responsibility and determining the appropriateness of these interventions remains inadequate. CONCLUSION: The nurses' brief intervention skills improved significantly after the completion of the e-learning programme, even though reservations remain among this group. The systematic education of nurses aimed at smoking cessation intervention and analyzing their motivation for treatment may contribute to improved nursing care, and thus lead to a reduction of smoking prevalence in the general population.

Supporting smoking cessation in older patients: a continuing challenge for community nurses.

Tobacco smoking continues to pose negative health consequences for smokers and their families, and is the single greatest cause of health inequalities in the UK. Older people are particularly vulnerable to the negative health impacts of smoking and therefore, supporting older smokers to quit remains an important public health goal. Community nurses are required to help patients to lead healthier lifestyles and have ideal opportunities to encourage smoking cessation in older people who are affected by smoking-related health conditions, or whose existing conditions may be exacerbated by continued smoking. This paper discusses how community nurses can support their older patients to quit smoking by fostering a patient-centred partnership through good communication and empathy. The newly developed 'Very Brief Advice on Smoking' (VBA) interventions can provide a useful tool for community nurses who experience time constraints to advise older people that psychosocial support with treatment is the most effective method of smoking cessation, while respecting the health decisions of patients.

The meaning of smoking for patients with mental disorder.

When patients smoke cigarettes in psychiatric services, it brings to the forefront current ethical and political dilemmas. This study aims to explore the meaning attributed to smoking by mental health patients who smoke and who are hospitalized in a psychiatric ward of a general hospital. This qualitative descriptive study was conducted with 96 smokers who were hospitalized in a psychiatric ward in Brazil. Semi-structured interviews, test of nicotine dependence, and content thematic analysis were carried out. The results show that tobacco has an important role in the lives of psychiatric patients. The meanings they attribute to tobacco use are related to overcoming difficulties that are consequential of mental disorders and of side effects caused by their treatments.

Evaluation of a theory-based education program to motivate nursing students to intervene with their seriously mentally ill clients who use tobacco.

Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.

A review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health.

BACKGROUND: The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease, and early cardiovascular disease and death. Effective cessation interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality. AIMS: To review available evidence on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco treatment to guide the development of a program in college health. METHODS: A comprehensive literature search for studies published from January 1999 to February 2011, in multiple databases was conducted, along with hand-searching of reference lists. Inclusion criteria were: participants aged 18-30 years, intervention involved the Internet through either Web sites or e-mail or texting, and outcome measurement of tobacco cessation/abstinence. Studies were evaluated utilizing a tool synthesized from guidelines presented by the Cochrane Collaboration. FINDINGS: Eight studies met the inclusion criteria (four randomized controlled trials, four cohort studies). Theoretical frameworks utilized were the Transtheoretical Model of Change, Health Belief Model, Theory of Social Support, and social cognitive theory. Interventions varied and included computer-generated advice letters, Web-based cessation guides, computer-generated text messages, and peer e-mail support. With smoking abstinence as the primary outcome measure, there was a statistically significant improvement in quit rates. Because of the use of multiple components, differences in interventions and the number of contacts, it is not clear what types of computer-based applications are most effective. Small sample sizes, lack of control groups, and inconsistency in outcome measures limit the ability to provide conclusive evidence to support these interventions-but support the feasibility to use in the design of future programs. CONCLUSIONS: Use of technology-based interventions, such as the Internet, may be an effective tool for tobacco treatment interventions, especially with college students. There is great potential to reach large numbers of students, many who may not identify themselves as smokers or seek traditional methods for treatment. Additional research is needed to determine which technology-based interventions are most effective and to provide more conclusive evidence.

Nurses' treatment of tobacco dependence in hospitalized smokers in three states.

Hospital-based nurses (N = 1,790) from three states reported their interventions to help patients quit smoking. Frequency of nurses' interventions in one low tobacco use state, California (n = 651), were compared to nurses' interventions in two high tobacco use states, Indiana (n = 720) and West Virginia (n = 419). Nurses in California were significantly more likely to Advise smokers to quit (OR 1.34, 95% CI [1.06, 1.69]) and Refer smokers to a Quitline (OR 2.82, 95% CI [1.36, 5.88]) compared with nurses in the high tobacco prevalence states. Other aspects of their interventions did not differ by state. Quitline referral was infrequent (16%) but was quadrupled if nurses arranged for smokers to quit (OR 4.07, 95% CI [3.11, 5.32]).

Tobacco intervention practices of postsecondary campus nurses in Ontario.

Cessation interventions offered by nurses to postsecondary students could represent an important strategy for reducing smoking among young adults. This study examines how nurses working in campus health clinics identify smokers and provide cessation support. Of 108 nurses working at 16 universities in the Canadian province of Ontario, 83 completed a researcher-designed questionnaire. Of these, 8.2% asked almost all patients about their tobacco use and 27.4% asked almost none; 83.1% advised identified smokers to quit, 63.9% offered them assistance, and 59.0% arranged follow-up visits. Smoking was most often assessed during patient visits for respiratory or cardiovascular concerns. Assistance most often involved referral of smokers to other professionals or services. A government-funded tobacco control initiative implemented on 10 of the 16 campuses had limited influence on whether nurses assessed tobacco use and advised cessation. Education and support may be needed to improve the frequency and quality of tobacco interventions provided by nurses working on postsecondary campuses.

Training nurses in the treatment of tobacco use and dependence: pre- and post-training results.

AIM: This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. BACKGROUND: Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. METHOD: A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. RESULTS: Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. CONCLUSION: Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Integrating results from smoking cessation drug research and development into clinical occupational health practice.

This article documents evidence-based pharmacologic interventions to promote successful smoking cessation among employees who smoke. The article also highlights supporting evidence for the use of pharmacologic agents to treat tobacco dependence and can guide successful, personalized, pharmacologic smoking cessation interventions in occupational clinical practice. Prescribing clinicians will also find information about the latest research and development of medications to promote smoking cessation, including recently implemented black box warnings by the U.S. Food and Drug Administration.

Counteracting ambivalence: nurses who smoke and their health promotion role with patients who smoke.

Morbidity and mortality associated with smoking are major health problems. Nurses play an instrumental role in tobacco reduction, but their own smoking often interferes with this clinical opportunity. We conducted a grounded theory study with 23 nurses who smoked to describe how they managed the contradictions encountered when caring for tobacco-dependent patients. Nurses counteracted ambivalence in one of four ways in relation to smoking policies: indifferent, evasive, engaged, and forced compliance. Influencing these approaches were nurses' perceptions of patients' need for tobacco-dependence interventions and perceptions of their own vulnerability in addressing tobacco use. The challenge remains how best to support smoking nurses to enable them to become unambivalent participants in preventing and reducing tobacco dependence in their patients and themselves.

Theories used in nursing research on smoking cessation.

Theories tell how and why things work; how and why one variable is related to another. Research findings that are theory based can be placed in a framework that advances science further than findings that are unconnected to formal theory. However, much of the research in smoking cessation is atheoretical. This review of nursing research on smoking cessation published from 1989 through 2008 revealed that nearly half of the studies were based on explicit formal theories. The transtheoretical model and self-efficacy theory were the most frequently used explicit theories with most theories emanating from psychology. Five nursing theories were identified in this review. Studies that used implicit rather than explicit theories dealt with five major concepts: nicotine dependence, social support, high-risk situations, mood-affect, and the influence of clinical diagnosis. Largely missing from this set of studies were investigations based on biobehavioral models, including genetics and neuroscience. The relevance of the theories and concepts identified in this review to current clinical guidelines on smoking cessation is discussed. With their grounding in theory and their expert knowledge of clinical issues, nurses are in an excellent position to develop theories that will help researchers in every discipline make sense of smoking cessation.

Systems approaches to tobacco dependence treatment.

Nurses have been at the forefront of initiatives to improve patient outcomes through systems change. Nursing research addressing systems approaches to treatment of tobacco dependence has demonstrated increased implementation of evidence-based practice guidelines. Existing health system research conducted by nurse scientists has focused on four strategies: tobacco use identification systems, education and training of nursing staff to deliver tobacco intervention, dedicated staff for tobacco dependence treatment in both acute and primary care settings, and institutional policies to support tobacco intervention. Nursing involvement in multidisciplinary health services research focusing on tobacco treatment has lagged behind advances in clinical nursing research of individual-focused smoking cessation interventions. Health information technology shows promise as part of an integrated approach to systems changes to support tobacco intervention, particularly in light of the current national emphasis on adoption and meaningful use of electronic health records. Future directions for translational research present unprecedented opportunity for nurse scientists to respond to the call for policy and systems changes to support tobacco treatment.

Nursing interventions in tobacco-dependent patients with cardiovascular diseases.

Smoking is a well-established risk factor for cardiovascular disease (CVD). This chapter provides an overview of a program of nursing research relevant to tobacco use in patients with CVD. The Women's Initiative for Nonsmoking (WINS) provides a rich demonstration of a key randomized clinical trial (RCT) on the efficacy of smoking cessation in women. The National Institutes of Health priority for data mining of existing RCTs is demonstrated in the numerous presentations of findings from secondary papers from WINS that answer additional research questions relevant to smoking cessation, including the influence of depression on smoking, myths about and underuse of nicotine replacement therapy. The methodological and logistical challenges inherent in tobacco intervention studies are presented, including a discussion of research needed in the measurement of withdrawal symptoms. Additionally, the role and contributions of nurses serving on the federal guideline development process are highlighted. International research activities of the coauthors from Jordan and Korea are also presented, including a discussion of the need for research in waterpipe use.

A review of research by nurses regarding tobacco dependence and mental health.

The prevalence of tobacco use and dependence among those with psychiatric and/or substance use disorders is exceptionally high, contributing to significant morbidity and mortality. The purpose of this review is to discuss the findings conducted by nurses regarding smoking and mental health. A search of the available literature since 1950 resulted in a review of 17 studies authored or coauthored by nurses. Most study designs were descriptive with only one investigator reporting the results of a small clinical trial. In addition to documenting smoking patterns in this population, investigators found that many psychiatric nurses assessed their clients for tobacco use and advised them to stop smoking but few intervened intensively to aid cessation. Psychiatric nurses reported low efficacy for delivering interventions and considerable doubt about their clients' abilities and motivation to stop smoking. Although some desired additional training in tobacco dependence interventions, nurses reported feeling ethically conflicted about, and were inconsistently supportive of, system level interventions such as tobacco free health care settings. It is likely that these findings, as well as the paucity of tobacco dependence studies, reflect the relatively small number of psychiatric nurses conducting research as well as the inattention, until recently, of mental health leaders, policy makers, and funders to the importance of tobacco dependence research in this clinical population. As tobacco dependence treatment for those with mental illnesses and/or addictive disorders becomes more of a public health priority, opportunities abound for nurse researchers to contribute to the growing evidence in this often neglected area.

Evidence-based smoking cessation interventions for patients with acute respiratory disorders.

Worldwide, tobacco use continues to be the most significant preventable cause of death and hospital admissions, particularly related to respiratory diseases. Acute respiratory illnesses requiring hospitalization provide an opportunity for nurses to intervene and help smokers quit. Of the three top hospital admissions related to respiratory diseases, chronic obstructive pulmonary disease (COPD) is the one that continues to have increased mortality whereas community acquired pneumonia and asthma have decreased over the past 5 years. The course of all three can be caused or exacerbated by continued smoking. This review describes the state of the science of nursing research focused on tobacco cessation interventions for hospitalized patients with COPD, asthma, or community acquired pneumonia. Additionally, we describe two evidence-based, nurse-driven, hospital protocols to treat tobacco dependence that can serve as models of care. Recommendations are made as to how to effectively promote nursing interventions for tobacco cessation in the acute care setting.

Tobacco dependence treatment education for baccalaureate nursing students.

Tobacco use is the leading cause of preventable disease and death in the United States. Nurses are effective interventionists for tobacco dependence treatment but lack the related education. This quasi-experimental study evaluated the impact of the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum on baccalaureate nursing students' perceived knowledge, confidence, skills, and opinions related to tobacco dependence treatment. Cohort 1 completed a process evaluation to assess acceptability of the pretraining survey and intervention. Cohort 2 completed pretraining and posttraining surveys. A subsample received a 2-hour intervention, whereas other participants received 6 hours of training. Cohort 1 rated the pretraining survey instrument favorably. In cohort 2, the Rx for Change program had a positive impact on perceived knowledge, confidence, skills, and opinions. Outcomes did not differ based on duration of intervention or students' smoking status. Further research related to standardized content for tobacco dependence treatment is indicated.