Transcript Hospitalization

Hospitalization:
Nursing Role with
In-Patients Who Smoke
Created by the Registered Nurses’
Association of Ontario
Client/Patient Experience
when they become ill or hospitalized

Client/patient motivation
◦ Approx. 70% more smokers than non-smokers
access the health-care system
• Exposure to healthcare professionals who can assist
them with cessation
• Health issues could act as motivation to quit
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Teachable moments
• Opportunity to link smoking with illness
Discussion: Palliative Care &
Smoking Cessation
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Should smoking be addressed with
palliative patients?
What approach would you take when
addressing smoking with this patient
population?
Consider challenges you would have as a
nurse discussing smoking cessation with
this patient population.
Mental Health & Smoking
Individuals who suffer from mental illness are
about twice as likely to smoke cigarettes as the
general population
• Up to 90% of individuals with schizophrenia are
smokers
• Almost half of all cigarettes smoked in North
America are consumed by people who suffer
from mental illness
• Research: Lower quit rates in mentally ill people
who smoke
• Mental health clients who smoke have a life
expectancy of nearly 20% less than other
Canadians (even after suicides are discounted)
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(Els & Kunyk 2008)
Consider…
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Clients are smoking as a form of self-medication
Fear that quitting may cause mental instability
Cost of cigarettes is a significant portion of
income
Smoking is a form of socialization
Smoking to ease boredom, loneliness, and/or
anxiety
Access to cigarettes at treatment facilities is
often high
Smoke-free supportive housing is rare
(Selby & Herie 2009)
Medications & Smoking
Chemicals in tobacco can interact with
medications:
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• Examples:
Drug/Class
Mechanism of Interaction
and Effects
Caffeine
Increased metabolism
Alprazolam (Xanax)
Decreased half-life
Warfarin
Increased metabolism
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Important to keep this in mind when
encouraging clients/patients to quit
• Requires monitoring of drug levels & referral to physician
who prescribed medication
Ottawa Model
A systematic approach to tobacco
dependence treatment for hospitalized
smokers
• Designed and implemented at the
University of Ottawa Heart Institute
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• Adopted by a number of hospitals in Ontario &
across Canada
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Uses 5As Protocol
• (Ask, Advise, Assess, Assist & Arrange)
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Smokers are more likely to be
hospitalized than non-smokers
• Opportunity to help smokers quit smoking
Ottawa Model: On Admission
1.
Ask
• Ask about client/patient tobacco use in the past 6
months
• Document smoking status & quitting history
2.
Advise
• Advise client/patient to quit
3.
Assess
• Assess the smoker’s interest in quitting (during
hospital stay, within 30 days, within 6 months?)
4.
Assist
• Brief counseling (includes pharmacotherapy
options)
Ottawa Model: During
Hospitalization
for people who want to quit smoking
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Counselling focuses on:
• Managing withdrawal symptoms
• Planning how to remain smoke-free following
discharge
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Pharmacotherapy
• Offered during the hospital stay
• Prescribed for 10 – 12 weeks after discharge
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Self-help materials for smokers wanting to
quit are provided
Ottawa Model: During
Hospitalization
for people who DO NOT want to quit smoking
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Counselling focuses on:
• Pros and cons of smoking
• ie. ‘what do you see as some of the advantages and
disadvantages of smoking?’
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Pharmacotherapy is offered during the
hospital stay to help patients remain
comfortable in the smoke-free environment
Self-help materials tailored to smokers who
do not want to quit are provided
Information about community cessation
services is provided
Ottawa Model: On Discharge
5.
Arrange
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Offer follow up to all smokers
Interactive, voice response (IVR) –
mediated telephony system & database
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Automated calls inquiring about smoking
status
Results can be scanned by a nurse
Clients/patients receive a telephone call from
a nurse if they appear to need more support
Ottawa Model: Best Practices
Document smoking status
Designate staff to provide treatment
Include tobacco dependence treatment in
clinical pathways, care maps, or Kardex
systems used for quality management
4. Ensure pharmacotherapy for smoking
5. Track tobacco users for more than 30 days
after discharge, provide counselling
6. Ensure training for health-care professionals
7. Provide self-help material
8. Establish referral links
9. Evaluate the provisions of tobacco dependence
treatment
10. Provide feedback to health-care professionals
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Hospital & Long-Term Care
Facilities Smoking Policies
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Provincial/Territorial
• Varies slightly between provinces/territories
• Examples:
 In Newfoundland and Labrador ventilated smoking
rooms are permitted
 In B.C. and P.E.I ventilated smoking rooms are
permitted in long-term care facilities
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Local
• Facilities decide on their own individual policies
Tobacco Interventions
Related to Discharge Planning
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It is important to provide support,
information and follow-up
• Booklets
• Web resources
• Community counselling
Nurses Who Smoke
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Smoking prevalence among nurses is
similar to the general population
 Approximately 16%–18 %
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Nurses who smoke may feel uncertain or
conflicted about conducting smoking
cessation interventions
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Support for nurses who smoke:
◦ http://www.TobaccoFreeNurses.org/
Motivational Interviewing
Techniques
1.
Express Empathy
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2.
Avoid Arguments
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3.
Helps identify and understand resistance
and reasons for unhealthy behaviours
Client is more likely to see the healthcare
provider as being on his/her side
Develop Discrepancy (Dissonance)
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Ask about pros and cons of smoking
Listen for discrepancies that allow for the
creation of dissonance
Motivational Interviewing
Techniques (cont.)
4.
Roll with Resistance
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5.
Do not meet resistance with
confrontation, instead utilize reflection
to create dissonance
Support Self-efficacy
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Clients/patients need to be encouraged
Examine client/patient strengths
Help client/patient imagine success
Effects of exposure to secondhand smoke on the ability to quit
smoking
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It can be more difficult for a client/patient to
remain smoke-free upon discharge if they have
family & friends who smoke
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Living with a smoker is the primary cause of
relapse during a quit attempt
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Assisting clients/patients regarding how to
negotiate clean air policies in their home and
workplace should be part of discharge planning
• Web-based resources available