Registered Nurse Initiation of a Tobacco Intervention Protocol
This article summarizes the development and implementation of a registered nurse-initiated protocol to intervene with hospitalized patients who are tobacco-dependent, may be experiencing tobacco withdrawal, and who are hospitalized in a smoke-free environment. Tobacco use is the leading cause of preventable death in the United States. Hospitalization provides a unique teachable moment to treat tobacco dependence. Nurses can be effective in talking with patients about tobacco use. The clinical nurse specialist spheres of influence model and the role of the clinical nurse specialist were important for developing a tobacco use intervention protocol. A multi-disciplinary team created key objectives. These included identifying and assessing all patients who use tobacco, providing treatment to manage both withdrawal and address tobacco dependence, providing comfort to patients while hospitalized in a tobacco-free environment, encouraging lifelong cessation. The bedside admitting nurse was chosen as the pivotal professional to trigger tobacco use interventions. A protocol was finalized that requires the bedside nurse to assess all patients for past and current tobacco use. The nurse is then prompted to (1) provide information about tobacco dependence and treatment, (2) ask if the patient wants nicotine patch therapy to address withdrawal and, (3) order a consult with a specialist at the patient's request. Extensive and varied educational programs were developed to support the implementation of the protocol. The tobacco use intervention protocol has become important for providing assessment and intervention to patients who use tobacco. It has increased the number of specialist consults provided to patients. It has increased compliance with quality reporting data by national quality accrediting bodies.
- [Show abstract] [Hide abstract] ABSTRACT: The US Public Health Service Guideline for Treating Tobacco Use and Dependence 2008 Update emphasizes tobacco use as a chronic medical disorder; highlights both behavioral counseling and the use of 1 or more of the 7 approved medications; and points out the utility, efficacy, and reach of telephone quitlines. The treatment of users of smokeless tobacco continues to be less than optimal. Although providing evidence-based treatment for tobacco- dependent patients is a challenge for busy physicians, a team approach including trained and certified tobacco treatment specialists (TTS) provides an efficient treatment model. TTS represent a new and growing part of the health care team and hold great potential for expanding the collective tobacco treatment expertise in the medical setting. The effective treatment of tobacco dependence frequently requires tailoring, and often intensifying, interventions (both counseling and pharmacotherapy) to meet the needs of the individual patient.
- [Show abstract] [Hide abstract] ABSTRACT: 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.
- [Show abstract] [Hide abstract] ABSTRACT: to evaluate a three-hour smoking cessation program and its effect on nurse knowledge, counseling behaviors, and confidence in counseling behaviors. program evaluation. a Magnet-designated, 500-bed community hospital in Southern California. 107 nurses. program content included behavior counseling and pharmacotherapy along with role playing. Investigator-developed self-report surveys were completed on the day of the class and at 3, 6, and 12 months. Short- and long-term changes in nurse knowledge, attitudes, and behaviors about tobacco cessation efforts. knowledge significantly increased from baseline to post-test. Counseling skills improved. Nurses who completed all surveys exhibited no significant changes about asking patients to quit smoking but did demonstrate significant changes at three months regarding advising patients, assessing quit readiness, and providing assistance. Changes were maintained over the year. Nurses' average ability to counsel patients was rated "good or very good" after one year. At 3, 6, and 12 months, most respondents reported providing cessation counseling or referrals to at least one patient. these findings support tobacco cessation programs for bedside nurses as useful in enhancing nurse confidence in patient-counseling skills. study findings demonstrated benefits to using the developed curriculum. Additional research is needed on tobacco cessation programs for hospital nurses, particularly with longitudinal outcomes and actual nurse behaviors.