Smoking Cessation and the Role of the Nurse

Habitual smoking is a worldwide health crisis that can shorten life expectancies by over 20 years and create fatal illnesses such as lung cancer, emphysema and heart disease (Whyte,2007).Because smoking can lead to chronic and acute illnesses, nurses can have and impact on their clients health by educationg them on the importance of smoking cessation.


Paste the rest of your old paper plus the new part and all the references over these words. Leave the following text intact.Nursing strategies for this are to act as role models by not smoking themselves, promoting smoking cessation in the adult clients, and educating children and adolescents on the dangers of taking up smoking.
The International Council of Nurses believes that nurses can be very helpful in the prevention of smoking and smoking cessation. Nurses can help to reinforce this influence on their client’s by not smoking themselves since they are regarded by the public as important health role models. Just as important, or even more so is to provide a good example for their own children in order to safeguard the nurses health and that of their family. Children of smokers have an increased risk of sudden infant death syndrome, respiratory infections, lung cancer and ear infections (Kellogg, 2002).
Smoking and the willingness to try a smoking cessation program should be assessed with clients. Nurses working in Dr’s offices who see the same clients on a regular basis are in an optimal position to do this. Cost should not be a deterrent since the clients’ employer may offer programs or their insurance benefits may cover the cost of smoking cessation programs. While some clients may not be ready to quit, the nurse may follow an approach called the “transtheorhetical model of change.” This method is a way to help clients move through stages such as: precontemplation, contemplation, preparation, action and maintenance in order to prepare them for smoking cessation. During precontemplation, the client has no intent on quitting smoking in the next six months. The contemplation stage is the time that the client has an intention to quit during the next six months time. Preparation is the stage that the client has planned to quit in the next 30 days and has taken behavioral action toward action. The stage that follows preparation is the action stage which includes clients who have quit for less than six months. Lastly, is the maintenance stage in which the client has remained free of smoking for more than six months.
Another approach for the nurse to use with smoking cessation is the intervention steps known as the five A’s which include: ask, assess, advise, assist and arrange (Whyte, 2007). Asking clients about their smoking is always the first step. For the younger person asking about what their friends do is also important. Assessing includes whether or not the client is ready to make a change within the next 30 days. Advising pertains to providing help and motivation for the smoker to quit. Assisting the client could include many options such as: setting a quit date, recommending smoking cessation pharmacotherapy, removing all tobacco items from the clients’ environment, individual or group therapy, expecting challenges and enlisting help from friends and family. Lastly, arranging follow up contact by either in-person or telephone conversations to keep track of the client and continue with support.
Nurses can also help support their clients by educating them on the available pharmacotherapy treatments for smoking cessation. There are six currently available treatments approved by the Food and Drug Administration (FDA) for smoking cessation: one nonnicotine treatment and five nicotine replacement products that differ based on delivery mechanism (Ford, 2006). The nicotine replacement products include the nicotine inhaler and nasal spray which are available by prescription and the nicotine gum, lozenge and patch which are available over the counter. Clients should be advised to completely stop smoking before using nicotine replacement product to increase their chance of success. Sustained-release bupropion (bupropion SR) is approved by the FDA for smoking cessation, is available by prescription in tablet form and should be started before the client stops smoking. It is believed to ad smoking cessation through the inhibition of various neuro chemicals normally activated in the brain by smoking (Scanlon, 2006). Bupropion SR Bupropion SR and the nicotine patch can be combined for another alternative.
While interventions and pharmacotherapy’s can be effective in smoking cessation with the adult population, smoking prevention among children and adolescents is better than the cure. The younger a person begins to smoke, the greater their risk of smoking-induced diseases such as cancer or heart disease (Whyte, 2002). For this age group, peer lead prevention programs can be very effective. These can include videos or films which highlight the social consequences such as: smelly clothing, bad breath, financial cost and decreased athletic ability. Nurses working in schools can help by promoting smoke-free environments and reinforce the dangers of smoking.
Smoking has many adverse effects on health and contributes greatly to morbidity and mortality. Because smoking can lead to chronic and acute illness, nurses can have an impact on their clients’ health by educating them on the importance of smoking cessation and the avoidance of smoking in children and adolescents. Nurses can also set a healthy example by not smoking themselves. These strategies can help to increase abstinence rates and decrease tobacco-related mortality and morbidity which can help to improve their client’s lives.
Intervention #1- Promoting smoking cessation in adult clients.
Disadvantage #1- The high addictiveness of cigarettes.
Due to the high addictiveness of tobacco, clients participating in smoking cessation treatments do not always respond as readily as many healthcare professionals would like. It is the complex neurobiology of tobacco that is likely to be responsible for the development of tobacco dependence. The nicotine is the principal addictive component of tobacco smoke and shares many of the pharmacological characteristics of a psychostimulant drug such as amphetamine and cocaine.
Balfour, D., (2002). The Neurobiology of Tobacco Dependence: A Commentary. Respiration. 69, (1). 7-11. Retrieved February 4, 2008, from Proquest database (677604631).
Disadvantage #2- The financial costs of smoking cessation treatments.
Smoking cessation medications can range in price from $3.50 to $11.00 per day. Medicare does not cover smoking cessation treatments and private insurers have been reluctant to cover these costs as well. Their lack of coverage comes even as the healthcare savings has been estimated to be $1,623 a year for each person that quits smoking. Fortunately, tobacco cessation treatments are available and effective, and more medications are being developed to treat tobacco dependence. However, the inability of tobacco users to afford these treatments remains a barrier to reducing smoking cessation.
Solberg, L., (2005, June). Impact of insurance coverage on the use and effects of smoking cessation medications. Disease and Management Health Outcomes. (3). 151-58. Retrieved February 5, 2008, from EBSCO database (1173-8790).

Intervention #2-Educating children and adolescents on the dangers of taking up smoking.
Disadvantage #1-Peer pressure and the smoking behavior of their closest friends.
Research findings show that adolescent peer relationships contribute to adolescent cigarette smoking. Youth who are friends with smokers have been found to be more likely to smoke themselves than those with only nonsmokers as friends. Best friends, romantic partners, peer groups and social crowds all have been found to contribute to the smoking or non-smoking behavior of teenagers. Rather than coercive pressures, the decision to smoke has been found to be more about trying to fit in, social approval and popularity.
Castrucci, B.C., Gerlach, K.K., Kaufman, N.J., Orleans, C.T., (2002, September). The association among adolescents’ tobacco use, their beliefs and attitudes, and friends’ and parents’ opinions of smoking. Maternal and Child Health Journal. 6(3). 159-67. Retrieved from EBSCO database February 5, 2008.
Disadvantage #2- Advertising and promotion of smoking that appeal to adolescents.
Despite tobacco industry claims, researchers have consistently implicated cigarette marketing activities as an important catalyst in the initiation of smoking in adolescents. Due to advertising, studies show and increase in smoking rates among population subgroups specifically targeted by marketing campaigns.
Biener, L., (2000, March). Tobacco marketing and adolescent smoking: more support for a casual inference. American Journal of Public Health, 90(3). 407-11. Retrieved February 5, 2008, from EBSCO database (0090-0036).


References

Kellogg, John Harvey, (2002, June). Tobaccoism. American Journal of Public Health, 92 (6). 932-934. Retrieved October 12, 2007, from EBSCO database (0090-0036).

Potts, Lisa A., (2007, August 15). Emerging psychotherapies for smoking cessation. American Journal of Health-System Pharmacy, 64 (16). 1693-1698. Retrieved October 12, 2007 from EBSCO database (1079-2082).

Saarman, L., Daugherty, J, & Riegel, B. (2002, June). Teaching staff cognitive-behavioral intervention. MedSurg Nursing, 11(3). 144-151. Retrieved January 7, 2007, from Expanded Academic ASAP database (A87509029).

Scanlon, A. (2006, November). “Nursing and the 5A’s guideline to smoking cessation interventions”. Australian Nursing Journal, 25(4), 14- . Retrieved January 7, 2007, from Expanded Academic ASAP database (A154562471).

Whyte, F., & Kearney, N. (n.d.). Enhancing the nurse’s role in tobacco control. Retrieved February 4, 2007, from http://www.tobacco-control.org/tcrc_Web_Site/Pages_tcrc/Resources/Factsheets/enhancenursesrole.pdf