Nurses

Smoking Cessation in Nursing

        Health care providers can have a significant impact on their patients’ smoking habits.   Nurses interact one-on- one with a number of patients each shift which makes them good candidates to perform tobacco cessation screening and brief interventions. In addition, when patients are admitted into a hospital they are forced into a period abstinence which can be taken as an advantage to encourage them to remain abstinent. ¹

        According to the TTUD 2008 clinical practice guidelines, most patients want their health care provider to ask about their smoking status. In addition, patients are more likely to quit after being advised to do so by a health care provider. ^{1 2}  A review of 31 studies found that adults who received advice and encouragement to quit from a nurse had higher chances of quitting than those who did not. Among those who received advice from a nurse, 15-20% quit smoking. On the other hand, for those in the group who didn’t receive advice form a nurse only 3% quit. It’s evident that a nurse’s advice can help patients successfully quit smoking. It has also been found that nurses working in a hospital setting have a higher effect on the quitting decision making than nurses in other settings.

        Due to the fact that nurses are on the front lines working with and interacting with patients daily, they are uniquely provided with the opportunity to intervene in the patients’ tobacco use.^{5 2} With that in mind, a survey conducted by Sarna and colleagues looked at the frequency in which nurses intervene in tobacco use by implementing the 5A’s intervention strategy.  In addition, they were interested in finding the nurse’s awareness of Tobacco free Nurses (TFN, a web-based resource about tobacco control created specifically for nurses).

• Overall, the majority (73%) of nurses asked about tobacco use ,
• 62% advised  and assessed  
• Only 37% assisted with cessation efforts
  • 19% arranged follow-up
  • 24% recommended  medication 
  • 22% recommended resources or
  • 10% recommended use of the quitline.   In addition, it was found that only
• 15% of the nurses were aware of the TFN. Those who were aware were more likely to both assess and assist their patient with cessation. ⁵

Sarna and colleagues concluded that awareness of tobacco cessation programs makes nurses and health care practitioners more inclined to intervene in tobacco use with their patients. For that reason, it is important to increase nurses' awareness of the resources available to them for successfully conduct tobacco cessation intervention.  Current research also suggests that one of the main barriers for nurses concerning assessing and assisting their patients in smoking cessation is the lack of knowledge of available resources.^2,5

Nurses and brief intervention

For more information on brief interventions please visit our page on them by clicking here.

The 5 A’s is a commonly used brief intervention by health care providers.  The 5 A’s consists of:^2,4

• Ask about tobacco use
• Advise the patient to quit
• Assess readiness to quit
• Assist the patient in quitting
• Arrange a follow up to check their status

        It’s important to note that the 5A’s intervention can be delivered successfully among patients who tend to be more motivated to quit. If a patient is not ready to quit, then nurses can simply advise them to do so. A key factor for the success of brief intervention is motivation. Consequently, the TTUD clinical practice guideline (2008) stresses the importance of motivation when it comes to quitting smoking. Therefore, it has been found to be beneficial for nurses to be familiar with motivational strategies like the “5R’s” to enhance the patient’s motivation to quit: ^2,7

• Relevance: Why is quitting personally relevant
• Risk: Potential negative consequences particularly relevant for the patient
• Rewards: Benefits of stopping smoking
• Roadblocks:  Identify possible barriers to quitting
• Repetition: Repeat at every treatment session.

3A’s:

        The 3 A’s is an abbreviated version of the 5A’s and it consists of conducting only part of the intervention (Ask, Advise, Asses).   However, the use of the 3A’s is more commonly used by health care providers who lack time to interact with their patients, which may not be the case for most nurses. However, the 3A’s can be beneficial for nurses that work in certain areas of the hospital, like the emergency room. ^2,5

Intervention support:

        If a health care practitioner finds out that their patients is ready to quit, they can conduct the 5 A’s from beginning to end. Currently, it seems that even though smoking status is often assessed by many health care practitioners, they do not follow up with their patients. Resources have been developed to assist health care providers to assist in this follow up or continuation of the cessation intervention.   It is helpful to keep in mind that there are many resources available that can be used to help your patient reach cessation. ⁷

• Fax to Assist: This program is a quick and convenient way to refer your client to the state Quitlines where a trained cessation counselor will connect with your patient to conduct counseling sessions over the phone.  We have other information about our Fax to Assist program on our website.  

• Quitlines: The Maryland State Quitline is a telephone based support program that provides quality and evidence based treatment for people who want to quit smoking.  We recommend reading more on our site here or at the Quitline’s webpage.

Things to remember:

• Remember that the majority of smokers want to quit and just need someone to offer information about how to begin.
• Remember that most smokers do not need a formal program to quit; they just need some advice.
• Have knowledge of the  Stages of change for quitting smoking: Precontemplation, Contemplation, Preparation, Action, Maintenance.
• Hearing the same advice from several people is more effective than if it is heard just once, so encourage other professionals working with your clients to talk to them about their tobacco use too.

Tools for talking to your clients about tobacco use:

• The Nurses Help Your Patients Stop Smoking Guide sponsored by the NATIONAL INSTITUTES OF HEALTH, National Heart, Lung, and Blood Institute provides a comprehensive guide for nurses to help their clients successfully quit smoking.
  • Included in the guide is information on how to: Quit and Be Free, Breaking the Habit, Sticking with Your Effort to Stop Smoking, Smoking Cessation Contract, Pocket Guide to Nurses' Smoking Intervention.

Useful websites for you:

• Tobacco Free Nurses Initiative

Other useful documents: Helping Smokers Quit: A Guide for Nurses⁴Social Causes and Health Care Position Statement: Prevention of Tobacco Use in Youth.⁵Fax to Assist If you are employed by a HIPAA-covered facility, please CLICK HERE for more information on Fax to Assist and our Fax Referral Program.