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Helping patients quit smoking: checking patients for their smoking status should be part of every nurse's patient assessment.

Last year, a survey of 371 nurses showed go percent of respondents believed it was part of their responsibility to advise clients to quit smoking. (1)

Nurses have been mobilising to help patients quit smoking; they are creating smoke-free environments and preventing youth from taking up smoking. Many nurses now appreciate that their advice to clients to quit is vital and should form part of their ongoing assessment and interactions with clients.

Quitting smoking has immediate and long-term benefits, and is the single most effective step to lengthen and improve patients' lives. Quit attempts are well worth the difficulty, for both the client and nurse. With smoking among Maori, and especially Maori women, being disproportionately high (41 percent for men and 51 percent for women), (4) it is good to see programmes specifically targeting these population groups. ALL district health boards (DHBs) are creating tobacco control action plans. One of the aims of these plans is to make smoke-free checks a routine part of patient assessment: "Pulse, respiration, blood pressure, temperature, smoking status." (2) Nurses are well placed to contribute to this life-saving work.

Nurses' smoke-free work continues to grow, despite some fearing that giving smoking cessation advice might alienate them from their patients. Students from the University of Auckland's school of nursing, in a presentation to their colleagues, addressed concerns nurses have raised (see table below). (3) After the presentation, every student nurse in the audience agreed students, as part of their undergraduate education, should learn how to help patients quit smoking.

All nurses should be comfortable asking clients if they smoke and advising them to quit--and more and more are. For those who are not, a review of education for smoking cessation interventions is underway. The goal of the review is to empower health professionals through education to implement the new smoking cessation guidelines. The guidelines provide an evidence-based framework based on three steps. A--Ask about smoking status; B--give Brief advice; and C--provide Cessation support. (5) Nurses are more than capable of delivering interventions, including nicotine replacement therapy, an effective, over-the-counter quitting aid recommended by the MoH. However, this is not yet part of nursing curricula, as it is not currently within the scopes of practice for enrolled nurses, nurse assistants or registered nurses. Smoking cessation education is available, however, from the Heart Foundation, Te Hotu Manawa Maori and the Quitline.

The number of smoke-free job opportunities for nurses is growing. Many nurses work in the smoking cessation area and others are instrumental in leading smoke-free initiatives in DHBs. Tobacco control is a ViabLe career pathway for nurses, although not yet recognised as a specialty practice area by the Nursing Council.

Nurses also recognise that tobacco control exists in a wider health promotion context. Freedom from exposure to advertising in the form of tobacco product retail displays will protect children from taking up smoking, as tobacco displays increase the uptake of cigarettes. Earlier this year, in submissions to the Health Select Committee, NZNO, the College of Nurses Aotearoa and Nurses for a Smokefree Aotearoa/New Zealand, called for a complete ban on tobacco displays in dairies, supermarkets, service stations and other retail outlets. In its submission, NZNO stated that "... tobacco displays promote smoking, undermine efforts to quit, reduce the effectiveness of other non-smoking messages and "normalise" a product which causes more harm to public health than any other single factor ... A complete ban on all tobacco displays is the only humane, responsible and effective action to address the huge environmental, economic and human costs of smoking."

All nurses can pray a part in moves to ban retail displays of tobacco. Raise the issue with your Local MP, write a fetter to your Local newspaper and Let people know there is support for a complete ban on tobacco product retail displays. A local action kit is available from the Cancer Society and ASH. See www.ash.org.nz or contact the writer on grace.wong@aut.ac.nz for more information.

The National Tobacco Control Hui, being held in Wellington in late June and organised by Te Hotu Manawa Maori, will provide a wonderful opportunity to learn about smoking cessation and network with smoke-free nurses and the tobacco control community. To register, go to http://ntcc.manaakisolutions.co.nz. A meeting of Nurses for a Smokefree Aotearoa will be held at lunchtime on Friday, June 27. All nurses are welcome to attend. For further details, contact Wong on the email above.

References

(1) Wong, G., Fishman, Z., McRobbie et al. (2007) ASH-KAN Aotearoa: Assessment of smoking history, knowledge and attitudes of nurses in New Zealand. http://www.ash.org.nz/pdf/ASH_nurses_FINAL.pdf.

(2) Evison, K. (2008) Tobacco control: An update for cessation practitioners and smokefree co-ordinators. Presentation. Auckland Smoking Cessation Network.

(3) Arcus, 3., Shepherd, G. & Washer, A. (2008) Nurses for Smokefree Aotearoa.School of Nursing, The University of Auckland.

(4) Ministry of Health. (2007) New Zealand Tobacco Use Survey 2006. http://www.moh.govt.nz. Accessed 4/04/2008.

(5) Ministry of Health. (2007) New Zealand Cessation Guidelines. http://www.moh.govt.nz. Accessed 4/04/2008.

Grace Wong, RN, BA, MPH, is a senior nursing lecturer at Auckland University of Technology and a researcher with ASH.
Perceived problem Insight

Too busy Interventions can take as
 little as 30 seconds.

Lack of expertise Virtually no expertise is needed
 to refer patients to Quitline.

No financial incentive Smoking cessation should be
 part of every client's care.

Most smokers 65 percent of smokers have tried
can't or won't quit to quit in the past five years (4)
 With help from a nurse, a patient
 may decide to quit.

Stigmatizing smokers Be positive. Say things like
 You can do it.

Negative message might Smokers want encouraging messages
scare away patients from health professionals to quit.

I smoke myself Health professionals may also
 need support to quit.
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Title Annotation:VIEWPOINT
Author:Wong, Grace
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:May 1, 2008
Words:978
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