Intervention for the Cessation of Smoking - Essay Example

NURSING Demonstrate understanding of basic research concepts in the analysis and consideration of that research for utilization into nursing practice ______________ ___________ _______________________ Demonstrate understanding of basic research concepts in the analysis and consideration of that research for utilization into nursing practice 1 Introduction Three resource publications have been chosen pertaining to research in intervention for the cessation of smoking in order to understand the basic research concepts utilized therein and for their possible application to nursing practice. One of the chosen publication documents the 'Guidelines for Clinical Care' issued by the University of Michigan, Health System with the primary objective of providing a framework for care providers to assist patients in smoking cessation. Second publication is also about smoking cessation and is titled 'Integrating Smoking Cessation into Daily Nursing Practice' issued by Registered Nurses Association (RNA) of Ontario. It is disseminated as a nursing best practice guideline to target audience. Third publication is also about smoking cessation and is titled ' Guidelines for Smoking Cessation' issued by the National Advisory Committee on Health and Disability (National Health Committee), Wellington, New Zealand. We would examine the clinical context in which the guidelines can be applied, discuss the research basis of the chosen resources, explain the type of research that were utilized to make the recommendations, summarize their findings and /or recommendations and how they relate to the potential utilization of the research and consider the potential feasibility for application of this research into nursing practice. Clinical Context All three chosen research publications expect improved clinical interventions to promote smoking cessation. Clinical context identified in three papers also follows more or less similar outline. It commences with care providers assessing and documenting smoking status of every patient. Following it up with the provision of actual smoking cessation intervention to all smokers. In a complementary manner treat behavioral/psychological/motivational aspects of cigarette addiction with advice and counseling and treat biologic aspects of cigarette addiction with pharmacological therapies. All three publications tend to suggest best practices to be followed by care providers in clinical settings to their clients leading to effective cessation of smoking. Basis, Type and Currency of research All of the three chosen publications listed a common basis for the research. It was found that most smokers desirous of quitting smoking placed importance on clinical advice about it but a substantial number of smokers reported that such advice was neither readily forthcoming nor was made with sufficient strength to prove effective. This telling fact left an apparent gap for suggesting ways to improve clinical intervention for cessation of smoking. Michigan publication is updated as of February 2001 having been originally developed in 1996.The basis for research was an extensive literature survey covering the period 1975-1997 using the major keywords smoking/(prevention & control), smoking cessation, tobacco use disorder/(prevention & control, rehabilitation). The search was restricted to literature that was referenced as either guidelines or controlled trials. The search was conducted in components each keyed to a specific causal link in a formal problem structure. The search was a single cycle (UMHS, 2001).RNA publication is dated October 2003 with the process of formulation beginning in February 2001. A search of the literature for systematic reviews, clinical practice guidelines, relevant articles and websites formed the basis. It identified a total of 14 clinical practice guidelines related to smoking cessation. An initial screening was conducted using the main inclusion criteria that the guideline was dated no earlier than 1996 and guideline was evidence-based (e.g., contained references, description of evidence, sources of evidence). Eight guidelines were short-listed for critical appraisal using the 'Appraisal Instrument for Clinical Practice Guidelines' (Integrating, 2003).New Zealand publication is reviewed as of May 2002.Its first compilation began in 1999.A systematic literature review, undertaken for the period 1999 to February 2002,formed its basis. Finalization had substantial interested persons' feedback and endorsements of several organizations as additional inputs (Guidelines, 2002). Major Findings Michigan publication suggested a 5 cornered strategy to ensure effective smoking cessation comprising of ASK, ASSESS, ADVISE, ASSIST and ARRANGE. The care providers were expected to adopt this strategy in respect of smoker clients. A flow chart representation of this strategy was drawn to help gain clarity. Regarding ASK/ASSESS the publication emphasized that it should be documented and techniques to remind physician of a patient's smoking status such as including smoking status stickers etc must be used. ADVISE must be clear, strong and personalized. As part of ASSIST care providers should help the patient with a quit plan; consider referral to intensive counseling (multi-session, group or individual) if needed; encourage pharmacologic therapies as appropriate; give key advice on successful quitting and provide supplementary educational materials. In ARRANGE care provider must schedule follow-up. They should ensure timing to ensure that follow-up contact occurs soon after the quit date. The publication also suggested actions during follow-up both in case if the client is abstinent or still smoking. For patients not yet ready to make a quit attempt the 4 R's motivational intervention detailed (UMHS, 2001).RNA publication also recommended ASK, ADVISE, ASSIST and ARRANGE protocol with all clients as a minimal intervention. It additionally recommended an intensive smoking cessation intervention, of more than 10 minutes duration, when their knowledge and time allowed. Nurses recognize that tobacco users may relapse several times before achieving abstinence and need to re-engage clients in the smoking cessation process. Nurses must take up intervention, paying particular attention to gender, ethnicity and age-related issues, and tailor strategies to the diverse needs of populations. In case of women who were pregnant and postpartum intensive intervention was recommended. Nurses should be knowledgeable about community smoking cessation resources, for referral and follow-up. Nurses encourage smokers, as well as non-smokers, to make their homes smoke-free, to protect children, families and themselves from exposure to second-hand smoke (Integrating, 2003). New Zealand publication adopted a 5 As strategy comprising of ASK, ASSESS,ADVISE, ASSIST and ARRANGE.Newzealand version chose not to ADVISE a client early on in intervention and preferred to ASSESS first. In case of ADVISE this publication added two more dimensions of supportive and non-confrontational advise. Rest of the guideline was more or less similar to the Michigan model stated above (Guidelines, 2002). It was observed that in all three publications pharmalogical part of intervention, forming part of ASSIST, was quite identical. Differences were minor. Pharmalogical intervention was focused around use of Nicotine Replacement Therapy(comprised in use of Nicotine patch/gum/nasal spray/inhaler) and Bupropion.While Michigan publication went on to document available dosages/cost, dosing, duration, instructions and side effects in case of each of these treatment types; the RNA publication listed both without documenting in detail the above aspects. New Zealand publication also had same phrmalogical treatment but highlighted the fact that Bupropion was recommended by the Medicines Adverse Reactions Committee (MARC) as second line pharmacotherapy in New Zealand(Guidelines, 2002). Relevance to Nursing Practice Three chosen publications have at center stage the ASK, ASSESS, ADVISE, ASSIST and ARRANGE flowchart of clinical intervention for cessation of smoking. While the publications bring out the need for more clinical intervention to assist cessation of smoking they also suggest in details the most effective way of doing so by means of a detailed step by step analysis of the above intervention flow chart. The analysis has broken the process down to the stage of ready use verbatim by care providers while providing for situational flexibility. Publications cover pharmalogical as well non-pharmalogical interventions.Pharmalogical interventions are fairly standard across clinical usage but they are exhibited as staged part of strategic intervention. Thus content, timing, manner and audience of intervention have been stated with clarity for immediate use. Clinical intervention is no longer a stray tool for nursing to address smoking cessation rather it has become a planned and sharpened tool with clear objectives. For instance as the RNA publication states," The most important tip is emphasizing the minimal intervention aspect of this best practice guideline. This takes less than three minutes. Nurses and others need to know that minimal intervention can be easily integrated in their daily practice. The minimal intervention is crucial for implementation. It can be implemented not only by nurses, but by all healthcare providers in any clinical setting"(Integrating, 2003). Further the New Zealand publication recommends to implement a practice-wide system that ensures the smoking status of every patient is up to date and include smoking status in routine data collected. It urges care providers to ask how the patient feels about their smoking and at the same time warns that the most important variable determining how smokers will respond to any intervention is their readiness to change. It also recommends structuring an agreed approach to assisting smokers who are ready to quit apart from anticipating barriers and addressing them as appropriate. It says having culturally and educationally appropriate materials on smoking cessation (where available) in consulting rooms helps substantially (Guidelines, 2002). The 4 R's motivational intervention for patients not yet ready to make a quit attempt would be a definitive addition to nursing practice(UMHS, 2001). These direct statements of planned and idealized activities when implemented would be a direct addition to nursing practice for cessation of smoking. . . References UMHS Smoking Cessation Guideline, February 2001 Integrating Smoking Cessation into Daily Nursing Practice, Nursing Best Practice Guideline, Registered Nurses Association of Ontario, October 2003. Guidelines for Smoking Cessation, National Advisory Committee on Health and Disability (National Health Committee), Wellington, New Zealand. May 2002 Read More