Implementation and Evaluation Plan to Follow Up on the Effects of Smoking Among Nurses - Assignment Example

? Section D: Implementation Plan In the initial stages of this intervention, a program deign was made. Decisions were made based on the content, level of intensity and relevant issues to be addressed in the intervention program. Indeed smoking among nurses is a problem that has persisted for long, yet little has been done to mitigate it and its effects to this group of smokers. This plan for the implementation of the program actually does translate the design into a very effective operation that could alleviate the problem or reduce it to a greater extends. During planning for the implementation process, precision of relevant details and focused execution is of essence. There are various approaches which have been fronted by many medical practitioners and scholars as being effective in this process (Canadian Council on Smoking and Health, 2003). As has been noted in earlier discussion, effective cessation interventions for tobacco related issues require a healthcare facility-based program, which was approximated to take a minimum of at least 6 weeks. This would combine various methods and tools to assist in the implementation process. While carrying out this plan, the participation of all stakeholders is of greater importance since owning of any program by those affected is one sure way of ensuring it is well implemented. The implementation plan would take the following steps: Determining the first program and type that needs to be addressed Here, the cessation intervention programs will take into account the three most important types of gaining change. These would be the awareness of the effects and necessity of changing the behavior, supportive environment that would ensure the nurses are not attracted to smoking and are encouraged by the efforts, and the change in lifestyle for these nurses to start seeing some of their normal practices as actually being abnormal. This implementation part requires that the health facility identifies prior to implementation the strengths and relevant weaknesses of the nurses to ensuring that the above aspects of change are realized. In this case, we take advantage of the strengths that these smoking nurses have to adapt to change by using them to conquer their weaknesses. This is because the implementation program is geared towards making sure that we have a long-term effect and change in behavior in that the cessation would last longer (Royal College of Nursing, 2002). While creating awareness; the level of awareness for participants is increased by creating an interest in the topic. In this case, newsletters, health fairs, posters and testing for toxic levels could be realized. This simply works by motivating the nurses to attend the intervention program. In lifestyle change, the behavior of the participant is changed. This will be done through modification processes, skill building to tackle the urge for smoking and using the experiential learning processes. This kind of implementation practice should be done throughout the period allocated for the intervention program. Supportive environment will be given so as to ensure that a long term, healthy and sustained lifestyle is achieved by these nurses. This will be implemented by putting much emphasis Determination of the level of intensity of the intervention program In the implementation process, the level of intensity in which the intervention program is being carried out will help in the determination of the degree of success, and this is affected by the amount of resources in place, time that has been allocated for such an exercise, and the human resources available in the carrying out of the process. It is expected that the level of awareness for nurses attending the intervention for cessation of smoking might not be high since most of the nurses might assume they already know enough. However, it is envisaged that since an enabling environment that supports change of behavior would have been put in place, including best exercise facilities, provision of healthy foods that discourage use of cigarettes, incentives and relevant recognitions accorded to healthy behaviors by these nurses would make it possible to achieve high maintenance of required healthy behaviors. Focusing on selected program areas An analysis will then be done in the finding out of the possible pros and cons of each program that had been identified. The acceptability of the nurses to have such an area covered will be determined. This target group of smokers should be given priority within the implementation setting. Other possible cessation programs could be looked into and the issues comprehensively addressed to ensure that the effect is felt among the smokers (Canadian Council on Smoking and Health, 2003). The personal monitoring process for smoking cessation intervention Once everything has been set up for the program, it is necessary that certain things are carried out in order to help the persons who are smokers to cease smoking. This will begin by screening the nurses for the use of tobacco. This is because not all people would admit that they smoke since some of the smokers do it privately. There is need to give some form of minimal smoking cessation interventions in form of messages to these nurses who are found to be smoking whenever such an opportunity presents itself. In most cases, over half of those screened for smoking tobacco normally do express the desire to stop smoking but are pulled back by the addiction. The best duration to give this stage is 30 days for the participants in the process to quit smoking as they undertake the intervention. There is need to indicate to the people who smoke that their fellow medical team is ready to give assistance to them so that they can quit smoking. Therefore, a serene clinical environment is of greater importance. There should be a public display within the healthcare environment where messages that encourage the nurses to quit smoking are placed. This could have a faster effect on making the nurses exercise restraint as far as smoking is concerned. The cessation materials should be made in such a way that they are visible to all passersby (Canadian Council on Smoking and Health, 2003). When the above has been done, it is necessary that information is provided to the nurses so that this could support them in their use of identified pharmacological and non-pharmacological aids that are usually administered to people who smoke and are willing to quit smoking. In checked or monitored settings, the subsequent implementation of short term replacement of nicotine as a way of helping the people who smoke to stop doing so has been approved by the medical authorities. This is because the inherent risks that are associated with such short term aids has been overtaken by the serious risks that are normally posed to people who do cigarette smoking. The program for minimal smoking cessation intervention which normally lasts for one to three minutes will be carried out under keen clinical observations. This will have to take the following process: ASK where the nurses will be asked about their tobacco use for the six months that have elapsed and if they are ready to quit the smoking habit. Dependent on the availability of time for such an exercise, the nurses will be assessed in terms of their motivation to start a change of behavior by application of the techniques for motivational interviewing (Berger, 2004). The tobacco use status will then be documented so as reference could be made and such records will be well kept. ADVICE is necessary and this is given to all the nurses participating. The importance of them having to quit smoking is expressed in the most non-judgmental manner which should also not be ambiguous to provide the best information to them. ASSIST where the healthcare providers give the minimal intervention exercise. This should then be followed by giving the smokers support and any other self-help resources that have been identified. ARRANGE process is initiated where the follow-up activities are undertaken to ensure that the nurses are faring on well after quitting. The minimal intervention program should be given when deemed necessary and where one seems not to have responded well, other means could be employed (Miller & Rollnick, 1991). While implementing the various strategies identified for this process, it might be necessary to introduce the pharmacological methods where drugs are used to help the nurses quit smoking. It is usually necessary that pharmacological therapies be administered to all the smoking people unless when we have very special circumstances that prohibit such an approach. Appropriate treatment is normally sought by looking at the medical records of these smokers (National Health Committee, 1999). Research has shown that the pharmacological approach to encouraging people to quit smoking normally doubles the duration that a given smoker would have taken if he or she happened to quit smoking. These pharmacological approaches include the tobacco-dependent treatment, NRT or nicotine replacement therapy and the bupropion hydrochloride treatments are supposed to be given a priority while considering measures to undertake since they have been found to be most effective in the smoking cessation intervention programs (Canadian Council on Smoking and Health, 2003). Section E: Evaluation Plan A very logic model will be put in use for the implementation program. This will be the depiction of inputs to the program, activities identified, outputs and the outcomes relating to the program. The program will begin by achieving short term outcomes which might take from 0 to 6 months. This will be followed by the intermediate outcomes that would take 3 to 9 months. Finally, there will be long term outcomes which could take from 6 to 12 months. This evaluation will be done by use of the logic model framework. Evaluation Data Collection Data is collected in different ways. The nurses are to be taken through a process where the personal details of each person are taken. These details are represented in form of a cueing system by use of charts. This could be done through the labels given to each of the nurses’ status of smoking in a very clear and visible manner by use of stickers, or on a flow sheet. This has the effect of prompting the providers of such health care services to effectively integrate and consistently address the smoking cessation program. It has been recognized that those individuals who are in the smoking status are normally at different stages when it comes to being ready to stop smoking when asked to through the intervention program. The stages of Change model when well used could have the capacity to helping the nurses who are in the smoking cessation program to understand their various levels of willingness to quit smoking and change their behavior. When using this model, the progress of the nurses towards quitting smoking is normally accomplished when one who has been smoking is able to transit from one stage to the next in the behavior change to quit smoking (Fiore, 1997). Outcomes The outcomes expected from this implementation are that the nurses who would have participated in this process would quit smoking within the first 6 months. Given the approach taken, it is expected that long term cessation of smoking will be realized. However good a smoking cessation intervention program might be, its implementation requires thorough involvement of the person, in this case the nurse, so that he or she can be able to own it and be part of the implementation process. Most smokers also have been known to quit smoking in public but end up smoking in private places where no one can see them. Such behaviors might prove to be detrimental when it comes to the implementation of smoking cessation programs. References Berger, B.A. (2004). Assessing and interviewing patients for meaningful behavior change. Part 2. The Case Manager, 15(5), 58-62 Canadian Council on Smoking and Health (2003), Guide your patients to a smoke-free future: A program of the Canadian Council on Smoking and Health. Ottawa, Ontario: Canadian Council on Smoking and Health Fiore, M. C. (1997). AHCPR smoking cessation guideline: A fundamental review. Tobacco Control, 6 (Suppl. 1), S4-S8 Miller, W. & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: The Guilford Press. National Health Committee (1999), Guidelines for smoking cessation: Quit Now. New Zealand Guidelines Group Royal College of Nursing (2002) Clearing the air: A nurses guide to smoking and tobacco control. London, England: The Royal College of Nursing. Read More