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7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives
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Establishing AcademicPartnerships for Evidence-Based Tobacco CessationInitiatives
J anie Heath PhD, APRN-BC, ANP, ACNP Associate Dean Academic Nursing PracticeMedical College of GeorgiaSchool of NursingAugusta, GA
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Session Objectives
Recognize the health impact andhealthcare costs related to tobacco useDiscuss innovative strategies to bridgeclinical practice and research with tobaccocessation
Identify resources to shape a nursingresearch agenda for translation of cessation interventions in clinical practice
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What is the PROBLEM aboutTobacco Use
46 million adults smoke (20.9%of population)GEORGIA = 23.3% prevalenceWere HIGHER than national
average!
1200 individuals DIE every day
because of tobacco use(450,000 / yr)
Centers for Disease Control and Prevention. (2006). MMWR 54:11241127.
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What is the PROBLEM aboutEvidence-Based Practice (EBP)
Pravikoff et al (2003) found that there are
knowledge gaps and a lack of readiness toembrace EBP among nurses, educators,clinicians, and administratorsother findingsincluded:
Nurses seldom read researchMany nurses do not have access to a library intheir clinical environments
Many nurses do not have access to theInternet at the point-of-care
Pravikoff, D.S., Pierce, S., & Tanner, A. (2003). Are nurses ready for evidence-based practice?A study suggests that greater support is needed. American Journal of Nursing , 103(5):95-96.
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Why IMPORTANT to TranslateEBP Into Clinical Practice
EBP, such as with the USPHS Clinical Guideline,Treating Tobacco Use and Dependence ,improves patient outcomes and improves qualityand efficiency of healthcare delivery
Nursing has a responsibility to identify, retrieve,appraise, implement and evaluate the best
research / evidence for patient care
Heath, J . (2005). Closing the gap on evidence based practice and smokingcessation. In B. Mazurek-Melnyk & E. Fineout-Overholt (Eds). Evidenced Based Practicein Nursing and Health. A Guide for Translating Research Evidence in Practice, CD-ROM.Philadelphia:Lippincott Williams & Wilkins.
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CHALLENGES to Translate
EBP Into Clinical PracticeLack of awareness about evidence-based tobacco cessationLack of trainingLack of timeLack of efficiency in systems tosupport EBPLack of priority to support EBP and
tobacco cessationLancaster, T., Silagy, C., & Fowler, G. (2002). Training health professionals in smokingcessation. Cochrane Review. In: The Cochrane Library, Volume 4.
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SOLUTIONS to optimize
Tobacco Cessation EBP J CAHO now requires ALL pts
admitted with MI, heart failure, and/orpneumonia to receive tobaccocounseling
AHRQ support for advancedtechnology to disseminate cessationEBP guideline
www.nurses4tobaccocontrol.orgwww.tobaccofreenurses.orgwww.rxforchange.ucsf.edu
http://www.nurses4tobaccocontrol.org/http://www.tobaccofreenurses.org/http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/http://www.tobaccofreenurses.org/http://www.nurses4tobaccocontrol.org/7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives
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A MODEL for Optimal EBP Tobacco CessationOutcomes
Provide Training:Nsg EDUNsg CE
Provide SystemsSupport:Priority in
Organizations
Provide Research
Funding:Organizations
Federal
EnsureAccountability:
LicensureCertification
CessationInterventions=
Standard of Nsg Practice
Raise
Awareness:
GrassrootsState
NationalInternational
Heath, J ., Andrews, J . (2006). Translation of tobacco cessation interventions into clinical practice. Nursing Research, 55(4): S4
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The JOURNEY to Academic Partnerships
for Evidence-Based Tobacco CessationInitiatives
The NP Practice , VA Medical Center Augusta, GAGarcia-Graham, J ., Heath, J (2000). The value of urgent smoking cessation for CABGpatients. AJN. Critical Care Supplement, 19-23.
The Tobacco Cessation Curricula in Acute Care NP Education ;Georgetown University, Washington, DC
Heath, J ., Andrews, J ., Thomas, S., Kelley, F, and Friedman, E. (2002). Tobacco curriculumin acute care nurse practitioner education. Amer J Crit Care, 11 (1), 27-32.
The University of California San Francisco Collaborative Rx for Change: Clinician-Assisted Curriculum, Summer InstituteGeorgetown University, Washington, DC
Heath, J ., Kelly, J ., Andrews, J ., Crowell, N., Corelli, R., Hudmon, K.S. (in press).Evaluation of a tobacco cessation curricula intervention among acute care nurse practitionerfaculty. Amer J Crit Care.
The Dissertation
Heath, J ., Crowell, N. (in press). Attitudes about tobacco cessation education amongadvanced practice nursing faculty: A national survey. J Prof Nursing.
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OUTCOMES from the Journey for Academic Partnerships
The FIRST tobacco relatedspecial issue for acute andcritical care nurses
March 2006, 18 (1)Invitation from a Summer
Institute Fellow, SuzannePrevost PhD, RN, FAANIssue includes 20 authors frominterdisciplinary fields-medicine,nursing, pharmacyArticles include practice,education, research, and policyrelated to tobacco cessation
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REAP the Benefits of the National Coalition for EBP TobaccoCessation
GeorgetownUniversityMedical
College of GeorgiaUniversity of
ArkansasVanderbiltUniversity
Research
Education
A dvocacy
P ractice
OUTCOMES from the Journey for Academic Partnerships
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Snapshot on RESEARCH with Academic Partnership
The QUEST RandomizedControl Trial pilot evaluatingthe effect of nicotine-freeQuest cigarettes, extra-
low Quest cigarettesand Commit lozenges onhealth and cessation outcomes
x 4 FNP graduate studentsx 2 pre-med BS studentsParticipated in the 14 weekstudy
The Georgetown University-University of MN partnership to be replicated at MCG
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On-Going Questions for TobaccoRESEARCH
The Georgetown University-University of MN partnership to be replicated at MCG
The effect of a step-down approach withQuest cigarettes (RE:
.6 mg x 2 weeks, .3mg x2 weeks, .05 mgx 2 weeks) on healthand cessationoutcomes in publichousing communities
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On-Going Questions for TobaccoRESEARCH
The Georgetown University-University of MN partnership to be replicated at MCG
The effect of a step-down approach withQuest cigarettescompared to commitlozenge andVerenicline/Chantixamong psych-mentalillness communities
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Snapshot on EDUCATION with Academic Partnership
The Summer Institute of Tobacco Control Practices inNursing Education
The Rx for Change:Clinician Assisted TobaccoCessation CurriculumSince 2003
> 80 schools of nursingparticipated> 4000 nursing studentstrained> 1400 hours of collectiveEDU
The Georgetown University-UCSF partnership continued at MCG
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On-Going EDUCATION Research:The Intervention
The Rx For Change Curriculumdeveloped by K. Hudmon DrPH,RPh& R. Correlli Pharm D
UCSF School of PharmacyBased on the USPHS Clinical PracticeGuideline: Treating Tobacco Use andDependence
Extensively reviewed by experts intobacco controlComprehensive > 350 CD-slides, ancil laryhandouts, evaluation measures, casestudiesSelected Modules
Epidemiology
Forms of tobaccoGenes & tobacco usePathophysiologyNicotine addictionPharmacotherapyCounseling techniques
Acces s atwww.r xforchange.ucsf.edu
http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives
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Remaining Questions for Tobacco EDUCATION Research
How to ensure nursing studentsand nurses receive knowledgeand skills to perform cessationinterventions (implement andevaluate)
The effect of tobacco education in
nursing curricula to help patientsquit smoking The amount of tobacco educationneeded to have a positive effecton patient outcomes
The best teaching strategies fortobacco education to effect clinicaloutcomes
Kelley, J ., Heath, J ., Crowell, N. (2006). The Rx for change tobacco cessationintervention: Advanced practice nursing student outcomes Crit Care Nurs Clin N Am, 18(1): 131-138 .Heath, J ., Kelly, J ., Andrews, J ., Crowell, N., Corelli, R., Hudmon, K.S. (in press).Evaluation of a tobacco cessation curricula intervention among acute care nurse practitioner faculty. Amer J Crit Care.
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Snapshot on ADVOCACY with Academic Partnership
Nursing leaders tacklingtobacco cessation
The Great AmericanSmoke-Out
Capital Hill visits Tobacco Free MCGCampaign letters
Local, state and nationalactivities
The Georgetown University-AACN partnership replicated at MCG
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Remaining Questions for Tobacco ADVOCACY Research
How to ensure nurses feelempowered to changetobacco cessation practice
How to better inform nurseson tobacco controlpolicies/advocacy initiatives
Leading resource =www.nightingalesnurses.org
Malone, R. E. (2006). Nursing's involvement in tobacco control: historical perspective and vision for thefuture. Nurs Res, 55(4 Suppl), S51-57.
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Remaining Questions for Tobacco ADVOCACY Research
PredominantquestionHow to help nurses
find their political willfor tobacco control
Heath, J ., Andrews, J ., Andres, K. (2003). Tobacco control: An update to influence policy-makingdecisions. Policy, Politics, and Nursing Practice, 4(1), 36 44.
Malone, R. E., & Balbach, E. D. (2000). Tobacco industry documents: Treasure or quagmire? Tob Control ,9(3), 334-338.
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Snapshot on PRACTICE with Academic Partnership
Providing tobaccocessation servicesOut-patient
Group counselingIndividual counseling
In-patientIndividual consultation
Tobacco cessationprotocols/pre-written orders
Access materials atwww.nurses4tobaccocontrol.org
The Georgetown University model of practice replicated at MCG
http://www.nurses4tobaccocontrol.org/http://www.nurses4tobaccocontrol.org/7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives
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Remaining Questions for Tobacco PRACTICE Research
How to ensure all nursesperceive tobacco cessation asrelevant to practice
How to ensure workloadallows for tobacco cessationinterventionsHow to ensure nursingaccountability with tobaccocessationLeading resource =
www.tobaccofreenurses.org
Sarna, L., Bialous, S., Barbeau, E., & McLellan, D. (2006). Strategies to implement tobacco controlpolicies & adovcacy initiatives. Crit Care Nurs Clinics N Am, 18(1): 113-122.
http://www.tobaccofreenurses.org/http://www.tobaccofreenurses.org/7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives
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Remaining Questions for Tobacco PRACTICE Research
How to ensure that the
organizational culturesupports EBP and/researchutilization for nursing practiceHow to ensure organization/
department budgets includeresources to support tobaccocessation interventions (for pts& nurses)How to ensure leadershipsupports the healthcarecost/benefit ratio to sustaintobacco cessation efforts
Balkstra, C.R., Fields, M., Roesler, L. (2006). Meeting J oint Commission on accreditation of Healthcare Organizations requirementfor tobacco cessation: The St. J oseph's/Candler Health System Approach to Success. Crit Care Nurs Clin N Am . 18(1):95-104
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Questions-
But first consider thisCLOSING THOUGHT
Through the discovery of tobacco cessationknowledge , the integrationof that knowledge, theevaluation of that knowledge,and the dissemination of that knowledge .TOGETHER we can helpnurses make a difference instopping the deadly effects
of tobacco use and improvethe health and well-being of ALL individuals.
THANK YOU