What are the factors that influence the delivery of smoking cessation advice in critical care environments?
Smokers in Hospital
• Hospitalisation can provide an opportunity for smokers to quit
• smokers make up a high percentage of patients admitted to intensive care (Green and Briggs 2006, Jones et al. 2001)
Smokers in Hospital
• Healthcare professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice.
What does this mean to you?
A B C
Images of Critical Care
Images of Critical Care
Literature review
Search methodsElectronic databases [Medline, CINAHL plus and Google Scholar] were used to search for relevant literature. Keywords for the literature search included the following: • Smoking cessation• Quit smoking• Smoking cessation advice• Critical Care• Intensive Care• Acute Care
Literature review
• explored key factors that influence the delivery of smoking cessation advice by doctors and nurses in acute care settings
• provided a summary of key factors such as: Education Attitudes, Views and beliefs Patient acuity Time constraints Lack of systems and resources Organisational culture
• scant literature about smoking cessation advice in critical care environments
• apparent lack of research on smoking cessation advice in critical care environments.
Aim
• To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings.
• will add the perspectives of critical care-doctors and nurses- in relation to the delivery of smoking cessation advice.
Methods
• single centre study in large tertiary hospital• Study sites: two adult critical care departments
including a 14 bedded general intensive care and a 16 bedded cardiovascular intensive care unit
• Quantitative cross sectional design with an online survey
• target population: nursing and medical staff working in adult critical care
Survey instrument
• electronically distributed questionnaire • Two surveys were developed, one for doctors
and one for nurses • The questionnaires consisted of four parts and
included a combination of closed and open questions
Study sample
eligible to participate: 202 nurses 35 doctors • 105 respondents completed the survey (44% response rate)• 105 respondents consisted of 90(85.7%) nurses and
15(14.3%) doctors • Response rate per unit:
27(25.7%) Cardiovascular Intensive Care Unit 78 (74.3%) General Intensive Care Unit
DemographicsCharacteristic Doctor Nurse Total %
Sex
Male 10 10 20 19.0
Female 5 80 85 81.0
Ethnicity
European/Pakeha 11 60 71 67.5
Asian 4 21 25 23.8
Maori 0 3 3 2.9
Pacific Island 0 2 2 1.9
Other 0 4 4 3.8
Years of practice
Less than 12 months 2 5 7 6.7
1-5 years 3 17 20 19.0
6-10 years 4 26 30 28.6
11-15 years 2 13 15 14.3
More than 15 years 4 29 33 31.4
Age of Nurses*
18-24 6 6.7
25-34 21 23.6
35-44 27 30.3
45-54 25 28.1
55-64 8 8.9
65 2 2.2
Key findings
• both doctors and nurses are aware of health risks of smoking and potential for nicotine to cause addiction
• Both groups reported satisfaction with level of smoking cessation education they received. Most education has been delivered though in-service education and hospital based study days
• both professional groups showed positive attitudes towards smoking cessation and regarded advising patients to stop as part of their responsibility
Key findings
• Patient acuity and its effect on competence influences critical care doctors’ and nurses’ ability to provide smoking cessation support
• The recovery phase following critical illness has been identified as an opportunity to provide patients with cessation advice
Recommendations
• to make smoking cessation education specific to critical care areas
• include more information on available referral pathways and documenting provided advice
• focus on the application of the ABC approach in awake, orientated and ex-tubated patients
• integrate questions about smoking cessation advice or follow-up advice into the current work of follow-up clinics
Recommendations
• need for a specific cessation protocol for critical care (cessation advice is given following assessment of cognitive function and competence)
• complexity of available smoking cessation documentation seems to be a challenge
Conclusion
• provision of smoking cessation advice is an on-going World Health Organisation and New Zealand Government priority
• all parts of the health sector need to provide responses
• However responses need to be adapted to the specific context such as the unique challenges of critical care
ReferencesAbdullah, A. & Husten, C. (2004). Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax, 59(7), 623. doi: 10.1136/thx.2003.018820.
Jenkins, M. (2009). Implementing the ABC Approach for Smoking Cessation:Framework and work programme. Retrieved from http://www.moh.govt.nz/moh.nsf/pagesmh/8794/$File/implementing-abc-approachsmoking cessation-feb09.pdf
Ministry of Health. 2007. New Zealand Tobacco Use Survey 2006. Wellington: Ministry of Health.
Wright , C. (2008). Excess Costs to Health Care as a Result of Tobacco Use in New Zealand During 2006/2007. Ministry of Health, Wellington, NZ.
Further Reading
Aekins, V. (2008). Maori health: Smoking as a serious issue. Nursing & Health Journal Articles, 3.
Blakely, T., Thomson, G., Wilson, N., Edwards, R., & Gifford, H. (2010). The Maori Affairs Select Committee Inquiry and the road to a smokefree Aotearoa. NZ Med J, 123(1326), 7-18.
Rice, V., & Stead, L. (2008). Nursing interventions for smoking cessation. The Cochrane Database of Systematic Reviews (1), Art.No: CD001188. doi: 10.1002/14651858.CD001188.pub3.
Jones, M. (2009). Nurses’ Role in Smoking Cessation Provision of NRT to Patients and Their Whanau. Retrieved 10/05/2011, from Ministry of Health http://www.moh.govt.nz/moh.nsf/pagesmh/7447/$File/nurses-role-smoking-cessation.doc