What are the factors that influence the delivery of smoking cessation advice in critical care environments?

Smoking is a big problem Largest cause of preventable death, disease & disability Approximately 5000 deaths yearly in NZ (Abdullah & Husten 2008)

Directly or by second hand smoke Damages every body organs Causes cancer Aggravates existing health conditions (Ministry of Health, 2007)

The cost of smoking Smokers use the health system more than non-smokers Health System cost directly linked to Smoking: $1.9 billion per year (Wright, 2008) Decrease in GDP due to lost work production (Jenkins, 2009)

MOH targets Better help for Smokers to quit 95% of smokers expected to be asked & offered support to stop smoking

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

Literature review Search methods Electronic 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

Recruitment Eligibility criteria were identified as registered medical and nursing staff of all levels of practice full and part-time doctors and nurses were included in the study Not included: doctors and nurses on long term leave (parental leave, sick leave, any other form of long-term leave) during the two month study period

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

Demographics

Healthcare professionals’ smoking status Smoking statusTotal countDoctorNurse N%N%N% Current smoker Ex-smoker (>28 days since last cigarette) Ex-smoker (<28 days since last cigarette) Never smoked

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

References Abdullah, A. & Husten, C. (2004). Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax, 59(7), 623. doi: /thx Jenkins, M. (2009). Implementing the ABC Approach for Smoking Cessation:Framework and work programme. Retrieved from approachsmoking cessation-feb09.pdf approachsmoking cessation-feb09.pdf Ministry of Health New Zealand Tobacco Use Survey 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), Rice, V., & Stead, L. (2008). Nursing interventions for smoking cessation. The Cochrane Database of Systematic Reviews (1), Art.No: CD doi: / CD 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 cessation.doc