1. Nico-hosp-intro 1.1 Smoke-free hospital European Training guide Training programme designed for hospital staff to deal with smoking Version 2003 Smoke-free Hospital European Training Guide Nico-hosp

2. Nico-hosp-intro 1.2 Smoke-free hospital European Training guide Navigate in Nico-hosp Introduction Assessment and Evaluation Motivation : health effects Minimum/Basic Activities Communication and Motivation NRT Bupropion Consultation Motivation : addiction

3. Nico-hosp-intro 1.3 Smoke-free hospital European Training guide Introduction 1. Justification of the training manual 2. European Smoke-free Code 3. Clinical staff role in smoking cessation 4. Smoking concerns all hospital staff 5. What staff must do?

4. Nico-hosp-intro 1.4 Smoke-free hospital European Training guide Justification of the training manual

5. Nico-hosp-intro 1.5 Smoke-free hospital European Training guide Justification (I) Smoking is a health priority. It is the leading preventable cause of premature death and disability in developed countries. The reduction of the tobacco consumption is the most important public health measure that can be adopted by developed countries to improve both health and economy. The benefits achieved by smoking cessation are obvious, with a marked reduction in mortality and morbidity due to smoke related illness. To deal with smoking we need multidisciplinary and comprehensive actions.

6. Nico-hosp-intro 1.6 Smoke-free hospital European Training guide Justification (II) Health Care Professionals play an important role both as clinicians and health educators. Currently, training in smoking prevention and therapy is poor or virtually nil in university curriculum. It is necessary to improve periodically our knowledge regarding this problem. All Hospital Workers must contribute to create a fine environment for health education, avoiding smoke at the hospital, enforcing smoke banning and guaranteeing that in all waiting rooms there are leaflets and journals promoting healthy ways of life.

7. Nico-hosp-intro 1.7 Smoke-free hospital European Training guide Guide Objectives To update the knowledge of Health Care Professionals and provide specific training on: Tobacco related illnesses Relevant aspects regarding smoking consumption: behaviour related, tobacco consumption, determining factors and relapse reasons. Diagnosis of smoking in people. Effective intervention techniques: No smoking advice Pharmacological therapies Physiological support

8. Nico-hosp-intro 1.8 Smoke-free hospital European Training guide Smoke-free Hospital code Engage decision-makers. Inform all personnel and patients. Appoint a working group. Develop a strategy and an implementation plan. Set up a training plan to instruct all staff on how best to approach smokers. Organise cessation support facilities for patients and staff in the hospital and ensure continuity of support on discharge into the community. Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.). Support systems are in place to protect and promote the health of all that work in the hospital. Promote smoke-free actions in the community setting. Renew and broaden information to maintain commitment to the policy. Ensure follow-up and quality assurance. First convince,then constrain considering legislation if needed. Have patience!

9. Nico-hosp-intro 1.9 Smoke-free hospital European Training guide Clinical staff role in smoking cessation Past In Northern Europe, tradition of nurses dealing with nicotinic weaning. In France, tradition of doctors dealing with nicotinic weaning, In the States, tradition of psychologists dealing with smoking cessation, Present NRT are available OTC (possible self medication ). Nicotine substitutes are available in hospitals. Future Staff have a central information role. Smoking : a nurse diagnosis as well as medical one Smoking amongst patients: nurses and other health professionals are often the closest.

10. Nico-hosp-intro 1.10 Smoke-free hospital European Training guide Smoking concerns all hospital staff All hospital staff in contact with in and out patients. All hospital staff in contact with in and out patients. Smoking cessation consultation for the most severe patients (<3%). Smoking cessation consultation for the most severe patients (<3%). Smoking cessation facilitators/units to help various services in dealing with smoking patients. Smoking cessation facilitators/units to help various services in dealing with smoking patients. Doctors, surgeons of all specialities, Doctors, surgeons of all specialities, Other health care professionals; pharmacists, etc… Other health care professionals; pharmacists, etc…

11. Nico-hosp-intro 1.11 Smoke-free hospital European Training guide What staff must do ? Identify smokers Note down smoking with vital signs (pulse,...) Collect smoking history Getting the smoker to progress towards quitting (not ready, hesitating, ready) Provide help and assistance to smokers willing to quit Prevent relapse Explain why smoking is not allowed Supply NRT to smokers in need Smoking diagnosis for all Smoking diagnosis for all Advancing towards preparing smokers to quit Reduce risks and substitute lacks with those who do not want to quit Help smokers who are ready with NRT Help with other treatments

12. Nico-hosp-intro 1.12 Smoke-free hospital European Training guide European adaptation will be developed with many contributor : :Belgium Michael Pettiaux. Fares - BrusselSpain Galice Begoña Alonso. Direction Générale de la santé publique. Gouvernement de Galice. Santiago de Compostela Jorge Suanzes. Direction de la santé publique. Gouvernement de Galice. Santiago de Compostela Catalogne Pilar Roig. Hopital Sant Joan de Reus. Tarragona Esteve Salto. Direction Générale de la santé publique. Catalan Government. Barcelona Elvira Mendez. Institut Catalan d’Oncologie. Barcelona Tarsila Ferro. Institut Catalan d’Oncologie. BarcelonaFrance Anne-Laure Douspis. AP-HP – European Network for Smoke-free Hospital. Paris Loïc Josseran. AP-HP - European Network for Smoke-free Hospital Paris Anne Marie Schoelcher AP-HP - Network for Smoke-free Hospital Paris Bertrand Dautzenberg. AP-HP - European Network for Smoke-free Hospital ParisIreland Ann O`Riordan, National Health Promoting Hospitals Network, Ireland This training guide is base on the French Nicomède training module developed with the help of French Ministry of Health