In 1964 a link between smoking and respiratory disease in men was discovered, and as additional research was conducted the link was also found in females. Over the years more research was discovered that the negative health factors related to smoking were more in-depth and much riskier than was originally believed. Some of the better-known diseases that smoking can cause include cancer in the mouth and lungs as well as peptic ulcers, coronary heart disease, and Chronic Obstructive Pulmonary Disease (COPD) (Colditz, 2000). Even though all of this research has been collected smoking remains the leading cause of preventable disease in America. It results in 430,700 deaths each year (Colditz, 2000). Research has also shown that individuals who have stopped smoking experience better health over the rest of their lives resulting in a better quality of life. While smoking cessation programs have been created over the years, additional research has shown that smokers have the best chance of quitting when they have a support network. When a patient is admitted to the hospital, the nursing staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational opportunities available at the hospital.
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While there are many programs available to individuals who wish to quit research has shown that the method with the highest success rate combines several methods into one. The combination of health care provider support, nicotine replacement therapies, and increased training in coping mechanisms results in a success rate as high as 58% (Health, 2000). The physical and psychological effects of nicotine must be addressed when designing a treatment program so that the individual needs of the smoker can be met (Health, 2000).
Many studies have shown that a period of hospitalization can have a positive effect on decreasing smoking if the hospital takes advantage of it with a proper smoking cessation program. When a patient is hospitalized because of a cardiac event it has the possibility of increasing the smoker’s motivation and readiness in accepting smoking cessation advice. The patient’s long-term abstinence from smoking is related to their belief that cigarettes contributed to their cardiac problems. The cessation advice given should reinforce the connection between cigarettes and the cardiac problem (Health, 2000).
Many patients are forced to stop smoking while in the hospital but are unable to continue abstaining from cigarettes after they had been discharged. Many studies have shown that programs that were developed specifically for use of patients in the hospital combining smoking-cessation and relapse-prevention programs have a better chance of success than smoking-cessation programs alone (Stevens, V.J., Russell E. Glasgow, R.E., 1993). In surveys conducted with smokers, the reason voiced most often as being the catalyst to stop smoking was a concern about their health (Stevens, V.J., Russell E. Glasgow, R.E., 1993). While the patients are in the hospital the perfect opportunity is created to promote a smoking cessation program. Their presence in the hospital brings about the realization that their health problems are a result of their lifestyle and can prompt changes if handled correctly by the hospital staff.
There has been a significant amount of research done that illustrates the increased risks of smoking after Coronary Artery Bypass Grafting (CABG) surgery. The study found that smokers who continued to smoke or started to smoke after undergoing CABG surgery increased the risk of myocardial infarction (Health, 2000). Because of this increased health risk, healthcare providers must stress the importance of not smoking.
The Agency for Healthcare Research and Quality (AHRQ) has published guidelines for smoking cessation programs. Before publishing those standards 3,000 studies underwent analysis looking for methods that would increase the effectiveness of any program (Health, 2000). Through their research they found that patients that had received CABG surgery would quit smoking under several circumstances; including when they learned that the surgery was necessary, upon admission to the hospital, following treatment, or hospital discharge (Health, 2000).
According to AHRQ’s guidelines, nurses should ask each patient about their cigarette use during each visit and advise their patients that use tobacco to quit each time. Nurses are the largest category of healthcare providers and are positioned in every level of healthcare because of their position they have the best chance of influencing their patients to quit smoking (Health, 2000). The percentage of smokers who had received advice on smoking cessation was 92%; however, only 61% of those smokers received that advice from physicians. This statistic shows the importance of nurses to communicate with their patients about the dangers and risks of smoking and provide information and encouragement on programs that will help them stop smoking (Health, 2000).
Researches in 15 studies have shown that nurses treating patients admitted to the hospital in acute care settings with cardiac difficulties were more open to smoking-cessation advice from nurses than patients admitted for another diagnosis (Health, 2000). As there is more available research to the layperson that smoking can result in heart problems or cancer, patients in the hospital for those problems are ready to listen to advice on their habits. The guidelines developed by the AHRQ can be used by any nurse to implement a variety of smoking cessation programs in the clinical setting (Health, 2000).
In order to implement a smoking cessation program, financial resources must be available. The training of the counselors in smoking-cessation techniques, the bedside counseling as well as the required follow-up ranges in cost from 3,697 dollars to 7,444 dollars (Meenan, R.T., 1998). While these numbers look large the program is less expensive than other lifesaving treatments and becomes more cost-effective as the program is utilized (Meenan, R.T., 1998). Even the presence of one smoking cessation session at the hospital with qualified counselors can create a positive impact on the patient’s ability to quit (Segnan, N., et. al. 1991). In one study where there were three groups combined with one central group who received no counseling about smoking and the three other groups who received slightly more counseling and support depending on the group. The only group that did not see an increase in patients abstaining from cigarettes was the group with no counseling (Segnan, N., 1991). The effects of the other treatment programs increased in success with the increase in counseling; however, the differences in those groups were only different in result by several percentage points (Segnan, N., 1991).
One of the problems in analyzing various studies on the effectiveness of hospital-based smoking cessation programs is the various definitions of cessation utilized. Very few of the studies used the same terminology. Other studies focused on the evaluation of patients not being treated for cardiac problems. (Stevens, V.S., 1993). The research has shown that nurses and other health care providers are in the best position to impact the success or failure of those programs. Success can be determined by how much time the nurses spend with the patient focusing on smoking cessation programs, as well as their willingness to follow up with the patient once they have been discharged. Phone calls to the patient at three to six months intervals after the smoking cessation program combined with letters provide the continued support that is required to prevent the patient from relapsing back into their old habits. By taking advantage of the period of time in which the patient is hospitalized and forbidden to smoke to teach them better habits influences a positive change in the patient’s life. It is possible to transform smokers into ex-smokers by treating the entire individual rather than only treating the disease.
Colditz, G.A. (2000). Illnesses Caused by Smoking Cigarettes. Cancer, Causes & Control. 11(1). 93-97.
Graham-Garcia, J., Health, J. (2000). Urgent Smoking Cessation Interventions; Enhancement the Health Status of CABG patients. The American Journal of Nursing. 100(5). 19-23.
Meenan, R.T., Stevens, V.S., Hornbrook, M.C., Chance, P., Glasgow, R.G., Hollis, J.F., Lichtenstein, E., Vogt, T.M. Cost-Effectiveness of a Hospital-Based Smoking Cessation. Medical Care. 36(5). 670-678.
Segnan, N., Ponti, A., Battista, R.N., Senore, C., Rossa, S., Shapiro, S.H., Aimar, D. (1991). Randomized Trial of Smoking Cessation Interventions in General Practice in Italy. Cancer Causes & Control, 2(4), 239-246.
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Stevens, V.J., Glasgow, R.E., Hollis, J.F., Lichtenstein, E., Vogt, T.M. (1993). A Smoking Cessation Intervention for Hospital Patients. Medical Care, 31(1), 665-72.