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