winnie wu role of smoking counselling & cessation … of smoking counselling ... role model...
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Role of Smoking Counselling& Cessation Counsellor and sharing of experience on anti – smoking services
Wu Man Ying Winnie
APN (FM & GOPC) /NDH
2007
Learning Objectives
1. Understand the background and services of Smoking Counselling & Cessation Clinic
2. Recognize the role of Smoking Counselling & Cessation Counsellor
3. Identify patients for referral to SCCC
Background
Since May 2002, HAHO had initiated the Smoking Counselling and Cessation Program (SCCP) in 10 Smoking Counselling and Cessation Centres(SCCCs 無煙 新天地) including fivehospitals and five General Out-patientClinics
Locations of SCCC(May 2002)Hong Kong IslandPamela Youde NethersoleEastern HospitalSai Ying Pun Jockey Club GOPC
Kowloon RegionPrincess Margaret Hospital SOPCQueen Elizabeth HospitalOur Lady of Maryknoll HospitalCheung Sha Wan Jockey Club GOPCTseung Kwan O Jockey Club GOPC
New TerritoriesNorth District HospitalTuen Mun Hospital, Ambulatory Care Centre
Tuen Mun Yan Oi Polyclinic
Background( Cont’d)
Till now the number of SCCCs has increased to 30 including 16 full-time & 14 part-time hospitals/ GOPCs
In the past few years, a total of about 200 smoking cessation counsellors have been trained by IANS
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HAHO Quitline 2300 7272
The statistics of Smoking Counselling & Cessation Centres (May 2002-April 2007)
Number of new cases: 17,000
Average success quit rate at 1 month62.5% (2002)68.3% (2003)76.2% (2004)75.3% (2005)75.0% (2006)
Role modelIndividual CounsellingMotivate and encourage smokers to have Smoking CessationHelp smokers to overcome barriersProvide pharmacological and behavioral change therapyTelephone follow up counsellingPrevent relapse of smoking
Role of Smoking Cessation Counsellor
1st visit : Face to face counselling2 week : Telephone counselling
1 month : Face to face counselling
3 month, 6 month, 1 year : Face to face counselling or telephone couselling
Monitor client’s progress as follows
Monitor vital signs, body weight, body height, BMIAssess smoker’s smoking history: e.g. daily smoke consumption of cigarettes, smoking habit & quit history and etcIdentify and assess the smoker of readiness to quitAssess the smoker’s nicotine dependence level by using Fagerstrom Test
Total score may vary from 0 to 10Score 0-3 : low nicotine dependenceScore 4-5 : moderate nicotine dependenceScore 6-10 : high nicotine dependence
At First Visit (Face to face counselling)
Assess the smoker’s stages for change (Pre-contemplation, contemplation, preparation, action & maintenance)Review the smoker’s medical history, surgical history, psycho- social history and etcMeasure CO level by using CO monitor
At First Visit (Cont’d)
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At First Visit (Cont’d)
Motivate the smoker to quit
Educate the smoker about the effects/ hazards of smoking
Educate the smoker about the benefits of smoking cessation
Set a quit date
Identify and develop plans to avoid triggers
At First Visit (Cont’d)Skills training: help smokers to overcome barriers associated with cessation, such as nicotine withdrawal symptoms, depression and weight gain. and coping skills, behavior therapy, weight control and using ‘5D’ to deal with cravings
‘ 5D ’ : DeclareDelayDeep breathing Drink more waterDistract yourself
At First Visit (Cont’d)
Recommend nicotine replacement therapy (NRT). Educate the client how to use NRT, dosage, duration of therapy and adverse reactionEncourage smokers express their fears and difficultiesGain support for smoker from spouse, family members and friendsArrange follow up
1 week telephone counselling
Ask about :The smoker’s smoking statusThe difficulties while quittingThe use of NRTAny signs of nicotine withdrawal symptomsRepeat the coping skillsProvide support, concern and encouragement
1 month follow up ( prefer face to face counselling )
Check vital signs: BP, pulse, BWMeasure CO level by using CO monitorAsk about the smoking status, side effect of NRTEncourage the quitter to report perceived benefits form stopped smokingProvide skills in maintenance and prevention of relapse
1 month follow upFor smoker- reinforce smoker’s decision to quit- review the benefits for quitting- assist the smoker to anticipate the problems during quitting Encourage diet control & exercise to prevent gaining body weightGive support, concern and encouragement Including : successful award certificate and souvenirArrange follow up
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3 month, 6 month, 1year follow up (telephone or face- to- face counselling)
Ask about the smoking statusEncourage the quitter to report the benefits of quitting Avoid triggersProvide skills in maintenance and prevention of relapseFor smoker- Reinforce smoker’s decision to quit - Review the benefits of quitting- Assist the smoker in solving problems during quitting
3 month, 6 month, 1year follow up( telephone or face- to- face counselling)
Provide support , concern and encouragement & including souvenir
Arrange follow up
Suggest and encourage the quitters to share the quitting process to smokers
Health benefits of quitting smoking20 mins
BP/P normal, circulation improves8 hrs
. CO level in blood drops to normal rate. O2 level in blood increases to normal
24 hrs Chance of heart attack decreases
48 hrs Nicotine not detectable, taste and smell improved
Health benefits of quitting smoking
72 hrs Breathing easier, energy increases
2-12 wks Circulation improves, walking easier
1-9 months .Coughing, sinus congestions, fatigue
and SOB all decrease.Body’s overall energy level increases
Health benefits of quitting smoking
1 yearHeart disease death rate is halfway back to that of a nonsmoker
10 year.Ca lung death rate drops almost to the
rate of nonsmokers.Incidence of other cancers decreases
( College of Nursing at Ohio State , 2002)
Nicotine Replacement Therapy (NRT)
Nicotine Patch
Nicotine Gum
Nicotine Inhaler
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Consult Medical Advisor for the following conditions
Severe cardiovascular diseaseUnstable anginaHyperthyroidism
Diabetes MellitusUncontrolled hypertension
Client aged < 18 years old
Professionals from own affiliated hospital e.g. In-patient, SOPD, para-medical staff such as dietian, physiotherapist and etc
Self-enrolment through NDH Quitline(2929 1080) or HAHO Quitline (2300 7272)
Walk-in
Sources of Referrals
SCCC / NDH Sources of ReferralApril 2006 – 31 March 2007)
27.1%
56.6%
2% 0%
6.1%8.2%
0%
10%
20%
30%
40%
50%
60%
Per
cent
age
of r
efer
ral
In-patient SOPD Other dept. NTEC Cluster Quitline Walk-in
Waiting time of the referrals
Stat or as soon as possible if medical condition needed
1 day later
Usually within 1 month
Difficulties / Problems encountered
Withdrawal symptomsMisunderstanding about the complications after quitting smoking Weight gainNo concept of the harmful effect of smoking to the healthNot supported by relatives (e.g. old aged)Poor social or psychological supportDenial
Help our patients stop smoking Today!!!