Tobacco Use Treatment in Nursing Curricula

Transcription

1 Tobacco Use Treatment in Nursing Curricula What Faculty, Students, and Nurses Need to Know Carol Essenmacher MSN, CNS, C-TTS Disclaimer This is to inform you, the participant of this educational activity, that the faculty/ presenters, planners, content reviewers and spouse/partner of this activity have declared that there is/are no financial, vested conflicts of interest to disclose. No products will be endorsed and there will be no discussion of off label usage of products. There is no commercial support or sponsorship for this activity. Objectives Describe evidence based interventions aimed at the problems associated with tobacco dependence Describe critical elements and implications of tobacco treatment contained in nursing education curricula (Academic/Clinical) List options for incorporating tobacco treatment programming into curricula (Academic/Clinical) Essenmacher 1

2 State of Tobacco Cessation Education in Nursing Academia Devastation of tobacco use Limited and inconsistent tobacco treatment content in current nursing curricula (Heath, et. al., 2012; Price, et al., 2008) Nursing bias and attitudes (Clark, et. al., 2004; Essenmacher, et. al., 2009; Lentz, 2008; Prochaska, 2010; Prochaska, 2011) Nurses feel unprepared & unqualified Issues unique to psychiatric population (Colton & Manderscheid, 2008) Academic/Clinical Curricula Delivery Methods Face-to-face class or seminar Webinar Teleconference Add to Nurse Residency Programs Include educational credit/ce s What Nurses and Students need to know. And Nursing faculty Essenmacher 2

3 Ethics & Tobacco Nursing Implications Diminished autonomy Imperative that nurses explore patient s statements Hooked from the first cigarette (DiFranza, 2008; Sanouri, et. al., 2008) Informed Consent (Goodin, 1988) Taking rights away Raising confidence levels (patient & nurse) Common Nursing Language Tobacco use vs. smoking Example: cigarettes per day (cpd) vs. pack years; mutually agreed upon assessment tools; define brief intervention vs. intensive intervention Performance Measures Stats & Data Mining To use NIC/NOC, that is the question Nicotine Dependence: A Tale of Two Problems 1. Biological: - Nicotine addiction - Central Nervous System development: nicotine-caused changes in brain receptor number, density, sensitivity, and permeability alter the brain s response to normal neurotransmitters changes neuronal gene expression, second messenger system functions, modulations mechanisms, and even arborization patterns, creating an environment that is engineered to function best in the presence of nicotine (American College of Chest Physicians: Tobacco Toolkit). Essenmacher 3

4 Nicotine Dependence: A Tale of Two Problems continued 2. Psychosocial: The habituation process: 1 cig ~ 10 puffs 1 pack ~ 200 puffs Pack/day x 1 yr ~ 73,000 puffs Pack/day x 20 yrs ~ 1.5 million puffs Socialization Rationalization, grief, PTSD, substance abuse, psych Dx, etc. (Mis)perceptions Biological Strategies Non-pharmacological strategies: The Big 3 (eat right, exercise right, sleep right) Quit Q Planning for biologically-based triggers The role of Complimentary Alternative Medicine in tobacco cessation treatment Deep breathing and relaxation techniques Biological Strategies: Pharmacological Tobacco products: cigarettes, cigars, mini-cigars, chew/dip/snuff, loose tobacco Nicotine content in tobacco products Medications( This is not strep throat or a URI R.D. Hurt, MD, Mayo Clinic): Chantix Zyban/Wellbutrin/Bupropion Nicotine Replacement Therapy: Patch, gum, lozenge, inhaler, nasal spray Bioavailability Essenmacher 4

5 Psychosocial Strategies Nurse training with Motivational Interviewing/Stages of Change Cognitive Behavioral Therapy Thought stopping/thought challenging Strategies for limit setting w/ family/friends Family/friend support American Cancer Society: Helping a Smoker Quit How to socialize w/o using tobacco Treatment Models Centralized: a separate direct care service, consulting, QI, Stats, Research Decentralized: direct care services colocated within treatment areas, little oversight Blended: separate direct care service w/oversight of co-located treatment, consulting for high risk patients (recent cancer Dx/MI/stroke, HgBA1C 8.9 or higher, impending transplant, home oxygen patient, etc), staff training & clinical champions Academic Dissemination Options: Undergraduate ADN/BSN programming topics: Recognizing personal bias & ethics Accurate assessments, physical effects, psychological effects Improving effectiveness of tobacco treatment strategy delivery Comprehensive knowledge of medications MI/CBT/SOC training Nicotine effects on medications Program development support Essenmacher 5

6 Academic Dissemination Options: Graduate Undergraduate Programming PLUS: Comprehensive staff training (clinical and academic) i.e. Train the Trainer Program design & development Program evaluation Research/publication opportunities C-TTS Dissemination: Clinical Opportunities Clinical tobacco treatment champions MI trainers for behavioral health change CBT trainers Nurse Residency at clinical site Mentorship QI/Performance Measure projects Practice research & publication Nursing Implications Common nursing language is a MUST! Nursing impact on sluggish quit rates = OPPORTUNITY!!! Training and competency g p y Nursing evaluation of tobacco treatment models and strategies Program development Essenmacher 6

7 Resources Intensive Tobacco Dependence Intervention with Persons Challenged by Mental Illness: Manual for Nurses by Daryl Sharp, PhD, et al. (2009). Tobacco Free Nurses: Rx for Change: C-TTS training: via Mayo clinic and many other sources ATTUD membership: Society for Research on Nicotine & Tobacco: Global Network of Tobacco Control Nurses: Tobacco Cessation Leadership Network: Motivational Interviewing: Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update,. US Department of Health and Human Services. ISBN: References American College of Chest Physicians: The scientific & clinical basis for the toolkit recommenations of tobacco dependence treatment process and approach. (2012). Available at: Centers for Disease Control and Prevention. (2005). Annual smokingattributable mortality, years of potential life lost, and productivity losses United States, MMWR, 54, Centers for Disease Control and Prevention. (2008). Average annual number of deaths, MMWR, 57(45), Clark, E., McCann, T. V., Rowe, K., & Lazenbatt, A. Cognitive dissonance and undergraduate nursing students knowledge of, and attitudes about smoking. Journal of Advanced Nursing, 46(6), Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prevention of Chronic Diseases, 3, A42. References continued DiClementi, C. C. (1999) Motivation for change: Implications for substance abuse. Psychological Science, 10(3), DiFranza, J, R. (2008). Hooked from the first cigarette. Scientific American, 298(5), Essenmacher, C., Karvonen-Gutierrez, C., Lynch-Sauer, J., & Duffy, S. A. (2009). Staff s attitudes toward the delivery of tobacco cessation services in a primarily psychiatric Veterans Affairs Hospital. Archives of Psychiatric Nursing, 23(3), Goodin, R. E. (1989). No smoking: The ethical issues. Chicago, IL: The University of Chicago Press. Heath, J., Inglett, S., Young, S., Joshua, T. V., Sakievich, N., Hawkins, J., Andrews, J. O., & Tingen, M. S. The impact of the Georgia Health Science University nursing faculty practice on tobacco cessation rates. Nurse Clinician of North America. 47(1), Lenz, B. K. (2008). Beliefs, Knowledge, and self-efficacy of nursing students regarding tobacco cessation. American Journal of Preventive Medicine, 35(6S), S494-S500. Essenmacher 7

8 References continued Miller, W. R., & Rollnick, S. (2009). Motivational interviewing: Preparing people for change. (2 nd ed.). New York: The Guilford Press. Price, J. H., Jordan, T. R., Jeffrey, J. D., Stanley, M. S., & Price, J. A. (2008). Tobacco Intervention training in graduate psychiatric nursing education programs. Journal of American Psychiatric Nurses Association. 14(2), Prochaska, J. J. (2010). Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence, 110, Prochaska, J. J. (2011). Smoking and mental illness: Breaking the link. New England Journal of Medicine, 365(3), Sanouri, W. W., Ursprung, A., & DiFranza, J. R. (2010). The loss of autonomy over smoking in relation to lifetime cigarette consumption. Addictive Behaviors, 35, Essenmacher 8