Transcript Slide 1

TACKLING TOBACCO DEATHS
THE NURSES’ ROLE IN TOBACCO CONTROL
AND
SMOKING CESSATION
JENNIFER PERCIVAL
RCN TOBACCO POLICY ADVISOR
Tobacco is a public health priority
Source: WHO
In the year 2000
1 in every 6 deaths worldwide
was caused by smoking
By the year 2030
1 in every 3 deaths worldwide
will be due to smoking
70% of these deaths will be in
developing countries.
THIS ADVERT
WAS USED IN
THE 1950’S
Tobacco advertisers have no boundaries
Tobacco advertising has successfully
encouraged more women to start smoking
Women and Tobacco
• In the UK lung cancer
surpassed breast
cancer as leading cause
of cancer death in 1987
• Now more women die
from lung cancer than
breast, ovarian, cervical
& endometrial cancers
combined
The true picture is very different
WHO – ‘THE SILENT EPIDEMIC’
WORLD HEALTH ORGANISATION
Epidemiologist
Sir Richard Peto
His research has shown:
“Tobacco use is increasing.
Over 100 million deaths from tobacco
will occur during the next 20
years……. and if nothing changes
there will be ONE BILLION deaths this
century.”
• Half of all regular smokers die prematurely:
¼ in middle age (35-69)
¼ in old age
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Stopping before 35 avoids most of the risks of premature death.
• Stopping smoking works.
The WHO Framework Convention
on Tobacco Control (FCTC)
Main Measures that 169 countries have signed up to
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Ban all tobacco advertising
Increase Tax on tobacco products
Take effective measures on Passive smoking
Put large Warnings on tobacco products
Provide Public Education campaigns
Provide Cessation Guidelines and Services
Take Action on illicit trade/smuggling
Control sale of tobacco to children/ minors
Put large warnings on all
tobacco products
Provide
Public
Education
campaigns
Take effective measures on Passive smoking
WHO estimates that nearly 700 million,
or almost half of the world’s children,
breathe air polluted by tobacco smoke,
particularly at home.
Control sales of tobacco to minors!
What is smoking?
• A Chronic relapsing dependence
syndrome
• Use of the addictive drug nicotine
• Reinforced by sensory, behavioural and
social conditioning
• Entrenched by powerful withdrawal
syndrome
• Promoted commercially, exempt from
consumer protection legislation
Nicotine
Why are
cigarettes
so
harmful?
4,000
chemicals
Tar
Carbon
monoxide
Stopping Smoking
Withdrawal effects: duration and frequency
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Light-headedness
Sleep disturbance
Poor concentration
Craving
Irritability/aggression
Depression
Restlessness
Increased appetite
<48 hrs
< 1 wk
<2 wks
> 2 wks
< 4 wks
< 4 wks
< 4 wks
> 10 wks
10%
25%
60%
70%
50%
60%
60%
70%
Nicotine delivery
Royal College of Physicians, Nicotine Addiction in Britain, 2000
Nicotine Replacement
Therapy, Zyban &
Champix
Reasons for NRT failure
• Unrealistic expectations
• Incorrect use
• Not used for long enough
• Nicotine is often seen as the dangerous
element in cigarette smoke
• Safety concerns can be a barrier to use
Core communication skills
• Boost the person’s motivation and
self-efficacy
• Build rapport
• Use reflective listening
• Provide reassurance
Standard Treatment Programme
Pre Quit Assessment
• Assess current readiness and ability to quit
• Inform the client about your programme
• Assess current smoking
• Assess past quit attempts
• Explain how tobacco dependence develops
• Assess nicotine dependence
My observations from
working in the
UK Stop Smoking services
are that
direct persuasion is not
enough to make people
decide to stop smoking
People want the ‘benefits’ of
being a non smoker …….
without recognising the often
long process of ‘change’ they
need to go through to acquire
them.
You will have already
observed that
direct persuasion
does not make
people decide
to change
Miller WR et al. J Consult Clin Psychol 1993;61:455–61;
Miller and Rollnick, 1991
GOOD ADVICE
Robert was diagnosed with cancer of his tonsils
at age 36
“I knew you could get cancer from smoking, but I’d planned to
give up long before that happened to me”
Reasons for
Current
Behaviour
ADVICE
Reasons for
Current
Behaviour
ADVICE
Current
Behaviour
Everyone has their own beliefs
about safe behaviour
This child is strapped in and protected from the sun but....?
A DIFFICULT TIME
GUILT
NICOTINE
ADDICTION
FEAR
CONCERN
FOR BABY
PEOPLE
“NAGGING”
STRESS
RELIEF
HABIT
PARTNER
SMOKES
NORMAL
Problem: Many pregnant
women do not like to
say they smoke
A carbon monoxide (CO) test is
an immediate and non-invasive
biochemical method for helping
to assess whether or not
someone smokes
THE CHANGE PROCESS
• No-one changes their behaviour
without first changing their attitudes
and beliefs.
• When a client argues with you it
means you have made a wrong
assumption.
• Long term behaviour change takes
time to consolidate
Principles of Motivational Interviewing
• Use a neutral manner to give clients information
about the impact of their lifestyle on their health
• Help people interpret the health implications,
risks and benefits of not changing.
• Assist people to explore for themselves the
importance of making a specific change.
• Leave the responsibility for changing and the
right to decide whether or not to change, with
the client.
Helping people to stop smoking
• Avoid making pressure to change: this will
create resistance. You can never win and, in
the process, may lose the chance to help
• Roll with any resistance: do not argue with
the patient if they say their action is not
harmful. Instead, respectfully clarify their own
thoughts or views
• Support the patient’s self-confidence: look for
the positive aspects and build on them
HELPING PEOPLE TO STOP SMOKING
WHAT WORKS?
• Find out what the tobacco user already knows
about the risks and seek permission to provide
further information.
• Link these facts to their current health status or
medical condition.
• Explain the short and long term benefits of
quitting and assess their understanding.
Try asking: What do you think might happen
to you if you continue to smoke?
PEOPLE NOT READY TO STOP
Respect their view
“It sounds like it would be hard for you to stop now”
“Are you planning to be a life long smoker”?
If they say NO
Ask: “What would need to change for you
to consider stopping smoking”?
Explain your medical / social concerns
Leave the subject open for future discussion
Asking questions can plant a
seed of change
‘New thoughts’ often help people think differently
about what they believe to be true.
Unsure about change?
• Help them explore the perceived
advantages and disadvantages of smoking
• Ask more about what brought them to see
you and find out their concerns
• Describe any ambivalence you notice
• Plant a seed of change
Helping people to stop smoking
• Show empathy: even if you do not share a
person’s viewpoint, find ways to show that
you understand and respect them
• Identify discrepancies: there are often
differences between how a person behaves
and how they see themselves
Name these in a neutral way
eg.’Don’t want their kids to start smoking’
People making plans to quit
• Congratulate this decision
• Check their expectations of changing
Ask “What could get in your way?”
“What can you do to avoid that”?
• “What help will you need?”
• “Who can you ask?”
Helping people to change
Ask:• “What are you planning to do next”?
• “Who are you going to ask to support you?”
• “What quit date have you decided?
Can you commit to not having a single puff
of a cigarette from then onwards?”
• “What medication are you going to use?
RELAPSE
Why do smokers return to tobacco?
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Stopping under pressure from someone else
Lack of personal motivation
Attaching insufficient importance to stopping
Withdrawal symptoms
Poor timing
A question of self-image
“I thought `just one’ wouldn’t hurt”
Relapse prevention
Ask:
• What makes this a good time to stop?
If they have tried many times before:
• What have you learnt from past attempts?
• What will you do differently now to stay
stopped?
• How would you feel if you had a cigarette
again?
• Who is going to support you?
1. I’ve tried before, its too late now, the
damage is already done”
2.“My doctor’s told me to see you about
quitting smoking”
3 “I’ve really cut down since my heart attack.”
4 “I feel so low since I’ve stopped smoking
and I crave a smoke all the time.”
5 “I want to give up, but it’s hard as my
partner smokes.”
6 “I don’t like to ask my in-laws not to smoke
in the house.”
Contact details
[email protected]
Email address