Transcript How to engage Health Professionals Obstacles, Challenges and Successes JENNIFER PERCIVAL RCN TOBACCO POLICY ADVISOR European representative to ICN and TFI/WHO.

How to engage
Health Professionals
Obstacles, Challenges and
Successes
JENNIFER PERCIVAL
RCN TOBACCO POLICY ADVISOR
European representative to ICN and TFI/WHO
“Tobacco kills more people than
any other single agent”MPOWER WHO 2008
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
80% of these deaths will be in
developing countries.
Source: WHO
Why should healthcare professionals
be concerned about tobacco use?
Tobacco use is one of the biggest public health threats
the world has faced.
Globally, use of tobacco products is increasing, although
it is decreasing in many high-income countries.
There are now more than one billion smokers in the world.
Almost half of the world's children breathe air polluted by
tobacco smoke.
Because it takes time from when people start using
tobacco to when their health suffers, the epidemic
of disease and death has just begun.
Ref: World Health Organisation MPOWER Report
Tobacco: deaths by World Bank regions
estimates for 1990 and 2020
8.4 million
Middle Eastern Crescent
Latin America & Caribbean
Sub-Saharan Africa
Other Asia and Islands
4.9 million
China
India
3 million
Former Socialist Countries
Established Market Economies
1990
2001
2020
[Murray & Lopez, 1996]
70% of future tobacco deaths will occur in developing countries
Healthcare professionals need to be
involved because
Smoking is a risk factor for six of the eight leading
causes of deaths in the world.
Smoking will kill at least a third of all current smokers
and many other smokers will develop serious disability
and illness because of tobacco use.
Tobacco use kills 5.4 million people a year - an average of
one person every six seconds - and accounts for one in
10 adult deaths worldwide.
People killed by tobacco lose on average 10 - 15 years
of life.
Sir Richard Peto
WHO Epidemiologist
“Most of those who
will be killed by
tobacco in the first half
of this century have
already begun to
smoke.
“These tobacco deaths could be
substantially reduced only .... by
current smokers give up the habit.”
Sir Richard Peto
WHO Epidemiologist
“This huge predicted death toll
could be reduced if all Health
service staff became involved in
tobacco control
and routinely offered support to
individuals and their families to
stop smoking”.
WHO Framework Convention on Tobacco Control
Six cost effective interventions to reduce death and
disease caused by tobacco use
• Higher taxes on cigarettes and other tobacco products
• Bans/restrictions on smoking in public and work places
• Comprehensive bans on advertising and promotion of all
tobacco products, logos and brand names
• Better consumer information: counter advertising, media
coverage, research findings, ban sales to minors.
• Large, direct warning labels on cigarette boxes and other
tobacco products
• Help for smokers who wish to quit, including increased access
to Nicotine Replacement (NRT) and other cessation therapies
Source: World Bank Fact Sheet “Tobacco control at a glance” June 2003
What’s in a
cigarette?
4,000
Chemicals
plus
Tar and
Carbon
monoxide.
What damage is smoking doing?
Stroke
Bladder cancer
Gum disease / tooth loss
Pancreatic cancer
Cancer of lips, tongue, throat,
larynx, oesophagus
Skin – healing, wrinkling
Narrowed arteries
Impotence
CHD, heart attacks
Reduced fertility
COPD (bronchitis, emphysema)
Testicular cancer
Chest infections
Cervical cancer
Asthma
Miscarriage
Lung Cancer
SIDS
Stomach ulcers
Gangrene
Stomach cancer
PVD
Kidney cancer
Macular degeneration
Osteoporosis
Health benefits of smoking cessation
• Increased life expectancy
• Halving of risk of lung cancer risk after
ten years
• Heart disease and stroke risk declines
Accelerated decline in lung function
reduced
• Improved reproductive health
• Improved recovery from surgery
What are the barriers
to engaging
Health Professionals?
Why is smoking overlooked?
1. Smoking viewed as a lifestyle choice
2. Beliefs that smoking cessation
treatments don’t work
3. Lack of time
4. Lack of knowledge
5. Lack of skills
6. Fear of offending patients
Nurses Attitudes to the Topic of Smoking
Myth No.1
If I ask about my patient’s smoking habits they:
Will not like me or let me care for them
Will think I don’t understand
Will not return to see me for their care
Will not let me come back into their home again
Nurses Attitudes to the Topic of Smoking
Myth No.2
Many nurses who smoke believe that:
It would be hypocritical to discuss
stopping smoking while they are still using
tobacco themselves
It is estimated that 25% of nurses in the
UK smoke
Engaging the
nursing profession
What works?
Examples from the RCN
RCN TOBACCO EDUCATION PROJECT - GOALS
• To increase nurses’ knowledge about the
impact of smoking on public health
• To provide support to nurses wishing to stop
smoking
• To help nurses provide smokers with
effective cessation support through training
and the provision of support materials
Keeping the
topic alive in
the nursing
media is very
important
Involve the
press and send
your local
papers success
stories
RCN
ADVICE
The
Tobacco Education Project
published
CLEARING THE AIR 2
SMOKING AND
TOBACCO CONTROL
– AN UPDATED GUIDE
FOR NURSES’
With support from the Dept of
Health 33,000 copies were printed
and distributed
Linked with Pharma to provide
Training Materials
Video Pack & Manual
Engaging professionals
Challenges and
Opportunities?
Examples from Europe
WHO SMOKING CESSATION TASKFORCE
WHO asked the European Forum of National Nursing
and Midwifery Associations (EFNNMA) to set up a
Taskforce.
The aims were to:
• Endorse the health professionals’ role in tobacco
control.
• Influence the smoking habits of health
professionals.
• Maximise the effectiveness of nurses.
Royal College of Nursing UK seconded their Tobacco
Education Project Manager to undertake this work.
THE CHALLENGES FOR THE
NURSING PROFESSION IN EUROPE
• High smoking prevalence amongst nurses.
• Little nurse autonomy.
• No smoking cessation skills training.
• Low cost of cigarettes.
• High average consumption of tobacco.
• Lack of government funded resources, health
education campaigns or mass media initiatives.
• No state subsidies for pharmacotherapy.
• Few resources for smokers wishing to quit.
Worldwide the following barriers
have been identified :
• Low levels of nurse education and training in
tobacco control, prevention and cessation.
Smoking among nursing professionals continues to
be high in some regions
• Due to marketing tactics there is risk of an
explosion in smoking rates by nurses in countries
where traditionally women had low smoking
prevalence.
• Lack of nursing leadership: Nurses leaders
worldwide have seldom, embraced the cause and
promoted the benefits of nursing engagement in
tobacco control.
Adverts have been targeting women
Conference
Recommendations
• Nurses and midwives to be included on national
steering/planning groups alongside others involved in
tobacco control.
• Provision of a comprehensive training programme to
increase communication skills.
• Provision of patient education materials to back up the
`stop smoking’ message.
• Examples of good practice and patient support literature
to be made widely available to countries without
government campaigns.
NURSES SELF HELP BOOK TRANSLATED BY POLISH NURSES
EXAMPLES OF SUCCESSFUL WORK BY NURSES
ICELANDIC
NURSES
ASSOCIATION
translated
and widely
distributed the
RCN publication
for nurses,
Clearing the Air
May 31st –World No Tobacco Day 2006
http://www.who.int/tobacco/en/
WHO RECOMMENDATIONS for
HEALTH PROFESSIONAL
ORGANISATIONS 2006
•Assess and address the tobacco
consumption of professionals
•Help staff become role models and stop
smoking
•Promote smoking cessation
•Include tobacco control in the health
professionals' curricula
•Refrain from accepting any kind of
tobacco industry support
•Actively support the WHO FCTC policies
THE INTERNATIONAL COUNCIL
OF NURSES
MONOGRAPH
The role of the Nurse in
Tobacco Control
and Smoking Cessation
has been published and sent to
156 nursing organisations
worldwide
This book is available from the
ICN book stand
How can
QUITLINES
Help to engage
healthcare professionals?
‘In my experience, helping
staff understand addiction
and the process of
stopping smoking increases
their confidence to routinely
engage smokers
and offer support’.
Jennifer Percival RCN Tobacco Policy Advisor
GOOD ADVICE
SMOKERS GIVE MANY
REASONS FOR CONTINUNING
•
•
•
•
•
•
Enjoyment
Habit
Social norm
Ritual
Routine
Few mention addiction.
REASONS FOR
SMOKING
REASONS
FOR
SMOKING
The Goal:
Providing effective brief
interventions to
tobacco users needs to
become an integral part of
health service delivery.
Work with policy makers to ensure they are
aware of the importance of staff giving
advice to smokers about stopping
We know most smokers want to stop, but their
chances of success are low unless they are
offered support and treatment.
Brief advice and support plus the provision of
pharmacotherapy have been shown to increase a
smoker’s chance of quitting.
Use National and WHO European Guidelines
Healthcare staff need to be provided with
the education and tools to:
• Understand the importance of Tobacco Control
• Ask people if they smoke and be able to link
people’s health problems to their smoking
history
• Raise the issue of stopping smoking
• Offer brief advice and support on ways to quit
• Make a referral to the Quitline
Smoking is too big to ignore
New Zealand Best Practice
•Ask about smoking
• Give Brief advice to
quit
C
• Offer essation
support
Nurses Attitudes to the Topic of Smoking
Myth No.2
Many nurses who smoke believe that:
It would be hypocritical to discuss
stopping smoking while they are still using
tobacco themselves
It is estimated that 25% of nurses in the
UK smoke
Helping Nurses Stop Smoking
This topic attracted interest from the nursing
journals as approximately 25% of UK nurses
were still occasional smokers.
It was important to help nurses stop smoking
They are the largest staff group in the NHS
and their health matters to their employer.
Nurses who have stopped smoking have
been found to be much more confident to help
others to quit.
‘NO BUTTS’
AN EXAMPLE OF
A CAMPAIGN
DESIGNED TO
HELP
NURSES
STOP SMOKING
1999 - 2000
`NO BUTTS’
A peer-led campaign
to encourage nurses
to consider stopping
smoking.
• Joint venture between Department
of Health for England, RCN (UK)
and Nursing Times magazine.
• Campaign followed the progress of
five nurses who wanted to stop
smoking.
• `No Butts’ ran for 6 months,
received high profile coverage and
was featured on national television
and radio.
• A nurses self help to stop smoking
book was provided through the
magazine. 25,000 copies were
sent out during the campaign.
A survey was conducted
amongst Nursing Times
readers –
251 people responded.
79% were female,
17% male and 4% did not
state their sex.
Readers were given the
opportunity to quit with
the magazine.
A prize of a year’s
membership to a health
club was donated by a
national chain.
Results showed that more than half
of the nurses who smoke did so because of
stress at work (52%)
but the majority wanted to quit
49% said it was a habit
34% addiction
33% enjoyment
20% to relax or calm nerves
72% said they disliked the smell of cigarettes
45% were worried about the cost
Only 36% identified health risks as a cause for concern
Many respondents were long term smokers:
40% for more than 20 years
and 38% for 11-20 years
89% said they had tried to stop
unsuccessfully in the past
Reasons for past relapse included:
29% Lack of willpower
23% Withdrawal symptoms
14% Weight gain
12% Stress
30% said NRT had helped them to stop in the past
70% wanted more information on treatments
5 nurses were selected
Then followed up for a period of
6 months as they went through their
cessation attempts.
They were of different ages and came
from a variety of backgrounds.
Their experiences of stopping
smoking were readily identified by the
readership.
A self help
to stop smoking
booklet was
published to
help staff give
up smoking.
MAKING THE DECISION
The questionnaire asked:
“What would you miss the most if you stopped”?
“What don’t you like about being a smoker”?
Answering these questions helped the nurses decide if their
habit had reached the point of all pain and no gain.
Deciding to stop smoking is the first big step.
All our finalists had good reasons why they didn’t want to
smoke and the benefits they would have from giving up.
PLANNING TO STOP
Finalists were asked to keep a diary noting:
the times they smoked, why they chose to smoke then and
what they planned to do instead.
Looking ahead to anticipate problems is one of the keys to
making a successful quit attempt.
Setting a date – November 5th was chosen to give the
“No-Butters” a reasonable lead-in time before the demands
of the Christmas social season.
Finding support was encouraged and this made a big
difference
Planning rewards also helped them push through the
difficult days.
QUITTING
Using pharmacotherapy products doubles a
quitters chance of success.
Most of the finalists tried different methods of NRT in
the early weeks and found it helped them.
During the first week changing your usual routine helps
break the habits that support smoking.
There is no right way, each person knows what works for
them.
As the weeks passed the quitters found it easier to stay
stopped as the new routines and habits became
integrated into their day to day lives.
PREVENTING RELAPSE
Some of the reasons people give for relapse:
Not planning a stop programme and being unaware of their
personal triggers for lighting up
All the “No-Butters” spent time thinking through their plans
before November 5th.
Another danger area is thinking you could have “just one”
cigarette – many people get caught out doing this.
Rethinking why you want to stop and what you can do
instead of have a cigarette is the key to preventing relapse.
Four out of the 5
nurse participants
stopped during the
campaign.
The one participant who
relapsed provided the
opportunity for this issue
to be explored in-depth.
Many nurses wrote in praising the campaign:
“after 18 years something has clicked that
has convinced me that I really need to be a
non-smoker”.
SUMMARY
This campaign is
easily transferable
to other countries,
and could help
nurses think about
stopping smoking
In 2006 a joint Department of Health and RCN
campaign was planned to provide:
• Personalised support for nurses wanting to quit
• An competition and award for staff teams that quit
•A dedicated helpline for nurses
• Better access to nicotine replacement therapy
• New self-help materials for nurses
In addition, Directors of Nursing were to encourage
staff to stop smoking by allowing them time off to
receive cessation support
Press, Posters, Internet Sites
THE NEW STAFF CAMPAIGN
Engaging Nurses in
Tobacco control
• Nurses, the largest group of health care
professionals worldwide have so far been
an invisible partner in worldwide tobacco
control efforts.
• The WHO Tobacco Free Initiative (TFI) is
keen to enhance the capacity of National
Nursing Associations (NNA’s) to engage in
tobacco control activities.
WHO TFI and ICN
• Would like to set up an international network to
engage the 13 million strong global nursing
workforce in tobacco control.
• The proposed new network could work under
the leadership of ICN and WHO with the
assistance of an international committee
• This goal is to capacity build and multiply the
number of nurses actively involved in promoting
the goals of the WHO FCTC.
WHO Tobacco Free Initiative
• No formal mechanisms exist to coordinate
the activities of NNA’s or individual nurses
• it is vital to put structures in place to
harness the 13 million strong global
nursing work force.
• Nurses are in an excellent position to
make a difference and need to be enrolled
in the fight against tobacco.
• The input of the nursing profession is
essential.
Engaging Nurses in Tobacco control
• To increase the number of nurses actively involved in
promoting the goals of the WHO Framework Convention for
Tobacco Control
• To encourage NNA’s to embrace the Code of practice on
tobacco control for Health professional organizations
• To build upon the capacity and skills of nurses to assist people
to stop smoking
• To increase nurses understanding of treatment therapies NRT
Zyban and Champix
• To provide tobacco control resources for use in patient care
• To enhance the culture of nurses as leaders and advocates of a
smoke free society
Nurses are too large a group
To enable nurses to take active roles supporting national and
international tobacco control
policy and legislation
to ignore
• To support nurses to become tobacco free role models
•