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Evidence-Based Practice

Smoking LEADING CAUSE OF PREVENATBLE DEATHS WORLDWIDE RELATED TO MANY HEALTH PROBLEMSEvery 8 seconds one person dies from tobacco useCigarettes cause 1 out of 5 American deathsSmoking-related diseases cost the united states more than $150 Billion a year. Identification of Problem?. Healthy

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Evidence-Based Practice

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    1. What is the best treatment modality for smoking cessation? Evidence-Based Practice Good afternoon. My name is Brandi Fuselier and this Courtney Garner, Rachael Robison, & Katy Stewart. Today we will be presenting our Evidenced-Based Practice Presentation that addresses the clinical question: What is the best treatment modality for smoking cessation?. This particular question can be applicable to all healthcare domains including acute care and community-based settings. The information yielded from this project can positively influence the care and outcomes of those seeking smoking cessation. Good afternoon. My name is Brandi Fuselier and this Courtney Garner, Rachael Robison, & Katy Stewart. Today we will be presenting our Evidenced-Based Practice Presentation that addresses the clinical question: What is the best treatment modality for smoking cessation?. This particular question can be applicable to all healthcare domains including acute care and community-based settings. The information yielded from this project can positively influence the care and outcomes of those seeking smoking cessation.

    2. Smoking LEADING CAUSE OF PREVENATBLE DEATHS WORLDWIDE RELATED TO MANY HEALTH PROBLEMS Every 8 seconds one person dies from tobacco use Cigarettes cause 1 out of 5 American deaths Smoking-related diseases cost the united states more than $150 Billion a year Identification of Problem Although there has been a steady decline in the usage of tobacco products including cigarette smoking, it continues to be the leading cause of premature death worldwide. Cigarette smoking is a modifiable risk factor for a host of health-related complications, particularly cardiovascular and respiratory disease as well as many forms of cancer. Every 8 seconds one person dies from tobacco use. Cigarettes cause 1 out of 5 American deaths. And according to the World Health Organization, smoking-related diseases cost the United States more than $150 Billion a year Although there has been a steady decline in the usage of tobacco products including cigarette smoking, it continues to be the leading cause of premature death worldwide. Cigarette smoking is a modifiable risk factor for a host of health-related complications, particularly cardiovascular and respiratory disease as well as many forms of cancer. Every 8 seconds one person dies from tobacco use. Cigarettes cause 1 out of 5 American deaths. And according to the World Health Organization, smoking-related diseases cost the United States more than $150 Billion a year

    3. Healthy people 2010- Reduce tobacco consumption by 12% Approximately 51% of smokers attempted cessation last year in the united states Unaided smoking cessation has been found to only have success rates of 2%-4% First-line therapy has traditionally been pharmacological agents Limited research on effectiveness of non-pharmacological treatments in sustaining abstinence Identification Of Problem Both state and federal health promotion initiatives have been created in order to reduce the number of individuals that smoke. These initiatives include the Healthy People 2010 goalswith one goal being to reduce tobacco consumption by 12% by 2010. Within these projects, it is reiterated that smoking cessation has both immediate and long-term health benefits. In fact, within 20 minutes of quitting, a persons heart rate decreases. After 12 hours, carbon monoxide blood levels return to normal. One year after cessation, a persons risk for cardiovascular disease is decreased 50% (of that of a smoker) and in 15 years, their risk will have returned to that of a non-smoker. Despite the clear benefits of smoking cessation, smokers often find it difficult to remain abstinent and relapse is common. Indeed, approximately 51% of smokers attempted cessation last year in the U.S. and unaided smoking cessation has been found to only have success rates of 2-4%. Often times, those seeking assistance with smoking cessation are prescribed pharmacological agents as first-line therapies. There are a variety of other, non-pharmacological methods, for smoking cessation that often go unexplored when discussing options with clients. There has been limited research on the effectiveness of these therapies in sustaining long-term abstinence. Both state and federal health promotion initiatives have been created in order to reduce the number of individuals that smoke. These initiatives include the Healthy People 2010 goalswith one goal being to reduce tobacco consumption by 12% by 2010. Within these projects, it is reiterated that smoking cessation has both immediate and long-term health benefits. In fact, within 20 minutes of quitting, a persons heart rate decreases. After 12 hours, carbon monoxide blood levels return to normal. One year after cessation, a persons risk for cardiovascular disease is decreased 50% (of that of a smoker) and in 15 years, their risk will have returned to that of a non-smoker. Despite the clear benefits of smoking cessation, smokers often find it difficult to remain abstinent and relapse is common. Indeed, approximately 51% of smokers attempted cessation last year in the U.S. and unaided smoking cessation has been found to only have success rates of 2-4%. Often times, those seeking assistance with smoking cessation are prescribed pharmacological agents as first-line therapies. There are a variety of other, non-pharmacological methods, for smoking cessation that often go unexplored when discussing options with clients. There has been limited research on the effectiveness of these therapies in sustaining long-term abstinence.

    4. PATIENT POPULATION OF INTEREST IS SMOKING ADULTS AGES 18 AND OVER INTERVENTION OF INTEREST IS THE USE OF NONPHARMACOLOGICAL AGENTS (SUCH AS GUIDED IMAGERY, QUITLINES, & EXERCISE) Comparison of interest is pharmacological agents Outcome of interest is effectiveness in smoking cessation PICO From the problem we formulated the PICO: Patient population of interest is smoking adults ages 18 and over Intervention of interest is the use of nonpharmacological agents (such as guided imagery, quitlines, & exercise) Comparison of interest is pharmacological agents Outcome of interest is effectiveness in smoking cessation From the problem we formulated the PICO: Patient population of interest is smoking adults ages 18 and over Intervention of interest is the use of nonpharmacological agents (such as guided imagery, quitlines, & exercise) Comparison of interest is pharmacological agents Outcome of interest is effectiveness in smoking cessation

    5. IN ADULTS AGES 18 YEARS AND OLDER IS THE USE OF NON-PHARMACOLOGICAL AGENTS (SUCH AS GUIDED IMAGERY, QUITLINES, AND EXCERISE) IN COMPARSION TO PHARMACOLOGICAL AGENTS MORE EFFECTIVE IN SMOKING CESSATION? EBP Question Understanding the importance of smoking cessation and the necessity to provide information regarding all the available treatment options, the clinical question we formulated was: In adults age 18 years and older is the use of non-pharmacological agents (such as guided imagery, quitlines, and exercise) in comparison to pharmacological agents more effective in smoking cessation? Understanding the importance of smoking cessation and the necessity to provide information regarding all the available treatment options, the clinical question we formulated was: In adults age 18 years and older is the use of non-pharmacological agents (such as guided imagery, quitlines, and exercise) in comparison to pharmacological agents more effective in smoking cessation?

    6. What is being done to study the problem? Medical research Randomized control trials Systematic Reviews Literature Reviews Clinical Guidelines Case studies Inadequate nursing research Review of Literature When we began researching our clinical question, we discovered that most of the research conducted was medically-based and included randomized control trials, systematic & literature reviews, clinical guidelines, and case studies. We also noted that there was inadequate nursing research concerning the topic. When we began researching our clinical question, we discovered that most of the research conducted was medically-based and included randomized control trials, systematic & literature reviews, clinical guidelines, and case studies. We also noted that there was inadequate nursing research concerning the topic.

    7. pros of using Non-pharmacological agents Little to no adverse/ side effects No prescription needed May not require visit to PCP to initiate treatment Majority are cost effective Wide variety of options Review of Literature When reviewing the literature regarding non-pharmacological agents, we found that these therapies cause little to no adverse side/effects, do not require a prescription, may not require a visit to the primary care provider to initiate treatment, are cost-effective, and there are a variety of options available.When reviewing the literature regarding non-pharmacological agents, we found that these therapies cause little to no adverse side/effects, do not require a prescription, may not require a visit to the primary care provider to initiate treatment, are cost-effective, and there are a variety of options available.

    8. Cons of using Non-pharmacological agents May not be as readily available to consumers May require more time and effort Lack of health care provider knowledge regarding options Review of Literature We also discovered the negative aspects of non-pharmacological therapies which include not being readily available to consumers, this is why we tried to choose therapies that could be utilized by the majority of individuals. Likewise, they may require more time and effort due to the apparent lack of health care provider knowledge regarding the various options.We also discovered the negative aspects of non-pharmacological therapies which include not being readily available to consumers, this is why we tried to choose therapies that could be utilized by the majority of individuals. Likewise, they may require more time and effort due to the apparent lack of health care provider knowledge regarding the various options.

    9. Guided Imagery Involves using the imagination and mental images to promote relaxation, changes in attitude, or behavior, and encourages physical healing. Helps reduce stress Audio CDs available to guide clients through the process . Specially trained nurses on guided imagery. http://www.academyforguidedimagery.com Review of Literature Of the non-pharmacological therapies that we researched one, guided imagery, is a technique that involves using the imagination and mental images to promote relaxation, changes in attitude, or behavior, and encourages physical healing. It also helps reduce stress, which is identified as the major cause of failure to quit smoking. Audio CDs are available for purchase that guide clients through the process. These audio CDs be used in addition to a trained specialist on guided imagery. The academy for Guided Imagery has trained thousands of psychotherapists, nurses, and doctors. To find one in your area visit their website at http://www.academyforguidedimagery.com. Of the non-pharmacological therapies that we researched one, guided imagery, is a technique that involves using the imagination and mental images to promote relaxation, changes in attitude, or behavior, and encourages physical healing. It also helps reduce stress, which is identified as the major cause of failure to quit smoking. Audio CDs are available for purchase that guide clients through the process. These audio CDs be used in addition to a trained specialist on guided imagery. The academy for Guided Imagery has trained thousands of psychotherapists, nurses, and doctors. To find one in your area visit their website at http://www.academyforguidedimagery.com.

    10. Non-pharmacological Studies - Guided Imagery Guided imagery was twice as effective as Bupropion (Zyban) (Grohs et al. 2008). Guided imagery was more effective than counseling alone (Wynd, 2005). Review of Literature When reviewing the studies assessing the effectiveness of guided imagery, one study conducted by Grohs et al. found that guided imagery was twice as effective as Bupropion (Zyban), a commonly prescribed medication to aid in smoking cessation. The study included 779 males and female participants, ages 18 and over that smoked at least 15 cigarettes a day in the last 3 months with the intent to quit. The participants were randomly assigned to either the pharmacological interventional group or psychotherapy (guided imagery). During a 12-month follow-up, the researchers found that the abstinence rate was 39.1% for those using guided imagery while the rate for those taking the medication was only 12.3% . In a similar study published in the Journal of Nursing Scholarship, 71 male and female smokers at least 18 years of age were randomized to evaluate the effectiveness of guided imagery as a nursing intervention for smoking cessation and abstinence. This study included a placebo-control group that solely received counseling to compare to the guided imagery intervention. At the 24-month follow-up, the researchers found that guided imagery was more effective than counseling alone, with an abstinence rate of 26% in comparison to 12% for the control. When reviewing the studies assessing the effectiveness of guided imagery, one study conducted by Grohs et al. found that guided imagery was twice as effective as Bupropion (Zyban), a commonly prescribed medication to aid in smoking cessation. The study included 779 males and female participants, ages 18 and over that smoked at least 15 cigarettes a day in the last 3 months with the intent to quit. The participants were randomly assigned to either the pharmacological interventional group or psychotherapy (guided imagery). During a 12-month follow-up, the researchers found that the abstinence rate was 39.1% for those using guided imagery while the rate for those taking the medication was only 12.3% . In a similar study published in the Journal of Nursing Scholarship, 71 male and female smokers at least 18 years of age were randomized to evaluate the effectiveness of guided imagery as a nursing intervention for smoking cessation and abstinence. This study included a placebo-control group that solely received counseling to compare to the guided imagery intervention. At the 24-month follow-up, the researchers found that guided imagery was more effective than counseling alone, with an abstinence rate of 26% in comparison to 12% for the control.

    11. Exercise Individuals are often afraid to stop smoking for fear of weight gain. Types of exercise helpful to those attempting smoking cessation include: weight-bearing, cardiovascular, and stretching. Review of Literature One fear that smokers often have is of gaining weight after cessation. A great way to prevent weight gain with cessation is exercise. The types of exercise helpful to those attempting cessation include: weight-bearing, cardiovascular, and stretching.One fear that smokers often have is of gaining weight after cessation. A great way to prevent weight gain with cessation is exercise. The types of exercise helpful to those attempting cessation include: weight-bearing, cardiovascular, and stretching.

    12. Non-pharmacological Studies - Exercise Exercise was shown to aid in withdrawal symptoms associated with nicotine dependence (Usser, Taylor, & Faulker, 2008). Review of Literature In a systematic review of 13 studies, exercise was shown to aid in withdrawal symptoms associated with nicotine dependence including cravings, weight gain, and negative affect. Also, exercise was viewed by those seeking assistance with smoking cessation as a way to redirect their energy in a more constructive and health-promoting manner, which in-turn, positively influenced their self-concept. Additionally, this review supported the use of exercise as a means of both smoking cessation and relapse prevention since physical activity promotes a healthy lifestyle and those maintaining abstinence contested smoking deviated from this way of living. In a systematic review of 13 studies, exercise was shown to aid in withdrawal symptoms associated with nicotine dependence including cravings, weight gain, and negative affect. Also, exercise was viewed by those seeking assistance with smoking cessation as a way to redirect their energy in a more constructive and health-promoting manner, which in-turn, positively influenced their self-concept. Additionally, this review supported the use of exercise as a means of both smoking cessation and relapse prevention since physical activity promotes a healthy lifestyle and those maintaining abstinence contested smoking deviated from this way of living.

    13. Common Quitlines 1-800-QUITNOW 1-877-NOBUTTS Review of Literature 1-800-QUITNOW is a national router number which excepts callers throughout the nation and seamlessly connects them to a state quitline. This quitline is staffed by trained cessation experts. For clinicians, they can provide an easy, fast, and effective way to help smokers quit. A typical number of sessions provided are 5 and the length for a session is 30 minutes with follow-up sessions of 10-15 minutes. To supplement coaching, smokers are also given free nicotine patches and gum. 1-877-NOBUTTS is a state resource center for smoking cessation. This quitline provides support for pregnant smokers and smokeless tobacco users in addition to cigarette smokers. It also provides support for loved ones of those who are trying to quit. Deaf or hard of hearing as well as foreign language services are also provided. 1-800-QUITNOW is a national router number which excepts callers throughout the nation and seamlessly connects them to a state quitline. This quitline is staffed by trained cessation experts. For clinicians, they can provide an easy, fast, and effective way to help smokers quit. A typical number of sessions provided are 5 and the length for a session is 30 minutes with follow-up sessions of 10-15 minutes. To supplement coaching, smokers are also given free nicotine patches and gum. 1-877-NOBUTTS is a state resource center for smoking cessation. This quitline provides support for pregnant smokers and smokeless tobacco users in addition to cigarette smokers. It also provides support for loved ones of those who are trying to quit. Deaf or hard of hearing as well as foreign language services are also provided.

    14. Non-pharmacological Studies Quitlines Review of Literature Of the numerous non-pharmacological methods available, telephone counseling shows to be an overall cost-effective method for smoking cessation. Indeed, help lines were found to be more effective than brief counseling from a healthcare provider or self-help materials alone. Likewise, in a systematic review performed by Lichtenstein, Glasgow, Ossip-Klein, & Boles (1996), the researchers concluded that quitlines were effective in addressing the needs of large populations and enabled those in rural areas to obtain support with smoking cessation efforts.Of the numerous non-pharmacological methods available, telephone counseling shows to be an overall cost-effective method for smoking cessation. Indeed, help lines were found to be more effective than brief counseling from a healthcare provider or self-help materials alone. Likewise, in a systematic review performed by Lichtenstein, Glasgow, Ossip-Klein, & Boles (1996), the researchers concluded that quitlines were effective in addressing the needs of large populations and enabled those in rural areas to obtain support with smoking cessation efforts.

    15. Pros of using pharmacological agents Increased availability of OTCs Various forms of Nicotine Replacement Therapy Easy to use, time efficient More knowledge and research available Review of Literature When comparing pharmacological agents the positive benefits of these treatments include: the increased availability of over the counter medications like the various forms of nicotine replacement therapies such as gum and patches, they are easy to use and time efficient, and there is more knowledge and research available regarding these therapies. When comparing pharmacological agents the positive benefits of these treatments include: the increased availability of over the counter medications like the various forms of nicotine replacement therapies such as gum and patches, they are easy to use and time efficient, and there is more knowledge and research available regarding these therapies.

    16. cons of using pharmacological agents May require prescription Adverse side effects Expensive Review of Literature The cons associated with pharmacological agents include the fact they may require a prescription, can cause adverse side effects, and may be expensive. The cons associated with pharmacological agents include the fact they may require a prescription, can cause adverse side effects, and may be expensive.

    17. Pharmacological Studies Nicotine Replacement Therapy, Varencicline (Chantix), & Bupropion (Zyban), were effective in sustaining both short-term and long-term abstinence from smoking(Wu, Wilson, Dimoulas, & Mills, 2006). Varencicline (Chantix) superior to both NRT (in indirect study comparisons) and Bupropion (Zyban) (Wu, Wilson, Dimoulas, & Mills, 2006). All of the available types of NRT increased abstinence rates 1.5 to 2-fold (Silagy, Lancaster, Mant, & Fowler, 2004). Review of Literature The most common first-line therapies for smoking cessation include nicotine replacement therapy, Chantix, and Zyban. In a systematic review of these medications, researchers concluded that all three pharmacological agents were effective in sustaining both short-term and long-term abstinence from smoking. Additionally, they found Chantix to be superior to both NRT and Zyban. A systematic review evaluating 103 studies related to NRT revealed that all of the available types (nasal spray, transdermal patch, gum, etc.) increased abstinence rates 1.5 to 2-fold.The most common first-line therapies for smoking cessation include nicotine replacement therapy, Chantix, and Zyban. In a systematic review of these medications, researchers concluded that all three pharmacological agents were effective in sustaining both short-term and long-term abstinence from smoking. Additionally, they found Chantix to be superior to both NRT and Zyban. A systematic review evaluating 103 studies related to NRT revealed that all of the available types (nasal spray, transdermal patch, gum, etc.) increased abstinence rates 1.5 to 2-fold.

    18. Pharmacological Agents Mechanisms of Action/Side Effects NRT Releases constant amounts of nicotine throughout the body using a tapering-off method. Available in several forms Side Effects: skin irritation (patch), dizziness, racing heart rate, sleeping difficulties, headache, vomiting, muscle aches, and stiffness. Review of Literature It is also important to note that each of these pharmacological interventions have varying mechanisms of actions and side effects. Nicotine Replacement Therapy releases constant amounts of nicotine throughout the body using a tapering-off method and is available in several forms including gums, patches, lozenges, nasal sprays, inhalers, and sublingual tablets. Nicotine replacement may cause skin irritations (the patch), dizziness, racing heart, sleep difficulties, headache, n/v, muscle aches, and stiffness. It is also important to note that each of these pharmacological interventions have varying mechanisms of actions and side effects. Nicotine Replacement Therapy releases constant amounts of nicotine throughout the body using a tapering-off method and is available in several forms including gums, patches, lozenges, nasal sprays, inhalers, and sublingual tablets. Nicotine replacement may cause skin irritations (the patch), dizziness, racing heart, sleep difficulties, headache, n/v, muscle aches, and stiffness.

    19. Pharmacological Agents Mechanisms of Action/Side Effects Varencicline (Chantix) Limits dopamine release and effectively blocks nicotine receptors in brain. Available in tablet form. Side Effects: sleeping difficulties, constipation, vomiting, flatulence, gingivitis, chest pain, influenza-like symptoms, edema, and thirst. Review of Literature Chantix works by limiting dopamine release and effectively blocks nicotine receptors in the brain. It is available in tablet form and may cause nausea, sleep difficulties, constipation, flatulence, gingivitis, chest pain, influenza-like symptoms, edema, thirst & vomiting. Chantix works by limiting dopamine release and effectively blocks nicotine receptors in the brain. It is available in tablet form and may cause nausea, sleep difficulties, constipation, flatulence, gingivitis, chest pain, influenza-like symptoms, edema, thirst & vomiting.

    20. Pharmacological Agents Mechanisms of Action/Side Effects Bupropion (Zyban) Atypical antidepressant norepinephrine & dopamine reuptake inhibitor Available in extended-release tablets Side Effects: anxiety, sleeping difficulties, seizures, dizziness, drowsiness, dry mouth, loss of appetite, abdominal pain, constipation, and diarrhea. Review of Literature Zyban is an atypical antidepressant that works as a norepinephrine and dopamine reuptake inhibitors. It is available in extended-released tablets and may cause anxiety, seizures, constipation, diarrhea, dizziness, drowsiness, dry mouth, loss of appetite, nausea, nervousness, stomach pain, stuffy nose, & difficulty sleeping.Zyban is an atypical antidepressant that works as a norepinephrine and dopamine reuptake inhibitors. It is available in extended-released tablets and may cause anxiety, seizures, constipation, diarrhea, dizziness, drowsiness, dry mouth, loss of appetite, nausea, nervousness, stomach pain, stuffy nose, & difficulty sleeping.

    21. 1. A comprehensive program that includes pharmacological agents as first-line therapies is supported. 2. Non-pharmacological interventions should serve as adjuvant therapies to medications to increase clients rates of sustained abstinence from smoking. 3. Treatment plans should be individualized and tailored specifically to each client in order to ensure positive outcomes Recommendations Based on the literature findings here are our recommendations. All of the articles obtained reiterated that although non-pharmacological agents are effective in smoking cessation, a comprehensive treatment program that includes pharmacological agents as first-line therapies is supported. Indeed, non-pharmacological interventions should serve as adjuvant therapies to medications to increase clients rates of sustained abstinence from smoking. And treatment plans should be individualized and tailored specifically to each client in order to ensure positive outcomes. Based on the literature findings here are our recommendations. All of the articles obtained reiterated that although non-pharmacological agents are effective in smoking cessation, a comprehensive treatment program that includes pharmacological agents as first-line therapies is supported. Indeed, non-pharmacological interventions should serve as adjuvant therapies to medications to increase clients rates of sustained abstinence from smoking. And treatment plans should be individualized and tailored specifically to each client in order to ensure positive outcomes.

    22. Both pharmacological and non-pharmacological treatment options address the various needs of the individual seeking smoking cessation. Combining non-pharmacological and pharmacological modalities and tailoring to the individual yields the best smoking cessation rates (Mundey, 2009). National Guideline Clearinghouse supports a multidimensional approach to smoking cessation. Literature Supporting Recommendations Both pharmacological and non-pharmacological treatment options address the various needs of the individual seeking smoking cessation. Mundey concludes that combining non-pharmacological and pharmacological modalities and tailoring to the individual yields the best smoking cessation rates. It should be noted that this article was not included in the review of literature due to it being a general review of literature, as opposed to a systematic review. However, it did include valid data and gave a good summary of the available cessation treatments. National Guideline Clearinghouse also supports a multidimensional approach to smoking cessation that is comprised of pharmacotherapy, social support/quitlines, and referrals to tobacco cessation consultants. The guideline also notes that in assisting a patient with smoking cessation, the tobacco user must be ready to quit. The guideline does not, however, recommend the specific usage of other non-pharmacological methods like exercise and guided imagery which were found to be effective in the appraisal of evidence. Since guidelines are designed to direct clinical practice, it is necessary for newer recommendations to identify more non-pharmacological agents as effective treatments for smoking cessation. Both pharmacological and non-pharmacological treatment options address the various needs of the individual seeking smoking cessation. Mundey concludes that combining non-pharmacological and pharmacological modalities and tailoring to the individual yields the best smoking cessation rates. It should be noted that this article was not included in the review of literature due to it being a general review of literature, as opposed to a systematic review. However, it did include valid data and gave a good summary of the available cessation treatments. National Guideline Clearinghouse also supports a multidimensional approach to smoking cessation that is comprised of pharmacotherapy, social support/quitlines, and referrals to tobacco cessation consultants. The guideline also notes that in assisting a patient with smoking cessation, the tobacco user must be ready to quit. The guideline does not, however, recommend the specific usage of other non-pharmacological methods like exercise and guided imagery which were found to be effective in the appraisal of evidence. Since guidelines are designed to direct clinical practice, it is necessary for newer recommendations to identify more non-pharmacological agents as effective treatments for smoking cessation.

    23. HOSPITAL A HOSPITAL B HOSPITAL C Current Practice Currently in the healthcare facilities, smoking cessation is inadequately addressed. We surveyed three major hospitals in the Tulsa area about their admission assessment questions regarding smoking cessation and the treatment options provided. Hospital A asks if an individual is a current smoker and interested in quitting. A packet of written materials is then provided if clients express interest in quitting. Hospital B also asks if an individual is a current smoker and interested in quitting and offers a patch to those desiring cessation. Hospital C only asks if an individual smokes with no follow-up questions or interventions. Currently in the healthcare facilities, smoking cessation is inadequately addressed. We surveyed three major hospitals in the Tulsa area about their admission assessment questions regarding smoking cessation and the treatment options provided. Hospital A asks if an individual is a current smoker and interested in quitting. A packet of written materials is then provided if clients express interest in quitting. Hospital B also asks if an individual is a current smoker and interested in quitting and offers a patch to those desiring cessation. Hospital C only asks if an individual smokes with no follow-up questions or interventions.

    24. Multidisciplinary Approach Awareness Campaign In-services (CEUs) Cafeteria posters/pamphlets Web-based materials PSAs (through television/radio) Admission assessment Designated smoking cessation experts on floors Recycling information (at specific time intervals) Implementation Strategies In order to effectively implement the changes presented, a multidisciplinary approach will be necessary. Physicians, staff nurses, nurse managers, case managers, clinical instructors, and other important members of the multidisciplinary team will need to come together in order to ensure these changes are implemented across the continuum of care. Similarly, clients themselves need to be included in the process in order to ensure their active participation in their healthcare and increase the likelihood of compliance with recommended therapies. An awareness campaign is an excellent tool to utilize in order to effectively disseminate this new information to both healthcare providers and consumers. This campaign could use various methods to distribute this information including in-services, which could be required or offered as continuing education credits. Likewise, common gathering places in the hospital, like cafeterias, are also great avenues to spread new information. Having a table assembled with posters and pamphlets regarding the new recommendations can draw people (including staff, patients, & families) to the area to inquire what information is being presented. They can then learn about the new recommendations and also obtain written materials to review again later and to also share with others. Links located on hospital and health department websites could direct clients to sites that offer information about the various treatment options for smoking cessation. In addition, hospitals often have a channel designated on their televisions that strictly provides information about the facility & health-related issues. If there was a particular time of day when these recommendations could be broadcasted, patients and their families could receive this information in a very in-formal manner. In this same way, PSAs sponsored by local health departments could be broadcasted on local radio & television stations. Admission assessments could be revised to include interventional questions related to smoking cessation. For example, if a client said yes to having a smoking history, the nurse would respond with, Are you interested in quitting? And then, if they say yes again, the nurse can provide them with information about the various treatment options available. Likewise, they can refer these clients to designated smoking cessation experts on the floor that can serve as consultants prior to discharge. Recycling the information is a very important strategy to also utilize in order to ensure it is effectively disseminated as well as to reinforce the recommendations into practice. The in-services could be held every quarter along with the cafeteria displays. Also, the television/radio broadcasts could be played throughout the day or week. Another excellent approach could be to assess the possible relapse times (for example 6-12 weeks) for those who quit and recycle the information then to increase the likelihood of sustaining abstinence. In order to effectively implement the changes presented, a multidisciplinary approach will be necessary. Physicians, staff nurses, nurse managers, case managers, clinical instructors, and other important members of the multidisciplinary team will need to come together in order to ensure these changes are implemented across the continuum of care. Similarly, clients themselves need to be included in the process in order to ensure their active participation in their healthcare and increase the likelihood of compliance with recommended therapies. An awareness campaign is an excellent tool to utilize in order to effectively disseminate this new information to both healthcare providers and consumers. This campaign could use various methods to distribute this information including in-services, which could be required or offered as continuing education credits. Likewise, common gathering places in the hospital, like cafeterias, are also great avenues to spread new information. Having a table assembled with posters and pamphlets regarding the new recommendations can draw people (including staff, patients, & families) to the area to inquire what information is being presented. They can then learn about the new recommendations and also obtain written materials to review again later and to also share with others. Links located on hospital and health department websites could direct clients to sites that offer information about the various treatment options for smoking cessation. In addition, hospitals often have a channel designated on their televisions that strictly provides information about the facility & health-related issues. If there was a particular time of day when these recommendations could be broadcasted, patients and their families could receive this information in a very in-formal manner. In this same way, PSAs sponsored by local health departments could be broadcasted on local radio & television stations. Admission assessments could be revised to include interventional questions related to smoking cessation. For example, if a client said yes to having a smoking history, the nurse would respond with, Are you interested in quitting? And then, if they say yes again, the nurse can provide them with information about the various treatment options available. Likewise, they can refer these clients to designated smoking cessation experts on the floor that can serve as consultants prior to discharge. Recycling the information is a very important strategy to also utilize in order to ensure it is effectively disseminated as well as to reinforce the recommendations into practice. The in-services could be held every quarter along with the cafeteria displays. Also, the television/radio broadcasts could be played throughout the day or week. Another excellent approach could be to assess the possible relapse times (for example 6-12 weeks) for those who quit and recycle the information then to increase the likelihood of sustaining abstinence.

    25. Multidisciplinary Approach Client & healthcare team satisfaction Awareness Campaign Short Term In-services evaluation forms Smoking history reassessment Follow-up phone calls & questionnaires Development of focus groups Long-Term Assess the number of individuals enrolled in smoking cessation programs. Assess hospital readmission rates for smoking-related complications Evaluation of Effectiveness Several different strategies can be implemented to evaluate the effectiveness of the awareness campaigns. Of course, assessing client and healthcare team satisfaction is priority. This can be achieved by providing evaluation forms to those in attendance to assess their perception of the information provided and if they planned to utilize this information in their practice. Also, hospital or individual practitioners can make notes on patients records to the answers they provided during the admission assessment regarding smoking. If and when they return to the facility, these same questions can be asked again and a comparison can be made. Follow-up calls & questionnaires can be sent to those who received counseling to track individual progress. Another strategy could be to create focus groups that included physicians, nurses, and those individuals that were smokers and tried the approaches outlined, and assess their feelings on the campaigns and whether they were effective. Focus groups enable everyone involved in the recommendations to come together to evaluate the methods used and can reveal a wealth of information from various viewpoints. In regard to long-term outcomes, assessing the number of individuals enrolled in smoking cessation programs can be utilized along with hospital readmission rates for smoking-related complications. Several different strategies can be implemented to evaluate the effectiveness of the awareness campaigns. Of course, assessing client and healthcare team satisfaction is priority. This can be achieved by providing evaluation forms to those in attendance to assess their perception of the information provided and if they planned to utilize this information in their practice. Also, hospital or individual practitioners can make notes on patients records to the answers they provided during the admission assessment regarding smoking. If and when they return to the facility, these same questions can be asked again and a comparison can be made. Follow-up calls & questionnaires can be sent to those who received counseling to track individual progress. Another strategy could be to create focus groups that included physicians, nurses, and those individuals that were smokers and tried the approaches outlined, and assess their feelings on the campaigns and whether they were effective. Focus groups enable everyone involved in the recommendations to come together to evaluate the methods used and can reveal a wealth of information from various viewpoints. In regard to long-term outcomes, assessing the number of individuals enrolled in smoking cessation programs can be utilized along with hospital readmission rates for smoking-related complications.

    26. What are other approaches to studying the identified problem? Long-term randomized control trial studies Specific studies comparing pharmacological and nonpharmacological interventions Studies on nursing related interventions Larger sample sizes Patient surveys Suggestions for Further Study Other approaches that could be used in the future to study this identified problem include: long-term randomized control trial studies, specific studies comparing pharmacological and non-pharmacological interventions, studies on nursing related interventions, larger sample sizes, and patient surveys. Other approaches that could be used in the future to study this identified problem include: long-term randomized control trial studies, specific studies comparing pharmacological and non-pharmacological interventions, studies on nursing related interventions, larger sample sizes, and patient surveys.

    27. What new research questions have emerged as a result of the project? Why are long-term abstinent rates so low? What are ways to overcome barriers to successful smoking cessation? What is the most effective non-pharmacological treatment for smoking cessation? What types of physical activity including intensity levels are best for smoking cessation? Suggestions for Further Study The questions that have emerged as a result of the project include: Why are long-term abstinent rates so low? What are ways to overcome barriers to successful smoking cessation? What is the most effective non-pharmacological treatment for smoking cessation? What types of physical activity including intensity levels are best for smoking cessation? The questions that have emerged as a result of the project include: Why are long-term abstinent rates so low? What are ways to overcome barriers to successful smoking cessation? What is the most effective non-pharmacological treatment for smoking cessation? What types of physical activity including intensity levels are best for smoking cessation?

    28. Nicotine Vaccine Rimonabant Pharmacogenetics Future Therapies Also, there are various therapies currently under research that have the potential to positively influence the success rates of those seeking smoking cessation. These include: nicotine vaccines, rimonabant which is a drug that reduces nicotine-induced dopamine turnover in the brain, and pharmacogentics which involves genotype-based treatment matching. Also, there are various therapies currently under research that have the potential to positively influence the success rates of those seeking smoking cessation. These include: nicotine vaccines, rimonabant which is a drug that reduces nicotine-induced dopamine turnover in the brain, and pharmacogentics which involves genotype-based treatment matching.

    29. Questions

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