[NYAPRS Enews] NY RNs Create Smoking Cessation Program For People w Psych Dis

[Matt Canuteson]

RNs Create Smoking Cessation Program For Patients With Mental Illness

By Lorraine Steefel Nurse.com May 4, 2009


Follow the smoke and you may find a patient with mental illness. Mental
health patients smoke 44% of U.S. cigarettes and represent an estimated
200,000 of the 443,000 smoking-related deaths in the U.S. annually,
according to the Centers for Disease Control and Prevention.

Smoking bans exist in most public places, but on many hospital grounds,
this group is permitted to light up. Concerned for their health, nurses
at New York-Presbyterian Hospital-Payne Whitney Westchester in White
Plains, extended a smoking ban to the outside campus and created a
smoking cessation program in an attempt to reverse the statistics.

Embedded in Culture

Tobacco use, the most common shared condition that those with major
mental disorders have, has been allowed, accepted, and even encouraged
in mental health settings. It has been a reward for good behavior and a
means of socialization. The prevailing attitude has been that people
with mental illness have so few enjoyable things in life - why take this
pleasure away?

The past relationship between mental illness and smoking is complicated.
Tobacco 

"The old attitude is short-sighted and uninformed," says Linda Espinosa,
RN, MS, vice president of nursing and patient care services and
initiative chairwoman. "We are taking responsibility for their health
and that of our staff by establishing a totally smoke-free environment,
while providing them with coping skills and ways to replace the need to
smoke," she says.

First Steps to Quitting

The CDC estimates 70% of people with mental illness want to quit
smoking, a figure comparable to the general population, and that they
can be successful with the assistance of targeted smoking cessation
strategies, adequate support, and the use of nicotine replacement
therapies. 

In 2008, Espinosa created a task force across disciplines that includes
nurses, physicians, pharmacists, social workers, psychosocial
rehabilitation specialists, and other staff, and formed subgroups to
research literature about treatments for nicotine withdrawal. They
created staff and patient education programs, smoking policies, and
methods to prevent problems that might occur with cessation, and
designed a marketing campaign.

"We didn't want just a smoke-free environment; we wanted to help
patients [and staff] quit smoking, and included them early on in the
discussion," Espinosa adds.


On each unit, administrative senior staff nurses and patient care
directors implemented the recommendations of the work group. These
included the framework of the five A's to help people quit -
* Asking about tobacco use

* Advising to quit

* Assessing willingness to make a quit attempt
* Assisting in the attempt to quit

* Arranging for follow-up



Helping patients quit includes providing staff and patient educational
opportunities, managing medications, and changing environments, says
Patricia Ireland-Vincoli, RN, BSN, administrative senior staff nurse on
the addiction recovery unit.


Because of a mandate by the Office of Alcoholism and Substance Abuse
Services, the addiction recovery unit went smoke-free first in July
2008. Ireland-Vincoli touts the American Lung Association Power to Be
Free program as a successful resource used to educate staff, who then
teach patients about smoking cessation. 


For three months before the smoke-free date, patients on the addiction
recovery unit discussed strategies and coping measures during weekly
group sessions with staff and certified alcohol and substance abuse
counselors. Certain out-of-door areas were converted to nonsmoking areas
for this group. Nicotine products such as the patch, gum, inhalers, and
prescription medications were available to ease cravings.


Although some studies have found a link between smoking cessation and
depression, today's correctly prescribed medications treat withdrawal
and depression, says Espinosa. Dual agents, such as buproprion and
nortriptyline HCL, for example, are antidepressants that treat symptoms
of nicotine withdrawal, she says.


Moving Forward to Cessation

"On the second chance unit where the majority of patients come from
state mental institutions with a history of psychoses, the initial
response to the smoking ban was a decrease in the activities of daily
living by a few patients," says Derrick Jenkins, RN, administrative
senior staff nurse. 

"When we created new reward strategies, such as patient-chosen movies
with snacks and video game time, patients became motivated and their
daily functioning ratings began to rise," Jenkins says. In place of
escorted smoking walks, patients walk to the gym to exercise, play
basketball, or throw Frisbees.

 

A Difficult Journey

Smoking literature suggests people with mental illness may be more prone
to relapse, but staff support can help sustain their efforts to quit.
"Some patients [on the addiction recovery unit] tell us they quit while
here but will resume smoking on discharge because they can't give up
drugs or alcohol and smoking all at once," says Iriland-Vincoli. "As
healthcare providers, we have to offer healthy choices."

 

Patients who are referred to the unit are alerted before their admission
that smoking is not permitted on campus.

 

Because healthcare professionals are aware of the related health risks
of smoking, not acting is unacceptable, according to the American
Psychiatric Nurses Association. Smoking cessation is an integral part of
mental health treatment, and achieving health and wellness will require
being tobacco-free.

On Nov. 20, 2008, New York-Presbyterian Hospital-Payne Whitney
Westchester became a smoke-free campus on Great American Smoke-Out Day,
an annual event sponsored by the American Cancer Society.

"Patients and staff who thought they would never be able to quit are
making progress and are happy about themselves," Jenkins says.

 

http://include.nurse.com/article/20090504/NJ02/105040083
<http://include.nurse.com/article/20090504/NJ02/105040083>  

 

 

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