Survey of Tobacco Cessation Curricula in Kansas Nursing Programs

Preparing nurses to intervene in the tobacco epidemic: Developing a model for faculty development and curriculum redesign

As the largest group of health professionals, nurses have a tremendous potential to help curb the tobacco epidemic. However, studies conducted across a range of global settings continue to indicate that both practicing nurses and nursing student have limited knowledge, skills and confidence needed to implement evidence-based tobacco cessation interventions. A contributing factor is the limited inclusion of tobacco control content in nursing curricula. Additionally, there is limited understanding of nurse educators' knowledge and perceptions about teaching tobacco dependence content. This paper presents the Loma Linda University School of Nursing's concurrent experience with both faculty development and curriculum redesign in the area of tobacco dependence prevention and treatment. An internal survey was administered at baseline and at 2-year follow-up to assess faculty's knowledge, perceptions and practices related to teaching tobacco dependence content and skills (n = 42). Faculty and curriculum development strategies and resources utilized, evaluation findings and subsequent lessons learned are described. The findings have implications for nursing programs seeking to enhance their curricula and commitment to ensuring that their graduates are prepared to provide evidence-based tobacco cessation interventions with each patient they encounter.

Tobacco cessation counseling training in US entry-level physical therapist education curricula: prevalence, content, and associated factors

BACKGROUND

The US Public Health Service (USPHS) recommends tobacco cessation counseling (TCC) training for all health care professionals. Within physical therapist practice, smoking can have adverse effects on treatment outcomes in all body systems. In addition, people with physical disabilities have a higher smoking prevalence than the general population, creating a strong need for tobacco cessation among physical therapy clientele. Therefore, TCC training is an important component of entry-level physical therapist education.

OBJECTIVE

The aims of this study were: (1) to determine need for TCC training within entry-level physical therapist education and (2) to identify potential barriers to implementation of USPHS guidelines in the academic environment.

DESIGN

A descriptive cross-sectional survey was conducted.

METHODS

Directors or academic coordinators of clinical education from entry-level physical therapist programs (N=204) were surveyed using an online instrument designed specifically for this study. Data regarding program and faculty characteristics, tobacco-related training content, and faculty opinions toward TCC in both physical therapist practice and education were analyzed descriptively.

RESULTS

The response rate was 71%. A majority (60%) of programs indicated inclusion of tobacco-related training, most commonly 1 to 2 hours in duration, and of these programs, 40% trained students in the implementation of USPHS clinical guidelines for TCC.

LIMITATIONS

Data analyses were constrained by limited or missing data in some areas. A single faculty member completed the survey for each program.

CONCLUSIONS

There is a need for TCC training in entry-level physical therapist education. Inclusion may be facilitated by addressing perceived barriers toward TCC as a component of physical therapist practice and promoting the relevance of TCC as it relates to intended outcomes of physical therapy interventions.

Evaluation of a theory-based education program to motivate nursing students to intervene with their seriously mentally ill clients who use tobacco

Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.

[Do we teach the smoking cessation intervention to future nurses? Result of a descriptive study]

Introduction :

Les infirmières qui ont reçu une formation en cessation tabagique ont tendance à intervenir davantage auprès des fumeurs que celles qui n’ont pas été formées. Il est démontré qu’une intervention même très brève conduit à une diminution de la prévalence du tabagisme. Or, les programmes qui préparent à l’exercice de la profession infirmière laissent actuellement peu de place à la formation en cessation tabagique. Les objectifs de la recherche sont de décrire les pratiques d’enseignement de la cessation tabagique dans les programmes de formation infirmière et de comparer en tenant compte de la formation en cessation tabagique reçue par les professeures.

Méthodologie :

Un devis descriptif-comparatif a été choisi.

Résultats :

Au total, 278 professeures (20,8 %) ont répondu à un sondage en ligne effectué à l’aide d’un questionnaire validé. Celles-ci avouent offrir en moyenne une heure en cessation tabagique par année. Les aspects physiopathologiques sont couverts au détriment de l’intervention professionnelle en cessation tabagique. Les obstacles identifiés par les professeures sont le manque de temps, de connaissances et de pertinence avec le cours enseigné. Seulement 11,9 % des sujets mentionnent avoir reçu une formation spécifique en cessation tabagique. Or ce sont ces dernières qui enseignent davantage d’éléments reliés à l’intervention en cessation tabagique.

Conclusion :

Une meilleure intégration de l’intervention en promotion de la santé, incluant la cessation tabagique, dans la formation initiale devrait amener la future infirmière à réaliser davantage d’interventions personnalisées en cessation tabagique.

Teaching Smoking Cessation to Future Nurses

Smoking cessation strategies are barely discussed in nursing education programs, even though initial education shapes how future professionals practice their profession. The aim of this research is to describe the practices, attitudes, and beliefs of nursing educators of Quebec with regard to smoking cessation strategies in initial nursing education. A descriptive design was chosen along with an online questionnaire. A total of 278 educators (20.8%) participated in the survey. Although educators recognize the importance of incorporating smoking cessation strategies into their teaching practice, they allocate an average of only one hour per year to the topic. Tobacco use is addressed mostly in terms of risk factors, with little focus on how to help patients quit. The perceived obstacles are related to false beliefs and a lack of knowledge. The results of this study demonstrate the need to raise educators’ awareness of the importance of incorporating smoking cessation strategies into classroom teaching.

Faculty-perceived barriers and benefits to teaching tobacco cessation

AIM

The study explored nurse faculty beliefs regarding patient tobacco use and the promotion of patient tobacco cessation.The second aim explored perceived barriers and benefits in teaching baccalaureate students about patient tobacco use and cessation.

BACKGROUND

Nurse faculty have a role in ensuring that graduates entering the nursing profession are knowledgeable, skillful, and have the self-efficacy needed to take action regarding patient tobacco use and cessation.

METHOD

Four 90-minute focus group interviews were taped, transcribed, and analyzed.

RESULTS

Two major themes were identified: barriers and opportunities. Barriers included a knowledge deficit about patient tobacco use and cessation, which lagged behind published evidence. Opportunities included perceptions that providing patient tobacco cessation should occur throughout the nursing process during nurse-patient interactions.

CONCLUSION

Nursing faculty development regarding patient tobacco use and cessation needs to occur as well as the development and dissemination of curriculum resources.

Making a case for systematic integration of theory-based tobacco education into graduate psychiatric/mental health nursing curriculum

Tobacco use and dependence is a serious public health issue that disproportionately affects the mentally ill client population. Mental health professionals, including psychiatric/mental health advanced practice nurses (PMHAPNs), are disinclined to integrate tobacco cessation interventions into their practice, due in part, to a general lack of tobacco-related knowledge (C. Essenmacher, C. Karvonen-Gutierrez, J. Lynch-Sauer, & S. A., Duffy, 2008; A. J. Molina, T. Fernandez, D. Fernandez, M. Delgado, S. de Abajo, & V. Martin, 2012; L. Sarna, L. L. Danao, S. Chan, S. Shin, L. Baldago, E. Endo, & M. E. Wewers, 2006); D. Sharp, S. Blaakman, R. Cole, & J. Evinger, 2009). This paper provides an in-depth literature review of tobacco education in nursing curricula and proposes the systematic integration of theory-based tobacco content into psychiatric/mental health graduate nursing programs.

Online tobacco cessation education to optimize standards of practice for psychiatric mental health nurses

This article presents an overview of an online education offering to improve standards of practice for nurses intervening with tobacco-dependent mentally ill populations. Designed as a pilot study and guided by the theory of reasoned action framework, the pretest-posttest educational program was conducted to examine attitudes and beliefs, knowledge, and intentions to integrate tobacco cessation interventions into practice. Although positive attitudes and beliefs were demonstrated, knowledge gaps continued to exist after the online program. Strengths and challenges of the online education offering are presented with recommendations for future research.

Promoting tobacco dependence treatment in nursing education

ISSUES

There are 17.3 million nurses worldwide, the largest group of health-care professionals, and they have great potential to address the epidemic of tobacco use and its related morbidity and mortality. However, the evidence indicates that the educational preparation of nurses for tobacco control remains inadequate.

APPROACH

This paper provides an overview of the efficacy of nurses in the delivery of smoking cessation interventions, existing tobacco control content in nursing educational programs, model curricula, teaching resources and strategies for reducing barriers to curricular change.

KEY FINDINGS

Despite the efficacy of nursing intervention for tobacco cessation, lack of appropriate knowledge and/or skill presents a major problem for implementation. An important factor fostering this lack of preparation is limited tobacco control content in current nursing educational programs. Barriers to enhancing and building this curricula include lack of preparation of educators, low priority for this content in an already overloaded curricula, negative attitudes, continued smoking by nursing students and/or faculty and lack of tested curricula. The availability of new tobacco control resources, including those specifically tailored for nurses can assist educators in teaching this content and nurses in implementing interventions.

IMPLICATIONS

Research and changes in policy are needed to ensure that nursing education includes essential content on tobacco control.

CONCLUSION

Nurses can be effective in delivering tobacco cessation interventions. Efforts are needed to promote curriculum that ensures that all nursing students and practicing nurses receive tobacco control content and are competent in the delivery of interventions; and to disseminate resources to nursing educators

Beliefs, knowledge, and self-efficacy of nursing students regarding tobacco cessation

INTRODUCTION

Evidence-based clinical interventions for smoking cessation have proven to be effective in reducing smoking rates among patients who use tobacco. Ensuring that registered nurses (RNs) are knowledgeable and have the self-efficacy to provide such clinical interventions can contribute to declines in tobacco use among their patients who smoke. The aim of this study was to determine if baccalaureate nursing (BSN) students in Minnesota received training in the clinical treatment of tobacco dependence and to identify perceived barriers that may limit their ability to intervene with their patients.

METHODS

Quantitative descriptive, with data collected in spring of 2007. The sample was 675 senior BSN students enrolled in ten Minnesota private and public institutions. The survey questionnaire included demographics, knowledge about tobacco treatment, personal tobacco-use history, beliefs about smoking, self-efficacy, and behavioral application of cessation intervention.

RESULTS

BSN students generally reported that they were comfortable assessing tobacco use among their patients and referring tobacco users to cessation resources. Nursing students who considered themselves smokers (7.9%) and who reported using tobacco in the last 30 days but did not consider themselves smokers (17.5%) indicated more agreement regarding the positive aspects of smoking, and were less likely to view it as their professional responsibility to help smokers quit, than did non-smoking nursing students (74.6%).

CONCLUSIONS

Nursing students' personal smoking behaviors affected their beliefs about smoking and their view about the professional role in helping smokers quit. These findings have implications for undergraduate nursing programs regarding professional role socialization and education about clinical smoking cessation interventions.

Evidence-based approach to an inpatient tobacco cessation protocol

Tobacco use contributes to USD53 to USD73 billion per year in healthcare expenditures and causes nearly 440,000 deaths per year. Given the strong cause-effect relationship between smoking and poor health outcomes, it is critical that smokers are identified early and advised about smoking cessation. Furthermore, the Joint Commission now mandates that tobacco cessation advice be given to patients admitted with heart failure, pneumonia, and acute myocardial infarction. As such, an interdisciplinary group at an urban academic medical center developed and implemented a tobacco cessation protocol with the goal of identifying and targeting inpatient smokers through evidence-based education and counseling. The protocol focused on admission assessment, education, and provision of standing orders for medication treatment for nicotine withdrawal and/or tobacco cessation therapy during the inpatient encounter and referral for outpatient counseling at discharge.

Are nurses prepared to curb the tobacco epidemic in China? A questionnaire survey of schools of nursing

BACKGROUND

Smoking prevalence among Chinese males is the highest in the world and its morbidity and mortality is growing. Previous studies suggested nurses are inadequately prepared to treat tobacco use and dependence.

OBJECTIVES

To examine the inclusion and organization of tobacco control content in the undergraduate nursing curriculum of Hong Kong and Mainland China; and the smoking status of faculty and students.

DESIGN

Cross-sectional survey.

METHODS

Deans of 32 nursing schools in Hong Kong and China with an undergraduate programme (representing over 12000 students) completed a self-administered questionnaire.

RESULTS

Most schools included the health hazards of tobacco (56.3-100%), but few covered tobacco cessation theory (31.3-62.5%), or behavioural (9.4-56.3%) and pharmacological (3.1-34.4%) interventions in the curriculum. Most curricula covered less than 1h of tobacco content per year of study. Nearly all schools (93.1%) reported smoking among faculty but only half reported access to smoking cessation programmes.

CONCLUSIONS

This is the first known study to examine the extent of tobacco control education in the nursing curriculum in China. Results suggested deficiencies in the coverage and clinical practice in smoking and smoking cessation, and recommendations were made to strengthen the curriculum.

Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty

We report on the findings of a national survey that examined factors that influence faculty's intentions to integrate tobacco education in their advanced practice nursing curricula. The addiction component of tobacco use is taking its toll on the health of 48 million smokers in the United States. Several national health authorities recommend and/or mandate that tobacco prevention and tobacco cessation be addressed at every point of entry in the health care delivery system. However, there is increasing evidence that health care providers may not be adequately prepared to meet national goals and/or standards. One hundred sixty-one advanced practice nursing faculty in the United States completed an 88-item survey regarding external factors (e.g., personal history of tobacco use, clinical practice, and current tobacco topics taught) and components of the Theory of Reasoned Action model (including perceived self-efficacy, behavioral beliefs, subjective norms, and control beliefs related to tobacco education). Descriptive statistics, chi(2) analysis, Pearson correlation, and linear regression were used to analyze the data. The findings revealed that sex (chi(2) = 7.949, P = .024), level of education (chi(2) = 26.853, P = .0005), years of academic teaching (chi(2) = 19.418, P = .013), and combined clinical and course responsibility (chi(2) = 10.430, P = .0236) were significant external (demographic) factors and that behavioral beliefs (attitude about tobacco education) demonstrated the strongest relationship with intention scores (r = 0.876, P < .0005). Overall, 62.7% of nurse practitioners reported high scores (>or=5, on a scale of 1-7) for intentions to integrate tobacco education, as compared with 37.5% of nurse midwives, 30.3% of clinical nurse specialists, and 8.7% of nurse anesthetists. This study adds to the growing body of evidence that nursing curricular gaps with tobacco education exist and that national efforts are needed to ensure that widespread changes occur to help reduce the morbidity and mortality related to tobacco use.

Evaluation of a Tobacco Cessation Curricular Intervention Among Acute Care Nurse Practitioner Faculty Members

Background In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC.

Objective To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs.

Methods Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula.

Results The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (P&lt;.001). Perceived effectiveness in teaching tobacco cessation also increased (P &lt; .001), as did mean scores for the perceived value of using an evidence-based national guideline (P&lt;.001).

Conclusions Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

Nurses' Tobacco-Related Knowledge, Attitudes, and Practice in Four Major Cities in China

PURPOSE

To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses.

DESIGN

A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003.

METHODS

2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity.

FINDINGS

2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions.

CONCLUSIONS

Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives.

Tobacco control curricula content in baccalaureate nursing programs in four Asian nations

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation. Tobacco use is one of the leading causes of death worldwide, and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco. China is expected to lead the world in tobacco-related deaths by 2025. Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common. Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke. Training health care professional students about these issues can have a profound impact on public health. In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during "World No Tobacco Day" on May 31, 2005. The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.

Using evidence-based educational strategies to increase knowledge and skills in tobacco cessation

To meet the demand for improved patient outcomes and accountability for healthcare delivery, nurses must embrace a culture of evidence-based practice (EBP). Integrating EBP for tobacco cessation in nursing practice is particularly important for the 44.5 million smokers in the United States who contribute to 157 billion dollars of healthcare costs annually. Unfortunately, studies reveal that healthcare providers are not aware of what is considered the best evidence, the United States Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence, resulting in missed opportunities to promote optimal health outcomes for individuals wanting to quit smoking. Fortunately, leading healthcare authorities such as the Joint Commission of Accreditation for Healthcare Organizations and Centers for Medicare and Medicaid Services now require providers to offer tobacco cessation services. The challenges and opportunities to do this effectively are many and with limited resources it will be increasingly important to ensure that nurses have the necessary knowledge and skills to improve tobacco cessation outcomes. For tobacco cessation interventions to become a standard of nursing practice, strategic efforts must be directed at advancing nursing research that evaluates best educational strategies for promoting tobacco cessation interventions within nursing curricula. In this article, a framework to help address nursing strategies to bridge the gap between EBP and tobacco cessation will be described.

Using the Rx for Change tobacco curriculum in advanced practice nursing education

In today's health care system driven by quality outcome indicators and performance care measures, it is essential for nurses to know how to intervene with tobacco-dependent patients. This article discusses pilot results from the "Rx for Change: Clinician Assisted Tobacco Cessation Curriculum" intervention conducted at Georgetown University School of Nursing and Health Studies using advanced practice students. The results reveal that 6 hours of tobacco-cessation training can increase knowledge and self-efficiency scores.

Tobacco and its trendy alternatives: implications for pediatric nurses

Although acute and critical care pediatric nurses may not rank tobacco prevention and cessation among their top patient-care priorities, the importance of providing health education, especially during vulnerable moments, cannot be overlooked. This article provides an overview of trendy tobacco alternatives, such as bidis, clove cigarettes, hookah pipes, and smokeless tobacco, that entice youth. The significant health consequences of these tobacco products and the implications for pediatric acute and critical care nursing practice are also discussed.

Providing Smoking Cessation Counseling: A National Survey Among Nurse Anesthetists

Current research has demonstrated that smokers have an increased incidence of intraoperative and postoperative complications. Certified registered nurse anesthetists (CRNAs) have knowledge of a patient's smoking status and are in a unique position to provide smoking cessation counseling (SCC). The results from a national survey about SCC practice among CRNAs is revealed in this article.

Active Participation in a Research Study

As nurse educators, it is necessary to make the connection between nursing theory and nursing practice. By implementing a new teaching strategy in a nursing research course, faculty researchers were able to accomplish 3 goals: (1) get students excited about the research process and view its relevance to nursing practice; (2) understand how all nursing and medical interventions begin with research; and (3) enlist student help on a faculty-sponsored research project. The authors discuss the project and its outcomes.

School Nurses' Opinions About the Prevention of Tobacco Use

To further understand school nurses' tobacco policy beliefs and attitudes toward tobacco companies, a convenience sample of 53 school nurses completed questionnaires about anti-tobacco policies and attitudes toward tobacco companies. Overall, these nurses strongly agreed with tobacco policies such as banning youths from wearing clothing with a tobacco logo to school and fining restaurant owners who permit smoking. In addition, these nurses on average were negative toward tobacco companies. For example, they thought that tobacco companies and advertising leads to youth tobacco use. However, this group of school nurses thought that youths were basically neutral toward tobacco companies. Considering their professional experience with tobacco prevention at school, school nurses would be logical designers of tobacco prevention school interventions. An implication of these results is that school nurse education should include policy and activism components.