INTRODUCTION
Nowadays, there is an escalating recognition for nurses that produce evidences illustrating how nursing endeavours in both clinical and community settings are efficiently improving the health status of patients, decreasing death rates and improving the quality of life not only of patients, but the larger community, as a whole. In most instances, when these nursing activities are merged and blended well with the technical capabilities of the nurse, the strengths of the nurses can bring about relevant development in the lives of the people.
In the Education Project 1, a meta-analysis of the available literature was conducted. This literature review explores how cigarettes abuse can impact on disease processes and health issues for adult men and women. Hence, in this paper, the information from that is used to design a plan of management for a client with a particular health issue. This client smokes and has recently been diagnosed with heart disease which often extends over longer period of time and may extend into the community.
CORE HEALTH ISSUES
There are two core health issues which will be given ample attention in this paper.
Core Health Issue 1: Smoking as a Serious Health Hazard that may Result to Heart Disease
One core health issue is that smoking is found to be the single greatest cause of avoidable illness and preventable ill health (Department of Health, 1998; World Health Organisation, 2008). Many studies have proven that smoking is related to heart and arterial diseases (Shalhoub, 2005). In a study by Duaso & Cheung (2002: 479), one in four respondents was a smoker. This study also reveals that sixty-three per cent (63%) of smokers wanted to receive help to quit the habit.
However, it is also shown that only eleven per cent (11%) of the smokers who visited the surgery during the year 2001 had received health promotion advice from the nurses. These nursing staff are said to be encouraging them to give up smoking. The findings suggest that more emphasis should be placed on regular smoking screening and smoking cessation clinics which would be welcomed by the patients.
Core Health Issue 2: Reasons for smoking differ between genders, and among socioeconomic groups and different cultures
Another core health issue, as suggested by McCance-Katz, et al. (2005: 528), is that smoking affects men and women differently. Men and women may abuse the cigarettes, but not always in the same ways (Ridolfo and Stevenson 2001). When women smoke cigarettes, they take shorter and fewer puffs and experience improvements in mood that men do not. In the same way, women generally are less successful in quitting smoking than men do.
As compared to males, females tend to smoke not for nicotine but more on the other influences of smoking. These non-nicotine effects include sensory effects like the social pleasure they get from smoking, smelling and seeing cigarette smoke as well as conditioned responses to the smoke stimuli (Brandon, et al., 2007: 284). These women smokers seem to enjoy smoking in groups as evidenced by more males smoking alone. The implication of these observations is that treatment for men and women can be customized, depending on the gender.
ACTUAL AND POTENTIAL PROBLEMS
Cigarette abuse is a big societal concern nowadays to its ill-effects. Smoking habits[7], especially when above board may result to numerous health risks and problems (Shalhoub, 2005). Even the available nursing interventions that can be done for patients suffering from cigarettes abuse with heart complications and diseases may pose some actual and potential problems. For instance, some drugs are said to have side effects. Treatment using patch over gum, on the other hand has potential of creating problems as a result of the patients’ adherence to the gum regimen.
NURSING INTERVENTIONS
Nursing Interventions for Core Health Issue 1: Smoking is a Serious Health Hazard
Since smoking is a serious health hazard, there is a need to address the problem properly. Numerous evidences point the link of smoking to heart diseases (Edwards, 2004: 219).
In order to help a smoker patient in his medical problems, there is a need to first clarify some of the information about the patient, majority of which were obtained from the hospital. The gaps between the hospital information/data and the patient’s personal accounts of his smoking history have to be filled in the gaps in.
The first questions to be asked are the things related to what he had presented like how long had he been smoking and how often. Questions about his intake of alcohol or drugs will also be asked. This is important to determine the gravity of the patient’s unhealthy lifestyle. Other questions that are related to smoking will also be inquired.
The extent of the problems regarding his smoking will be assessed. Also his awareness of the implications of his smoking problem as well as the probability that he will have a hyperlipidemia will be assessed before the session ends. After the questions related to these matters will be asked, his family history will then be probed. Simple anecdotes about his life would be asked. The medical history of his parents and siblings would be solicited.
After the interview with the patient, interviews with his parents and siblings are also necessary to assess the extent of influence of the family members to the current state of the patient. To be able to get the cooperation of the family members, the purpose of the interviews will be explained to them fully. For the patient to be helped with his problems, the full cooperation of his family and relatives are needed.
The questions to be asked from the family members are the medical history of the family as well as the medical history of the patient. The extent to which the family members know the addiction of the patient to smoking will also be assessed. The family members and relatives will also be asked if they know the implication of the addiction of the patient to the said cigarette. The feelings of the family members will also be inquired about the problems.
The addiction of the patient to cigarette will be inquired. It is essential that family intervention be sought for the problems of the patient to be easily addressed. The impact of the problem is not only felt by the patient himself but his family members as well.
Therefore, the help of the family members is necessary so that the problems at hand will be easily solved. The service of a drug rehabilitation centre is needed to cure the addiction of the patient to drugs (Wright & Leahey, 2005). An intervention for smoking should also be provided. After the patient has been treated, it is advised that he engage to community activities such as sports competition or any worthwhile activities sponsored by the community to keep him busy and to ensure that the patient will not go back to his old habits.
Nursing Interventions for Core Health Issue 2: Most Smokers Want to Quit and Accept Help through Advice and Support from Healthcare Professionals
During the olden days, smoking is done anywhere, even in public places where numerous people can get affected, even non-smokers, from the acts of those who are smoking indiscriminately in any place. It is good that nowadays, smoking is restricted or banned in almost all public places. Cigarette companies are currently not allowed to advertise on radio, magazines and television.
Most smokers want to quit, and may be helped by advice and support from healthcare professionals. Nurses are the largest healthcare workforce, and are involved in virtually all levels of health care. Result of the study conducted by Rice & Stead (1999) reflects that advice and support from nurses could increase people’s success in quitting smoking, especially in a hospital setting. Similar advice and encouragement given by nurses at health checks or prevention activities seems to be less effective, but may still have some impact.
Since 1990 health promotion and lifestyle advice has been integrated in general practice and has been mainly undertaken by practice nurses. A study by Duaso (2002: 478) revealed that a response rate of 64% was achieved. Questionnaire analysis revealed unhealthy lifestyles among the population studied that could be addressed through health promotion. Health needs to be promoted. The low rate of lifestyle advice reported by the patients implies that more preventive advice should be provided in primary care settings. As a nursing intervention in this case, more effective health promotion will be given to the patient. The interventions to be given should be according to the needs of the patient.
PREVENTION MEASURES AND THEIR EFFECTIVENESS
Primary Strategies
The primary strategies in this case are aimed at reducing, and eventually eliminating cause of ill health. Likewise, the primary strategies are geared towards controlling exposure to risk. The primary measure of smoking cessation will be both point prevalent and self-reported prolonged abstinence.
The major advantage of point prevalence estimates is that they are widely reported in the literature and can be verified bio-chemically. However, point prevalence abstinence does not account for slips and lapses that might occur between follow-up periods. Prolonged abstinence, on the other hand, which is abstinence sustained after a two-week grace period, accounts for these lapses but cannot be verified bio-chemically, and ultimately, must be assessed via self-reports. However, self-reports tend to be accurate, and misreporting rates are generally very low.
Relapse is defined as smoking on seven consecutive days or smoking at least once each week on two consecutive weeks. The latter defines participants who smoke regularly after the quit date, but less than on a daily basis (e.g. social smoking). Continuous abstinence (i.e., not smoking, not even a puff since target quit date) will also be measured.
Secondary Strategies
The secondary strategies are aims to reduce progression of a disease i.e. early detection early intervention and prevention of complications. This will be done by quitting smoking at the earliest time possible.
For instance, progression of diseases brought about by smoking can be easily curtailed as a result of stopping smoking. Stopping smoking, even late in the course of the disease may result in mild improvement in lung function, and more importantly it will slow the rate of decline in lung function. Sometimes your lung function can improve back up to the level of a non-smoker.
The nurse can also oversee taking of drugs prescribed by the doctor. (Reinberg, 2008). Example of medicine is the bupropion[12] (Smoking cessation, 2002). Sometimes, the nurses can oversee nicotine replacement therapy. This type of therapy is done through patches, gum, lozenges, and others. These are given to reduce cravings of the patient to nicotine from cigarettes. It is also beneficial for these patients to be involved in counselling and other supportive measures.
LEGAL AND ETHICAL ISSUES RELEVANT TO THE SCENARIO
The ethical relevance of the confidentiality of treatment for client with smoking problem is important. This is usually one of the major concerns of clients. Privacy for them is very important. Before treatment, they would usually try to seek assurance that their treatment will be held confidential. Hence, release of any information should be approved by them.
Reveal to clients upfront any information relevant to their case. Unless, very relevant, limitations on the relevant information should not be imposed. In the case of minor clients, special considerations must be observed. Respect to patients should be observed at all times. Specifically, clients’ lifestyle, autonomy, as well as ethical decision making should be taken into consideration.
Policy measures are also important in encouraging smokers to quit the habit (Radke & Schunkert, 2006: 2386). The presence of these policy measures will create awareness. People will be more careful. The government should be careful in not sending confusing messages to the public. The policy measures to be developed should be firm.
One good policy is on spending more on a media-based education campaign. Orientation of the people will greatly improve the awareness to the ill-effects of cigarettes.
Smoke-free environments at work and in public places should be the aim of the government. The citizenry has to help the government in this aspect. It is for the good of the majority of the people, not only for the current generation, but also for the future generations. The impact of a healthy environment today is long-term.
Taxation can be used to keep cigarette prices high as an incentive for people to quit. It will also help to include in doctors’ contracts of obligations to encourage people to stop smoking. One innovative policy measure is the development of a “stop smoking” service in every hospital.
In all these legal and ethical considerations, respecting the client decision(s) to continue or reduces their smoking use is of utmost importance.
CONCLUSION
There are potential benefits of smoking cessation advice and/or counselling given by nurses to patients. Evidences reflect that this type of intervention is effective. It should be noted, however, that the evidence of impact is weaker when interventions are short-termed or are given by nurses whose main role is not health promotion or smoking cessation.
There is a need to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice. This is done so that all patients are given an opportunity to be asked about their cigarette use and to be given advice and/or counselling to quit along with reinforcement and follow up. The role of the nurse is not only to relieve suffering of patients, but also in improving their quality of life.
BIBLIOGRAPHY
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