WHAT NURSES AND MIDWIVES SAY
Barbara Greene is an educator and mentor for Waitemata DHB hospital clinical staff who deliver Smokefree ABC to patients. Her story shows that, although the nurse may do the leading, it is the patient who is in charge of the decision. She says,
As I have formerly worked as a Quit Coach, I sometimes talk with patients about smoking cessation in order to role model ways it can be approached. On this occasion a midwife asked me to assist as a new mother was keen to be smoke free and that she (the mother) wanted the father to be smoke free as well.
The mother was very happy to receive a Quitcard but the father was being really 'staunch' -"Nah, nothing wrong with smoking" and other 'addiction talk'. After a few minutes of asking questions that wouLd encourage deeper reflection, listening and providing information, I asked him if he would be happy for his new baby to become a smoker down the track. "Yep, when she is 18, yeah no worries!"
I looked at him and then lightly and warmly said "I respect your intelligence far too much to pretend that you think that either of us believes that". The rapport that was established between us enabled success with this light challenge to his 'addiction talk'. His whole demeanour changed - he became much more present and a few moments later I wrote a Quitcard for him too.
Since then I have tried this general approach and found that it is useful to honour a smoker's high intelligence which is sitting there just underneath the addiction justifying itself.
Shirley Deuchrass – Practice Nurse, Musselburgh Medical Centre, Dunedin
It always surprises me how few people, including nurses, understand the severity of smoking on the cardiovascular system. The National Heart Foundation website has a wonderful visual tool, “Your Heart Forecast” to help patients understand the necessity to quit smoking.
Once you have keyed in the data on “Your Heart Forecast” and moved through the programme (it is quick) you can click on “quit smoking” and change the visual graph to show patients how quitting smoking can reduce their risk of a heart attack or stroke. The programme allows an opportunity to change the blood pressure reading and lipid results so that the quit provider can look at the broader picture, such as the effect changing lifestyle factors can have on a patient’s risk of heart disease.
It is a chance to reduce the risk of CVD as well as smoking related cancers. Prevention is what nurses love and rarely see in the health system as it is. The smoking cessation programme I deliver and “ask about the elephant” is prevention on a scale that makes everyone smile.
Once the patient is taking NRT they sometimes become complacent and don’t want to keep visiting the medical centre. I have a list of patients that I phone on a weekly basis for support. It seems to be working.
Success Stories from Val Southcombe R.N., Quit Coach, Wanganui
I now realise that there is no ‘best’ age to quit smoking.
An 87 year old gentleman who had smoked for 71 years quit using NRT and loads of affirmation from me as support Quit Coach. His life went from housebound, using a walking frame, drinking copious cups of coffee and waiting to die….. to back to a walking stick only and once more tending a vegetable garden. He felt motivated to reduce coffee intake and generally had a new feeling of wellbeing.
A 59 year gentleman, smoked for 41 years. Referred by his GP for cardiovascular problems. I used NRT with motivational work/affirmation. He quit successfully with the added bonus of restored sexual function after 10 years dysfunction. Now a non smoker, with restored cardiovascular health, restored marriage and restored self esteem.
Jill Lamb is a Colposcopy Nurse at Christchurch Womens Hospital
Jill discusses smoking cessation with all her patients and recently had a success story with a prisoner. "She felt she was having difficulty accessing support to become smokefree and was appreciative of having someone else offer support and the free nicotine products to assist her. Adequate support is the key – even if this does take time. Encouragement, support and acknowledging progress are all crucial steps.”
Jill is not discouraged by unsuccessful stories about quitting because every experience is unique to each individual and no two journeys are the same.
Lynley Blythe is an Occupational Health Nurse in Whangarei
Lynley says “It takes trust to build a relationship and knowledge to give advice. Nurses share not only a unique therapeutic relationship with their patients, but want to be part of their smokefree journey. It is important to accept the differences amongst individuals in this journey towards quit smoking. Nurses can help patients to identify their strengths and clarify myths about quitting.”
Lynley has had many successes in assisting patients to quit, including one who couldn’t walk to the end of the driveway without puffing who now enjoys fast walking several times a week and biking.
Jan Klausen is a midwife who works who works for Hawkes Bay DHB. Urging pregnant/new mothers to quit smoking is a vital issue for the wellbeing of the child and Jan tells us of an encounter which she has had. Jan hopes that it will inspire every nurse to go beyond their fears and pre-conceived judgement of how the woman will responhd and be courageous enough to ask "Do you want to be Smokefree?". She says,
I wanted to succeed where others had failed as I went into Lucy's room. SHe had declined NRT earlier. I wondered if I might be the one she said "Yes" to. Lucy, a 20 year old primiparous woman sat smiling, cuddling her new baby. I introduced myself, began building rapport and soon gained her confidence.
"Lucy, I asked, if I could show you that the advantages of going smokefree outweighed the disadvantages, would you be keen to learn?" She smiled shyly and although she hesitated slightly, whispered "I suppose I could give it a go."
I whipped out some paper, made a hasty grid with 2 columns. Collaboratively we made 2 lists of advantages and disadvantages. It was fun and we laughed when she was first to offer a new 'advantage' I then asked her to rate how much the particular reason meant to her betwen 10% being not very important and 100% being hugely important.
We then added up each side and divided the number of reasons into each total to give a percentage in each column. Lucy was astounded to see the advantages as she had listed and rated them outweighed the disadvantages by 2 to 1. As she sat contemplating the reality of her own convictions, holding her newborn infant, I simply asked "would you like me to prescribe you some patches? I can also teach you how the inhaler will help with urges". Lucy nodded "OK".
Jane Kittow is a midwife with Hawkes Bay DHB and her story clearly demonstrates why you shouldn’t give up with a patient and that every patient has their own ‘trigger’. She says,
Recently while working in labour ward I answered a bell for my colleague. I introduced myself and said, “Can I help you? Your midwife is on her meal break”. The reply was ‘’I know you, you got me to stop smoking’’. The woman was Kelly whom I have met during previous pregnancies. Kelly had just birthed baby number seven.
I had met Kelly with other pregnancies but it was during her sixth pregnancy that I had seen her regularly at Ante Natal Clinic as she was cared for by the Secondary Care Team.
Kelly began smoking in her teenage years and was at that time smoking 10- 15 cigarettes per day. Kelly told me that every time she came to clinic for her routine checks we had talked and always “I harped on” about making a smoking cessation referral. Each visit Kelly declined even though we talked about the benefits of becoming smokefree.
I asked Kelly about it and said “What clicked for you?” She told me that it was in the last few weeks of pregnancy she accepted NRT and a referral to smoking cessation.
Kelly thought she would give it a go as I had not only reinforced the health and monetary benefits of becoming smokefree but also spent time pointing out that children of parents that are not smokefree were likely to smoke as adults as they observe the role modelling of their parents. Kelly decided that she did not want this for her children and would give it her
Kelly has been smokefree for 14 months now (Dec 2011) and not once felt tempted to smoke again. She told me “The Best Thing is More Money for My Kids”. Each week Kelly spends $40 on one of her children for the little extras i.e. clothes, books, toys and this made her feel great to be able to do this.
On Reflection: The most important message I have gained as a health professional is don’t give up hope. Always be consistent and keep offering advice and referral. Always educate and impart your knowledge to women, their whanau and their
support network. Use each visit or meeting as an opportunity. As health providers we can make a difference.
It was really good to meet Kelly again and have the positive feedback on my efforts to help her become smokefree.