Project Description


Marissa Abram, RN, CASAC-T
Phoenix House
Project Lights Out Phoenix House

Smoking cessation is a challenge faced by many of the clients that enter substance abuse treatment. When they enter our program they are expected to comply with the rule of not smoking. Our clients smoking habits are assessed and they are offered pharmacological treatments on initial evaluation and then by request as they continue through treatment. The goal of this project is to standardize treatment by providing training to medical/clinical staff with knowledge deficits. This would include educating them on use of the five A's (ask, assess, advise, assist, arrange) the pharmacological products available, educating about strategies to quit, the health benefits of quit and dealing with cravings so they can effectively pass this information to the clients in a supportive manner. A psychosocial component will also be added, by developing staff guided, peer-led smoking cessation groups. As smoking is considered program non-compliance, behavi oral interventions with include cognitive exploration on ambivalence/obstacles to quitting, benefits of quitting, how smoking behaviors relate to addiction of other substances.



Jennifer Armentrout, BSN, RN, PHN
Sharp Mesa Vista Hospital
Living Well

The Sharp Mesa Vista Psychiatric Hospital campus went tobacco-free on July 1st, 2013. When this policy was implemented, the patients were not given any means of tobacco cessation support (open discussions, group therapy sessions, etc.). The goal of the project is to give those patients the support they need to quit, by educating the patients about living well. In order to give the patients the means to live well, we will discuss the benefits of exercise, healthy eating, drug cessation (including tobacco), relaxation techniques, and following treatment recommendations. Currently, the hospital screens patients for tobacco upon admission and the appropriate nicotine replacement therapy is ordered. These nicotine replacements include patches and lozenges, but I would also like to include inhalers. During the proposed group, which will meet once weekly for 45 minutes, the discussions will cover multiple subjects, all with an emphasis on living well.  I plan to ask the patients about their favorite ways to exercise and relax, as well as the types of healthy foods they enjoy. Then, we will do deep breathing exercises and have nutritious snacks. After that, I will discuss the importance of following treatment recommendations to maintaining optimal health. Finally, I will illustrate how quitting tobacco can help one live well. During this portion, we will work on recognizing their tobacco habits and learning methods that will help them quit. I will ask patients that are not ready to quit to keep an open mind and consider participating in a group with the others.


Suzan Blacher, MSN, RN, CARN, CCIT
Family Recovery Specialists
An Adolescent Tobacco Dependence Intervention and Cessation Program

Adolescents are a unique group of individuals who experience tobacco use and dependence. They are not “little adults”. The project idea is to offer an adolescent group currently in an outpatient substance abuse program who are tobacco users (with or without nicotine dependence) specific strategies and/or treatments for quitting that are based on the unique needs of adolescents.  Main Activities that Comprise Project:

  • Assessment:
    • Types & patterns of  tobacco use with severity of use and dependence, exposure to second hand smoke
    • Motivation to quit
    • Psychosocial, cultural, environmental, gender influences
  • Provide tobacco dependence screening and education to adolescents.
  • Modify and apply adult counseling and behavioral interventions using developmentally appropriate language and approaches.
  • Consider using nicotine replacement therapies (NRTs) only after determining nicotine dependence.
  • CO2 testing
This program will include education about the physical, emotional and social risks associated with substance use. Clients will be taught refusal skills and other coping mechanisms in order to make better choices related to living a physically and emotionally healthy lifestyle free from substance use.


Janick Bridges, RN, FNP-C
Healthcare for the Homeless- Houston
Stop Choking, Quit Smoking

A smoking cessation program would benefit the patients of Healthcare for the Homeless- Houston (HHH), a federally qualified health center located in the downtown area of Houston, Texas. The program would consist of a support group meeting once a week at the clinic for  one hour. The clinic providers would refer the patients. Student nurse practitioners who come to the clinic for their preceptorship would be actively involved with the group. The students would be supervised by the project leader and by the clinic counselor, who is the clinic chaplain and a licensed therapist in drug addiction recovery. Each meeting would begin with a twenty minute interactive education activity presented by a student or by the project leader. The educational activities would include: 

  • Presenting visuals such as posters describing cardiovascular disease and lung disease
  • Information on the history of tobacco • Common misconceptions about tobacco quitting
  • Tips on quitting 
Many suggestions for teaching are available on "100 Pioneers for Smoking Cessation Virtual Leadership Academy" on the University of California San Francisco (UCSF) website at http://smokingcessationleadership.ucsf.edu. The second part of the meeting would give an opportunity to the participants to share their progress and/or difficulties with the rest of the group. This segment would be lead by the clinic counselor/therapist. The student(s) would also be involved and use one-on-one motivational interviewing techniques.


Nicole Rozek-Brodrick, APRN, RN, NP, CNS, DNP
University of Colorado Colorado Springs School of Nursing
Teaching Tobacco Cessation to Undergraduate Nursing Students in a Psychiatric Clinical Rotation

Objectives

  1. Describe the 5 A method in detail (ASK about current smoking status, ADVISE   to quit and provide information on how beneficial quitting is, ASSESS willingness to quit, ASSIST with finding resources and making a plan to quit, ARRANGE for follow-ups to help the patient follow through.
  2. Explain the States of Change; including dealing with resistance (Prochaska, DiClemente, 1983). 
  3. Explain harm reduction strategies verses cessation techniques, and address the top pharmacologic and nonpharmacologic treatments for nicotine dependence.

Activities

  • Students will be given a pretest regarding their knowledge on tobacco cessation - addressing the 3 and 5 A methods, treatments available and resources available for patients
  • Students will be provided with a PowerPoint presentation from the Rx for Change addressing the 5 A and 3 A method.
  • Students will review the clinical vignettes from the Rx for Change website prior to their clinical practicum and then discuss them in case consult after their weekly clinical.  
  • Examine the various pharmacologic and nonpharamocologic treatments of nicotine dependence reviewing the risk/benefit ratio


Sarah Farwick, BSN, RN
Chicago Lakeshore Hospital
No Smoking! No Butts About It!

The goal of this project is to implement a smoking cessation program for Chicago Lakeshore Hospital.  CLH is a free-standing psychiatric hospital for adults, adolescents and children.  Currently we are only providing nicotine patches for our patients who smoke.  We do not have a comprehensive smoking cessation program in place.  However, a recent topic of discussion has been that due to safety concerns for our patients, our medical staff and medication performance improvement team is considering no longer using nicotine patches.  Therefore it is timely for us to initiate a strong smoking cessation program with effective interventions.  The program will start with the medical director assessing the patients for tobacco use/dependence.  Once identified, this will be added to the patient's treatment plan and interventions to help the patient reach their goal of smoking cessation will be determined.  While on the inpatient units, patients will attend an educational session with registered nurses who will review materials with the patients and provide activities and discussion related to smoking cessation.  Patients will have access to a "No Smoking" box which will consist of activities that the patients can do if they are having difficulty with nicotine cravings.  We will also post signs in our display cabinet related to smoking cessation to help bring awareness to our program.  Additionally, we plan to become a smoke free campus, which would affect some of our employees.  Therefore, we would also initiate a smoking cessation program for our staff which would include education and assistance with quitting.


Constance Green, RN, MS, NPP

Suffolk County Community College
Let's Quit Together

HANDS ACROSS LONG ISLAND (HALI) was formed in 1988 as a grassroots, multi-service, organization managed and operated by, and for, psychiatric survivors. HALI is the largest and most successful peer-run, multi-service mental health agency in NY State. After consulting with HALI staff, a multi-faceted program called, “LET’S QUIT TOGETHER!” as outlined below was developed:

  1. Total agency Cigarette Count: We will keep a daily count and post a weekly total for the HALI Agency as a group. The idea here is to focus on cigarettes smoked by the group as a whole. We believe it will create a feel that we are working as a team! This will decrease focus on individual’s successes or failures. 
  2. Smoking Cessation Support Table: We will have a support table placed near the smoking exit. There will be a support person there to offer a variety of alternatives to smoking. Some examples include talking, opportunity to take a walk with someone, tobacco cessation literature, board games, relaxation tape, gum/mints, water coloring, etc. 
  3. Ask me How I Quit Buttons:  There are several people that have successfully quit smoking at HALI.  We will give those people buttons that say, “Ask Me How I Quit!” Hopefully, this will encourage members to talk about quitting and to hear success stories. 
  4. Reward/Incentive Program Tokens redeemed for prizes: 
    One token for logging in the number of cigarettes smoked.
    One token for stopping at Support Table to try to delay smoking or not smoke.


Erica Joseph, FNP-C
Southeast Louisiana Veterans Healthcare System
The Importance of Tobacco Cessation Classes in Conjunction with Pharmacological Interventions

This project idea is to enhance an existing tobacco cessation program in the population that I serve. Many times the client will accept pharmacological intervention but refuse to attend the tobacco cessation classes. It is important to get them to engage in both and agree to attend these classes. My idea is to gain more knowledge so that I can play an instrumental role in offering tobacco cessation classes to those veterans that I serve at the community based outpatient clinic (CBOC) in the Baton Rouge, Louisiana area. Classes are held at several surrounding CBOC locations but not at location where I provide care for veterans. I would like to educate as many veterans as possible who agree to have medications prescribed and commit to attending the tobacco cessation classes.  They need to be educated on how to quit smoking and techniques or coping skills to assist them in becoming successful in their efforts. Education to include why and how to quit smoking to result in long-term success.


Jeanette Lee, MS, NPP
Broome County Mental Health
Smoking Cessation Program for Clients with Mental Illness

Utilizing the manual of 'Intensive Tobacco Dependence Intervention with Persons Challenged by Mental Illness: Manual for Nurses' developed and implemented at Rochester, NY and the 2009 update of 'Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers', I like to start smoking cessation program for clients at Broome County Mental Health since there is no smoking cessation program available for clients with mental illness.  This will be my Capstone Project for DNP from Binghamton University with Dr. Geraldine Britton.


Patricia O'Brien, PhD, RN, PMHNP-BC
Long Island University School of Nursing
Patient Education Group on Smoking Cessation with student nurse and staff nurse co-leaders

Student nurses in each clinical section of the Behavioral Health Nursing course will prepare a patient education group on smoking cessation.  The students will invite a staff nurse to co-lead the patient group, thus educating the staff nurses on the content and involving them in a process that they may continue after the student rotation ends.  The LIU School of Nursing has on average 14 clinical sections per semester and uses a variety of units in large hospitals throughout New York City.  This maximizes the impact this project can have on students, patients, and nursing staff.  Content of the group will include:  Reasons to quit, Exploration of past efforts (what worked & didn't work), Triggers to smoking, Strategies to quit (medication, creating a support system, a quit date, cleaning house, stress management).

References for evidence based practice: 1.Guide to quitting smoking. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/002971-pdf.pdf.; 3.Treating tobacco use and dependence: 2008 update. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf. Accessed Feb. 28, 2011; Prochaska, J. (2009). Ten critical reasons for treating tobacco dependence in inpatient psychiatry. Journal of the American Psychiatric Nurses Association, 15, 404-409.


Chizimuzo Okoli, PhD, MSN, MPH, RN
University of Kentucky
Developing a Tailored Tobacco Treatment Program for Individuals with Schizophrenia

The central hypothesis of this proposed change project is that tobacco treatment tailored to a specific mental health diagnosis (e.g., adapting evidence-based treatment to the unique challenges experienced by smokers with schizophrenia) is more effective and acceptable than a targeted approach (i.e., simply transferring interventions that work with the general population to this high risk group). The goal of this project is to adapt, tailor, and test the effectiveness of an evidence-based tobacco treatment approach specific to individuals with schizophrenia. This project would be completed in two phases: 

  • Phase # 1: Adapt and tailor a tobacco treatment approach for smokers with Schizophrenia. The content, components, and treatment approach of an existing evidence-based tobacco treatment will be tailored based on data from preliminary studies, focus groups with former and current smokers with schizophrenia, and key informant interviews with healthcare providers who deliver tobacco treatment to individuals with mental illness. An evidence-based treatment manual for smokers with schizophrenia will be produced from this effort. 
  • Phase # 2: Test the efficacy and acceptability of the tailored tobacco treatment intervention. Our working hypotheses are that compared to those randomly assigned to receive a standard tobacco treatment (n=20), individuals with schizophrenia receiving tailored treatment (n=20) will: a) achieve greater abstinence; b) smoke fewer cigarettes per day (among those who do not achieve abstinence); and c) have greater satisfaction ratings with the intervention. These outcomes will be measured at the end-of-treatment and at 3-month follow-up time points


Leigh Powers, DNP, APRN, PMHNP-BC
East Tennessee State University
Educating Clinicians for Successful Implementation of a Tobacco Cessation Program

Evidence suggests that an ongoing relationship with a provider that includes even brief support for tobacco cessation can significantly improve rates of quitting. Therefore, this project aims to enhance provider knowledge of tobacco cessation interventions and provide an easy-to-use toolkit for future use in practice. This tobacco cessation project will provide a brief overview of nicotine dependence.  Participants will view a voice-over PowerPoint presentation discussing tobacco use, associated risks, prevalence, and costs. Through an appointment role-play video, participants will be instructed how to screen patients for tobacco use during appointments. The project will review the five A’s of tobacco treatment (Ask, Assess, Advise, Assist, Arrange), an evidence-based intervention easily implemented in a clinic setting. Information will be provided related to cessation products. Medications will be discussed, both prescribed and over-the-counter. A review of supplementary materials for support such as therapy, text messaging, telephone support services and online resources will also be presented. A discussion will also be given on how to deal with patients unwilling to quit. This educational component will be included within East Tennessee State University’s College of Nursing DNP Psychiatric Nurse Practitioner specialty program. As part of the DNP Internship practicum, the module will provide an educational foundation for future psychiatric nurse practitioners to acquire skills in integrating smoking cessation into their practice. With success, the module may be expanded for inclusion within the family and adult nurse practitioner programs. The module can also be utilized within the ETSU nurse-managed clinics to educate current medical providers.


Joseph Schatz, MSN, CRNP, PHRN
ChesPenn Health Services
Smoking Cessation: Addressing the Unique Needs of Single Mothers in an Urban Community

I am a PMHNP-BC who works as a Behavioral Health Consultant within a Federally Qualified Health Center. In the year that I've been employed in this role, I've come to recognize that single mothers attempting to quit smoking face unique challenges and barriers in their journey towards overcoming nicotine dependence. I've collaborated with the FQHC's Certified Tobacco Treatment Specialist and Community Health Educator to develop a hybrid six week smoking cessation curriculum which focuses both on smoking cessation via motivational interviewing and on addressing the stressors associated with being a single mother. The curriculum will be presented collaboratively with the Certified Tobacco Treatment Specialist leading the psychoeducation related to smoking cessation and the APRN providing the clinical interventions related to parenting skills, coping strategies, and self-care. The realistic hope is that the group will be cohesive and members will provide more informal support to each other outside of the sessions.  

Our six week curriculum will follow the outline below. Each week, we will fluidly address both the smoking cessation-specific education/motivational interviewing and the clinical concerns related to parenting stress. 

  • Week One: Need to Change
  • Week Two: Want to Change
  • Week Three: Plan to Change
  • Week Four: Change
  • Week Five: Questioning Change
  • Week Six: Accept Change
  • Week Seven: Maintain Change


Bridgette Vest, DNP, RN, PMHNP, GNP
Veterans Affairs Medical Center
Tobacco Cessation for Veterans

I would like to develop and implement a nurse champion program in every clinical area of the Salem Veterans Affairs Medical Center in order to disseminate evidence-based interventions for tobacco cessation to Veterans, their families and staff of the medical center.  I will educate nurses and meet with them regularly, providing support and ongoing education.  They will be educated in brief interventions and the referral process to the Tobacco Cessation Clinic for pharmacotherapy and ongoing tobacco cessation support.