Free Nursing Dissertations - Smoking Cessation Is Difficult (p 456). A&e Patients May Require More
Smoking cessation is difficult (p 456). A&E patients may require more complex, theoretically driven, smoking cessation interventions to respond to their needs and encourage adherence.
The relative failure of health professionals to achieve smoking cessation in their patients has resulted from ‘lecturing’ patients who are not ready to quit (Richmond, 1999), and the lack of theory-led interventions that are sensitive to individual differences between patients. The Stages of Changes theoretical model of smoking cessation proposes that smokers will fall in one of five categories of precontemplation, contemplation, preparation for cessation, action or maintenance of cessation. Prochaska and DiClemete (1982) have produced screening questions so that nurses can determine the stage of their individual patients and act accordingly. From a Stages of Change perspective (Prochaska and DiClemente,1982), smoking cessation is an interactive process of information exchange between the health professional and the patient, but ultimately the patient will decide when they are ready to give up cigarettes. It must be approached with due regard to the four R’s proposed by Fiori, Jorenby and Baker (1997). It should be relevant to the patient and their personal life, with consideration given to the risks of smoking and rewards in smoking cessation for that patient in particular, and repetition where motivational interviewing is replicated to encourage the patient to reflect on the merits/ drawbacks of smoking in their particular circumstances over time. Smoking cessation is a combination of overcoming physiological nicotine dependence and cognitive-behavioural processes of desiring change, and acting on the desire to change. The patient will only be prepared to quit smoking when they perceive the negative factors to out-weigh the positive factors. Any health assessment must elicit degree of readiness to quit, and provide advice according to the needs of the patient. Brief motivational interviewing is one approach with ambivalent patients who are unsure if they want to quit or not, based on the assumption that patients will be more effective at quitting when they have reached the decision by themselves. Smokers who are not ready to quit may benefit from a short outline of risks of smoking including Personalising smoking as a major risk of heart disease [for that patient] (Richmond, 1999, p 456).
The patient
A 59 year old man presented at the A&E department with chest pain, nausea, breathlessness and no past history of cardiovascular disease. He reported, upon admission, that he had suffered severe and intermittent chest pain for an hour, followed by severe pain in his arm and collapse approximately 20 minutes earlier. He was not intoxicated upon admission, and self reported light alcohol use. There was a strong family history of cardiovascular disease with both parents having died due to heart failure before the age of 65.
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