Monday, November 5, 2007

This presentation is part of : Strategies for the Advanced Practice Nurse
The Development of Two Smoking Cessation Clinics by Advanced Practice Nurses
Wendye Disalvo, BSN, MSN, Thoracic Oncology, Dartmouth Hitchcock Medical Center, lebanon, NH, USA and Elizabeth Maislen, MA, Cardiothoracic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Learning Objective #1: The learner will be able to discuss the impact of smoking on world health
Learning Objective #2: The learner will be able to discuss two initiatives used in the development of smoking cessation programs

Background: The World Health Organization estimates there are 1.3 million smokers globally with an estimated tobacco related mortality of 10 million deaths by 2030. In the United States, there are 45 million adult cigarette smokers with 435,000 tobacco related deaths annually. The sequela of tobacco use accounts for serious illness in 8.6 million Americans per year. Due to this significant morbidity and mortality treatment of tobacco addiction is paramount. At Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire two Advance Practice Nurses (APNs) working in separate clinical areas spearhead the establishment of smoking cessation programs. Although the programs are different in structure, each APN utilize evidenced based guidelines to treat smoking addiction

The APNs encountered barriers to the establishment of these programs which included systematic identification of current smokers, standardization of referral methods, negotiation of time and space constraints, and overcoming negative beliefs concerning smoking cessation from physician and nurse colleagues alike. These barriers may be overcome through nurse and physician education.

Method:  The APN initiative included attending the University of Massachusetts Medical School Tobacco Treatment Specialist Core Certification Training Program.  The week long course provided the foundation and the acquisition of skills necessary to intervene with smoking addiction. The core curriculum included addiction  and withdrawal pathophysiology, pharmacotherapy, motivational interviewing, treatment planning and follow up. 

Outcomes: Once the programs were operational, the APNs established a separate peer review group to provide feedback on selected cases in order to optimize treatment. Note templates were standardized for better data collection and documentation. The group also allocated time to review current literature with the future goal of setting a research agenda for tobacco addiction treatment as well as identifying additional funding sources.