An International Partnership for Nursing Education on Tobacco Dependence Treatment

Tobacco use is the largest preventable cause of death, including cancer death, in both Czech Republic (CZ) and Poland (PL), annually responsible for 16,000 deaths and 67,000 deaths respectively. Tobacco prevalence in both countries remains a serious public health problem, with 2.5 million, or 36.9% of the population over the age of 15 years being smokers in CZ and 9.8 million, or 30.3% of the population over the age of 15 years in PL. Additionally, tobacco use among youth 13-15 years of age is very high at 39.8% in CZ and 23.3% in PL. Of great significance is the high proportion of nurses who smoke in both countries, between 20% – 35%.

Increased access to tobacco dependence treatment has been identified as a priority within the tobacco control national plan in both countries and nurses, the largest group of healthcare professionals, if properly educated on providing evidence-based cessation interventions, would be ideally positioned to decrease the burden of tobacco-related morbidity. All smokers should receive support for quitting, and research demonstrate that smokers with a cancer diagnosis benefit from receiving cessation and quitting, with improved treatment outcomes.  Evidence suggests that interventions following the 5As framework are effective in increasing quit rates. The 5As include: Asking about smoking status, Advising patients to quit, Assessing willingness to quit, Assisting with a quit plan, and Arranging for follow-up for ongoing support.

The goal of this collaboration was to build capacity among nurses in general practice and in oncology to implement evidence-based interventions with all patients who smoke. It was based on a previous, successful, experience in the United States and China. 

The target population was 300 staff nurses in PL and 200 staff nurses in CZ , caring for adult patients.

The team developed a web-based instrument through REDCap, which was adapted and then translated to Czech and Polish. The survey included information about the project and informed consent.  The team also developed 2 webcasts per country, one on nurses’ role in tobacco dependence treatment and anther on tobacco dependence treatment in oncology settings. Nurses were recruited through a variety of nursing websites and through direct contact with administrators in selected hospitals in both countries. Nurses interested in participating accessed the link provided to the informed consent and the online pre-test of knowledge, skills and attitudes related to smoking cessation interventions completed immediately before the e-learning courses. After completing the survey nurses were provided, via e-mail, with the link to the 2 webcasts. Three months later nurses were asked to complete a survey assessing changes in practice. A webpage with additional resource materials for each country was also created.

In PL over 278 nurses enrolled and in  CZ, 418. After eliminating surveys with missing data, the final sample was 238  and 370, respectively. Over 90% of nurses in both countries were female, with a mean of 18 (PL) to 21 (CZ) years of experience, and approximately 40% in both countries worked in Medical-Surgical units. Current smoking was 8% in PL and 19% in CZ.

Nurses were asked about the frequency of providing smoking cessation interventions to patients, on a 5-point scale (never, rarely, sometimes, usually, always). For analysis, usually/always were collapsed to indicate consistency of delivering the intervention in accordance to evidence-based practice and the 5As framework. In CZ, over half of the nurses in CZ consistently asked (58%) about smoking status and advised (56%) patients to quit; less than half (48%) assessed willingness to quit , 21% assisted with a quit plan but only 5% arranged for follow up. In PL, the results were similar but a higher proportion of nurses consistently advised (86%) and arranged for follow-up (38%). Referral to a quitline, a proven resource to support abstinence available in both countries, was reported by approximately 1 in 5 nurses in both countries.

These baseline data demonstrate that there is potential to grow nurse involvement in providing evidence-based tobacco dependence treatment to hospitalized smokers. The impact of availability of the distance learning, web-based educational program will be evaluated post-implementation.

Globally, as countries move towards implementation of the World Health Organization recommendations to address tobacco dependence, and develop strategies to reach the United Nation’s target of reducing tobacco use in 30% by 2020, initiatives to engage nurses in tobacco control will be necessary. This collaborative project provides a model for translating evidence into practice through a long distance educational program that could inform other research teams and countries interested in contributing to fighting the tobacco epidemic.