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Smoking cessation should be every nurse's business

Community practitioners are in an ideal position to actively encourage patients to stop smoking

Community practitioners – practice nurses, midwives and health visitors – are in ideal positions to actively encourage patients to stop smoking


While smoking rates for adults are falling, they have plateaued in some groups, notably in pregnant women, according to the Royal College of Midwives. Picture: Alamy

Government cuts to public health budgets have led to only half of local authorities offering all smokers the best support to quit, a recent report from Action on Smoking and Health (ASH) and Cancer Research UK (CRUK) revealed.

The joint report found 44% of local authorities no longer offer a universal stop smoking service that is available to all smokers, while 3% have cut all smoking cessation service provision.

ASH and CRUK’s research found 22% of local authorities have switched to an integrated lifestyle service model, in which smoking cessation support is included as part of a holistic approach that also includes advice on weight management, alcohol use and general well-being.

Significant reduction in services

‘With smoking remaining one of the leading causes of preventable ill health, it is concerning that we are seeing such a significant reduction in funding for stop smoking services,’ says British Medical Association public health medicine committee chair Peter English.

‘These services remain one of the most effective ways of quitting and are a vital source of support for those who have taken the difficult step to seek help.'

With just 56% of local authorities now commissioning a universal specialist service that is open to all smokers, regional variations in provision are visible. Smokers would previously have received support to quit smoking in community locations, such as their general practice or local pharmacy.

‘What we know works best is nurse-led smoking cessation advice’

Wendy Preston, RCN head of nursing practice


Wendy Preston

‘Each practice would receive a payment for every successful quit from their local authorities,’ says RCN head of nursing practice Wendy Preston.

Smoking cessation referral services 

England

Scotland

Wales

Northern Ireland

‘What we know works best is nurse-led smoking cessation advice.

‘However, in some areas, this national tariff payment has been withdrawn and smoking cessation support has either been replaced with nothing or in some places it has been replaced with an integrated lifestyle service.

‘While there may be cutbacks and general practice nurses are being advised that they are no longer funded to provide smoking cessation services, it remains everyone’s business,’ says Ms Preston.

‘Smoking cessation is the most important treatment that we have for respiratory care for smokers.’

Lung health

The RCN is one of 29 professional organisations that make up the Taskforce for Lung Health. Its five-year plan sets out a framework to improve the nation’s lung health, which calls for the planning and funding of effective, high-quality stop smoking services accessible to everyone who wants to quit.

‘The problem is at the moment, we are not there,’ says Ms Preston. ‘In fact, we are a long way off.

‘Keeping people healthy should be front and centre of government policy, not treated as an optional extra.

‘There has been a drop in general practice provision, community provision – such as local pharmacies – and in hospital provision. We need to overturn this if we are going to continue to reduce smoking rates.’


Gill Walton

Smoking in pregnancy

While smoking rates for adults are still falling, they have plateaued in some groups – most notably in pregnant women. The Royal College of Midwives' (RCM) position statement, Support to quit smoking in pregnancy, calls for specialist stop smoking support to be made available to all pregnant women at all NHS trusts and health boards with maternity services across the UK.

‘Smoking significantly increases the risk of miscarriage, stillbirth and sudden infant death and birth abnormalities,’ says RCM chief executive Gill Walton.

‘Smoking also damages a mother’s health and is associated with maternal risks in pregnancy, such as placental abruption and eclampsia. Evidence shows that stopping smoking early in pregnancy can almost entirely prevent adverse effects and we need to be doing all we can to support women and their families to stop smoking.’

Effective ways to quit smoking


Viv Bennett

‘Getting help from a local stop smoking service remains the most effective method, with over 50% of people who do this quitting successfully,’ says Public Health England chief nursing officer Viv Bennett.

‘Face-to-face advice from a GP, nurse or pharmacist combined with stop smoking aids will also give people a much better chance than trying to go “cold turkey”.

‘There is a wide range of quit aids available. These include:

  • Prescription tablets – varenicline and bupropion
  • Nicotine replacement therapy products – such as patches, inhalers, lozenges or gum and e-cigarettes. When using nicotine replacement, a combination of products is recommended – a slow-release nicotine patch along with a fast-acting product, such as an inhaler or gum

Manage cravings and prevent relapse

‘Smokers often mistakenly believe that nicotine is harmful, whereas it is the many thousands of other chemicals in tobacco smoke that cause almost all of the harm from smoking. When quitting, people should be encouraged to use as much nicotine as they need to manage their cravings and prevent relapse to smoking.

‘While not completely risk free, vaping is far less harmful than smoking and evidence shows that using an e-cigarette is one of the most effective ways to quit, especially when combined with expert support.

‘It is important to remind smokers who may be unsure that there is no situation where it would be better for their health to continue to smoke rather than switching completely to an e-cigarette.’

 

Offering smoking cessation advice to pregnant women is an important part of the health visitors’ role, but they are sometimes being asked to do this with less time and less resources.

‘We are concerned that community practitioners may not have the time to put in to have those health promotion discussions across a wide range of health issues – smoking cessation being one of them,’ says Unite and Community Practitioners and Health Visitors Association lead professional officer Obi Amadi.

‘In terms of having conversations around smoking cessation, people need to know we as practitioners have the time and that we are actively listening’

Obi Amadi, Unite and Community Practitioners and Health Visitors Association lead professional officer


Obi Amadi

‘Additionally, they may not have the tools, such as carbon monoxide monitors. A lot of places don’t have them, including some general practices – and even some health visiting teams.

Meaningful discussion

‘When someone is smoking and they are pregnant, we must use every opportunity to have that conversation. When you have a whole list of things to get through during your visit or consultation, it can be difficult to have a meaningful discussion.

‘However, if you ask whether a pregnant woman is a smoker and they confirm that they are and they want to give up, that woman may never say it again. People are seen more in the community when they are pregnant. Whether it is the midwife, practice nurse or health visitor, they need to have the tools to be able to offer the best smoking cessation support.

‘Every front-line healthcare practitioner has a part to play in supporting smokers to quit’

Viv Bennett, Public Health England chief nurse

‘In terms of having conversations around smoking cessation, people need to know we as practitioners have the time and that we are actively listening.’

‘Every front-line healthcare practitioner has a part to play in supporting smokers to quit by providing Very Brief Advice (VBA),’ says Public Health England chief nursing officer Viv Bennett.

Transform life chances

The National Centre for Smoking Cessation and Training's (NCSCT) VBA on smoking encourages healthcare staff to offer simple 30-second advice opportunistically in any situation with a smoker.

‘Free online training is available from the NCSCT and the short time it takes to deliver VBA advice can transform someone’s life chances,’ says Professor Bennett.

NCSCT also offers customised training and assessment programmes for practitioners in England, Ireland and Wales. The VBA on smoking resource section begins with a short film showing how simple brief interventions to change smoking behaviour can be.

‘The NCSCT training resources can help nurses working in primary care to be confident to talk to patients about smoking cessation,’ adds Ms Preston.


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