Environmental constraints were noted that prevented the participants in the study from fully implementing best practice guidelines. The primary of which was time. They noted that because of other duties and paper keeping requirements, they had little time to properly present the best practice guidelines. Some noted that they had little time to do expected things such as breathing, much less introduce the patient properly to best practice guidelines.

During their third year of training the nurses were introduced to a comprehensive program concerning cigarettes and cessation programs. In addition they had already been taught more efficient time management training. With these new tools they felt more comfortable with teaching patients about the best practice guidelines to stop smoking.

Apparently education of the nursing students and maturation was important in feeling comfortable and competent in teaching patients these guidelines.

Sanders, Fowler, Mant, Fuller, Jones & Marzillier (1989) originally discovered that if a random group of patients was given information one time by a group of nurses telling them not to smoke that it was significantly more effective than in a controlled group told not to smoke but by non-nursing personnel. Those interviewed and who spoke with nurses at the end of one year had a 3.6% smoking cessation rate when compared to a control group with a rate of .9%. The nurses were 3x more successful rate with just minimal intervention in stopping a patient from smoking.

It is important that tobacco use be identified and dissuaded in youth according to the CDC (2010) for the following reasons

1. Daily 4,000 American youth (12-17 years) try their first cigarette

2. 25% become daily smokers

3. youth doesn't understand that nicotine is as addictive as heroin or cocaine

4. unaware of the consequences to future health

5. school programs can have major impact on smoking cessation and long-term health

The CDC (2010) recognizes the consequences of tobacco use

1. premature death

2. heart disease, stroke, chronic obstructive pulmonary disease

3. blood cholesterol elevation, bronchitis, bronchectasis

4. smokeless tobacco unsafe causing oral cancers

5. cigars increase risk of oral cancers

6. secondary smoke affects young children by hindering lung development and increasing risk of respiratory diseases

7. second hand smoke causes new cases of asthma and worsens existing asthma

The CDC (2010) recognizes an opportunity to make a significant impact on smoking habits in the general population by focusing on youth because well designed and implemented programs have in schools

1. proven effective in lessoning the use of tobacco

2. provides a tobacco free environment, establishes none use of tobacco is a norm

3. prevents the use of other drugs

School programs that are effective include the following measures

1. prohibit the use of tobacco in the school and all school functions

2. encourage administrators and staff to quit smoking

3. design program appropriate for K-12 that exposes why tobacco is used

4. nurses, teachers, administrators, family, community leaders provide the same health message against tobacco use

5. community promotes uniform anti-tobacco messages

Recommendations and Methodology

Recommendations for a nursing directed anti-smoking program would include the training of nurses during their first year of nursing school concerning the affects of being a cigarette smoker. In addition they would be taught time management practices that would allow them to convey the correct information about cigarettes to their patients.

Nurses would involve community leaders such as teachers, public health officials and politicians to propose correct methods of limiting smoking.

Programs could be proposed by nurses to schools to have a zero tolerance policy in and around the school and at all school functions. This zero tolerance would include all teachers, administrators and ancillary personnel prohibiting smoking on school grounds or activities as well as students and parents.

In addition in schools no tee shirts depicting cigarettes or any type of construed drug symbol would be allowed.

All habit forming or illicit drugs would be treated with the same negative connotation.

In addition politicians could limit advertising venues for cigarettes including any business that accepts government funding.
Additional restrictions could be adopted such as a zero tolerance advertising policy to include all billboards, shirts, camping equipment, television, radio, movies, and any surface that could be seen by anyone that promotes cigarette smoking. Legally additional taxes could be imposed to raise the price of cigarettes. The taxes could be used to pay for the sicknesses generated by cigarette smoking.

Intensive cigarette cessation programs could be provided free by all insurance companies and public clinics and hospitals to any patient requesting them as a covered preventive medicine program just as many cover breast exams today.

Discussion

It has been well demonstrated that the more intense and purposeful a program to help stop smoking is the more probable that it will work.

In order to reach the national goal of only 12% of the population smoking, it will be important to initiate such a program while at the same time realizing that it is still a legal habit.

Most people would welcome an effective smoking cessation program as most people understand that smoking is a dangerous and unhealthy habit. Acceptance should be wide spread.

But even though it is a legal habit we all are affected one way or the other by the negative attributes of smoking. The most important way we are affected is by the effect that it has on our loved ones and friends who we know that smoke. We don't want them to die or have a chronic ailment that will limit the act of living.

If we can't legally prevent smoking we should educate and also make it as difficult as possible to obtain the product that results in health problems, cigarettes.

A group of like minded individuals must assume the lead in attaining these goals.

It has been demonstrated that nurses can garner the knowledge and that they have the respect of patients to accomplish this admirable proposition. It should be the desire of every nurse to promote a stop smoking agenda.

Citations

1) American Cancer Society, 2010, Incidence of Cancer United States.

Retrieved 11-27-10.

2) American Lung Association, 2010, Incidence of respiratory diseases

Caused by smoking. Retrieved 11-26-10.

3) CDC, MMWR, 2008, Cigarette Smoking Among Adults-United

States, 2007. 11-14-2008/57(45); 1221-1226, retrieved 11-25-

2010

4) Andrews, J.O. & Heath, J (2003). Women and the global tobacco

Epidemic: Nurses call to action. Interventional Nursing Review.50

.215-228.

5) CDC, 2010, Healthy Youth! Health Topics Tobacco Use, School

Health Guide lines, retrieved 11-25-10, www.edu.gov/healthy

Youth.tobacco/guidelines/summary.htm

6) Fritz, D.J., Wider, L.C., Hardin, S.B.,Horrocks, M. (2008) Program

Strategies for Adolescent Smoking Cessation. The Journal of School

Nursing, Volume 24, Number 1.

7) Scanlon, a., Clark, E;, McGuiness, W. Acute (adult clinical inpatient)

care nurse's attitudes towards and knowledge of nationally endorsed

As smoking cessation guidelines. CH Australia, Volume 29, Issue

1, May 2008.

8) Smith, P.M., Burgess, E.. (2009) Smoking cessation initiated during

Hospital stay for patients with coronary artery disease: a Randomized controlled trial. CMAJ, 6-23-2009, 180 (13)

9) Ritchie, Linda, Evans, M.K., Matthews, J. Nursing students' and clinical

Instructors' perceptions on the implementation of a best practice

Guidelines (2010), Journal of Nursing Education, Vol 49, Nov 4,

2010.

10) Sanders, D., Fowler, G., Mant, D., Fuller, a., Jones, L., & Marziller, j.

Randomized controlled trial of anti-smoking advice by nurses in General practice. Journal of the Royal College of General

Practitioners, 1989, 39, pp 273-276.