1. Smoking cessation: Are we teaching students to save lives? Claire Doole Grace Wong School of Health Care Practice, Nursing, AUT Smokefree Nurses Aotearoa/New Zealand, AUT Australasian Nurs e Educators Conference 2011

3. Overview What’s driving smoking cessation in NZ Teaching and learning – what? Teaching and learning – how? Teaching and learning – resources Results of survey - NZ nursing schools

4. Background Smoking is the most important and preventable cause of morbidity and premature mortality in developed and developing countries (Young, Hopkins, Smith, & Hogarth, 2010). Half of those who smoke die early as a result of smoking (Doll et al, 2004) Almost 5,000 people die annually from smoking (MoH, 2009)

5. Better help to Quit At 30/6/2011 DHBs average was 85% Target was 90%

6. Vision New Zealand essentially smokefree by 2025 (Turia, T. (2011) NZ Parliament, Hansard, 14/7/2011) Targets 95% of hospitalised smokers to be provided with advice & help to quit by July 2012 For primary care, from July 2011 90% of enrolled patients...... by July 2012

7. ABC three step brief intervention A - ask whether a person smokes B - give brief advice to quit to all people who smoke C – make an offer of cessation treatment NZ Smoking Cessation Guidelines ( Ministry of Health, 2007) Brief interventions increase quit rates (Lancaster & Stead, 2008)

8. Aveyard & West (2007) Without treatment With medication With medication and support Cumulative chances of quitting over time – one quit attempt per year with and without cessation treatment

9. NRT doubles the chance of quitting for good

10. The MoH aims to have all health care practitioners embed smoking cessation in their practice Forty minute online training for health professionals(smokingcessationabc.org.nz) Training includes becoming a registered Quit Card provider Quit Cards give people who smoke access to subsidised nicotine replacement therapy (NRT)

11. Key success indicator for ABC implementation: “100% of all undergraduate courses related to health care have implemented ABC training into their curricula” (MoH, 2009). RNs identify Schools of Nursing as critical agents for changes in the culture and practice of nurses Students (nurses - registered & enrolled, physios, doctors) can become Quit Card providers NetP programmes check to see if new grads have learnt their ABCs

12. Situation in 2009/2010 – National survey Fourteen (of 17) School of Nursing responded to an online survey 12 provided some form of smoking cessation education Nine provided education on NRT Five provided the Ministry of Health recommended content solely At least six did not assess learning

13. How?

14. AUT nursing undergraduate Year one Introduction and overview (Maya) Year two Woven into teaching eg oxygenation (Gwen) Pharmacotherapy paper Year three How?

15. Student Online learning Class session Workbook Clinical Year three

16. Online learning www.smokingcessationabc.org.nz/ Students become NRT Quit Card providers 40 minutes

17. Classroom session DHB or Maori provider smoking cessation coordinator Smoking harm Dissect a cigarette with blade & discuss contents NRT dosage and issues Pair off and do a rehearsal Quit Card 120 minutes

18. Clinical Making it real Students and precepter RN Discuss the clinical areas smoking cessation policy - Tell a story from practice – what worked, what didn't go so well - Report findings in Workbook

19. Workbook Students discuss role of smoking cessation - related to their clinical practice area - Provide some stats and facts from ABC Smoking Cessation Guidelines - Clinical placement policy on ABC & students’ implementing ABC - Tell a story from practice – what worked, what didn't go so well Submit the certificate from ABC online learning module 30 minutes

20. Workbook submitted Completed Workbook is a required piece of work The smoking cessation is one section of five Submit the certificate from ABC online learning module Submit RN sign off that Workbook is clinically realistic Lecturer signs off work completed

21. So how has it been received by students and clinical settings? Issues Strengths

22. In summary Smoking related death and disease is a serious but preventable health issue Best practice smoking cessation guidelines are available Free online training is available Government mandate Ministry of Health mandate Industry mandate Schools of Nursing – Are we doing all we can?

23. Research shows that 1 in 40 smokers will quit for good, just because you gave them brief advice

24. References Aveyard, P., & West R. (2007). Managing smoking cessation. British Medical Journal, 335; 37, 335 doi: 10.1136/bmj.39252.591806.47 Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004). Mortality in relation to smoking: 50 years‘ observations on male British doctors. British Medical Journal 328(7455), 1519. Ministry of Health. (2010). Implementing the ABC approach for smoking cessation. Framework and work programme. Wellington: Ministry of Health. Lancaster T., & Stead L. (2008). Physician advice for smoking cessation. Cochrane Database of Systematic Reviews(2). Ministry of Health (2007). New Zealand Smoking Cessation Guidelines. Wellington: Ministry of Health. http://www.moh.govt.nz/moh.nsf/pagesmh/6663/$File/nz-smoking-cessation-guidelines-v2-aug07.pdf http://www.moh.govt.nz/moh.nsf/pagesmh/6663/$File/nz-smoking-cessation-guidelines-v2-aug07.pdf Wong, G. & Stokes, G. (2011). Preparing undergraduate nurses to provide smoking cessation advice and help. Nursing Praxis New Zealand, 27(3) 21-30. Young, R., Hopkins, R., Smith, M. & Hogarth, D. (2010). Postgraduate Medical Journal, 86, 26. Smoking cessation: The potential role of risk assessment tools as motivational triggers. doi: 10.1136/pgmj.2009.084947