Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives

7/27/2019 Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives

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Establishing AcademicPartnerships for Evidence-Based Tobacco CessationInitiatives

J anie Heath PhD, APRN-BC, ANP, ACNP Associate Dean Academic Nursing PracticeMedical College of GeorgiaSchool of NursingAugusta, GA


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Session Objectives

Recognize the health impact andhealthcare costs related to tobacco useDiscuss innovative strategies to bridgeclinical practice and research with tobaccocessation

Identify resources to shape a nursingresearch agenda for translation of cessation interventions in clinical practice


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What is the PROBLEM aboutTobacco Use

46 million adults smoke (20.9%of population)GEORGIA = 23.3% prevalenceWere HIGHER than national

average!

1200 individuals DIE every day

because of tobacco use(450,000 / yr)

Centers for Disease Control and Prevention. (2006). MMWR 54:11241127.


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What is the PROBLEM aboutEvidence-Based Practice (EBP)

Pravikoff et al (2003) found that there are

knowledge gaps and a lack of readiness toembrace EBP among nurses, educators,clinicians, and administratorsother findingsincluded:

Nurses seldom read researchMany nurses do not have access to a library intheir clinical environments

Many nurses do not have access to theInternet at the point-of-care

Pravikoff, D.S., Pierce, S., & Tanner, A. (2003). Are nurses ready for evidence-based practice?A study suggests that greater support is needed. American Journal of Nursing , 103(5):95-96.


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Why IMPORTANT to TranslateEBP Into Clinical Practice

EBP, such as with the USPHS Clinical Guideline,Treating Tobacco Use and Dependence ,improves patient outcomes and improves qualityand efficiency of healthcare delivery

Nursing has a responsibility to identify, retrieve,appraise, implement and evaluate the best

research / evidence for patient care

Heath, J . (2005). Closing the gap on evidence based practice and smokingcessation. In B. Mazurek-Melnyk & E. Fineout-Overholt (Eds). Evidenced Based Practicein Nursing and Health. A Guide for Translating Research Evidence in Practice, CD-ROM.Philadelphia:Lippincott Williams & Wilkins.


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CHALLENGES to Translate

EBP Into Clinical PracticeLack of awareness about evidence-based tobacco cessationLack of trainingLack of timeLack of efficiency in systems tosupport EBPLack of priority to support EBP and

tobacco cessationLancaster, T., Silagy, C., & Fowler, G. (2002). Training health professionals in smokingcessation. Cochrane Review. In: The Cochrane Library, Volume 4.


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SOLUTIONS to optimize

Tobacco Cessation EBP J CAHO now requires ALL pts

admitted with MI, heart failure, and/orpneumonia to receive tobaccocounseling

AHRQ support for advancedtechnology to disseminate cessationEBP guideline

www.nurses4tobaccocontrol.orgwww.tobaccofreenurses.orgwww.rxforchange.ucsf.edu
http://www.nurses4tobaccocontrol.org/http://www.tobaccofreenurses.org/http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/http://www.tobaccofreenurses.org/http://www.nurses4tobaccocontrol.org/


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A MODEL for Optimal EBP Tobacco CessationOutcomes

Provide Training:Nsg EDUNsg CE

Provide SystemsSupport:Priority in

Organizations

Provide Research

Funding:Organizations

Federal

EnsureAccountability:

LicensureCertification

CessationInterventions=

Standard of Nsg Practice

Raise

Awareness:

GrassrootsState

NationalInternational

Heath, J ., Andrews, J . (2006). Translation of tobacco cessation interventions into clinical practice. Nursing Research, 55(4): S4


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The JOURNEY to Academic Partnerships

for Evidence-Based Tobacco CessationInitiatives

The NP Practice , VA Medical Center Augusta, GAGarcia-Graham, J ., Heath, J (2000). The value of urgent smoking cessation for CABGpatients. AJN. Critical Care Supplement, 19-23.

The Tobacco Cessation Curricula in Acute Care NP Education ;Georgetown University, Washington, DC

Heath, J ., Andrews, J ., Thomas, S., Kelley, F, and Friedman, E. (2002). Tobacco curriculumin acute care nurse practitioner education. Amer J Crit Care, 11 (1), 27-32.

The University of California San Francisco Collaborative Rx for Change: Clinician-Assisted Curriculum, Summer InstituteGeorgetown University, Washington, DC

Heath, J ., Kelly, J ., Andrews, J ., Crowell, N., Corelli, R., Hudmon, K.S. (in press).Evaluation of a tobacco cessation curricula intervention among acute care nurse practitionerfaculty. Amer J Crit Care.

The Dissertation

Heath, J ., Crowell, N. (in press). Attitudes about tobacco cessation education amongadvanced practice nursing faculty: A national survey. J Prof Nursing.


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OUTCOMES from the Journey for Academic Partnerships

The FIRST tobacco relatedspecial issue for acute andcritical care nurses

March 2006, 18 (1)Invitation from a Summer

Institute Fellow, SuzannePrevost PhD, RN, FAANIssue includes 20 authors frominterdisciplinary fields-medicine,nursing, pharmacyArticles include practice,education, research, and policyrelated to tobacco cessation


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REAP the Benefits of the National Coalition for EBP TobaccoCessation

GeorgetownUniversityMedical

College of GeorgiaUniversity of

ArkansasVanderbiltUniversity

Research

Education

A dvocacy

P ractice

OUTCOMES from the Journey for Academic Partnerships


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Snapshot on RESEARCH with Academic Partnership

The QUEST RandomizedControl Trial pilot evaluatingthe effect of nicotine-freeQuest cigarettes, extra-

low Quest cigarettesand Commit lozenges onhealth and cessation outcomes

x 4 FNP graduate studentsx 2 pre-med BS studentsParticipated in the 14 weekstudy

The Georgetown University-University of MN partnership to be replicated at MCG


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On-Going Questions for TobaccoRESEARCH


The effect of a step-down approach withQuest cigarettes (RE:

.6 mg x 2 weeks, .3mg x2 weeks, .05 mgx 2 weeks) on healthand cessationoutcomes in publichousing communities


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On-Going Questions for TobaccoRESEARCH


The effect of a step-down approach withQuest cigarettescompared to commitlozenge andVerenicline/Chantixamong psych-mentalillness communities


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Snapshot on EDUCATION with Academic Partnership

The Summer Institute of Tobacco Control Practices inNursing Education

The Rx for Change:Clinician Assisted TobaccoCessation CurriculumSince 2003

> 80 schools of nursingparticipated> 4000 nursing studentstrained> 1400 hours of collectiveEDU

The Georgetown University-UCSF partnership continued at MCG


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On-Going EDUCATION Research:The Intervention

The Rx For Change Curriculumdeveloped by K. Hudmon DrPH,RPh& R. Correlli Pharm D

UCSF School of PharmacyBased on the USPHS Clinical PracticeGuideline: Treating Tobacco Use andDependence

Extensively reviewed by experts intobacco controlComprehensive > 350 CD-slides, ancil laryhandouts, evaluation measures, casestudiesSelected Modules

Epidemiology

Forms of tobaccoGenes & tobacco usePathophysiologyNicotine addictionPharmacotherapyCounseling techniques

Acces s atwww.r xforchange.ucsf.edu
http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/http://www.rxforchange.ucsf.edu/


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Remaining Questions for Tobacco EDUCATION Research

How to ensure nursing studentsand nurses receive knowledgeand skills to perform cessationinterventions (implement andevaluate)

The effect of tobacco education in

nursing curricula to help patientsquit smoking The amount of tobacco educationneeded to have a positive effecton patient outcomes

The best teaching strategies fortobacco education to effect clinicaloutcomes

Kelley, J ., Heath, J ., Crowell, N. (2006). The Rx for change tobacco cessationintervention: Advanced practice nursing student outcomes Crit Care Nurs Clin N Am, 18(1): 131-138 .Heath, J ., Kelly, J ., Andrews, J ., Crowell, N., Corelli, R., Hudmon, K.S. (in press).Evaluation of a tobacco cessation curricula intervention among acute care nurse practitioner faculty. Amer J Crit Care.


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Snapshot on ADVOCACY with Academic Partnership

Nursing leaders tacklingtobacco cessation

The Great AmericanSmoke-Out

Capital Hill visits Tobacco Free MCGCampaign letters

Local, state and nationalactivities

The Georgetown University-AACN partnership replicated at MCG


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Remaining Questions for Tobacco ADVOCACY Research

How to ensure nurses feelempowered to changetobacco cessation practice

How to better inform nurseson tobacco controlpolicies/advocacy initiatives

Leading resource =www.nightingalesnurses.org

Malone, R. E. (2006). Nursing's involvement in tobacco control: historical perspective and vision for thefuture. Nurs Res, 55(4 Suppl), S51-57.


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Remaining Questions for Tobacco ADVOCACY Research

PredominantquestionHow to help nurses

find their political willfor tobacco control

Heath, J ., Andrews, J ., Andres, K. (2003). Tobacco control: An update to influence policy-makingdecisions. Policy, Politics, and Nursing Practice, 4(1), 36 44.

Malone, R. E., & Balbach, E. D. (2000). Tobacco industry documents: Treasure or quagmire? Tob Control ,9(3), 334-338.


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Snapshot on PRACTICE with Academic Partnership

Providing tobaccocessation servicesOut-patient

Group counselingIndividual counseling

In-patientIndividual consultation

Tobacco cessationprotocols/pre-written orders

Access materials atwww.nurses4tobaccocontrol.org

The Georgetown University model of practice replicated at MCG
http://www.nurses4tobaccocontrol.org/http://www.nurses4tobaccocontrol.org/


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Remaining Questions for Tobacco PRACTICE Research

How to ensure all nursesperceive tobacco cessation asrelevant to practice

How to ensure workloadallows for tobacco cessationinterventionsHow to ensure nursingaccountability with tobaccocessationLeading resource =

www.tobaccofreenurses.org

Sarna, L., Bialous, S., Barbeau, E., & McLellan, D. (2006). Strategies to implement tobacco controlpolicies & adovcacy initiatives. Crit Care Nurs Clinics N Am, 18(1): 113-122.
http://www.tobaccofreenurses.org/http://www.tobaccofreenurses.org/


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Remaining Questions for Tobacco PRACTICE Research

How to ensure that the

organizational culturesupports EBP and/researchutilization for nursing practiceHow to ensure organization/

department budgets includeresources to support tobaccocessation interventions (for pts& nurses)How to ensure leadershipsupports the healthcarecost/benefit ratio to sustaintobacco cessation efforts

Balkstra, C.R., Fields, M., Roesler, L. (2006). Meeting J oint Commission on accreditation of Healthcare Organizations requirementfor tobacco cessation: The St. J oseph's/Candler Health System Approach to Success. Crit Care Nurs Clin N Am . 18(1):95-104


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Questions-

But first consider thisCLOSING THOUGHT

Through the discovery of tobacco cessationknowledge , the integrationof that knowledge, theevaluation of that knowledge,and the dissemination of that knowledge .TOGETHER we can helpnurses make a difference instopping the deadly effects

of tobacco use and improvethe health and well-being of ALL individuals.

THANK YOU

Documents

Establishing Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives