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Establishing Academic Partnerships for EvidenceBased Tobacco Cessation Initiatives

Janie Heath PhD, APRN-BC, ANP, ACNP


Associate Dean Academic Nursing Practice Medical College of Georgia School of Nursing Augusta, GA

Session Objectives
Recognize the health impact and healthcare costs related to tobacco use Discuss innovative strategies to bridge clinical practice and research with tobacco cessation Identify resources to shape a nursing research agenda for translation of cessation interventions in clinical practice

What is the PROBLEM about Tobacco Use

46 million adults smoke (20.9% of population)

GEORGIA = 23.3% prevalence Were 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.

What is the PROBLEM about Evidence-Based Practice (EBP)

Pravikoff et al (2003) found that there are knowledge gaps and a lack of readiness to embrace EBP among nurses, educators, clinicians, and administratorsother findings included:

Nurses seldom read research Many nurses do not have access to a library in their clinical environments Many nurses do not have access to the Internet 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.

Why IMPORTANT to Translate EBP Into Clinical Practice

EBP, such as with the USPHS Clinical Guideline, Treating Tobacco Use and Dependence, improves patient outcomes and improves quality and 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 smoking cessation. In B. Mazurek-Melnyk & E. Fineout-Overholt (Eds). Evidenced Based Practice in Nursing and Health. A Guide for Translating Research Evidence in Practice, CD-ROM. Philadelphia:Lippincott Williams & Wilkins.

CHALLENGES to Translate EBP Into Clinical Practice


Lack of awareness about evidencebased tobacco cessation Lack of training Lack of time Lack of efficiency in systems to support EBP Lack of priority to support EBP and tobacco cessation
Lancaster, T., Silagy, C., & Fowler, G. (2002). Training health professionals in smoking cessation. Cochrane Review. In: The Cochrane Library, Volume 4.

SOLUTIONS to optimize Tobacco Cessation EBP

JCAHO now requires ALL pts admitted with MI, heart failure, and/or pneumonia to receive tobacco counseling AHRQ support for advanced technology to disseminate cessation EBP guideline

www.nurses4tobaccocontrol.org www.tobaccofreenurses.org www.rxforchange.ucsf.edu

A MODEL for Optimal EBP Tobacco Cessation Outcomes


Provide Research Funding: Organizations Federal Raise Awareness: Grassroots State National International Provide Training: Nsg EDU Nsg CE
Ensure Accountability: Licensure Certification

Cessation Interventions= Standard of Nsg Practice

Provide Systems Support:


Priority in Organizations

Heath, J., Andrews, J. (2006). Translation of tobacco cessation interventions into clinical practice. Nursing Research, 55(4): S44

The JOURNEY to Academic Partnerships for Evidence-Based Tobacco Cessation Initiatives

The NP Practice, VA Medical Center Augusta, GA

Garcia-Graham, J., Heath, J (2000). The value of urgent smoking cessation for CABG patients. 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 curriculum in 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 Institute Georgetown 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 practitioner faculty. Amer J Crit Care.

The Dissertation

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

OUTCOMES from the Journey for Academic Partnerships

The FIRST tobacco related special issue for acute and critical care nurses

March 2006, 18 (1)

Invitation from a Summer Institute Fellow, Suzanne Prevost PhD, RN, FAAN Issue includes 20 authors from interdisciplinary fields-medicine, nursing, pharmacy Articles include practice, education, research, and policy related to tobacco cessation

OUTCOMES from the Journey for Academic Partnerships


Georgetown University Medical College of Georgia University of Arkansas Vanderbilt University

Research Education Advocacy Practice

REAP the Benefits of the National Coalition for EBP Tobacco Cessation

Snapshot on RESEARCH with Academic Partnership

The QUEST Randomized Control Trial pilot evaluating the effect of nicotine-free

Quest cigarettes, extralow Quest cigarettes and Commit lozenges on


health and cessation outcomes

x 4 FNP graduate students x 2 pre-med BS students Participated in the 14 week study


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

On-Going Questions for Tobacco RESEARCH

The effect of a stepdown approach with Quest cigarettes (RE: .6 mg x 2 weeks, .3 mg x2 weeks, .05 mg x 2 weeks) on health and cessation outcomes in public housing communities

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

On-Going Questions for Tobacco RESEARCH

The effect of a stepdown approach with Quest cigarettes compared to commit lozenge and Verenicline/Chantix among psych-mental illness communities

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

Snapshot on EDUCATION with Academic Partnership

The Summer Institute of Tobacco Control Practices in Nursing Education The Rx for Change: Clinician Assisted Tobacco Cessation Curriculum Since 2003

> 80 schools of nursing participated > 4000 nursing students trained > 1400 hours of collective EDU

The Georgetown University-UCSF partnership continued at MCG

On-Going EDUCATION Research: The Intervention

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

UCSF School of Pharmacy


Based on the USPHS Clinical Practice Guideline: Treating Tobacco Use and Dependence

Extensively reviewed by experts in tobacco control Comprehensive > 350 CD-slides, ancillary handouts, evaluation measures, case studies Selected Modules

Epidemiology Forms of tobacco Genes & tobacco use Pathophysiology Nicotine addiction Pharmacotherapy Counseling techniques

Access at www.rxforchange.ucsf.edu

Remaining Questions for Tobacco EDUCATION Research

How to ensure nursing students and nurses receive knowledge and skills to perform cessation interventions (implement and evaluate) The effect of tobacco education in nursing curricula to help patients quit smoking The amount of tobacco education needed to have a positive effect on patient outcomes The best teaching strategies for tobacco education to effect clinical outcomes

Kelley, J., Heath, J., Crowell, N. (2006). The Rx for change tobacco cessation intervention: 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.

Snapshot on ADVOCACY with Academic Partnership

Nursing leaders tackling tobacco cessation The Great American Smoke-Out Capital Hill visits Tobacco Free MCG Campaign letters Local, state and national activities

The Georgetown University-AACN partnership replicated at MCG

Remaining Questions for Tobacco ADVOCACY Research

How to ensure nurses feel empowered to change tobacco cessation practice How to better inform nurses on tobacco control policies/advocacy initiatives Leading resource = www.nightingalesnurses.org

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

Remaining Questions for Tobacco ADVOCACY Research


Predominant question How to help nurses find their political will for tobacco control

Malone, R. E., & Balbach, E. D. (2000). Tobacco industry documents: Treasure or quagmire? Tob Control, 9(3), 334-338. Heath, J., Andrews, J., Andres, K. (2003). Tobacco control: An update to influence policy-making decisions. Policy, Politics, and Nursing Practice, 4(1), 36 44.

Snapshot on PRACTICE with Academic Partnership

Providing tobacco cessation services

Out-patient

Group counseling Individual counseling Individual consultation Tobacco cessation protocols/pre-written orders

In-patient

Access materials at
www.nurses4tobaccocontrol.org

The Georgetown University model of practice replicated at MCG

Remaining Questions for Tobacco PRACTICE Research

How to ensure all nurses perceive tobacco cessation as relevant to practice How to ensure workload allows for tobacco cessation interventions How to ensure nursing accountability with tobacco cessation Leading resource = www.tobaccofreenurses.org

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

Remaining Questions for Tobacco PRACTICE Research

How to ensure that the organizational culture supports EBP and/research utilization for nursing practice How to ensure organization/ department budgets include resources to support tobacco cessation interventions (for pts & nurses) How to ensure leadership supports the healthcare cost/benefit ratio to sustain tobacco cessation efforts

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

Questions

But first consider this CLOSING THOUGHT


Through the discovery of

tobacco cessation knowledge, the integration


of that knowledge, the evaluation of that knowledge, and the dissemination of that knowledge . TOGETHER we can help nurses make a difference in stopping the deadly effects of tobacco use and improve the health and well-being of ALL individuals.

THANK YOU