Smoking Cessation Evidence Based Practice
Overview of Selected Evidence Based Practice
Relationship between Research and Evidence-Based Practice
Research is a systematic investigation undertaken to establish facts and increase knowledge to reach new conclusions. Research is mainly carried out in scientific fields to expand knowledge and to help realize some of the events that take place. Evidence-based practice on the other hand, is the integration of current best evidence to achieve clinical outcome (Mohammadi, 2016). Current research aids in identification of clinical complications and their methods of reduction and proper handling. It increases one’s knowledge on how to deal with certain conditions (Mohammadi, 2016). This gives out the best outcome in clinical field.
Evidence-based practice translates the best evidences into clinical practice and decision making and applies the evidences in clinical research to make patient-care decisions; while research develops new knowledge (Black et al., 2015). Research involves generation of new knowledge while evidence-based practice may involve opinions.
Contributions of Evidence-Based Practice to Professional Nursing
Evidence-based practice improves patients’ outcomes; the use of current research maximizes the benefits and minimizes the complications associated with chronic illness. It standardizes evidences across the field to provide patients with best outcome. It also lowers the costs of health care by helping to reduce costs incurred in caring for healthier patients and eliminating unnecessary costs of treating multiple chronic diseases and caring for the patients.
Additionally, evidence-based practice assists with efficient and effective decision making; the use of current research helps nurses to make the right decisions on patients and how to handle the different types of patients. Effective decision making helps to minimize complications of various illnesses. This also promotes effective nursing interventions that help the patients reach the goals set for them.
MSN Program Specialty Track and Practice Focus
An advanced registered nurse practitioner (ARNP) is registered nurse who has completed a graduate education level and has a primary responsibility for patient care. He/ she examines patients and provides relevant diagnosis based on the patients’ history. They admit, manage and discharge patients from health facility and prescribe medications where necessary (Swedish Medical Center, 2019).
How EBP Promotes Change
Patient outcomes improve when nurses apply evidence-based practice. It provides an opportunity for nurses to learn and engage in research and knowledge translation by participating in training programs. With EBP there is greater understanding and realization of the impacts of clinical practices as it encourages one to seek answers on how to improve the effectiveness of certain methods. It makes the nurses to focus on getting the best evidence-based guidelines and practice when they need it. Conclusively, EBP increases clinicians’ research abilities and offers them a sense of confidence when performing their duties.
Smoking Cessation Improvement
Improving Smoking Cessation Outcomes
Smoking is the leading cause of morbidity and mortality in the world. Smokers are offered treatment both in primary and secondary care settings. In the secondary setting, evidence-based models that routinely provide treatment to patients are used. Smoking cessation helps in reduction of lung cancer and heart diseases. It also helps in reduction of peripheral vascular diseases. Nursing concern on this phenomenon helps to determine whether cessation is more effective than prevention and also improves the health of smokers by regularly advising them to stop smoking.
During smoking cessation counseling and intervention- patients are advised to receive smoking cessation counseling which is provided according to age and economic status. This type of counseling is conventionally performed on less than 25 percent of patients’ in primary care clinical encounters.
Stakeholders and the Consequences of Smoking
Stakeholders may include individuals and/ or organizations with interest in the smoking cessation program and its outcome. The stakeholders include the employers, clinicians, health planners, smokers and the government.
Clinicians are required to use evidence-based practice so as to handle patients with care and to increase their knowledge on smoking cessation and the risks and benefits. To do this, they use current research to provide effective results. The government has to compensate clinicians for counseling and providing training programs for better understanding of the effects of smoking. Smokers on the other hand have the responsibility of cooperating with both the government and the clinicians to produce effective results and to reduce risks involved with smoking; following instructions and taking into account the clinicians advices on smoking cessation.
Consequences of Smoking
Smoking cessation is of paramount importance due to the consequences of smoking on the population. Smoking damages the nerve endings responsible for the smell and taste resulting in inability to feel these senses. Additionally, it has multiple health effects, which result in increased costs of healthcare delivery. Outcomes such as reduced cardiovascular activity and lung function; increased risk of chronic obstructive pulmonary disorders (COPD); increased risk of lung and liver diseases; and increased risk of morbidity are common among smokers (Olloquequi et al., 2018). Because of these impacts, smoking reduces productivity and the quality of life of the affected individuals.
Smoking Cessation Recommendation – 5 As Model
One of the approaches that can be used successfully in driving smoking cessation is the 5 A’s framework. The 5 A’s model is an evidence-based model consisting of brief questions. It assists busy practitioners to summarize and learn the effects and intervention of smoking cessation (Sherson, Jimenez, and Katalanos, 2014). It’s used to assess patients on their health behaviors and risks. Implementing the 5 A’s model would provide better outcomes than general counseling.
The first A of the model is to Ask. Asking the patients about their smoking status helps to identify their smoking history and factors contributing to their continued smoking. It also helps to identify strategies for intervention and confirms smoking as a valid concern for the patient.
Secondly, the patient is advised to quit smoking. Advice given should be strong and clear putting into consideration the assessment based on information available about the smokers from the asking. The advice may extend to strategies for achieving smoking cessation.
Thirdly, the nurse assesses the patients to determine whether they are ready to engage in smoking cessation. This is followed by the assisting process wherein nurses help smokers to quit by providing them with information about the harmful effects of smoking, second-hand smoke and benefits of quitting smoking. Methods of smoking- cessation are also provided to help the smokers do away with the smoking. While doing this, additional resources from local, state and federal government may be used. Interventions should be designed to increase future quit attempts by the unwilling patients.
Lastly, the nurse arranges how the smokers can get to smoking cessation campaigns and counseling services. The government may help by reducing travel costs so as to increase the number of smokers visiting counseling clinics. Their progress should be monitored to see how different smokers respond to medications and counseling.
With the 5 A’s in mind, the purpose of this EBP was to determine the effectiveness of the model in promoting smoking cessation.
PICOT and Literature Review Process for the EBP
The PICOT for the study was founded on the study purpose as stated above. The question intended to be answered is thus: Does the use of the evidence-based framework “the 5 A’s” (Ask, Advise, Assess, and Assist) intervention and strategy, help nurses to encourage cigarette smokers to accept the referral to counseling and quit smoking?
In this PICOT the targeted population included smokers of all ages; the intervention would be the use of effective smoking cessation strategies (5 A’s) by ARNP nurses; the 5 A’s is compared to no intervention measures; the outcome is smoking cessation; and the timeline is 6 months or more of smoking cessation. If the intended outcome is achieved, it will be useful in the primary care clinical setting since it will be a source of evidence of the effectiveness of 5 A’s in promoting smoking cessation. In that case, 5 A’s will be used more frequently to achieve positive outcomes.
Literature Review Process
For the intended outcomes to be achieved, a literature review will be conducted to provide supporting evidence to the primary research. A literature review is essential in an EBP as it serves the purpose of providing a theoretical background to evidence in test provides rationalization for research actions and promotes better understanding of the phenomenon in question.
For this reason, a literature review will be conducted in this EBP. The process begins with the selection of a topic. In this case, the topic would be the use of the 5 A’s framework in promoting smoking cessation. The topic helps to provide a sense of purpose to the study. The second step is to define the review scope, which means to thematically plan the EBP and to decide the kind of information intended to be collected. The third step is to select databases from which to collect information. For this particular EBP, some of the databases used include COCHRANE database for systematic reviews, SCDB, Smoking Cessation Database, CINAHL, and MEDLINE. From the databases, the researchers are conducted to obtain relevant articles, which are then reviewed. Some of the search terms used in article search included: smoking cessation, 5 A’s framework, interventions in smoking cessation, and smoking.
While conducting the research, the theoretical framework selected was Dorothea Orem’s self care theory. According to Borji, Otaghi, and Kazembeigi (2017) Orem’s self-care model has proven effective in the promotion of a culture of self care among patients. The theory suggests that nurses should focus on assisting patients to build capabilities for self care by identifying deficits in their self care potential and implementing strategies that help to cover those deficits. The model, once implemented in smoking cessation, would help nurses to identify challenges in self inspired smoking cessation and thus provide resources for assisting smokers to stop smoking. It is predicted that the framework will be effective in achieving the intended objectives.
Black, A.T., Balneaves, L.G., Garossino, C., Puyat, J.H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1), 14-20. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4263611/
Borji, M., Otaghi, M., & Kazembeigi, S. (2017). The impact of Orem’s self-care model on the quality of life in patients with type II diabetes. Biomedical and Pharmacology Journal, 10(1). Retrieved from biomedpharmajournal.org/vol10no1/the-impact-of-oremsself-care-model-on-the-quality-of-life-in-patients-with-type-ii-diabetes-in-ilam/
Olloquequi, J., Jaime, S., Parra, V., Cornejo-Cordova, E., Valdivia, G., Agusti, A., & Silva, R.O. (2018). Comparative analysis of COPD associated with tobacco smoking, biomass smoke exposure or both. Respiratory Research, 19(1), 13. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC5774164/
Mohammadi, E. (2016). A reflection on research, theory, evidence-based practice, and quality improvement. Evidence Based Care Journal, 6(1), 79-80. Retrieved from ebcj.mums.ac.ir/article_6732.html
Sherson, E.A., Jimenez, E.Y., & Katalanos, N. (2014). A review of the use of the 5 A’s model for weight loss counselling: differences between physician practice and patient demand. Family Practice, 31(4), 389-398. Retrieved from academic.oup.com/fampra/article/31/4/389/710905
Swedish Medical Center (2019). Advanced Nurse Practitioner. Retrieved from www.swedish.org/services/primary-care/types-of-providers/what-is-an-arnp