Background/Rationale
Tobacco use is responsible for more than 430,000 avoidable deaths in the United States. Center of Medicare and Medicaid requires smoking education as a publicly reported indicator for identified populations. Columbus Regional Hospital lacked a standardized approach to identification of smokers, incentives for clinicians to intervene consistently, an evidence-based intervention, continuity between sites of care. In addition, there was minimal documentation of smoking education (33%). The CNS partnered with the community coordinator to develop an innovative smoking cessation model across the continuum.
Description
The Transtheoretical Model was integrated in the admission database to assess tobacco use and readiness to change behavior. A standardized, stage-based consciousness-raising message was included in daily nursing documentation and patient materials. CNS developed and implemented the Smoking Aid Kit (SAK), a supportive package used during smoking cessation education. Tobacco counselors met with smokers in contemplation and preparation for a 15-minute stage-based intervention. Follow-up phone call was conducted to register smokers in the outpatient class 2 weeks postdischarge. A 4-week outpatient class was developed for further tailored interventions. Volunteered counselors participated in a 3-day training course with competencies taught by the CNS.
Outcome
Six months postimplementation demonstrated a increase in the number of patients within the hospital environment who received smoking cessation education. A significant increase in the documentation of smoking cessation education for CMS populations was also noted. Of the smokers counseled, 26% were registered for the outpatient class and had a positive stage of change movement. Five patients continue to be smoke-free and will be followed to evaluate annual quit rates. CNSs have the ability to influence change at the system level. Through collaborative practice, an innovative smoking cessation model demonstrated improved outcomes among smokers.
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.