1. Borrello, Sally Jo MSN, RN, CTTS

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A: Most patients who smoke know that doing so is bad for their health. They've heard it countless times, but still they continue to smoke. The act of smoking isn't just a bad habit; it's a physiologic and psychological addiction. Nicotine dependence should be viewed as a chronic disease, with multiple possible comorbidities. The majority of patients who smoke cycle through multiple periods of relapse and remission, so smoking cessation counseling is needed for ongoing support of those who are trying to quit and also for those who've already quit.

Figure. Q: Why talk ... - Click to enlarge in new windowFigure. Q: Why talk to my patients about smoking cessation when they already know smoking is an unhealthy practice?

The single most important health decision a patient who smokes can make is to quit. Although 70% of those who smoke want to quit, only 3% are successful without smoking cessation intervention. Nurses are in a prime position to begin the process of motivating their patients to consider quitting during their admission assessment. At this beginning stage, two questions are critical: "Do you smoke?" and "Do you want to quit?" Although you may not be able to spend much time in cessation counseling with your patient, the mere suggestion of quitting may be enough to move him to action in the near future.


In a nonjudgmental way you can provide resources for your patient to take home to use when he's ready to quit, even if he isn't ready to do so upon discharge. In addition to office-based or off-site counseling and community-based cessation classes, you may refer your patient to quit lines and print and Internet-based educational materials. You may also inform him about the option of pharmacotherapy to aid him in quitting. There are several free smoking cessation programs available online, such as those offered by the American Lung Association (, the National Alliance for Tobacco Cessation (, and


It's been shown that even a brief tobacco intervention is an effective motivator for the patient to begin thinking about quitting. For a patient who shows a willingness to quit, consider the U.S. Department of Health and Human Services' 5 A's model for treating tobacco use and dependence (Ask, Advise, Assess, Assist, Arrange follow-up). For a patient who shows an unwillingness to quit, consider the 5 R's model:


* Relevance: Encourage the patient to indicate why quitting is personally relevant.


* Risks: Identify potential negative consequences of tobacco use (acute, long-term, and environmental risks).


* Rewards: Identify potential benefits of stopping tobacco use, such as improved health, saving money, and better food taste.


* Roadblocks: Have the patient identify barriers to quitting and help him problem solve.


* Repetition: Repeat these steps at every visit.



Who better to begin smoking cessation counseling than you as you care for your patients every day?


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Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update.