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It’s one of today’s major paradoxes: Despite the health risks of tobacco, some people continue to smoke. As a result, nurses often face the challenge of helping patients — both psychologically and physically — stop smoking. Sometimes, a nurse must contend with an even more difficult obstacle: playing the role of both healer and patient. Sixteen percent of nurses in the U.S. still smoke.

Why is it so difficult to quit such a dangerous habit? Those who struggle to stop smoking say the habit relaxes them and reduces stress. And, they admit, they’re addicted to the “lift” from the tobacco. The good news, both for nurses guiding their patients and for nurses trying to end their own addictions, is this: ongoing research has resulted in new pharmacological and psychological techniques for would-be ex-smokers. In addition, there are new organizations designed specifically for nurses’ needs.

Tobacco-free nurses

The following quote on the Tobacco Free Nurses’ organization website sums up the challenge of trying to quit: “I first lit up a cigarette when I was 9. I started smoking at 16 and smoked for 15 years. When I wanted to quit, I found out it takes the average person three to four attempts to quit because nicotine is so powerful. I learned that if you pick it up again, it’s part of a process. It’s not that you failed, that’s just how it works. When I finally quit, I had more weapons to help me — my pills, my support, and my nurse practitioner to talk to. Now we have Tobacco Free Nurses to help, too.”

Stella Aguinaga Bialous, RN, DrPH, is president of the San Francisco-based Tobacco Policy International and co-investigator of the Tobacco Free Nurses Initiative (www.tobaccofreenurses.org). A professor at the UCLA School of Nursing, Linda Sarna, RN, DNSc, is principal investigator of the Tobacco Free Nurses Initiative, funded by The Robert Wood Johnson Foundation. They describe the Tobacco Free Nurses initiative as “the first-ever national initiative to assist nurses to quit smoking.”

Through the organization, nurses can access Nurses QuitNet, an internet-based smoking cessation program. Nurses receive free consultations with experts and information about pharmacotherapy and cessation programs in their area. The website offers links to resources for nurses who are helping patients stop smoking, as well as information about research done by nurses.

According to Bialous and Sarna, research continues to show that tobacco usage should be regarded as an addiction, with a multi-disciplinary approach required to support those seeking to stop. One new resource is the launch of a national telephone number, 1-800-QUIT NOW, which will provide another resource for nurses helping patients stop smoking, as well as for those who want to stop themselves.

Patricia Bax, RN, MS, CASAC (certified alcohol and substance abuse counselor), is the marketing coordinator of the New York State Smokers’ Quitline. Bax worked for the American Cancer Society as a tobacco control specialist for two years. The latest research indicates that counseling sessions are more effective when they last longer and are more frequent, Bax says. Research also shows that smokers are more likely to use phone counseling than attend either individual or group counseling sessions.

But Bax encourages smokers not to overlook help from peers. In working with the Niagara Falls Memorial Medical Center, she coordinated a Quit and Win contest with hospital employees. She believes the financial incentives, coupled with peer and colleague pressure, motivated people to quit. “The power of support, such as a buddy system, can not be underestimated,” she says.

Among new medications now in the testing phases or soon to be available, Bax lists:

A new, better-tasting nicotine gum that delivers faster results. It’s supposed to be available in 2005.

Rimonabant (Acomplia), a new drug under development that may help battle smoking as well as obesity. Bax notes that the French pharmaceutical firm Sanofi-Aventis will seek federal approval for the drug next year, which means the drug “ is probably two years away from being available in the U.S.,” Bax says.

A nicotine vaccine in the testing phases by researchers at the University of Minnesota. The vaccine blocks nicotine uptake in the brain. Although human studies began just last year, Bax predicts the vaccine could dramatically change how we treat nicotine in the future.

Rx for Change

Cheryl Lang, RN, a member of the nursing faculty at Front Range Community College in northern Colorado, is working on her master’s degree in nursing education at the University of Northern Colorado. Lang was trained at Georgetown University’s Summer Institute for Tobacco Control Practice in Nursing Education.

“This initiative is providing nursing faculty from around the country with the needed skills to implement smoking cessation curricula in their programs,” says Lang. She describes the institute’s curriculum, “Rx for Change,” as a comprehensive tobacco-training program that equips nurses and other health care professionals with state-of-the-art knowledge and skills for helping patients quit. Lang notes that the college’s nursing department has teamed with Poudre Valley Health System and the Larimer County Department of Health and Environment to apply for funding. The funds will be used to integrate the skills needed to work with patients on smoking cessation into the nursing program curriculum.

Officials at the Colorado community college decided to implement the unique curriculum because they wanted to do more to help patients addicted to tobacco. Tobacco-related diseases, from cancers to heart disease, to emphysema and stroke, kill more than 440,000 Americans every year, Lang says. In addition, the college faculty and administration felt they could better prepare their nursing students for employment in areas that “support tobacco-free lifestyles.”