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Lang is excited about the “Rx for Change”curriculum because it eliminates the need for teachers to prepare special smoking cessation materials. The “Rx for Change” program makes it easy for nurse educators to help students be experts, Lang says.

Among the teaching tools offered through the curriculum are videotapes, workshops for pharmaceutical aids, and role-play scenarios for practicing counseling strategies. Faculty members can choose which modules best suit their classes, as well as which research to emphasize. Some instructors stress studies that show the importance of personalizing the dangers of smoking based on each patient’s specific health concerns and risk factors. For instance, emphasizing the dangers to the unborn child, as well as the mother, would be critical information for a patient who is pregnant.

As a faculty member on a community college campus, Lang is aware of the importance of her role in helping nursing students stop smoking.

“As I’ve helped them to prepare to quit smoking, I’m struck by the conflict they feel about using smoking to handle their stress while knowing they should quit, especially as health care providers,” Lang says. The ambivalence felt by many smokers shows in their behavior and on-campus assessments, according to the Colorado nurse. Although these nursing students want to quit, they use smoking to relieve their stress. As a result, the students “feel caught and unable to move forward. I’ve really learned how important it is to have a nonjudgmental attitude and to help them to get ready to quit.”

Five stages

Whether they are nursing students or clinic patients, most individuals progress through five stages of smoking cessation, according to the Cancer Prevention Research Center at the University of Rhode Island:

Precontemplation — The smoker knows that quitting would be a wise health move but is not making any definite plans or setting any definitive dates.

Contemplation — The smoker has decided that the dangers of smoking outweigh the pleasures and is prepared to contemplate what it will take to quit.

Preparation — This midpoint is critical in smoking cessation. Smokers make up a battle plan for themselves, which may include asking for support from other individuals, from health care professionals to family members. At this time, they may also decide to use a medication.

Action — The smoker is ready to move forward and turn those plans into reality. Medications, counseling, and other forms of treatment may be used.

Maintenance — The now ex-smoker is in the successful stage of maintenance, where the goal is to maintain a new and healthy lifestyle without tobacco.

Although Lang has never smoked, she knows several students who continue to struggle with tobacco addiction. As an example, Lang describes a third-year student who succeeded in substituting physical activity and exercise for smoking. Toward the end of her third semester, though, the student nurse told Lang, “I had a lot of tests coming up and was feeling extremely stressed and did not have time to exercise. I started smoking again.” She believes nursing programs should offer more stress management techniques to their students. Lang says this student “believes she will stop smoking again and has set a short-term goal of quitting for herself, as she knows smoking is not consistent with who she wants to be.”

Other solutions

As for medications, Lang acknowledges there are many medications that can help people quit. She believes that using the correct dosage and timing are the most important factors in using pharmaceutical treatments. Depending on the patient and medication, pharmaceutical solutions may be delivered in various forms. “The selection of the form of administration is very individualized, sometimes based on convenience,” Lang says. “However, other factors, such as immediacy of nicotine availability or a steady blood level can make one form a much better choice for one patient over another.” Nicotine replacement products include a nasal spray and an inhaler available by prescription. Gum, patches, and lozenges are available over the counter. Bupropion (Zyban) (known as Wellbutrin when prescribed as an antidepressant) is available by prescription only.

In the same way, non-pharmaceutical solutions vary depending on the patient. Through her studies, Lang has learned strategies for each cessation stage, including how to prepare a “quit plan,” how to handle withdrawal symptoms and prevent relapse, and alternative methods such as acupuncture, massage, and hypnosis. For students who want to stop smoking, Lang has offered hypnosis groups, behavioral techniques for stress reduction, information on available medications, and information about other available resources in the community.

Lang’s message to nursing students and nurses who want to stop smoking is this: “It is OK to be wherever you are at with your smoking or your thoughts about wanting to quit or not. I want you to know there are no judgments and only help and resources to quit when you are ready to quit.”

In addition, Lang emphasizes, she asks nurses “to look inside and face your own feelings about your tobacco use. If you feel conflicted or embarrassed or concerned about talking with patients about their use because you smoke, pay attention to your feelings. Talk with people about it. Let your ambivalence be your guide. One day your desire to quit will be stronger than your desire to smoke. Every step between now and then is about getting ready to quit at the pace that is right for you.”

Joanne Eglash is a freelance writer for NurseWeek.

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