title: Reframing tobacco dependency management in acute care: A case study.
abstract: Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.
authors.affiliation: College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada. Electronic address: annette.schultz@umanitoba.ca.
authors.forename: Annette S H
authors.initials: AS
authors.lastname: Schultz
authors.affiliation: St-Boniface General Hospital and Surgery Department Max Rady College of Medicine, Rady Faulty of Health Sciences, University of Manitoba, 351Tache Avenue, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Randolph
authors.initials: R
authors.lastname: Guzman
authors.affiliation: College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3 T 2N2, Canada.
authors.forename: Jo-Ann V
authors.initials: JA
authors.lastname: Sawatzky
authors.affiliation: St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada.
authors.forename: Rick
authors.initials: R
authors.lastname: Thurmeier
authors.affiliation: St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Fedorowicz
authors.affiliation: College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Fulmore
mesh_terms: D000293:Adolescent; D000328:Adult; D055317:Evidence-Based Practice; D006761:Hospitals; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D061845:Smoke-Free Policy; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention; D013514:Surgical Procedures, Operative; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*
keywords: Case study; Hospitals; Smoke-free policies; Tobacco dependence; Withdrawal symptom management