Reflective Essay on Smoking Cessation

musing Essay on Smoking CessationThis essay provides a pensive account of the delivery of an opportunistic fastball tip intervention. In constructing this account, Gibbs (1988) mildew of reflection has been utilised, which incorporates the following comp singlents description impressionings evaluation analysis conclusion and exertion plan.DescriptionWhilst shadowing a work out nurse, I was provided with the opportunity to lend oneself a truncated have issue intervention with a uncomplaining. The unhurrieds predict forget not be used, in respect of confidentiality (NMC mandate, 2008 NHS Confidentiality Code of Practice, DH 2003), however, for the objective of this reflection she get out be referred to by the pseudonym Sarah. Sarah is a 65-year ageing female presenting with a number of wellness issues. She is an overweight smoker who has tardily been diagnosed with chronic obstructive pulmonary disease (COPD), a lung disease characterised by the narrowing of the ai rways. COPD also refers to chronic bronchitis and emphysema, the latter of which Sarah has been diagnosed with. It is emphysema that is Sarahs primary wellness problem at present.The wellness promotion dodging adopted was a brief intervention comprising motivational interviewing (Rollnick, Miller and Butler, 2007), which took place indoors the get along surgery as part of Sarahs consultation. motivational Interviewing is a directive tolerant-centered flare of counselling designed to succor masses resolve ambivalence to the nobleest degree behavior falsify, much(prenominal) as smoking cessation.Alongside motivational interviewing, or so specific props and teaching aids were utilised, including the provision of evidence-based culture, the creation of a COPD self-management plan (British Lung Foundation, 2010), and details of helpful resources Sarah could utilise for further support. This included the Surrey NHS live Smoking Service (www.surreyquit.net), which offers fre e NHS support tailored to the unmarried (i.e. hebdomadally clinic visits or telephone contact).FeelingsI was initially quite anxious about this health promotion opportunity, as I was not confident in my ability to provide constructive support in the limited while we had. However, on initiating a conversation with Sarah, using open questions as recommended at heart motivational interviewing, the anxiety disappeared as I listened to Sarahs story. Active listening requires concentration, which in turn focalizeed me on how I readiness be open to help Sarah. In establishing that Sarah was concerned for her grandchildren, who stayed with her quite frequently and were thus around second hand smoke, this provided an anchor to facilitate the development of Sarahs motivation to deviate. In turn, this anchor also provided me with a patient of-centred method for relieving my fears, since I had found a way of engaging Sarah in the process.Interestingly, as Sarahs motivation grew, so di d my sustain motivation to ensure that Sarah gained as much from this brief intervention as possible. With every question that I could answer, I gained in confidence and enjoyed my component as educator and learner within the collaborative partnership amidst myself and Sarah. In this sense, the collaborative approach that underlies motivational interviewing and much of healthcare practice today can benefit both the patient and healthcare provider.My boilers suit feelings regarding the interaction with Sarah are one of fulfilment. I feel I irresponsiblely contributed to this patients increase resolve to stop smoking for both herself and her family.EvaluationMotivational interviewing was selected as the most appropriate health promotion intervention for Sarah for a number of reasons. Firstly, evidence regarding demeanor change and, in particular, smoking cessation, shows that level of motivation is an weighty factor in devising the best health promotion method or teaching plan for a patient (Prochaska, DiClemente, and Norcross, 1993). This approach takes into consideration humanist learning hypothesis and the principles of self-directed learning. tally to Prochaska et al.s (1983) five stages of behaviour change, Sarah currently resides in stage 2 of the following stages Stage 1 (pre- thoughtfulness) is when the individual does not intend to change behaviour Stage 2 ( reflection) is when an individual is considering change Stage 3 (preparation) is solemn resolve to embark on smoking cessation Stage 4 (action stage) is the first few crucial weeks and months where an individual is actively taking positive actions towards smoking cessation and Stage 5 (maintenance) is about 6-months to 5-years after the origin of the smoking cessation decision, where behaviour change has been sustained.Being in the contemplation stage suggests that Sarah still has some unresolved ambivalence about change and thus needs help moving to stage 3, where she can blend to prepar e for smoking cessation. If I had started to help Sarah plan for smoking cessation before she was ready, this could have been detrimental in both the short- and long-term. For example, it has been shown that overcoming the hurdles associated with smoking cessation can increase an individuals self-efficacy (i.e. confidence) in their ability to succeed at their quit attempt, which in turn acts to reduce the likelihood of a recur and increase the likelihood of long-term sustained smoking cessation (Schnoll et al., 2010). If Sarah was pushed towards a quit attempt before prepared, her risk of relapse would have been high this would have ultimately reduced her self-confidence to try again.The transition from the contemplation stage to the preparation stage has been cited as being critically all important(p) to the outcome of quit attempts (Prochaska, DiClemente, and Norcross, 1993), as has the fact that healthcare professionals can be extremely influential at this stage Long et al., 19 96). I considered motivational interviewing to be key to influencing Sarahs decisions regarding smoking cessation since it was designed specifically to help people resolve ambivalence about behavior change, which is the main diagnostic of people in the contemplation stage of motivation. Motivational interviewing can procure the resolve of ambivalence by avoiding confrontation and guiding people towards choosing to change their behavior themselves.I was aware that motivational interviewing would need to be attach to by detailed education about smoke-related health issues and the likely dividing line of COPD, together with possible complications and its association with increased morbidity and mortality. Sarah is an intelligent individual and keen to receive such(prenominal) information and reading material. Unfortunately, however, I was futile to answer all of her questions. In particular, I could not answer her questions regarding the pathophysiology of smoking. unreciprocated questions can act as a barrier to progress, something which I do not wish to produce in a patient who requires such barriers removing. Fortunately, I was able to answer Sarahs questions whilst referring to an educational information leaflet. I do, however, feel that I would have been able to engage with Sarah much effectively if it had not been necessary for me to focus my attention on the leaflet before me.It became apparent throughout the consultation that although Sarah was most certainly considering quitting smoking, she possess some traits that might hinder her efforts. In particular, Sarah appeared to have an external health locus of turn back. This means that she attributes control over her behaviour to external factors as opposed to midland factors. It is well documented within the lit that an internal locus of control is more productive to behaviour change and healthier lifestyle choices (Wallston and Wallston, 1978 Tones et al., 1992). fetching this into considerati on, I was mindful to acknowledge Sarahs control over her choices. In one instance, I used her save as an example since Sarah had informed me that her husband had quit smoking. I asked her how he managed to achieve this and in recognising her husbands role in his own smoking cessation, Sarah appeared to be adjusting her locus of control towards a more internal one.Nevertheless, Sarahs self-efficacy remained low throughout the consultation despite attempts to boost her confidence. It is believed that increased self-efficacy, which can be achieved via motivational interviewing, is an important factor involved in the mastery of smoking cessation (Brown et al., 2003 Karatay et al., 2010), thus I felt this was an important aspect to include in Sarahs self-management care plan to set herself an possible goal each week that would gradually build her confidence.AnalysisThe discussion section of wellness have been working with the NHS, patients, and healthcare professionals since 2005 to develop a strategy to improve the care and outcomes of people with COPD (DH, 2010). This strategy places a large focus on the prevention and treatment of smoking, as well as the grandeur of providing patients who have COPD with behavioural support and access to stop smoking returnss.The incision of Health (2009) have produced guidance on effective stop smoking services, offering three levels of behavioural intervention brief interventions (level one) intensive one-to-one support and advice (level two) and group interventions (level three). In terms of level one, brief interventions, the national Institute of Clinical Excellent (NICE) have published guidelines and recommendations for smoking cessation (NICE, 2004). Furthermore, previous UK guidance has emphasised the importance of offering opportunistic, brief advice to foster all smokers to quit and to signpost them to resources and treatments that might help them (West, 2005).They Department of Health guidance states that all smokers should be advised to quit and asked if they are enkindle in quitting this is unless there are exceptional circumstances such as other medical conditions that might hinder smoking cessation. Those who are elicit in quitting should then be offered a referral to an intensive, level two, support service such as NHS Stop Smoking Services. Sarah was referred to the Surrey service and informed of the success rates found for NHS Stop Smoking Services. There is evidence that such services are effective in the short-term (4-weeks) and the long-term (52-weeks) indeed, between 13-23% of successful short-term quitters remain abstinent at 52-weeks (NICE, 2007).Conclusion nearly 900,000 people in England and Wales have been diagnosed with COPD (NICE, 2004) and it is the fifth most common suit of death in the UK, resulting in over 30,000 deaths annually (National Statistics, 2006). By 2020, it is estimated that COPD will be the third most common cause of mortality general (Lopez et al. , 2006). Smoking is the largest risk factor for developing COPD, with 20% of long-term smokers at long last developing clinically significant levels of the disease and 80% developing lung revile (Garcia-Aymerich et al., 2003). These statistics highlight the urgency of grasping opportunistic health promotion and utilising brief intervention skills to help deliver the DH strategy and improve the care and outcomes provided to people with COPD.Delivering brief opportunistic interventions for smoking cessation requires an approach that does not pee defensiveness but develops a patient/provider partnership conductive of the patient making their own decisions, with support, as to their lifestyle. Motivational interviewing and consideration of individual patient characteristics and traits (i.e. locus of control, stage of readiness to change, etc.) provides a method of achieving this partnership within limited time and resources, as is often the case in bustling healthcare environments. Learning the skills within motivational interviewing will add to a healthcare professionals repertoire of techniques for supporting patients through behaviour change, as I found in the case reflected upon within this essay.Action PlanThe UKCC Code of Professional Conduct (1992) proposes that nurses should maintain and improve her professional knowledge and competence. In relation to my own knowledge and competence in opportunistic health promotion, I have recognised that I need to increase my skills for nurturing patient self-efficacy. Patient confidence is fundamental to successful behaviour change and although I feel satisfied with my approach to Sarah, it would have been useful to have possessed a larger repertoire of techniques for enhancing self-efficacy.I could also benefit from a great understanding of the pathophysiological mechanisms by which smoking causes COPD. Sarah was particularly interested in the physiological effects of smoking and whilst I could offer her basic in formation verbally, I needed to refer to information leaflets for more detailed insight, which disrupt the flow of conversation.I have started to explore these issues via a search of the literature on behaviour change and health promotion. As part of this search, I have come across the concept of implementation intention (Gollwitzer, 1999). The theory behind this concept is that in order for someone to implement a desired behaviour, it is necessary for them to devise a specific plan that will increase their intention to pursue that behaviour (Gollwitzer and Sheeran, 2006). This is an interesting technique that could be integrated into motivational interviewing and health promotion via the self-management care plans currently provided. I intend to explore this further and to discuss it with a superior.Using Gibbs reflective model to structure this account has helped me to recognise my strongest skills and those that require further development. I will endeavour to take a proactive approach to utilising this greater insight into my professional abilities.