HomeMedicine By SpecialtyPulmonary and RespirologySupportive Approach for Smoking Cessation at the North Bay Regional Health Centre

Supportive Approach for Smoking Cessation at the North Bay Regional Health Centre

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Colette Therriault says she started smoking when she was 11 years old. “My brother and I were sitting on a dock and he wanted me to have a cigarette with him,” the mother of four says. “I remember coughing, but I also remember really liking it.”

Colette started smoking that day, and smoked a half a pack a day (or more) until recently when she was an inpatient at the North Bay Regional Health Centre (NBRHC).

Admitted to the hospital for other health problems, Colette says quitting smoking was not a priority for her at the time. But that was before she was visited by Respiratory Therapist Shari Cole, NBRHC’s Tobacco Intervention Clinical Coordinator.

Shari visited Colette to perform a brief tobacco assessment as part of the hospital’s Tobacco Intervention Program. “Patients who smoke, regardless of reason for admission or desire to quit, are visited by a Registered Respiratory Therapist (RRT) who has been trained in cessation,” Shari explains.

First the patient is offered some nicotine replacement therapy to help with their cravings. “Depending on the patient’s feelings about their tobacco use, we can offer counseling, quit advice, and follow up through community links or Smokers Helpline,” Shari says. “Being in the hospital can be a time of motivation for someone to make a quit attempt.”

Shari says the majority of patients do not mind being asked about their tobacco use when it’s done in a non-judgmental, supportive way. “Even patients who have no desire to stop smoking appreciate being offered nicotine replacements to help them stay comfortable,” she continues. “Sometimes, even the most dedicated smokers will change their minds after receiving the program supports.”

NBRHC is unique because the RRTs, who are on duty 24/7, have been trained in cessation. Shari says this means the RRTs are able to assess the patient’s tobacco use, order the nicotine replacement and start the patient on the nicotine replacement all in the same visit. “This not only allows the patient access to replacement sooner, but also gives the opportunity to educate the patient more on the products and how they work.”

Tobacco Intervention Program

After a brief pilot at the old North Bay General Hospital, the Tobacco Intervention Program has been offered on the Medicine, Surgery, Critical Care Unit, Pediatrics, and Long Term Care/Long Term Rehabilitation units since the move to the new hospital site in 2011.

The NBRHC program follows the “Ottawa Model”—which is a means of providing brief, best practice supports to patients who smoke, using a systematic, standardized approach. This involves identifying patients who use tobacco, and offering them nicotine replacement, information and resources. “Even though it is a short intervention, this process has been shown to increase quit rates by over 10 per cent,” Shari explains.

The first few days Colette was in the hospital she had been too sick to smoke. After her assessment, Colette was offered nicotine replacement in the form of patches and inhalers.

Colette had never tried using nicotine replacement before this program. “Right away I felt it was effective. The inhaler was very helpful for the hand to mouth part of the habit.”

While Colette had tried to quit before, she had never tried to quit with the use of nicotine replacements before the program. The Ontario Medical Association recommends that any person attempting to quit smoking be offered stop smoking medications because these medications are shown to double a person’s likelihood of staying smoke free over the long term.

Colette continued with the nicotine replacements during the two weeks she was an inpatient at NBRHC and she was able to abstain from smoking that whole time.

Colette says she was worried about returning home after she was discharged. “I thought when I got back home that I would want to have a cigarette,” she says. Coping strategies she learned through the Tobacco Intervention Program to deal with the cravings and changing some behaviors made the transition easier.

“It was important for me to keep a routine, but a new positive routine. Drinking cold water, crocheting and the delay method worked for me.”

Shari says while the nicotine replacement is helpful for people as they work on quitting smoking, it is only a part of the process. “Colette, and people like her who are successful in quitting have a lot of work to do when it comes to managing cravings and overcoming the patterns that have been established from years of smoking.”

Supportive Approach

“We no longer just tell people they should quit smoking,” Shari says. “We give them the tools they need to help them be successful. It could be answering questions, providing recommended medications, or links to community resources. Stopping smoking is hard, and often takes more than one attempt or multiple supports.”

It was the supportive approach that Colette credits with her success in quitting smoking. “Shari really made me feel like this was something I could do. She never made me feel bad for being a smoker. She told me she had some tools to help me stop smoking if that was something I wanted.”

Colette has seen temptations on her quit journey, but says the key is to not get too upset if you have a slip. “You have to just look at it like it was a mistake, you’re only human and remind yourself you still want to quit. I feel very happy with how things have gone and I am looking forward to the day when I can call myself a non-smoker.”

Shari is quick to point out to Colette that she already is a non-smoker. “Smoke from a cigarette contains some 4000 chemicals that Colette has not been exposed to since her last puff.”

One of the best parts about quitting smoking for Colette is how proud her family is. The mother of four also has five grandchildren, one great-grandchild and another on the way. She has been keeping cravings at bay by crocheting, and is working on a baby blanket for the newest addition to their family.

“It’s an ongoing battle, it doesn’t really ever stop, not for me anyway.” But for Colette, it’s a battle that is worth the fight.



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