Highlights of our major accomplishments TFNI-Leadership & Advocacy
Below are some highlights of our major accomplishments:
- Surveyed over 4,000 nurses in several US states about cessation interventions in clinical practice. Nurses familiar with TFN were significantly more likely to ask patients about tobacco use, advise them to quit smoking, assess readiness to quit, assist in quit attempts, arrange for follow-up, recommend cessation medications, and refer to telephone quitlines and other resources.
- Created and continue to maintain an award winning website (www.tobaccofreenurses.org) to promote the role of nurses in tobacco control, enhance access to tobacco control resources and an ongoing listing of all articles on nursing and tobacco in the peer-reviewed literature.
- Created Nurses QuitNet®: Over 2,200 nurses who smoke registered to get cessation support. Although this partnership has ended, we continue to link nurses to evidence-based programs, including the national quitline (1-800-Quit-Now) and QuitNet® (www.Quitnet.com), through our website.
- Reached over 2 million nurses through paid and in-kind advertisement in the top nursing journals and newsletters.
- Reached over 500,000 nurses through a national meeting of nursing organizations, to assist them in developing plans for incorporating tobacco control in their organizational agenda. We continue to collaborate with these organizations in policy efforts.
- Engaged over 6,000 nurses through multiple presentations at professional meetings.
- Published 14 data-based and translational articles on nurses’ role in tobacco control as well as 9 other papers related to tobacco use and cancer,; 3 manuscripts are submitted, 4 in development; guest-edited 3 journal supplements.
- Developed 5 Fact Sheets, a brochure and a poster to disseminate information about nurses and tobacco, with over 16,000 downloads from the website.
- Encouraged over 500,000 nursing students to become smoke free role models and help patients quit via a TFN letter distributed by deans from Baccalaureate Schools of Nursing in 2005 & 2007, Associate Degree Schools, and LPN Schools, 2006 & 2007. The National Student Nurses Association approved a policy supporting the goals of TFN.
- Developed, with the Agency for Healthcare Research and Quality (AHRQ), the “Helping Smokers Quit: A Guide for Nurses”; a pocket guide based on the Treating Tobacco Dependence Guideline. According to AHRQ, the guide has the highest demand by health professionals (individuals and organizations). It will be updated with the 2008 Guideline release.
- Organized the 1st national conference on nursing research and cessation. Proceedings were published in a supplement of the July 2006 issue of the journal Nursing Research.
- Provided consultation for the revisions of the modified RX for Change© curriculum (http://rxforchange.ucsf.edu/) The Ask-Advise-Refer Curriculum.
- Analyzed the Tobacco Use Supplement, Current Population Survey 2002/2003 data for nurses: smoking prevalence for Registered Nurses was 11.1% and 23.4% for Licensed Practical Nurses.
- Launched Helping Smokers Quit, funded by the CDC, to assess the impact of a web-based educational program (using a modified version of the RX for Change©) for nurses in 30 hospitals in 3 states (California, West Virginia, and Indiana). The TFN website will be enhanced for the project.
- Collaborated with international colleagues to expand the outreach to TFN to the 13 million nurses worldwide, through a World Health Organization-sponsored global network of nurses in tobacco control. We will provide a pre-conference workshop for nurses as part of the 14th World Conference on Tobacco Or Health, in 2009
- Our project had a positive impact on highlighting the risks and challenges of addressing smoking in the profession. Over 2,000 nurses (n = 2,289) as of June 2007 made quit attempts using Nurses QuitNet® (76% of our target of 3000). Thousands others visited the site but selected not to register, so we have no way of measuring what their cessation interests were. Although we are only able to track those registered, other nurses who smoke may have made quit attempts due to the increased attention to smoking as an issue in the profession. We are currently analyzing the quit rates among a subset of those registered with follow-up data.
- According to our analysis of the Tobacco Use Supplement Current Population Survey 2002-2003 current smoking among the profession continues to decline among RNs (11.1%). However, despite the decline among LPNs (23.4%), smoking rates are higher than overall prevalence of smoking in the US and the goals for Health People 2010. Because of high rates among young nurses aged 18-24 (15.7%) with less education (24.9%), nursing students in associate degree programs will be the focus of our next intervention study, in development.
- Our efforts have had an impact on nursing cessation interventions with patients. The data from our web-based survey suggest that the majority of nurses ask about tobacco use (73%), assist with cessation efforts (73%), fewer recommend pharmacotherapy (24%), refer to community resources (22%), or recommend the use of the telephone quitline (10%). These are lower than the five-year targets set at our Nursing Leadership meeting (Ask, 100%, Assess, 75%, Advise, 75%, Assist, 75%, Arrange/Refer, 40%). We are encouraged that nurses who were aware of TFN were significantly more likely to deliver all aspects of an evidence-based intervention. We also have made efforts to disseminate the quitline number through publications and through direct dissemination of cards (>2000).
- The project has had an impact upon schools of nursing and nursing students. As described, our letters were sent to all schools of nursing (baccalaureate, associate degree, licensed practical nurses) to distribute their students. The National Student Nursing Association passed a position statement endorsing the goals of TFN in recognition of TFN efforts and we gave presentations at educator conferences. We will build upon these relationships in a future proposal to assist young nurses in quitting.
- Our efforts have also had an impact on tobacco control policies within nursing organizations. We disseminated the Code of Practice for Healthcare Professionals adopted by the World Health Organization and the TFN project was selected as an exemplar for World No tobacco Day 2005. We’ve written several policies, including the previous and the recent update the Oncology Nursing Society tobacco control position statement which we expect will be endorsed by the American Nurses Association. We will continue to monitor policy efforts of nursing organizations. We did publish an international review of such policies for oncology nursing organizations worldwide.
- As a result of this project, we developed a research proposal to do a secondary analysis of smoking trends among participants in the Nurses’ Health study. These papers are currently under review. Once they are published we anticipate that the findings will garner significant media attention and provide us with another opportunity to discuss this issue. When our focus group findings on smoking and the workplace were published, our press release received worldwide attention.
The most important creative outcomes of this project include:
- Tobacco Free Nurses website (www.tobaccofreenurses.org), a special program to support nurses quit attempts, NursesQuitNet®, and a special tab for our leadership activities.
- Media materials developed with PublicMediaCenter portraying a positive view of support for smoking cessation among nurses, along with Fact Sheets for easy download, user-friendly information on key issues.
- Nursing Research Supplement issue “Nurses and Tobacco Cessation: Setting a Research Agenda” edited by Sarna and Bialous
- Helping Smokers Quit pocket guide, developed in collaboration with the Agency for Healthcare Quality and Research
- Sarna L, Bialous S, Williams B, Hutchins K, Wewers ME, Froelicher, & Danao L. (2003). Views of African American nurses about tobacco control. Journal of the Black Nurses Association, 14, 1-8.
- Bialous S, Sarna L, Wewers ME, Froelicher, & Danao L (2004). Becoming Smokefree: How nurses quit smoking. Nursing Research. 53: 387-395.
- Sarna L & Bialous S (2004). Tobacco control policies of oncology nursing organizations. Seminars in Oncology Nursing. 20: 101-110.
- Bialous S & Sarna L. (2004). Sparing a few minutes for tobacco cessation. American Journal of Nursing. 104: 54-60.
- Sarna, L, & Bialous, S (2005) Tobacco control in the 21st century: a critical issue for the nursing profession. International Journal of Nursing Research. 19:15-24.
- Sarna L., Bialous, SA, Barbeau, E, McLellan, D (2006). Strategies to implement tobacco control policy and advocacy initiatives. Critical Care Nursing Clinics. 18:113-122.
- Sarna L., Bialous SA, Wewers ME, Froelicher, ES, Wells M, Balbach ED (2007). Web log analysis of the two years of the Tobacco Free Nurses Website. Online Journal of Nursing Informatics.
The most important national/regional communications include:
Partnership with the labor arm of the American Nurses Association (United American Nurses) and development of a specific Fact Sheet to guide labor unions in supporting smoking cessation
- Tobacco control workshop at the annual convention of the American Nurses Association, 2004
- Tobacco Free Nurses project, educational program at the American Association of Colleges of Nursing, 2004
- Nursing and tobacco cessation: setting a research agenda, pre-conference to the National Conference on Tobacco Or Health, 2005.
- A web-based survey to >3500 nurses in Magnet-designated hospitals to assess their awareness of TFN and their interventions with patients.
- Partnership with the President of the Philippine Nurses Association to make tobacco control the central issue of the organization in 2005.
- Presentation at the meeting of the National Federation of Licensed Practical Nurses, the National Coalition of Ethnic Minority Nurse Organizations, and the American Public Health Association.
- Identifying nurse leaders and champions in a variety of organizations who continue to build nursing support for the principles of TFN.