TRIGGER TAPE SYNOPSIS – RESPIRATORY CARE CURRICULUM Tape
Scenario
Dialogue
Problem
Solution
3
“No, I think I’d rather quit cold turkey and do it on my own. I don’t need no help.”
Man is sitting on the end of a patient examination table.
Many smokers try to quit without assistance, despite the proven positive impact of behavioral counseling and pharmacotherapy.
Ask the patient, “What would not using a medication accomplish?” Remind the patient that quitting smoking is like learning a new behavior: not smoking. Then explain that most people go through significant withdrawal when they quit. Ask, “Could you learn anything if you are irritable, anxious, and restless all day long?” Consider advising the patient that quitting is not something he can just make happen. Explain that having a plan and a good teacher increases his chances of being successful. Educate the patient about the impact of behavioral counseling and cessation medications. Consider saying, “Research clearly shows that combining a smoking cessation medication with a behavior modification program doubles or triples your chances of quitting for good. Do you want to give yourself the best chance of being successful?”
11
“Oh, but I don’t smoke around her. I always smoke outside at home…because of her asthma.”
Mother and child are in a patient examination room, talking to the child’s clinician.
Smokers often do not realize the lingering effects of the smoke on clothing, hair, etc.
First, acknowledge that it is clear that she cares a great deal for her daughter. Inform her that smoke can stay on clothes and hair for hours after smoking. Consider saying, “If you pick up or hug your child, this smoke could still irritate her lungs and bring on an asthma attack.” Advise the patient, “If you smoke outside but near an open window or door, the smoke is still entering your home,” and “You may not be smoking near your child, but that doesn’t mean you’re not having a negative impact. You are a role model for your child. Your smoking sends the message that smoking is okay. Is this a message you want your child to get?”
12
“I’d like to quit smoking, but it’s probably too late for me. I’m sure the damage has already been done.”
Man is sitting on a patient examination table, talking with his clinician.
Many individuals over age 40 think that the damage done to the body from smoking is beyond repair. They think, What’s the point of quitting?
Advise the patient that it is never too late to quit smoking. Explain that many of the positive physical changes that occur as a result of quitting happen within weeks or months and, further, research shows that even people in their 70s and 80s benefit from quitting. Remind the patient that even if someone has a smoking-related illness, quitting can reduce the rate of disease exacerbation.
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Copyright © 1999-2015 The Regents of the University of California. All rights reserved.
TRIGGER TAPE SYNOPSIS – RESPIRATORY CARE CURRICULUM (CONT’D) Tape
Scenario
Dialogue
Problem
Solution Point out that all of the cessation products cost generally the same as a pack of cigarettes, and are Do the math. Determine how much the smoker spends in a year on cigarettes and show them how much they will save if they quit. Remind the patient that although they perceive the products as being expensive, use is only for a short period of time, unlike continued smoking. Advise the patient, “There are seven effective medications for quitting that will significantly reduce your withdrawal symptoms from nicotine, making you more comfortable during the quitting process. Most of these medications can be used even if you are hospitalized so if it’s alright with you I’ll speak with your physician to determine what will work best for you.” Reframe surgery as the ideal time to quit. Hospitalized patients cannot smoke as inpatients, and surgical outcomes can be significantly improved in smokers who quit. Remind the patient that this is a good time to quit precisely because they will not be feeling well. The discomfort experienced as a result of the surgery will mask many of the negative feelings they might experience from quitting. Calmly remind this patient that they are in the hospital to get well, not to continue to harm himself by smoking. Reframe the hospitalization as the ideal time to quit and review the options available at your institution to help them do so. Help this patient to understand how smoking has contributed to his hospitalization and that permitting him to smoke would be unethical. Review his medical chart, ensure that he is receiving appropriate treatment for his tobacco dependence.
17
“All those smoking medications cost way too much.”
N/A
Many patients who smoke feel that they cannot afford cessation medications, so they continue to smoke.
24
“So, I’m going to be miserable enough recovering from this surgery. Why would I want to make it worse by quitting now?”
N/A
These patients feel that they will inevitably go through significant physical withdrawal when quitting.
25
“What do you mean I can’t go outside and smoke?”
Patient with IV pole, in hospital hallway, attempting to go outside to smoke
Many hospitalized patients think that they have the “right” to smoke and that they can leave the hospital at any time to do so.
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Copyright © 1999-2015 The Regents of the University of California. All rights reserved.
