Page 813 - Cardiac Nursing

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C HAPTER 3 4 / Smoking Cessation and Relapse Prevention 789
How confident are you that you can resist the urge to smoke in the 14 situations below?
Not at All Confident Slightly Confident Fairly Confident Very Confident
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1. When you feel bored or depressed ___________________________________________
2. When you see others smoking ___________________________________________
3. When you want to relax or rest ___________________________________________
4. When you just want to sit back and enjoy a cigarette ___________________________________________
5. When you are watching TV ___________________________________________
6. When you are driving or riding in a car ___________________________________________
7. When you have finished a meal or snack ___________________________________________
8. When you feel frustrated, worried, upset, tense, nervous, angry,
anxious, or annoyed ___________________________________________
9. When you want to snack, but don’t want to gain weight ___________________________________________
10. When you need more energy or can’t concentrate ___________________________________________
11. When someone offers you a cigarette ___________________________________________
12. When you are drinking coffee or tea ___________________________________________
13. When you are in a situation where alcohol is involved ___________________________________________
14. When you feel smoking is part of your self-image ___________________________________________
■ Figure 34-1 The Confidence Questionnaire (Modified Form). (Reprinted with permission from Con-
diotte, M. M., & Lichtenstein, E. [1981]. Self-efficacy and relapse in smoking cessation programs. Journal of
Consulting and Clinical Psychology, 49, 648–658).
9
9
self-efficacy scale, which is a shorter version of the scale by Con- with friends, the patient can socialize with nonsmokers in atten-
diotte and Lichtenstein, 69 is illustrated in Figure 34-1. dance instead of stepping outside with smokers. When dining
Less than 70% confidence for a given efficacy item denotes a out with others, escape can mean stepping outside while the oth-
high-risk situation for which patients may require help. 9,14 Patients ers smoke after-dinner cigarettes. It is important to stress to the
are taught to work on those situations in which they show the least patient that a combination of strategies (ACE) is essential. By
confidence to resist smoking. After identification of high-risk situ- having many strategies, the patient decreases the risk of being
ations, skills training helps people mobilize their resources by de- caught in a situation he or she is not prepared to handle. The last
veloping cognitive and behavioral strategies to cope with the situ- step in relapse prevention training is practicing the coping re-
ation. Tsoh et al. 71 recommend teaching patients to cope with sponse through rehearsal. Even though an urge may occur, if the
urges to smoke by using the ACE (avoid, cope, escape) strategies. patient is prepared to handle the situation, it decreases the likeli-
For example, if a patient does not feel ready to handle a risky situ- hood that he or she will pick up a cigarette. One nursing respon-
ation, encourage the patient to avoid it until the patient’s confi- sibility includes practicing the different strategies to strengthen
dence in his or her ability to handle that particular risky situation coping responses by role-playing with the patient a solution to
improves. If a patient routinely watches football at a smoke-filled handle the high-risk situation.
sports bar, tell him or her to invite some nonsmoking friends over In addition to the strategies developed for specific situations, re-
to his or her home to watch the game. If a patient is going to a lapse prevention training focuses on general lifestyle modifications
67
restaurant, he or she can ask to sit in the nonsmoking section, that help to enhance the patient’s self-control. Frequent assessment
thereby avoiding the option to smoke. If a patient cannot avoid a of dependence to smoking is useful and can guide the intensity of
risky situation, then coping with it is the next step. Possible coping follow-up intervention. To measure the level of nicotine addiction,
strategies include distraction, incompatible behaviors, and positive clinicians can ask to patients “time to first cigarette” in the morning.
self-talk. Distraction from the urge to smoke can be achieved by If patients smoke their first cigarette in the morning within 30 min-
going for a walk, telephoning a friend, reading, or any other activ- utes of waking, it indicates a high level of nicotine dependence. Time
ity that gets the patient’s mind off smoking until the urge subsides. to first cigarette is one of the six questions on the Fagerstrom Test for
72
Behaviors that are incompatible with smoking include chewing Nicotine Dependence, and it is known that this single item reliably
gum, snacking on low-calorie, low-fat foods, or engaging in tasks indicates the level of nicotine addiction (Fig. 34-2). 73 Exercise and
that occupy the hands, like knitting, sewing, woodworking, or relaxation techniques are two such strategies that have been used suc-
crossword puzzles. Positive self-talk involves the patient telling cessfully to help patients develop a greater sense of self-control. In a
himself or herself that he or she can continue to be a nonsmoker. study of patients after MI, smokers participating in an exercise train-
For example, a patient may say, “I can do this. I am capable of re- ing program combined with smoking cessation had greater cessation
maining a nonsmoker. I have the power to improve my health by rates and smoked significantly fewer cigarettes than those who did
remaining a nonsmoker.” Other things a patient can do include re- not participate in such a program. 74 Exercise may also help reduce
minding himself or herself about the health risks of cigarette smok- weight gain after quitting smoking and may minimize some with-
ing, the health benefits of quitting, and the monetary savings. drawal symptoms. For these reasons, patients should be encouraged
If the patient cannot avoid or cope with a risky situation, es- to increase their activity levels through walking or other forms of ex-
cape is the next option. “Escape” means getting out of a risky sit- ercise. Finally, patients who enjoy occasional social drinking should
uation without a puff. For example, if the patient is at a party be encouraged to avoid using alcohol while attempting to become a