The need to reduce the percentage of smokers and exposure to smoke was recognised by the World Health Organisation in 2003 who adopted the Framework Convention on Tobacco Control by placing restrictions on tobacco advertising, sponsorship and promotion, establishing new packaging and labelling as well as clean indoor air controls and strengthening legislation to tackle tobacco smuggling. (European Union Public Health Information System, 2009) This was adopted by Britain who recognised that tobacco consumption and exposure to smoke causes death, disease and disability, political commitment was necessary in order to take measures to protect all persons from exposure to tobacco smoke; and to promote and support cessation, therefore decreasing the consumption of tobacco products. (Ash, 2003)
The introduction of Smoke free legislation in the UK was complete by July 1 2007. This involved many charities and professional organisations as well as the government in educating the public on the dangers of smoking, in particular targeting the more socioeconomically deprived groups who have the highest smoking rates.
The Government feel that the price increases they have imposed on tabacco have proved to be an effective measure for reducing smoking as well as tobacco advertising, promotion and sponsorship all of which is banned in the UK. Instead health warnings now have to cover 30% of the front and 40% of the back of tobacco packaging, while terms such as ‘low-tar’ and ‘light’ are prohibited.
Between 1970-2000, British men experienced the most rapid decrease in death rates from tobacco in the world as a result of smokers quitting the habit and there are still over two-thirds (67%) of current British smokers who would like to give up smoking. To help these smokers to quit, the government set up the NHS Stop Smoking Service in 1999/2000, following recommendations of the White Paper Smoking Kills in 1998. Between April and September 2006 nearly a quarter of a million people in England set a quit date through NHS Stop Smoking Services. The majority of these people received nicotine replacement therapy and around half were still non-smokers at four weeks. (Cancer Research UK, 2011) Personally I think this is too soon to label someone as a non-smoker because it would only be at four weeks, if using nicotine replacement therapy, the patient would be considering stepping down to the lower dose patch, in my opinion eight to twelve weeks would be more realistic. I have drawn this conclusion having undertaken and passed my Smoking Cessation Intermediate Counsellor Course in January 2005 and actively ran smoking cessation clinics in General Practice for five years.
As you can see from the graph below which shows the prevalence of smoking in Great Britain between 1974 and 2009, the highest rates of smoking have generally been in the 20-34 age-group and the lowest prevalence is found among adults aged 60 and over. You can also see from the graph that smoking dropped across all the age groups significantly in 2007, this could have been due to the Smoke free legislation being completed in that year. After that the prevalence has remained stable if you look at the data ‘All aged 16+’ which could suggest that the NHS Stop Smoking Service has had little or no effect on smokers in this country and further intervention is required.
Government polices encourage nurses to use every opportunity and every resource available to them to promote a patient’s wellbeing and health regardless of the care setting they are in, but health promotion is a process that enables individuals to increase the control over their own health. (Keane & Coverdale, 2011)
According to the World Health Organisation:
‘Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions’. (World Health Organisation, 2011)
Therefore health promotion is a about getting people to take action, it is not something that can be done on or to people; it is done by, with and for people either on a one to one basis or in groups.
There are a number of different approaches to health promotion and according to Naidoo and Wills (2004) the five main models are medical, behaviour change, educational, empowerment and social change. The medical model is characterised by preventing ill health and premature death whereas the behaviour approach encourages patients to live a healthy lifestyle. The educational approach provides information and knowledge to patients to allow them to make informed decisions concerning their health and lifestyle choices. The social change model acknowledges the importance of the socio-economic environment in determining health and finally the empowerment model helps patients identify their own concerns and act on these accordingly. (Keane & Coverdale, 2011)
I believe the general purpose of all these models is to provide a logical flow which is related to the planning, development, implementation, and/or evaluation of an initiative, for example smoking cessation. Also having had previous experience in health promotion, especially smoking cessation, a patient will draw from a number of different models and theories and not always follow the order of a particular one.
As Mr Ward has a confirmed diagnosis of COPD, he has a wide range of healthcare professionals supporting him. John is a patient on the ‘Virtual Ward’; this is a new service that is being tested in North East Essex which aims to improve the care of patients with long term conditions. The virtual ward is a model where health and social teams work closely together to care for patients in their own homes and avoid unnecessary admission to hospital. John’s ‘day to day’ care is managed by the Community Matron with support from his GP and other clinical staff. (Anglian Community Enterprise, 2011)
There are other healthcare professionals involved in Mr Ward’s care such as the COPD Team, who are a team of nurses who strive to improve the quality of life of patients with COPD through evidence based care and education, this will also be the team who will support him with his home oxygen needs when the time arrives. The Community Nursing Team are also on hand to support John, these are teams of nurses who work in a variety of settings ranging from the patient’s home to local clinics and they have many roles. They undertake complex patient assessments which help to reduce/shorten hospital admissions as well as being responsible for managing teams of staff and delegating work according the skill mix. Not only do they provide nursing care to patients they also provide health education and promote healthy lifestyles, this is especially important to Mr Ward as he is still smoking. The nurse aims to work with the whole family therefore it is important that they form strong, trusting relationships with the family or carers as well as the individual, sometimes this can take a number of visits to achieve this. (Klainberg et al, 1988)
Mr Ward is also on the waiting list for pulmonary rehabilitation, which is a multi-disciplinary programme of care that is individually tailored and designed to optimise patients' physical and social performance and autonomy. Pulmonary Rehabilitation is generally offered to all patients who are considered functionally disabled by their breathing condition, although it is not suitable for patients with limiting musculo-skeletal conditions, or those who have unstable angina or have had a recent Myocardial Infarction. Mr Ward will be offered an eight week programme where he will be expected to attend twice weekly for two hours. The first and last sessions will consist of an assessment, firstly to establish John’s level of fitness before and after the rehab, but also to design his individual exercise programme. The rest of the sessions will include one hour of exercising followed by an hour of education to help John develop skills to manage his condition. (ACE, ND)
With all these different professionals involved in Mr Ward’s care it is important that there is good communication and information sharing at all times. The community matron and the community nurses have a ‘blue folder’ in which they keep a record of all their visits; every healthcare professional who visits John at home is urged to enter a record into this folder. If this patient was to become palliative and want to stay at home then this folder would be changed to green as the ambulance crew have been trained to look for a green folder which will supply them with all the relevant information, such as the patient’s resuscitation wishes.
Conclusion
COPD is an incurable but treatable disease which is primarily caused by smoking. According to NICE (2004) it is estimated to affect 1.5 million people in the UK and in 2005/2006 it was estimated to cost the NHS £5.2 billion with an approximately 1.5 billion hospital admissions for adults aged 35 and over. (National Statistics, 2011)
Mr Ward is aware that his smoking status is a cause for concern and giving up the cigarettes will slow down the progression of his disease, with the help of his local smoking cessation nurse John is making positive steps to tackle this issue.
Around 10 million adults in Britain smoke cigarettes but recent research suggests that self-reported cigarette smoking rates may underestimate true tobacco smoking prevalence by 2.8% in England. Research has also shown that since 2007, the rate of tobacco smoking has remained stable. (Cancer Research UK, 2011) Does this mean the Government are not doing enough to tackle smoking or does it show that whatever the Government put in place an individual will always exercise their the freedom of choice!
Mr Ward has a confirmed diagnosis of COPD and has a number of different healthcare professionals involved in his care therefore good communication is paramount, this is achieved by the use of his patient notes which are kept in his house but I do feel that lack of communication may have contributed to his lack of regular spirometry testing.
Spirometry is needed to make a firm diagnosis of asthma and COPD and to distinguish between the two, this is important because treatment of COPD is different from asthma. Together with the presence of symptoms, spirometry helps determine the severity of COPD and can be a guide to specific treatment steps. Therefore is should routinely be preformed once a year. Mr Ward hasn’t had a spirometry done for at least three therefore it should be a priority that the test is undertaken as soon as possible. John’s COPD was described as moderate three years ago but FEV1 in persons with COPD declines over time therefore it is a possibility that his COPD may well be severe and requires a change in treatment.
References
ACE, ND. Pulmonary Rehabilitation, [Online] Available at http://www.acecic.co.uk/Page.aspx?pID=190 [Assessed 01/12/11]
Advair, ND. FAQs About COPD [Online] Available at www.advair.com/copd/understand-copd/faqs-about-copd.html [Assess 08/11/11]
Anglian Community Enterprise, 2001, Virtual Ward Project. {Leaflet} January 2011: Anglian Community Enterprise
Ash, 2003. WHO Framework Convention on Tobacco Control, [Online] Available at http://www.ash.org.uk/current-policy-issues/framework-convention-on-tobacco-control [Assessed on 28/11/11]
Bellamy D, 2005, COPD & NICE Guidelines, Dispensing Doctors’ Association, [Online]. Available at www.dispensingdoctor.org/content.php?id=779
British Lung Foundation, 2007. COPD [Online] Available at www.lunguk.org/you-and-your-lungs/conditions-and-diseases/copd [Assess 08/11/11]
Cancer Research UK, 2011. Smoking – statistics, [Online] Available at http://info.cancerresearchuk.org/cancerstats/types/lung/smoking/#geog [Assessed 01/12/11]
European Union Public Health Information System, 2009. Smoking Policies [Online] Available at www.euphix.org/object_document/o4806n27110.html
Keane & Coverdale, 2011. Promoting Health: A Smoking Cessation Case Study, Nursing Standard, 26, 4, 35-40
Klainberg et al, 1988. Community Health Nursing: An Alliance for Health, The McGraw-Hill Companies
McAllister J, 2002. COPD - Nursing Care and Implications For Nursing. Nursing Times, vol: 98, issue: 37, page no: 43
Naidoo J, Wills J, 2004. Health Promotion. Foundations for Practice. Second edition. Bailliere Tindall and the Royal College of Nursing, London
National Statistics, 2011. Statistics on Smoking: England, 2011. The NHS Information Centre
NICE, 2004. National Clinical Guidelines on Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care, London
Nursing And Midwifery Council [NMC], 2008
Public Health Agency, 2009. Health promotion theories and models [Online] Available at http://www.healthpromotionagency.org.uk/Healthpromotion/Health/section5.htm [Assessed 29/11/11]
Sharma S, 2010. Pulmonary Rehabilitation, Medscape [Online] Available at http://emedicine.medscape.com/article/319885-overview#aw2aab6b6 [Assessed on 28/11/11]
Tones K, Green J, 2004. Health Promotion. Effectiveness, Efficiency and Equity. Third edition. Nelson Thornes, London
World Health Organisation, 2011, Health Education, [Online] Available at http://www.who.int/topics/health_education/en/ [Accessed on 30/04/2011]
Bibliography
Arnold J, 1998. Health Promotion Handbook, Mosby Inc, Missouri
COPD Exchange, 2010. Early COP: Case Finding or Screening? [Online] Available at www.COPDexchange.co.uk [Assess 18/11/11]
Currie G, 2011. ABC of COPD, Second Edition, Wiley-Blackwell, Chichester
Health & Safety Executive, ND. About COPD, [Online] Available at www.hse.gov.uk/copd/aboutus.htm [Assessed 17/11/11]
Kerr J, 2000. Community Health Promotion: Challenges for Practice, Harcourt Publishers Ltd
Respiratory Alliance, 2003. Bridging the Gap: Commissioning & Delivering High Quality Integrated Respiratory Healthcare, Berkshire
Respiratory Therapist, 2011. Smoking Causes COPD, [Online] Available at www.respiratorytherapist.com/index.php/2011/08/31/smoking-causes-copd/ [Assessed 17/11/11]
