Advancing tobacco dependence treatment in the hospital setting

11-claireClaire Gignac
Health Sciences North, Sudbury, Ontario, Canada
11-flag Canada
24 Oct 2014

Claire F. Gignac is an RN/counselor/trainer/educator at Health Sciences North/Horizon Santé Nord (HSN) — a research and teaching hospital — in Sudbury, Ontario, Canada.

Tell us about your background:

I started my career in 1984 as a registered nurse having worked in surgical, critical care program, Cardiodiagnostics, Cancer Centre clinical research and in Mental Health & Addictions. I received my papers as Clinical Educator through Michener Institute in Toronto, Canada and later becoming the third Master-Certified Tobacco Treatment Specialist in Canada through the University of Massachusetts Medical School Division of Preventive and Behavioral Medicine.

How did you get started in the field of smoking cessation?

My work with smoking cessation started in 2006 while working as Unit Manager in the Critical Care Program’s Critical Care Information System.  I developed an interest in Mental Health in 2011 and began my work as a tobacco treatment nurse for inpatients.  Work had been done in this field but I was intrigued to see how I could improve nursing education and pharmacotherapy at HSN.  It was rewarding to see these changes implemented and how nursing staff learned and applied these modifications into their clinical work.  They became part of their daily practice and were factors in the advancement of tobacco treatment in patient care at HSN.

My work to date has involved designing and producing a formal education program available to all nursing staff aimed at changing the behaviour and attitude towards nicotine addiction as well as the treatment of patients’ nicotine withdrawal within 24 hours of admission.  We developed a YouTube video (http://youtu.be/EgZyDYorb-w) produced for the general population to understand how HSN’s dedication in helping and counselling patients occurs.

Our research/teaching hospital’s policies and procedures have been updated to include Medical Directives in NRT in order to keep current with existing best practices.  My methodology of involving staff and behaviour changes is the dictum of all my work. I work with all staff (front line workers, physicians, support workers) offering fresh insight to the behavior associated with nicotine addiction.

Share with us some success stories:

One of the important changes I prepared was the creation of a self-learning package (SLP) for Mental Health staff.  With the completion of this SLP, steps were taken to introduce a Medical Directive.  With this Medical Directive in place, nurses could now initiate NRT upon patient admission rather than having to wait for psychiatrists to assess patient’s nicotine requirements and order the appropriate medication.  This means that nursing staff have the knowledge, skills and ability to ask, advise, assess, assist and arrange to manage patients’ nicotine addiction.

The first two years focused on the Mental Health & Addiction inpatient program and the positive results directly contributed to the spreading of the NRT Medical Directive to remaining nursing units.  HSN’s commitment is to have all nursing staff receive education and certification in the Medical Directive by the end of 2014.

With staff education in place, it was time to focus on patient education.  A gap was identified regarding available reading material on what was available as well on how to effectively use NRT at the hospital and at home.  I created several bilingual pamphlets on all available forms of NRT as well as on electronic cigarettes.  These were distributed to patients and visitors finding that staff was also using them as part of their patient education material.  A handout dedicated to patients engaged in battle with cancer called “improving cancer treatment through smoking cessation” was created and distributed.

Health Sciences North leads the way when it comes to identifying, assessing and managing nicotine withdrawal symptoms.  A dedicated smoker of 36 years was admitted at HSN for smoking-related breathing complications in December 2012.  She was immediately started on NRT to help with her withdrawal symptoms.  She credits the care and the nursing staff for helping her quit smoking.  “They got me through the biggest part of the withdrawal, and I thank them for this….I could not get over the compassion and care the nurses gave the patients on the floor.  This program has saved my life.”

What are some of the things you are working on now?

I am working with the Registered Nurses Association of Ontario (RNAO) to co-lead several Smoke-Free Pregnancy workshops across Ontario this fall and winter.  These workshops are woman-centered, focusing on pregnant and postpartum women to increase awareness and reduce stigma and discuss approaches to interview and counsel mothers on the risks of smoking and of smoking cessation medications.

I am member of ATTUD, the Association for the Treatment of Tobacco Use and Dependence since 2012 and have the honour of being part of ATTUD’s International Relations Committee representing Canada.

Since Sudbury’s smoking population is higher than the provincial average, I stand devoted in helping all smokers find a way to a healthier, cleaner and safer lifestyle.