The levels of evidence supporting the recommendations (A-C) are defined at the end of the "Major Recommendations" field.
Practice Recommendations
Recommendation 1
Nurses implement minimal tobacco use intervention using the "Ask, Advise, Assist, Arrange" protocol with all clients. (Strength of Evidence A)
Recommendation 2
Nurses introduce intensive smoking cessation intervention (more than 10 minutes duration) when their knowledge and time enables them to engage in more intensive counselling. (Strength of Evidence A)
Recommendation 3
Nurses recognize that tobacco users may relapse several times before achieving abstinence and need to re-engage clients in the smoking cessation process. (Strength of Evidence B)
Recommendation 4
Nurses should be knowledgeable about community smoking cessation resources, for referral and follow-up. (Strength of Evidence C)
Recommendation 5
Nurses implement smoking cessation intervention, paying particular attention to gender, ethnicity, and age-related issues, and tailor strategies to the diverse needs of populations. (Strength of Evidence C)
Recommendation 6
Nurses implement, wherever possible, intensive intervention with women who are pregnant and postpartum. (Strength of Evidence A)
Recommendation 7
Nurses encourage persons who smoke, as well as those who do not, to make their homes smoke-free, to protect children, families, and themselves from exposure to second-hand smoke. (Strength of Evidence A)
Education Recommendations
Recommendation 8
All nursing programs should include content about tobacco use, associated health risks, and smoking cessation interventions as core concepts in nursing curricula. (Strength of Evidence C)
Organization and Policy Recommendations
Recommendation 9
Organizations and Regional Health Authorities should consider smoking cessation as integral to nursing practice, and thereby integrate a variety of professional development opportunities to support nurses in effectively developing skills in smoking cessation intervention and counselling. (Strength of Evidence B)
All corporate hospital orientation programs should include training to use brief smoking cessation interventions as well as information on pharmacotherapy to support hospitalized persons who smoke. (Strength of Evidence B)
Recommendation 10
Nurses seek opportunities to be actively involved in advocating for effective smoking cessation services, including "stop smoking medications." (Strength of Evidence C)
Recommendation 11
Nurses seek opportunities to be actively involved in advocating for smoke-free spaces and protection against second-hand smoke. (Strength of Evidence C)
Recommendation 12
Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. Organizations may wish to develop a plan for implementation that includes:
- An assessment of organizational readiness and barriers to education.
- Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process.
- Dedication of a qualified individual to provide the support needed for the education and implementation process.
- Ongoing opportunities for discussion and education to reinforce the importance of best practices.
- Opportunities for reflection on personal and organizational experience in implementing guidelines.
(Strength of Evidence C)
Refer to the "Description of the Implementation Strategy" field for more information.
Definitions:
Strength of Evidence A: Requires at least two randomized controlled trials as part of the body of literature of overall quality and consistency addressing the specific recommendations.
Strength of Evidence B: Requires availability of well conducted clinical studies, but no randomized controlled trials on the topic of recommendations.
Strength of Evidence C: Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality.
