Nicotine is a highly addictive drug. Going into nicotine withdrawal can compound the discomfort that a person in hospital may already be feeling. As a nurse you are best placed to identify such distress in your patients and can help lessen the physical and psychological symptoms associated with nicotine withdrawal.
Symptoms of nicotine withdrawal include:
It may help for the patient to think of these symptoms as signs that they are breaking free of the addiction and becoming a non-smoker.
Managing withdrawal can help. Improving patient comfort can increase their trust in the treating team and enhance progress during their stay in hospital. Reducing the discomfort associated with withdrawal can make quitting more appealing to someone who isn’t sure they are capable. Even if your patient ends up smoking again after discharge, reducing symptoms now may increase their desire and willingness to quit in the future.
Simply empathising with the patient and recognising difficulties can make them feel heard and understood.
Nurses can help by providing patients with advice on managing cravings, as outlined below. In collaboration with the healthcare team, nurses can also assess the patients’ need for medication such as nicotine replacement therapy (NRT). Interestingly, a smoker is likely to be far more affected by caffeine when not smoking, so it is best to encourage them to consume much less than their usual daily amount of coffee.
Tips for Managing Cravings
Encourage your patient to:
- Try the ‘four Ds’ (delay the next cigarette, distract yourself, do something else, and drink water).
- Have some nicotine gum or a lozenge.
- Have a cup of herbal tea.
- Engage in hobbies, e.g. knitting.
- Talk to a Quitline counsellor for more ideas.
Helping Patients Quit
Nurses are ideally placed to ask patients how they feel about their smoking. Patients may be ready to quit and want assistance, or they may just want help with withdrawal now and information about how to quit for later.
If your patient does want to quit, ask why. What do they perceive are the benefits of not smoking? These may include saving money, feeling fitter or wanting a healthy pregnancy. Writing a list of reasons and keeping it handy can help maintain motivation during withdrawal.
Ask your patient whether they have tried quitting before. Most people try more than once before they succeed in quitting. You can help your patient think about why previous attempts failed and what led to relapse. Identifying relapse triggers can help in planning the next quit attempt.
Of those who try quitting cold turkey, roughly only 3% succeed. The best chance of quitting long-term comes from combining counselling with medications, such as NRT or varenicline. Your patient might like to talk to the pharmacist or inpatient drug and alcohol (D&A) team about medication options, side effects and cost.
Some advice that can help your patient remain nicotine-free after leaving hospital could include:
- Re-reading their list of reasons and benefits of quitting.
- Avoiding smoking triggers; for example, not going to places where they always smoked in the past.
- Keeping up with quit counselling for a while.
- Managing stress in positive and healthy ways.
If your patient would like to quit smoking and they want support and advice, you might refer them to the D&A team, direct them to www.quit.org.au or arrange a callback from Quitline. Facilitating support for your patient in hospital and for after discharge (e.g. GP follow-up) can help them quit for good. Assessing your patient’s needs and responding accordingly can get them started towards life as a non-smoker.
[show_more more=”Show References” less=”Hide References” align=”center” color=”#808080″]
- RACGP; Support for Smoking Cessation; http://www.racgp.org.au/yo[…]on/; accessed 17/10/2015.
- Quitline; Managing Nicotine Withdrawal; http://www.quit.org.au/st[…]al; accessed 2/11/15.
- Quitline; Staying Quit; http://www.quit.org.au/st[…]it; accessed 3/11/15.
- Cancer Council Victoria; Tobacco in Australia: Facts and issues, Chapter 7; http://www.tobaccoinaustralia.org.au/ch[…]on; accessed 17/10/15.
Claire Noonan is a GP based in regional NSW with special interests including mental health and bariatric medicine. As well as general practice, Claire conducts follow-up visits for patients who have had a bariatric procedure. This role comprises nutritional and psychological counselling as well as performing gastric band adjustments. Claire is a keen advocate for her patients. She is passionate about educating the wider community about health science as well as dispelling common myths about obesity and mental health conditions. Her qualifications include an honours degree in Medical Science majoring in neuroscience, a medical degree, fellowship of the RACGP and an associate diploma in piano.