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A stop-smoking programme: not just for patients

Caroline Douglas
BBNP GONLP
UCLH Stop Smoking
Services Manager
NLP Master Practitioner
Life Coach

University College London Hospitals (UCLH) NHS Foundation Trust is a large acute teaching hospital with seven hospital sites in central London. The trust has had a no-smoking policy for many years. Initially there were designated smoking areas provided for staff and patients. It was not well monitored and patients and visitors smoked in lift lobbies and outside main entrances.
In 2004, the policy was revised by a small multidisciplinary working group, which consisted of both smokers and nonsmokers. The trust's aim was to achieve a smoke-free environment by providing support to those who wished to stop smoking. The new smoke-free policy was approved by the Trust Board in March 2004, along with funding for implementation.
The plan included a stop-smoking nurse specialist to provide support to patients for four to six weeks and the provision of an inhouse stop-smoking staff support programme, including four weeks of free nicotine replacement therapy (NRT). The Trust Board supported the concept that the staff programme should both help staff to stop smoking and encourage staff to take care of themselves, and they agreed that this would demonstrate that they had a high level of interest in staff wellbeing and would smooth the introduction of the NHS no-smoking policy.
The trust went smoke-free in June 2005, the first acute trust in London to achieve smoke-free status.

The stop-smoking staff support programme
The stop-smoking staff support programme developed by the author began in September 2004 with 35 (out of 6,000) staff applying for a place.
It was publicised through posters and by email bulletin. Staff were assessed before being given a place. We found the best way to measure staff's level of motivation and confidence to stop smoking was by using the motivation and confidence scale (see Table 1).

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We now run a comprehensive eight-week group programme comprising behavioural support and four weeks of free NRT with a GP letter to prescribe a further four weeks of NRT.
The programme is based on the Maudsley model, cited in the white paper Smoking Kills.(1) It covers smoking and addiction and the benefits of stopping. It is also important to increase the person's chances of successfully quitting and staying stopped by including lifestyle changes.

When do staff quit smoking on the programme?
The majority of staff are given paid time off, as this is a trust initiative. They all quit smoking on the first week of the programme and use the NRT product they have chosen to help them do this. The following weeks on the programme focus on these key areas:

  • Stress and how it is caused.
  • Relaxation and calming of the mind.
  • Self-esteem.
  • Personal investment.
  • Happiness.
  • Implementing positive lifestyle changes.

This acts as a good deterrent and an incentive for programme members to quit smoking.
During the programme, we focus on personal investment where staff look at the importance of adding value to themselves and their health, and adding value to their colleagues and the trust. By doing this they are rewarding themselves for not smoking and inspiring themselves further to stay smoke-free.
Sophia Swaleh, radiologist at UCH, said:
"It supported me and encouraged me by enabling me  to focus on my goal and invest in myself."
Sophia stopped smoking in February 2005 and has remained a nonsmoker since then.
The relaxation part of the programme has proven very popular, so we have made sure that members are taken through a guided relaxation and visualisation each week. Staff are shown how to relax and then challenged to do some relaxation for five minutes a day and to note how different they feel and how they respond to stress.
Grant Mann, senior staff Nurse at UCH, said:
"The group was a thoroughly worthwhile experience. I enjoyed every session and found it beneficial in many ways, particularly the relaxation techniques."
Grant stopped smoking in February 2005 and has been smoke-free for just over two years.
At the end of the programme, all sessions are evaluated, certificates are handed out and we celebrate success.

What lessons did we learn?
Since our first programme we have learnt that staff are far more likely to relapse if they appear to have a negative attitude and do not participate fully on the programme.
We have also found that if a member of staff is not interested in the content of the programme, they will sometimes try to disrupt it by either interrupting or being very challenging.
It is important that the person leading the group is trained to run groups, aware of group dynamics and can remain objective throughout and guide the group in a positive direction.
 In all smoking cessation groups, there are a number of people who will relapse. At the beginning, when a person relapsed, we would ask them to leave the programme if they continued to smoke. We now offer individual coaching for members who would like or need extra support to be more successful at stopping smoking. The coaching is for one hour a week and focuses in more depth on the areas covered in the programme and any difficulties they are experiencing. However, if someone relapses and does not wish to have the individual coaching, they are asked to leave the programme.

How does the trust benefit from providing staff with an inhouse programme?
The nursing staff that have stopped smoking on the trust's programme have then felt inspired to help patients on their ward to stop smoking. Some have trained with the trust to become a level 1 or level 2 stop-smoking adviser.

What is our success rate?
Since September 2004 we have run seven programmes. During this time 172 people have applied for a place, but with only 15 places available on each course, 105 people were given a place on the programme (staff are allowed to reapply to a future programme and need to be reassessed before given a place). Of this number, 32 have relapsed and the total number who has stopped smoking is 73 (69.5%), which is an excellent outcome.
The document, The English Smoking Treatment Services: Short-Term Outcomes, suggests that the, "odds of quitting are about 40% higher if you receive treatment in a group compared to individual treatment".(2)
Groups are also more supportive for the smoker, and more cost-effective in staff time as more staff can be supported.
According to Department of Health requirements, staff need to have quit smoking for four weeks to be considered as a successful quit attempt. The trust looks for staff to quit for the full eight weeks of the programme and to continue with this after. Staff are followed up every six to 12 months and from the 73 staff who quit smoking during the programme, 32 have been smoke-free for over two years.

Conclusion
Helping staff to stop smoking has many benefits for the NHS, from reducing sickness and absenteeism to increasing productivity and reducing stress, as well as greatly improving staff members' quality of life. All primary care nurses can access a stop-smoking programme like this in the PCT they work for. When the NHS invest in smoking cessation programmes for their staff, they are more likely to encourage their patients to stop smoking too.
Gill Tew, childcare manager, sums it up:
"I think I have progressed and developed as my whole attitude to many things is now calmer and I feel much happier in myself in general."(3)

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References

  1. Department of Health. Smoking kills. London: DH; 1998.
  2. Judge K, Bauld L, Chesterman J, Ferguson J. The English smoking treatment services: short-term outcomes. London: Society for the Study of Addiction; 2005.
  3. Percival J. You can stop smoking. London: Virgin Books; 2006.