Students back 'quit' training: nurses are ideally placed to help patients quit smoking, but are nursing students being prepared to do so?
Subject: Nursing students (Psychological aspects)
Smoking cessation programs (Methods)
Smoking (Health aspects)
Authors: Mossman, Menu
Stevens, Khea
Van Rooyen, Amanda
Pub Date: 10/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: Oct, 2010 Source Volume: 16 Source Issue: 9
Product: Product Code: 8000142 Antismoking Programs NAICS Code: 62142 Outpatient Mental Health and Substance Abuse Centers
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 241179371
Full Text: Few nurses reported receiving smoking cessation education in either their initial or post-graduate education, then Ministry of Health (Moll) chief nurse Mark Jones said, in Action on Smoking and Health's (ASH) 2007 publication Smoking and Nurses in New Zealand.

Jones also said the potential for nurses to deliver effective smoke-free interventions had not been realised.

Last year, Auckland Medical School Professor of General Practice Bruce Arroll said: "Smoking is the most serious of the common risk factors for premature mortality and morbidity and as such deserves to get the attention of clinicians". (1) We wanted to find out how much this message resonated with nursing students.

The MoH introduced the ABC smoking cessation tool in its New Zealand Smoking Cessation Guidelines, in August 2007. The purpose of this initiative was to integrate the health sector's approach to smoking cessation into everyday practice. Its goat was to "to generate more supported quit attempts, more often". (2)

One of the key success indicators for implementing the ABC approach is that "100 percent of all undergraduate courses related to health care have implemented ABC training into their curricula". (2) Is this goal being met by providers of nursing education? Late last year, Smokefree Nurses Aotearoa/New Zealand (SNANZ) conducted a survey of the 17 nursing schools with undergraduate programmes. Of the 14 that responded, 12 (86 percent) provided some form of smoking cessation education and eight (57 percent) taught the recommended ABC approach. (3)


The University of Auckland's nursing programme covers smoking cessation in the last semester of the third year, but for the first time this year, training included an online component enabling students to become Quit Card providers. The e-module can be found at and takes 30-40 minutes to complete. (4) It is a government-funded scheme allowing registered health-care practitioners without prescribing rights the ability to offer fully subsidised nicotine replacement therapy, via a Quit Card, to smokers. The Quit Card is redeemed for a co-payment at a pharmacy for $3 per product (nicotine gum, lozenges and patches). (5) The online training programme started in April 2009, and 5459 people had successfully completed it by the end of March 2010.

SNANZ is also developing educational materials and a website ( nz) to support smoking cessation education in schools of nursing and nursing portfolios, and to give practical advice for nursing interventions.

No-one knew what ABC meant

What do students think about smoking cessation and are we adequately prepared to take on this role? We surveyed 22 third-year University of Auckland nursing students in May 2010. No-one knew what the letters A,B, or C represented in terms of smoking cessation (A=Ask, B=give Brief advice to stop, C=provide evidence-based Cessation support), although all respondents thought knowing how to deliver evidence-based smoking cessation support was important. When asked if it was the responsibility of nurses to advise clients to quit smoking, 95.5 percent replied yes. This result is comparable to a finding of the 2007 ASH-KAN survey, where 90 percent of nurses also felt it was their responsibility. (6) Eighty-six percent of our respondents said they would like more teaching on this subject.

Maryscot Thom, a student representative at the University of Auckland, has herself organised an extra-curricular smoking cessation training programme. "Eighty of our 90 classmates signed up to do this in their own time," Thom said, a clear indication of how nursing students feel about the issue. Two sessions were taught by the Heart Foundation over two weekends.

Thom's idea grew when she realised she did not have the skills to help a friend quit. It seemed strange that "as a third-year nursing student I was unable to provide this kind of support" She wanted the confidence to provide effective cessation support for clients as well, and to help other students achieve this. Them believes nurses are in an ideal position to facilitate smoking cessation, given the amount of contact they have with clients.

A MoH publication about the role of nurses in smoking cessation says smoking behaviour monitoring and cessation intervention, using the ABC approach, should be incorporated as part of standard nursing practice. It also refers to a meta-analysis which found advice and support from nursing staff was effective. (5)

We could find no published data on New Zealand nursing student attitudes toward smoking cessation, but our impression is they are overwhelmingly positive. Despite the validity of our survey results being limited by method (convenience sample in one location) and size, we suspect findings could be generalised to schools across the country. This represents a great opportunity for nurse educators to change nursing culture and incorporate the ABC approach into everyday practice.

Third-year nursing students can do online ABC training at nz, and student nurses can become Quit Card providers with the support of their schools of nursing.

For information about smoking cessation training material or support, contact Smokefree Nurses Aotearoa/New Zealand project manager Lynn Stevenson on email: Lynn.stevenson@


(1) Brinson, D. (2009) How to increase the delivery of effective smoking cessation treatments in primary care settings: guidance for doctors, nurses, other health professionals end healthcare orgonisations. Ministry of Health, with Health Sciences Assessment Collaboration.

(2) Jenkins, M. (2009) Implementing the ABC Approach for Smoking Cessation: Framework and work programme, pagesmh/8794/$File/implementing-abc-approach-smoking-cessation-feb09.pdf. Retrieved 10/6/10.

(3) Stokes, G. & Wang, G. (2010) Smoking Cessation Education in Undergraduate Nursing Programmes in New Zealand. Smokefree Nurses Aotearoa/New Zealand: Auckland University of Technology.

(4) Ministry of Health. (2009a) Smoking cessation e-learning tool. Retrieved 10/6/10.

(5) Ministry of Health. (2009b) Nurses' role in smoking cessation. Retrieved 10/6/10.

(6) Wang, G., Fishman, Z., McRebbie et at. (2007) ASH-FAN Aotearoa: Assessment of smoking history, knowledge and attitudes of nurses in New Zealand. ASH NZ. by-ASH/ASH_KAN_Aotearoa_Smoking_and_nurses_ in New_Zealand.pdf. Retrieved 10/6/10.

(7) Rice, V. H., 8, Stead, L. F. (2008) Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews (1), CD001188.

Manu Mossman, Khea Stevens and Amanda Van Rooyen are third-year nursing students at the University of Auckland.
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