以護理實證應用的戒菸護理措施提升住院病人戒菸

Application of Evidence-Based Smoking Cessation Nursing Interventions Increase the Quitting of Smoking in Hospitalized Patients

背景：本院推動住院病人二代戒菸措施以醫師為主要推動者，統計2019年1月至12月本院住院病人戒菸服務人數及衛教呈現負成長。
目的：探討以統合性系統性文獻回顧應用戒菸護理措施的專案提升住院病人戒菸率。
解決方案透過實證護理臨床應用，選定統合性文獻戒菸護理措施修訂為本院可行方案。推動過程中遇到阻力，分別擬訂「辦理二代戒菸在職教育訓練」、「修訂服用戒菸藥物者轉介流程」、「增訂拒絕戒菸者轉介流程」。收集戒菸人數及戒菸成功率，比較專案實施前基礎數值和實施後12個月及24個月差異。
結果：戒菸服務人數在12個月內從85人增加至105人，在第24個月進一步增加至125人。比較2019年和2020年的3個月點戒菸成功率，從專案實施前31.36%提升至實施後42.67%，增加11.31%；比較2019年和2020年的6個月點戒菸成功率從實施前27.16%提升至實施後42.67%，增加15.51%。2021年12月專案成果，3個月點戒菸成功率為44.40%，6個月點戒菸成功率為41.82%。
結論：本專案的戒菸護理措施提升住院病人戒菸率，專案推動成功因素，主要是透過實證，搜尋到有品質研究證據，透過7A找出證據與臨床差異，再透過跨團隊合作專案模式進行推動，其次戒菸護理措施實證應用，凸顯護理角色對於品質提升重要性，亦可作為護理專案解決方案之參考。

Background: The second-generation smoking cessation measures for inpatients in our hospital were provided primarily by physicians. Statistics from January to December 2019 showed a negative trend in the number of inpatient smoking cessation services and health education courses provided.
Purpose: In this study, a comprehensive systematic literature review on the application of smoking cessation interventions was conducted with the goal of helping enhance the inpatient quit rate at the author’s hospital.
Resolution: The literature on smoking cessation interventions was reviewed, with the findings used to formulate a feasible plan for the implementation of an effective related intervention at our hospital. During the implementation process, the challenges encountered led to the formulation of strategies, including:‘conducting second-generation smoking cessation on-the-job training,’‘revising the referral process for patients taking smoking-cessation medications,’and‘adding patients who do not cease smoking to the referral process.’Data on the number of individuals attempting to quit smoking and the success rate of smoking cessation were collected. The baseline values before project implementation were compared with the values at 12 and 24-months posttest.
Results: The number of individuals receiving smoking cessation services increased from 85 people within 12 months to 105 people, and further increased to 125 people by the 24th month. Comparing the 3-month abstinence rates for 2019 and 2020, an increase from 31.36% before project implementation to 42.67% after implementation was observed, indicating a rise of 11.31%. Also, comparing the 6-month abstinence rates between 2019 and 2020, an increase from 27.16% before project implementation to 42.67% after implementation was observed, indicating a rise of 15.51%. The project outcomes calculated in December 2021 show a three-month abstinence rate of 44.40% and a six-month abstinence rate of 41.82%.
Conclusions: The nursing interventions for smoking cessation in this project increased the abstinence rate among inpatients. Evidence-based practices, including searching for quality research evidence, utilizing the 7A framework to bridge evidence and clinical differences, and promoting the project using a collaborative cross-team approach, were the main factors contributing to the success of the project. The evidence-based application of smoking cessation strategies highlights the significant role played by nurses in enhancing the quality of care. The findings may serve as a reference for the future development of nursing project solutions.