A Nurse Quits

According to the U.S. Department of Health and Human Services, over 400,000 deaths per year are related to tobacco use. Medical costs and lost productivity related to this addictive habit reach approximately $90 billion per year. Figure 1 on page 8 represents a chart from the Centers for Disease Control and Prevention depicting the impact of cigarettes, which causes more deaths than AIDS, alcohol, or accidentrelated deaths.

As a nurse, I work in a tertiary care center with peripheral vascular disease patients who have tobacco addiction as one of their primary risk factors. Tobacco affects the dynamics of the blood vessels in a tobacco user's body. I provide education to these patients on a daily basis about breaking this habit. The issue affected my personal life in 2001 with the death of my father. He died after four months of experiencing two heart attacks and surgery for blockages in his peripheral vessels. He smoked for many years, and then switched to oral tobacco, thinking that it was better than the type that is smoked.

It affected me individually. I was a smoker. Now, I am tobacco-free and have been for eight years. Realizing the effects it had on my body and my children's health gave me the initiative to give it up for good.

It is not easy to quit. The average tobacco user attempts to quit seven or eight times before achieving success. What tobacco users do not realize is that quitting now will save their life or limbs in the long run. Tobacco acts like an out-of-control driver in the person's body, speeding through the blood vessels, causing build-up of traffic, crashing into vessels and injuring them. When the traffic comes to a stop due to the major pile-up, life and/or limb may already be lost. To avoid such a "wreck" in a smoker's body, the individual must implement a thoughtful plan.

The key to success is to PLAN. There is nothing in life that runs well without a thoughtful plan. Here is the six-step process that I discuss with my PAD patients.

Step 1 – Become Aware. Success starts with understanding why you smoke and why you want to quit. The tobacco user has to quit for himself or herself and not for someone else. Write down the reasons you want to quit, copy them, and post them at work and home and carry the list in your pocket.

Step 2 – Monitor your habit. Before quitting, keep a "smoke log." Record the time, place, your mood, the people you are with, and number of cigarettes smoked or amount used. This helps to identify the "triggers" or whatever makes you crave the nicotine. Step 3 – Set a quit method and date. Set your quit date within two weeks of your decision to quit. Take time to talk with your health care provider during this step. Discuss with him or her the various ways to quit smoking, including the option of using nicotine replacement therapy (NRT). There are five types of NRT presently available: nicotine patch, gum, inhaler or nasal spray, lozenges, and medications such as Wellbutrin® or Zyban®. Many stop smoking "cold turkey" by throwing the tobacco away. Others reduce or gradually taper the amount they use each day. You have an increased chance of success by combining a stop method, such as cold turkey or tapering, with a formal or informal support system (see Step 4), plus nicotine replacement therapy (NRT).

Step 4 – Form your support network. In this step, the tobacco user finds a support person or group. The group atmosphere provides encouragement among others who understand the feelings of withdrawal. The group also gives members an opportunity to share what works and what doesn't. It is crucial to learn techniques to deal with the withdrawal symptoms that will occur in the first two weeks. (See box on the next page.) The day before the actual quit date, you should thoroughly clean your house, car, and any other place that will remind you of your habit.

Step 5 – Quitting. Learn from your physician and support group how to deal with symptoms such as headache, sore throat, dizziness, or the inability to concentrate. The withdrawal symptoms may be very strong up to fourteen days after quitting. In addition, the tobacco user must understand that the urge may never go away, particularly in times of stress or tension.

Step 6 – Staying "quit." This can be the most difficult step. The most important thing is that you should not feel like a failure if you happen to slip – accept your mistake and get back on track! Review your reasons for quitting. If tobacco was purchased, get rid of it. When a craving is experienced, remember the four Ds:

1) DO something else.
2) DRINK plenty of water.
3) DELAY the urge.
4) DEEP breathe.

Keep these in mind during your entire quitting process. Keeping in touch with your health care provider during the entire process is helpful.

Even for those who have tried to quit eight times, my advice is to never stop trying. One of these times, you will hit the lottery jackpot and stay quit. Isn't your life worth that much?

A question that I am always asked is, "Can you really get your patients to stop?" The answer is, not a lot of them, but if I affect the life of just one of my patients by getting him or her to stop long-term, then I have helped that person forever. I encourage those of you who smoke to stop and those who know people who smoke to pass this article along to them. Good luck!

About the Author: Carolyn Horne, MSN, RN, is a Vascular Clinical Nurse Specialist at University Health Systems of Eastern Carolina.