my topic is
Effective Strategies for Smoking Cessation
Guidelines for Summative Assignment
Guidelines for the Implementing Evidence Based Practice summative assignment
Summative Assessment: 3000 words (+/- 10%) assignment will be on a topic of the students own choice or from the list provided; identified from practice experience and of relevance to service users and their families care experiences
The topic must be focus on improving patient safety and/ or patient experience.
Examine the evidence supporting a clinical topic (chosen from your clinical experience) and critically appraise the evidence to underpin the evidence based practice, including a discussion of factors that may inhibit the implementation of the evidence base.
Introduction
Introduce the research question and highlight any lack of evidence in the literature
Introduce the assignment and outline clearly what you aim to do.
Tell the reader what will be included in the assignment and in what order.
Introduce, define and discuss the importance of evidence based practice in relation to your field of nursing including the use and definition of evidence based practice.
Example
Evidence Based Practice was widely adopted as a strategy to enhance patient safety and ensure high-quality clinical outcomes (Keib et al., 2017; Stevens, 2013).
Thus, EBP has become the cornerstone of contemporary clinical practice for the global healthcare community.
EBP involves the “integration of best research evidence with clinical expertise and patient values (Sackett, 2002) to ensure safe, high-quality, patient-centered care (Keib et al., 2017).
In order to engage in EBP, nurses must not only appreciate research, but also find, critique, synthesize, and apply appropriate empirical findings to clinical practice (Keib et al., 2017; Sigma Theta Tau, 2005). By exploring topics and best practice that is relevant to nursing practice, nursing research creates knowledge, fosters clinical reasoning, and supports cost-effective care (Halabi, 2016).
Example
Nursing research is an analytical process using disciplined methods to answer questions concerning nursing practice, the ultimate goal being an expansion in knowledge (Polit and Beck, 2008).
Research is an important part of nursing as it provides the nurse with an evidence base for their clinical practice, ensuring patients are provided the safest and most effective care. Black et al. (2015) stated that nurses practicing in an evidence based manner improves the outcomes for patients.
Evidence based practice (EBP) is a term that is recognised throughout the nursing profession and the Nursing and Midwifery Council (2015) states that nurses must practice in accordance with the best available evidence to them in order to provide safe and effective care. EBP begins with questioning current practice and concludes with the application of the findings into the clinical setting
Example
This review will consider factors affecting the success rate of hirudo therapy to salvage a venous congested flap and potential associated complications the patient may experience. The search strategy and inclusion/exclusion criteria for identifying relevant papers will be stated; the findings of the papers will be described and the PARIHS tool will be used to aid the discussion of potential barriers to implementing the findings of this systematic review (Harvey and Kitson, 2016; Ellis, 2019).
Research question
Rationale for asking this question-why are you asking this? Is there a lack of evidence in the existing literature?
Introduce how you formulated your question
You must use PICO/PEO to clearly define your question.
Aims and objectives of this review
Rationale for asking this question-why are you asking this? Is there a lack of evidence in the existing literature?
Introduce how you formulated your question
You must use PICO/PEO to clearly define your question.
Aims and objectives of this review
Methodology
You need to look at the evidence base for your chosen topic. This will require good literature searching skills and a clear account of the search strategy you used. 6-15 papers are recommended but there may be more or less depending on your question.
Describe search terms used
Inclusion/Exclusion criteria
You need to look at the evidence base for your chosen topic. This will require good literature searching skills and a clear account of the search strategy you used. 6-15 papers are recommended but there may be more or less depending on your question.
Describe search terms used
Search Terms
Introduce your search terms. What keywords would we look for with this research question?
Outline how you performed your literature search i.e. what databases you used, inclusion and exclusion criteria, any other limits used and provide rationale for these decisions with references.
Outline how you identified your key articles (primary research only) and the reasons why. Include enough detail so that your search could be replicated by the person reading it. Include a copy of your search in the appendices
Example
A comprehensive search of the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and Education Resources Information Centre (ERIC) electronic databases was conducted to obtain relevant studies. Key terms used for these searches included: students, attitudes, perceptions, research, undergraduate, subjects, nursing, and participation using the BOOLEAN search terms AND, OR, and NOT to generate the most comprehensive list of empirical articles available. Database searches were limited to articles published in English. This search process yielded a total of 236 articles for review. Ultimately, a total of 15 research studies on pre-licensure nursing students\’ attitudes toward research were identified for inclusion in this review: 11 quantitative, 2 qualitative, and 2 mixed methods.
Results of the search strategy
Describe your findings and use a table to depict results and place in appendices
Quality Appraisal
Use an appraisal tool to appraise the papers you have selected.
Put this information in your appendices and refer to it in the text.
Mention bias in terms of research methodology for the papers you have selected
Summary and synthesis of the papers
What are the main points of the literature in relation to your research question?
Are there any themes coming through? Is there a reliance on particular areas?
Issues of Implementation
For the last quarter of the assignment (roughly) you are encouraged to use a framework such as PARIHS to explore issues of implementation.
Conclusion
Complete the essay with a brief conclusion drawing together the key ideas that specifically answered your research question and finally the implication of your findings for practice.
Above all make sure you are being critical in a structured and logical way
Example: Implications for practice
Outline the implications for your practice as a nurse.
What has the evidence added to your knowledge base?
What further information would you like to know?
How does the process of searching for the evidence inform your practice?
Were there gaps in the evidence?
REFERENCES
Harvard Style
Appendices
Refer to appendices in the text
These do not receive a mark but support your essay
Refer to appendices in the text
These do not receive a mark but support your essay
Effective Strategies for Smoking Cessation
Name
Institution
Course
Instructor
Date
A Systematic Review of Effective Strategies for Smoking Cessation
Introduction
Smoking is one of the leading causes of chronic diseases, including cardiovascular diseases, lung disease, and cancer (Carter et al., 2015). The literature identifies many evidence-base practices that have been applied over ther years to mitagete the evergrowing problems associated with tobacco smoking. Evidence-based practice basically defines the application of research evidence, patient’s preferences, and clinical expertise in addressing clinical problems (Chien, 2019). Nurses should be aware of these evidence based interventions to apply effectively in addressing the challenge of tobacco smoking (Martin et al., 2019). Stead et al. (2013) assert that smoking cessation has significant contributions towards preventing the diseases and increasing the life expectancy of individual smokers and the population at large.
The impacts of tobacco smoking are very signification and require active implementation of interventions that can enhance smoking cessation. According to Thurgood et al (2016), tobacco smoking causes about 6 million deaths annually across the globe, with future projections putting it at 8 million by 2030. The same case applies in the United Kingdom where most preventable illnesses and premature deaths are attributed to smoking. Smoking reduces the life expectance of smokers by around 10 years (Peletidi, Nabhani-Gebara, and Kayyali, 2016). According to the statistics by Public Health England, around 78,000 deaths in the UK were attributed to smoking in 2016, representing 16% of all deaths across the country (Public Health England, 2019).
Given the grave impacts that smoking has on individuals and the population at large, smoking cessation is indeed a very potent move towards cabbing the devastating impacts of smoking. Many interventions have been developed and implemented to increase smoking cessation rates on the population towards the moves to mitigate the impact of smoking (Martin et al., 2019). Some of the common interventions include smoke-free policies, price increases, smoking cessation support, advertising bans, warning labels, mass media campaigns, pharmacological interventions, and community-based programs combining several interventions (Brown, Platt, & Amos, 2014). These interventions have resulted in a significant decrease in the overall prevalence of smoking across the globe. For instance, Beard et al. (2019) report that smoking prevalence reduced from 26.9 to 20.2% since the start of the 21st century, with projected prevalence standing at 15.5% by 2025.
The UK has not been left behind in the fight against smoking. It has developed a comprehensive smoking control program that has made the country one of the countries with the lowest smoking prevalence at 14.4% (Beard et al., 2019). According to Public Health England (2019), 6.1 million people (14.9%) aged 18 years and above were smokers in England. With the decreasing trend, the country expects a decline of about 8.5% and 11.7% by 2023 (Public Health England, 2019). However, to fully mitigate the impact of smoking, the UK should strive to achieve the goal of being smoke-free at 5% prevalence or less by 2030. The impact of smoking in the UK is still considerably devastating. According to the Office of National Statistics, 485,000 smoking-related admissions to hospitals were reported between 2016 and 2017, approximately 1300 admission per day. Such cases cause the country about £760 million annually on domiciliary care services (Public Health England, 2019).
To achieve this goal of being smoke-free by 2030, the UK will have to keep identifying some of the most effective interventions for smoking cessation and implementing them among its populace. Various evidence-based interventions have been evaluated in the literature for their effectiveness in mitigating the impacts of smoking. Though they are many, the effectiveness reported varies considerably. A deeper look into the literature may give an objective look into these interventions to identify the most effective ones and their specific applicability and feasibility in the UK to implement them for the reduction of smoking prevalence in the country (Herbec et al., 2014).
This paper is a systematic review of the literature that aims to analyze research evidence on the effectiveness of the various interventions for smoking cessation with their differential impacts in the UK. From this review, one can generate vital information about the impacts and extent of the desired outcomes a given intervention might generate and the considerations and choices that the UK can make to enhance the effectiveness of the various strategies implemented to enhance smoking cessation in the country.
Research Questions
This study will answer the question:
- How effective are the various interventions for smoking cessation implemented in the UK in enhancing smoking cessation and preventing subsequent smoking in the country?
- Are the interventions proposed to enhance smoking cessation have differential effectiveness that can enable their discrimination and prioritization during implementation?
- What are the most effective smoking cessation interventions in the literature that the UK can prioritize in its quest to reduce smoking in the country?
These questions were constructed according to the PICO guidelines whereby a research question consists of four parts, namely population (P), intervention (I), comparison/control (C), and outcome (O) (Hastings and Fisher, 2014). In these questions, the initials are represented as follows;
P – UK citizens, particularly smokers
I – smoking cessation options in the literature
C – comparisons within the identified interventions
O – the most effective intervention in enhancing smoking cessation. See Appendix 1 for summarized details.
These questions are relevant to the study topic because they consider the many possible interventions that have been developed and reported to be effective in enhancing smoking cessation (Brain et al., 2017). The literature reports that the effectiveness varies from one treatment option to the next. Additionally, there are both financial and labour implications that are associated with the implementation of these inventions (Peckham et al., 2015). As such, instead of implementing all the interventions, the government can only identify the most effective ones and prioritize them and still get the same outcome.
West et al. (2015) assert that a systematic literature review gives a concise summary of the existing evidence to guide the development and selection of cessation interventions appropriate to a country’s current situation and resources. Moreover, Thurgood et al. (2016) report that the Department of Health (DH) has continued to call for individual primary care trusts (PCTs) in England to monitor and report the effectiveness of their local services in enhancing smoking cessation for ease of decision and policymaking. Despite such calls, there are still few papers that tend to compare these interventions side-by-side in terms of their effectiveness (Kong et al., 2014).
The Objective of the Study
This study aims to identify the various smoke cessation techniques evaluated in the literature to compare them in terms of effectiveness and recommend the most effective ones that the UK government and citizens can focus on to reduce the prevalence of smoking in the country to the expected level.
Methodology
The study was a systemic literature review that cover papers published on smoking cessation between 2010 to 2022 conducted in March 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines we utilized in reporting the study. All searches were done on the internet from which all the articles used were obtained. No particular database was considered for the search but any that could provide relevant papers for the study. Papers were obtained from Cinahl, Medline, Psycharticles, Psychbooks, British Library, Web of Science, the Cochrane Library, Science Direct, Google Scholar, and Swetswise was considered. Similarly, no design, in particular, was considered but any that a relevant paper used was considered, including RCTs, literature reviews, non-RCTs, cohort studies, and so on. Additionally, both pilot and fully powered studies were considered. Search words used to generate the relevant papers included combinations of words such as smoking cessation intervention, United Kingdom, UK, quit or quitting smoking, and tobacco smoking. The primary sentence was most “effective interventions for smoking cessation in the UK”. See Appendix 3 for summarized details.
Inclusion Criteria
Only evidence-based studies were considered for inclusion in the study, particularly the ones conducted in the UK and US, with other English-speaking countries also given little consideration. They had to be papers published between 2010 and 2022 and falling right within search words. Specifications such as the period of 2010 to 2022 and the UK could be set in the databases to autogenerate relevant papers. Databases with no such properties forced us to manually peruse or read through the paper to include or exclude them. See Appendix 2 for summarized details.
Data Analysis
A narrative synthesis for all the included interventions was conducted individually. Two reviewers assessed the paper to the suitability of their content, methodological rigour and quality. They would later come together with professional authors and reviewers to build a consensus and judge the papers based on the general agreement in the papers reviewed, the efficacy of findings, reported information on discrimination and ratings given in the identified papers, and other additional information and analysis. The first and second drafts of the propositions were done through an interactive engagement among reviewers and authors before building a consensus.
Results
Unrefined searches made in the databases using the search words generated more than 12,000 random papers. When the eligibility criteria were applied to specify the place (UK) and the period, the number was reduced to 67 articles. Initial assessment eliminated 41 more articles due to unsuitability in terms of study location and content. Fine reviews excluded 10 more papers based on focus and emphasis on the topic of interest, smoking cessation. The synthesis of the articles generated from the search was broken down using a PRISMA chart obtained from UNC (2022): see Appendix 4.
Quality Appraisal
After a thorough analysis of the articles, the result was summarized into the various somoking cessation interventions identified in the literature and their impact in terms of percentage increments. The summary is presented in a tabular form as show in Appendix 5.
Summary and Synthesis of the Papers
Most studies combined more than one intervention for evaluation. Both pharmacological and behavioural studies were combined, though the impacts were separately analyzed. Brief advice, nicotine replacement therapy (NRT), face-to-face support and many more were among the behavioural intervention that frequently reoccurred. West et al. (2015) report that brief advice can increase smoking abstinence by 2% after the 6th month of application. Face-to-face behavioural support is slightly more effective at about a 5% smoking abstinence increase because it is more structured and official and requires more commitment (Beard et al., 2019).
Printed self-help materials such as leaflets, booklets, and books that encourage and advise smokers to quit are less effective at 2% smoking abstinence increase because few people prefer reading to talking and is less committing (Kotz et al., 2014). This is also seen with telephone support at 2% smoking abstinence because of the possibility of lies and lack of physical contact with the physician (West et al., 2015) (Kong et al., 2014). Automated text messaging also suffers the same limitation, though with a higher smoking abstinence increase of 5% (Thurgood et al., 2016). The studies report that these interventions cannot be implemented as a single therapeutic option, but should be supplemented with others to enhance their effectiveness.
Among the pharmacological intervention, Nicotine Replacement Therapy (NRT) was the most common one, with a smoking abstinence increase of 6% when compared to placebo (Caeson-Chahhoud et al., 2019) (Brown et al., 2014). 1% increase in smoking abstinence was associated with the use of e-cigarettes (Jackson et al., 2019) (Bauld et al., 2010). Medicines like Bupropion/amfebutamone produce a similar impact to NRT through a combination of the two increased smoking cessation rates (Brown et al., 2016). Nortriptyline, on the other hand, did not report any impact in a study conducted in the UK (West et al., 2015). Varenicline reported a moderated rate of smoking abstinence increase of 7% (Langley et al., 2013). Cytisine is also effective at a 6% smoking abstinence increase (West et al., 2015). Most of these pharmacological practices were combined with behavioural interventions to confer the optimum impact (Jackson et al., 2019).
Government policies were also among the interventions evaluated for smoking cessation. For instance, Brown et al. (2014) found that national public campaigns with a clear behavioural target using psychological principles yielded a substantial smoking abstinence increase of 2% (Caeson-Chahhoud et al., 2019) (Bauld et al., 2010). Zhu et al. (2011) found that government policies for smoke-free houses and workplaces (secondhand smoke policy) implemented in the United States increased quitting though did not identify the specific quantitative estimates. Tobacco price increment also increased smoking abstinence by 2% (Hill et al., 2013). Few studies tried to establish the impacts of these government policy interventions with inconsistent findings, thus calling for further studies.
Issues of Implementation
Justification of the implementation of the findings was done using the PARiHS (Promoting Action on Research Implementation in Health Services). Hunter et al. (2020) describe the PARiHS as shown below;
SI = f (E, C, F)
where SI=successful implementation, E=evidence, C=context, F=facilitation and f=function of.
According to the evidence presented, it evidenced smoking cessation interventions will have positive impacts in the UK. As such, most of these interventions should be supported by the government to provide the resources needed, while much of the effort should be made by individuals to take up these interventions. However, these interventions should continuously be evaluated to enable a better understanding of their contributions and impacts on smoking cessation.
Discussion
The analysis summarized the effectiveness and efficacy of the smoking cessation interventions identified in the literature. The most common and most effective intervention was the combination of face-to-face behavioural support with varenicline or NRT. Brown et al. (2014) also report similar findings in which the implementation of NTR alongside face-to-face group intervention is more effective than other interventions. However, the success of these treatments may be hindered because most smokers prefer individual support by community advice which is not very effective (Brown et al., 2012).
Given that the UK has already made considerable moves to implement these interventions, it has proven that is it capable of implementing any, and all are feasible. Therefore, it does not limit the review from recommending any intervention found effective without necessarily considering other factors and moderators like affordability that influence the uptake of these interventions (Public Health England, 2019). This information should reach both the public and government to ensure that they put it into practice. This can be done through public campaigns, publication, billboards, media channels, and other technological channels, including text messages and the internet (West et al., 2013).
This review shows that there are still some gaps in the understanding of tobacco cessation in the literature. The use of tobacco only comes out in terms of smoking, leaving out the possibility of other means of utilization (Richmond et al., 2013). The inconsistencies observed in the papers in terms of implementation and impacts call for further studies to confirm the findings (West et al., 2013). While evaluating these impacts, factors and moderators that influence the infectiveness of these interventions should be evaluated and considered while making conclusions. Some interventions, including the use of phone applications for internet-based interventions, brief advice, and secondhand smoke policy have not yet been extensively explored and understood, thus requiring further evaluation.
This review used an additive model to determine the combined impacts of the pharmacological and behavioural interventions. The literature did not present enough evidence to compare the effectiveness of combined interventions. The primary consideration in this analysis has been the enhancement of smoking cessation and partly harm reduction using the e-cigarette. The e-cigarette is not well-established and would require more research. Focusing this study on the UK makes the findings more specific to the country, with a unidirectional consideration of only what has been possible there. This makes external application of the findings subject to further evaluation to determine such possibilities and feasibilities before deciding.
Limitation of the Study
Many limitations can be identified in the study. Any study design was considered for the study. Some designs such as nonrandomized studies are reported to be vulnerable to confounding as a result of self-selection of interventions, particularly psychological distress and comorbidities (Cartwright and Munro, 2010). Additionally, the review did not consider patients’ commitment to the treatments in terms of adherence or actual use of the medications or behavioural support. There is little to no consideration of the failed attempts among patients trying to quit smoking hence no accounting for them (West et al., 2013). Moreover, there were not enough papers capturing some interventions or aspects of the study. For instance, studies that examine other parameters like the quality of the intervention, influence of moderators, impact of other interventions like e-cigarette, and increased tobacco prices were not well-established (Bauld et al., 2010). Such limitations can compromise the accuracy of the study findings and conclusions.
Conclusion
Smoking cessation intervention that combines NRT with face-to-face behavioural support in group therapy and varenicline is the most effective in increasing smoking abstinence as per this review. The UK has made remarkable strides in its moves to reduce smoking in the country by implementing most of these moves. This review calls for a renewed focus on the combined interventions identified as the most effective ones for better results. The UK should not flex in the fight for a smoke-free community since it is yet to achieve this goal. Not only the government should bear the responsibility of ensuring the achievement of this goal of a smoke-free society, but individuals as well. Individual smokers should develop the urge to quit smoking and seek interventions that can effectively help them quit smoking. Behavioural support must not necessarily come from experts but also family members. The review proves the need for further research to establish the findings, particularly in areas that have received little focus such as the use of phones and new technologies in addressing smoking.
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Appendices
Appendix 1: PICO
| Patient/population | Intervention | Comparison | Outcome |
| UK citizens, particularly smokers
|
Smoking cessation options in the literature | Comparisons within the identified interventions | The most effective intervention in enhancing smoking cessation |
Appendix 2: inclusion and exclusion creteria
| Included | Excluded |
| 2010 to date | 2009 and before |
| English articles | Non-english articles |
| Handling smoking cessation | Not handling smoking cessation |
Appendix 3: Boolean operators
| Search | Keywords 1 | Keywords 2 | Keywords 3 | ||
| S1 | Effective*interventions | AND | Smoking interventios | AND | United kingdom |
| S2 | Intervention | Quit smoking | UK | ||
| S3 | Best therapy | Quiting | Tobacco smoking |
Appendix 4: Synthesis of the articles generated from the search displayed on a PRISMA chart
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Appendix 5: Quality Appraisal
| Intervention vs. comparison | Deliver to | Percent increase of desired outcome (95% CI) | Projected percentage increase if the intervention is implemented |
| Advices given by physician vs no interventions | Smokers on surgery | 2 | 2 |
| Face-to-face group-based
behavioural support vs written guidelines or brief advice. |
Smokers willing to quit | 5 | 7 |
| Face-to-face individual
behavioural support vs written guidelines or brief advice. |
Smokers willing to quit and wanting help with that | 4 | 4 |
| Proactive telephone
support vs. reactive telephone support |
Smokers willing to quit and wanting help with that | 3 | 5 |
| Printed self-help guidelines
versus nothing |
Smokers willing to quit with a set date of success | 2 | 2 |
| Single nicotine replacement therapy (NRT) versus placebo | Smokers willing to quit and wanting help with that | 6 | 6 |
| Combined NRT vs. placebo | Smokers willing to quit with a set date of success | 11 | 11 |
| Bupropion versus placebo | Smokers willing to quit with a set date of success | 7 | 7 |
| Cytisine versus placebo | Smokers willing to quit with a set date of success | 6 | 6 |
| Varenicline versus placebo | Smokers willing to quit with a set date of success | 15 | 15 |
| Nortriptyline versus placebo | Smokers willing to quit with a set date of success | 10 | 10 |
| National Public Campaign | Smokers, nonsmokers, and care providers | 2 | 5 |
| e-cigarette | Smokers willing to quit with a set date of success | 2 | 4 |
| Tobacco price increment | Smokers | 1 | 3 |