Tobacco control curricula content in baccalaureate nursing programs in four Asian nations

doi:10.1016/j.outlook.2006.09.005

Nursing Outlook

Volume 54, Issue 6, November–December 2006, Pages 334-344

https://doi.org/10.1016/j.outlook.2006.09.005 Get rights and content

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation.

Tobacco use is one of the leading causes of death worldwide,¹ and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco.² China is expected to lead the world in tobacco-related deaths by 2025.³ Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common.²

Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke.⁴ Training health care professional students about these issues can have a profound impact on public health.5, 6 In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during “World No Tobacco Day” on May 31, 2005.⁷ The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.

Section snippets

Tobacco Control Content in Nursing Education

Nurses can contribute to the education of the public about the harm of tobacco use and help to ensure that tobacco dependence is “recognized and treated as a chronic illness.”⁸ A growing number of studies support the efficacy of nurses in tobacco intervention,¹⁵ and in helping to reduce exposure to second-hand smoke.16, 17 Additionally, nurses world-wide, because of their large numbers (almost 3 million in the US alone)¹⁸ and the variety of practice settings (where many smokers receive care),

Purpose

The purpose of this article is to describe and compare tobacco control content in baccalaureate schools of nursing in China (Mainland and Hong Kong, SAR), Korea, Japan, and the Philippines. Each country has similarities and differences in nursing education.³⁴ This study focused on baccalaureate education because such preparation includes a focus on health promotion activities. Additionally, this allowed us to compare our findings to a survey of baccalaureate nursing programs in the US.²⁴ Before

Methods

A cross-sectional survey design was used to obtain information about the extent of tobacco control content in baccalaureate nursing curricula in schools of nursing in 4 countries in Asia. This project involved investigators from the US, Hong Kong, SAR, Japan, Korea, and the Philippines. Communication strategies involved the use of frequent email, mailed documents, fax, occasional telephone calls, and one face-to-face meeting with all of the investigators to discuss the project results. All

Tobacco Content

As shown in Table 2, the majority of the topics related to the health impact of tobacco were covered in the undergraduate curricula as part of required courses. Content for the schools in Hong Kong, SAR and Mainland China are listed separately and as an aggregate. In all programs surveyed, greater coverage was given to health risks and effects of smoking and less to content on cessation interventions (5 As), symptoms of withdrawal, and pharmacologic treatment. Less than half of all participants

Discussion

If the millions of tobacco users in Asia do not quit, if youth continue to take up tobacco use, and if exposure to second-hand smoke continues unabated, the anticipated tragic projections of wide-scale tobacco-related death and disability will become a reality. Although nurses can be effective in delivering tobacco cessation interventions,¹⁵ this survey of baccalaureate nursing education reveals that the next generation of nurses in these Asian countries may not be adequately prepared to help

Linda Sarna is a Professor at the School of Nursing, University of California, Los Angeles.

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However, numerous studies conducted across a wide range of settings, including Australia, Canada, China, Greece, Ireland, Japan, Lebanon, Morocco, Serbia and the United States, have explored both practicing nurses' and nursing students' knowledge, attitudes and practices related to tobacco control and consistently recommended that more education is needed to ensure that nurses have the knowledge, skills, and confidence needed to provide evidence-based smoking cessation interventions (Chalmers et al., 2002; Chan et al., 2007; Chandrakumar and Adams, 2015; Gorin, 2001; Jenkins and Ahijevych, 2003; Johnston et al., 2005; Merrill et al., 2010; Moxham et al., 2013; O'Donovan, 2009; Obtel et al., 2014; Patelarou et al., 2011; Saade et al., 2009; Sarna and Bialous, 2005; Sekijima et al., 2005; Wetta-Hall et al., 2005). One of the main reasons cited for this lack of preparation is a paucity of tobacco control content in nursing curricula (Sarna and Bialous, 2005; Sarna et al., 2006, 2009). In 2001, a survey of baccalaureate and graduate nursing education in the U.S. demonstrated that nursing programs' curricula did not have sufficient content in tobacco dependence treatment, most specifically in the area of clinical tobacco cessation techniques (Wewers et al., 2004).
As the largest group of health professionals, nurses have a tremendous potential to help curb the tobacco epidemic. However, studies conducted across a range of global settings continue to indicate that both practicing nurses and nursing student have limited knowledge, skills and confidence needed to implement evidence-based tobacco cessation interventions. A contributing factor is the limited inclusion of tobacco control content in nursing curricula. Additionally, there is limited understanding of nurse educators' knowledge and perceptions about teaching tobacco dependence content. This paper presents the Loma Linda University School of Nursing's concurrent experience with both faculty development and curriculum redesign in the area of tobacco dependence prevention and treatment. An internal survey was administered at baseline and at 2-year follow-up to assess faculty's knowledge, perceptions and practices related to teaching tobacco dependence content and skills (n = 42). Faculty and curriculum development strategies and resources utilized, evaluation findings and subsequent lessons learned are described. The findings have implications for nursing programs seeking to enhance their curricula and commitment to ensuring that their graduates are prepared to provide evidence-based tobacco cessation interventions with each patient they encounter.
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Thus there seems to be a deficit in adequate smoking cessation educational programs. Curricula lack information on effective quit programs, on practicing intervention skills individually (Sarna et al., 2006; Taniguchi et al., 2011) and on knowledge about harmful effects of smoking. This leads to blurry attitudes especially among nurse students (Secher-Sejr and Osler, 2002; Steffenino et al., 2005; Xue et al., 2011).
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In 2010, a questionnaire survey was conducted in a Berlin vocational school for healthcare workers.
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The students' own smoking behaviours and its influences on the treatment of patients should be reflected during school. It is necessary to develop adequate recruitment strategies and attractive interventions for this target group.
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International studies reveal the global dimension of this problem. A survey of baccalaureate programs in four Asian countries (N = 282) revealed that nearly half of the programs reviewed did not include tobacco related instruction, and of those that did, 94% did so only sparingly (Sarna et al., 2006). Similar findings were reported in a cross-sectional national survey among nursing students in Greece.
Tobacco use and dependence is a serious public health issue that disproportionately affects the mentally ill client population. Mental health professionals, including psychiatric/mental health advanced practice nurses (PMHAPNs), are disinclined to integrate tobacco cessation interventions into their practice, due in part, to a general lack of tobacco-related knowledge (C. Essenmacher, C. Karvonen-Gutierrez, J. Lynch-Sauer, & S. A., Duffy, 2008; A. J. Molina, T. Fernandez, D. Fernandez, M. Delgado, S. de Abajo, & V. Martin, 2012; L. Sarna, L. L. Danao, S. Chan, S. Shin, L. Baldago, E. Endo, & M. E. Wewers, 2006); D. Sharp, S. Blaakman, R. Cole, & J. Evinger, 2009). This paper provides an in-depth literature review of tobacco education in nursing curricula and proposes the systematic integration of theory-based tobacco content into psychiatric/mental health graduate nursing programs.
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Students indicated that they had been taught about the harmful effects of smoking at nursing school, but their education mostly did not include the health dangers of second-hand smoke, nicotine withdrawal and actual skills to help smokers to quit. This lack of knowledge and inexperience echoes the study of Sarna et al. (2006). They surveyed deans or chairs of 44 Korean nursing schools and found that < 5% of the Korean schools provided in-depth information concerning smoking cessation intervention.
Smoking is one of the most important preventable risk factors that contributes to premature death from many tobacco-related diseases. Clinicians should offer and provide effective smoking cessation interventions to their smoking patients. Yet, few clinicians receive training in smoking cessation intervention. This one-group, quasi-experimental study was conducted to describe a simulation-based training of smoking cessation intervention and to evaluate its effectiveness on nursing students' self-efficacy in performing smoking cessation intervention, based on 5-As recommended by the United States Department of Health and Human Services. In addition, nursing students' experience, attitude and perceived barriers of smoking cessation intervention were also described. Among the 21 students (mean age: 21.6 ± 2.0 years), 86% were female, 62% were in their third year and 1% were current smokers. Most of students believed the health benefits of smoking cessation (100.0–66.7%) and were well educated about health risks of smoking (81.0–61.9%). However, few were taught (33.3–14.4%) and practiced (28.6–0.0%) smoking cessation intervention. Students reported that they should be actively involved in smoking cessation for patients (100.0–95.2%), but lack of knowledge and skills were the main barriers (90.5–85.7%). The simulation-based training of smoking cessation intervention improved nursing students' self-efficacy in seven out of nine skills of smoking cessation intervention (mean scores of pre- vs. post-intervention: 30.86 ± 3.80 vs. 34.05 ± 5.10; paired t = 2.298, p = .027). These findings indicate that simulation could be effectively used in teaching smoking cessation intervention education delivered to nursing students.
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View all citing articles on Scopus

Linda Sarna is a Professor at the School of Nursing, University of California, Los Angeles.

Leda Layo Danao is a Senior Research Scientist at Jonsson Comprehensive Cancer Center, University of California, Los Angeles.

Sophia Siu Chee Chan is the Head at the Department of Nursing Studies at the Department of Nursing Studies, University of Hong Kong SAR, China.

Sung Rae Shin is a Professor at the Department of Nursing, Sahmyook University, Korea.

Lily Ann Baldago is a Regional Director at the Professional Regulations Commission VI, Philippines.

Emiko Endo is a Professor at Miyazaki Prefectural Nursing University, Japan.

Hideko Minegishi is an Associate Professor at Kitasato University, School of Nursing, Japan.

Mary Ellen Wewers is a Professor at School of Public Health, The Ohio State University.

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ArticleTobacco control curricula content in baccalaureate nursing programs in four Asian nations

Section snippets

Tobacco Control Content in Nursing Education

Purpose

Methods

Tobacco Content

Discussion

Lancet

J Obst Gynecol Neonatal Nurs

Semin Oncol Nurs

Nurs Outlook

Nurs Outlook

Prev Med

Appl Nurs Res

Int J Nurs Stud

Semin Oncol Nurs

Semin Oncol Nurs

Nurs Outlook

The Tobacco Atlas

Mayo report on addressing the worldwide tobacco epidemic through effective, evidence-based treatment

Training health professionals in smoking cessation (Cochrane Review)

Tobacco use and cessation counseling—global health professionals survey pilot study, 10 countries, 2005

MMWR

The role of health professionals in tobacco control

Effective tobacco dependence treatment

JAMA

Treating tobacco use and dependenceClinical Practice Guideline

Effectiveness of implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: a randomized controlled trial

J Natl Cancer Inst

Efficacy of a smoking cessation intervention using the AHCPR guideline tailored for Koreans: a randomized controlled trial

Health Promot Int

Policy recommendations for smoking cessation and treatment of tobacco dependence

Smoking cessation guidelines for health professionalsA guide to effective smoking cessation interventions for the health care system

Thorax

ABC of smoking cessationCessation interventions in routine health care

BMJ

Nursing interventions for smoking cessation

The Registered Nurse Population: National Sample Survey of Registered NursesPreliminary Findings

The Health Consequences of Involuntary SmokingA report of the Surgeon General

Exposure to environmental tobacco smoke

JAMA

Preventing 3 million premature deaths and helping 5 million smokers quit: A national action plan for tobacco cessation

Am J Public Health

Tobacco dependence curricula in US undergraduate medical education

JAMA

Tobacco dependence curricula in acute care nurse practitioner education

Am J Crit Care

Tobacco-related instruction in undergraduate nursing education in Illinois

J Nurs Educ

Tobacco interventions by oncology nurses in clinical practice

Cancer

Nurse practitioners’ knowledge, practice and attitudes about tobacco cessation & lung cancer screening

J Am Acad Nurse Pract

Survey of tobacco cessation curricula in Kansas nursing programs

Nurs Educ

The process of introducing a tobacco curriculum in medical school

Respirology

Smoking among Shanghai medical students and the need for comprehensive intervention strategies

Health Promot Int

Nursing regulation in Southeast Asia and the Western Pacific: a regional initiative

Reflect Nurs Leadersh

Article
Tobacco control curricula content in baccalaureate nursing programs in four Asian nations