Bir sigara bırakma polikliniğinde uygulanan psikoeğitimsel sigara bırakma programının etkinliği

Öz

BİR SİGARA BIRAKMA POLİKLİNİĞİNDE UYGULANAN PSİKOEĞİTİMSEL SİGARA BIRAKMA POROGRAMININ ETKİNLİĞİ

 ÖZET

Amaç: Bu çalışma; sigara bağımlısı olan hemşirelerin psikoeğitimsel  müdahalelerle sigara bırakma durumlarını incelemek amacıyla planlanmıştır.

Yöntem: Çalışmaya, bir üniversite hastanesinde çalışan, düzenli sigara içen gönüllü hemşireler alınmıştır. Sigara içen toplam 84 hemşire ile ön görüşme yapılmış ve katılmak isteyen 40 hemşire alınmıştır. Hemşireler rastgele 4 gruba ayrılmış ve bu gruplarla haftada bir kez olmak üzere toplam 4 oturumluk psikoeğitimsel destekli sigara bırakma programı uygulanmıştır. 4 oturumluk programa 28 kişi tam katılmış ve bu grup PP (per protocol) olarak kabul edilmiştir. Program tamamlandıktan sonra, 6.ay, 12.ay izlemi yapılmıştır. Hemşirelerin sigara bırakma durumlarını ölçmek için, Fagerstrom Nikotin Bağımlılık Testi, Özyeterlilik Anketi uygulanmış ve CO ve idrarda Kotinin ölçümü yapılmıştır.

Bulgular: Programa katılan hemşirelerin %57.5’i farmakolojik destek alarak programa devam etmiş, %42.5’i ise yanlızca psikoeğitimsel destek alarak programı tamamlamışlardır. Sigara bırakma oranları niyetli grupta (Intention To Treat ITT grubunda programdan sonra % 52.5 (n=21), 6. ay % 35.6 (n=14), 12. ay % 30.0 (n=12) iken, grubu tamamlayan Per Protocol (PP) grubunda sigara bırakma oranları programdan sonra % 72.7, 6. ay % 45.5, 12. ay % 40.9 olarak belirlenmiştir.  Programdan sonra PP grubunda, Özyeterlilik Testi, CO, Kotinin miktarları  arasında anlamlı farklılıklar bulunmuştur.

Sonuç: Programın sonunda hemşirelerin sigara bırakma motivasyonlarının arttığı, psikolojik ve farmakolojik desteğin bırakmayı kolaylaştırdığı ve özellikle programa düzenli devam eden motivasyonu yüksek grupta sigara bırakmaların anlamlı düzeyde arttığı gözlenmiştir.

Anahtar Kelimeler: Sigara bağımlılığı, Psikoeğitim, Sigara bırakma program, Hemşire

ABSTRACT

Efficiency of a psychoeducational intervention for smoking cessation in a cessation clinic

Aim: This study was planned for evaluating the quit rates of nurses with psychopharmacologic interventions.

Method: Out of 84 regular smoker nurses working at a university hospital who volunteered to receive, 40 provided consent and were recruited. Participants were randomized into 4 groups and attended a session of psychoeducational approach based smoking cessation program for 4 weeks. Per-protocol (PP) group consisted 28 nurses who participated all sessions. All participants were contacted over telephone at 6^th and 12^th months for follow-up. Measures used in the study were Fagerström Nicotine Dependence Scale, Self-Efficacy questionnaire, carbon monoxide (CO) measurement, and urine cotinine analyses.

Results:Twenty-three nurses (57.5%) took pharmacological medication, and 17 nurses (42.5%) took only psychoeducational intervention. Quit rates of entire participants at the end of program, and 6^th and 12^th months of follow-ups were 52.5%, 35.6%, and 30.0% in the intention-to-treat (ITT) group, and 72.7%, 45.5%, and 40.9% in the PP group, respectively. Pre- and post-intervention comparisons of self-efficacy scores, CO and cotinine levels were significantly different in PP group.

Conclusion: Psychoeducational intervention was found to be a significant factor to increase motivation for quitting, particularly in participants with complete attendance.

Keywords: Smoking addiction, Psychoeducation, Smoking Cessation Programmes, Nursing

Anahtar Kelimeler

• Sigara bağımlılığı,Psikoeğitim,Sigara bırakma program,hemşire

BİR SİGARA BIRAKMA POLİKLİNİĞİNDE UYGULANAN PSİKOEĞİTİMSEL SİGARA BIRAKMA POROGRAMININ ETKİNLİĞİ*

Öz

Anahtar Kelimeler

• Sigara bağımlılığı,Psikoeğitim,Sigara bırakma program

Kaynakça

1. 1. World Health Organization. WHO global report on trends in tobacco smoking 2000-2025,WHO Press, 2015
2. 2. [Global Adult Tobacco Survey Turkey 2012].Health Minister Publications; 948, Ankara, Anıl Matbaa,2014, p 23.
3. 3. İlhan MN, Arıkan Z, Kotan Z, Tunçoğlu T, Pınarcı M, Taşdemir A et all. Prevalence and socio-demographic determinants of tobacco, alcohol, substance use and drug misuse in general population in Turkey, Arch Neuropsychiatry 2016;(53):205-212.
4. 4. Sayan İ, Faruk Tekbaş Ö, Göçgeldi E, Paslı E, Babayiğit M [Determination of smoking profiles in nurses who are working in a training hospital ].Genel Tıp Derg 2009;19(1): 9-15.
5. 5. Atılgan Y, Gürkan S, Şen E [Our hospital personnel smoking status and influencing factors]. Tur Toraks Der 2008;(9):160-6.
6. 6. Güneş G, Pehlivan E, Eğri M, Genç M [Prevalence of smoking in doctors, nurses, and medical faculty students working in Turgut Özal Medical Center]. Journal of Turgut Özal Medical Center 1997;4(4):407-411.
7. 7. Beletsioti-Stika P, Scriven A. Smoking among greek nurses and their readiness to quit.International Nursing Review 2006;53(2):150-56.
8. 8. Rowe K, Clark JM. Evaluating the effectivenes of a smoking cessation intervention designed for nurses. International Journal of Nursing Studies 2000;36(4):301-11.

9. 9. Froelicher ES, Kozuki Y. Theoretical applications of smoking cessation interventions to individuals with medical conditions women’s initiative for nonsmoking (WINS)-Part III. International Journal of Nursing Studies 2002;39(1):1-15.
10. 10. Haddock J, Burrows C. The role of the nurse in health promotion an evaluation of a smoking cessation programme in surgical pre-admission clinics. Journal of Advanced Nursing 1997;26(6):1098-110.
11. 11. Lancaster T, Silagy C, Fowler G. Training health professionals in smoking cessation. (CD000214) The Cochrane Database Syst Rev. 2000;(3):CD000214.
12. 12. Villareal E. Using Roy’s adaptation model when caring for a group of young women contemplating quitting smoking. Public Health Nursing 2003;23(5):377-84.
13. 13. Wevers ME, Ahijevych KL, Sarna L. Smoking cessation interventions nursing practice, Substance Abuse Interventions In General Nursing Practice1998;33(1):61-73.
14. 14. Washington, OM. Effects of group therapy on chemically dependent women’s self efficacy. Journal of Nursing Scholarship 2000;32(4):347-52.
15. 15. Moxham L, Dwyer T, Reid-Searl T.Graduate nurses and nurses student’s behaviour: knowledge and attitudes toward smoking cessation, Nurse Education Today 2013 (33): 1143-1147.
16. 16. Gençöz F, Soykan Ç, Soykan A, Gençöz T. [Smoking Addiction and Treatment]. Ankara, Art Ofset Matbaacılık, 2003.p.20-35.
17. 17. Coşar B, Şahin K, Arıkan Z, Işık E. [Nicotine dependence, its psychopharmacology and the relationship of dependence behaviour with some psychiatric disorders]. 3P Dergisi1996;4(3):199-6.
18. 18. Yükseköğretim Kurumu [Health Education and Health Manpower Status Report].Editör Mustafa Solak, YÖK Yayınları, Eskişehir, 2014 p.89.
19. 19. Stuart K, Borland R, McMurray N. Self-efficacy, health locus of control and smoking cessation. Addictive Behaviors 1994;19(1):1-12.
20. 20. Urso P. Match the best smoking cessation intervention to your patient. Nurse Pract. 2003 Suppl 12(6):18-9.
21. 21. Akvardar Y. [Psycho-educational Approach Addiction Rehabilitation]. 3P Dergisi 2000;8(4):39-42.
22. 22. Fiore MC, Bailey WC, Cohen SJ. Treating tobacco use and dependence: clinical practice guideline. JAMA 2000 283(24):3244-54.
23. 23. Kamışlı S, Öz F.Evalution of a smoking cessation psychoeducational program for nurses. Journal of Addictions Nursing 2011;22(3):117–23.
24. 24. Rigotti, N, Munafo M, Stead L. Interventions for smoking cessation in hospitalized patients. Cochrane Database of Systematic Reviews 2007;3(3): CD001837.doi:10.1002/14651858.CD001837.pub2.
25. 25. Stuart K, Borland R, McMurray N. Self-Efficacy, Health Locus of Control and Smoking Cessation. Addictive Behaviors 1994;19(1):1-12.
26. 26. Faltz BG, Skinner MK. Substance Abuse Disorders, In MA. Boyd (Ed.) Psychiatric Nursing Contemporary Practice 2002 p.617-655.
27. 27. Michie S, HyderaN, Walia A, West R Development of a taxonomy of behavior change techniques used in individual behavioural support for smoking cessation. AddictiveBehaviors2011;36(4):315-19.
28. 28. World Health Organization (WHO), Carbon Monoxide, Environmental Health Criteria Geneva;1999. p. 213.
29. 29. Miwa K, Miyagi Y, Asanoi H, Masatoshi F, Sasayama S. Augmentation of smoking cessation education by urinary cotinine measurement. Jpn Circ J 1993;57(8):775-80.
30. 30. Karancı N. Self efficacy-based smoking situation factors: the effects of contemplating quitting versus relapsing in a Turkish sample. The International Journal of The Addictions1992;27(7):879-86.
31. 31. Yazıcı H. Personality depressive symptoms and smoking status among Turkish university students. Social Behavior and Personality 2008;36(6):799-10.
32. 32. Akkaş Ö,Olgun N. [Cigarette Smoking and Associated Factors Among Nurses]. Hemşirelik Forumu 2003;6(2):17-23.
33. 33. Dilbaz N, Apaydın L. [The Frequency of Smoking, Quitting Smoking and The Characteristics of Smoking Among Nurses of A Research and Training Hospital].
34. 34. Fagerstrom, K. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors 1978;3(3-4):235−41.
35. 35. Uysal MA, Kadakal F, Karşıdağ Ç. [Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis]. Tüberküloz ve Toraks Derg 2004; 52(2):115-21.
36. 36. Temel O, Şakar Coşkun A, Gök Ş, Çelik P, Yorgancıoğlu A.[The Effect of Nicotine among Active, Passive Smoker Health Personnel].Türk Toraks Dergisi 2009;10(3):107-111.
37. 37. Yalçınkaya AÖ, Karancı N. What are the differences in decisional balance and self-efficacy between Turkish smokers in different stages of change? Addictive Behaviors 2007;32(4):836–48.
38. 38. Boogar IR, Mirkouhi MG. Successful Smoking Cessation: The role of self-efficacy mildfulness and demographic Factors, J Mazand Univ. Med. Sci 2013;23(103):55-56.
39. 39. Perkins KA, Parzynski C, Mercincavage M, Conklin CA, Fonte CA. Is self-efficacy for smoking abstinence a cause of, or a reflection on, smoking behavior change? Experimental and Clinical Psychopharmacology 2012;20(1):56–62.
40. 40. Rawson RA, Obert JL, McCann MJ, Marinelli-CaseyP, Relaps prevention strategies in outpatient substance abuse treatment. Psychology of Addictive Behaviors 1993;7(2):85-95.
41. 41. Kapson HS, McDonald DO, Haaga D.A.F. The effect of unanimous first session attendance on psychoeducational smoking cessation groups. Group Dynamics: Theory Research and Practice 2012;16(2):148-58.
42. 42. Yalom ID. Grup Psikoterapisinin Teori ve Pratiği (çev. Atman Tangör, Özgür Karaçam) Kabalcı Yayınevi, 2012. p.21-38.
43. 43. Demir T,Tutluoğlu B, Koç N, Bilgin L.[One-Year Follow up Results of Smoking Cessation Outpatient Clinic]. Tüberküloz ve Toraks Dergisi 2004;52(1):63-5.
44. 44. Öztuna F. [Treatment and follow-up in the smoking cessation polyclinic: review]. Türkiye Klinikleri J Med Sci 2005;25(4):546-50.