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Open Access 01.12.2024 | Research

The role of nurses in smoking cessation interventions for patients: a scoping review

verfasst von: Yueying Jiang, Yuan Zhao, Panpan Tang, Xueqing Wang, Yunyu Guo, Leiwen Tang

Erschienen in: BMC Nursing | Ausgabe 1/2024

Abstract

Background

Smoking is a significant global public health concern, presenting substantial risks to individuals' health. Smoking cessation is essential for improving patients' well-being, and nurses play a critical role in assisting patients to quit smoking. However, there is a lack of research on nurses' specialized roles in smoking cessation interventions for patients.

Objective

To define the specific responsibilities of nurses in facilitating smoking cessation among patients, and provide guidance for future nursing interventions in smoking cessation.

Methods

The scoping review process was conducted for Arksey and O’Malley’s framework. Based on the three-step search strategy of Joanna Briggs Institute (JBI), a comprehensive search was performed across ten databases including PubMed, CINAHL, Web of Science, Embase, Cochrane Library, OVID, PsycINFO, CNKI, Wan Fang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals, covering studies from the inception of the databases to February 2024. The inclusion and exclusion criteria were developed using the JBI (participants, content, and context) principle. Randomized controlled trials or quasi-experimental studies with nurse-led or involved smoking cessation interventions for patients were included. Data extraction was conducted independently by two reviewers. The findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).

Results

In total, 53 studies were eligible for the final charting and synthesis. The analysis identified six key roles that nurses played in smoking cessation interventions: assessors, educators, practice facilitators, coordinating collaborators, organizers, and supervisors. Among these, the roles of assessors, educators, and practice facilitators were the most commonly reported. The motivation interview and 5A method were the predominant techniques employed for smoking cessation. Nurses primarily promoted smoking cessation through the distribution of pamphlets, face-to-face education, and the provision of smoking cessation guidance. The primary participants in these studies were patients with chronic obstructive pulmonary disease (COPD).

Conclusions

Nurses play an indispensable role in smoking cessation interventions, occupying multiple critical roles. However, this review identified a gap in the pre-intervention training of nurses, indicating a need for enhanced training programs to better prepare nurses for effective smoking cessation interventions.

Supplementary Material 1.

Supplementary Material 2.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12912-024-02470-2.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

JBI

Joanna Briggs Institute

COPD

Chronic obstructive pulmonary disease

APN

Advanced practice nurse

Motivational interviewing

TTM

Transtheoretical Model

Carbon monoxide

NRT

Nicotine replacement therapy

Introduction

Smoking is a significant public health issue worldwide and is a major risk factor for stroke, cancer, as well as cardiovascular and respiratory diseases, all of which pose serious threats to human life [1‐3]. According to the 2019 report by the World Health Organization (WHO), there are approximately 1.337 billion tobacco users aged 15 years or older globally [4]. China has the largest number of smokers, with over 300 million [5], followed by India with 276 million, Indonesia with 60 million, and the United States with 34.2 million [6]. Tobacco use is responsible for more than 8 million deaths annually and incurs a global economic cost of $1.4 trillion per year [4].

Fortunately, it has been confirmed that smoking cessation can significantly reduce the risk of death from chronic non-communicable diseases [7‐9]. While many smokers express a desire to quit smoking upon recognizing the dangers of tobacco use, they often struggle due to the psychological and physiological dependencies associated with addiction [10]. However, research has demonstrated that support and assistance from healthcare professionals can substantially increase the likelihood of successful cessation [11]. Nurses, as frontline clinical staff, have extensive contact with patients across various settings, including inpatient, outpatient, and emergency care [12, 13], and constitute the largest proportion of healthcare workers available to support smoking cessation both with healthcare facilities and communities [14, 15]. Evidence suggests that smoking cessation advice provided by nurses can improve smoking cessation rates [16], as they can enhance the chances of smokers quitting through appropriate interventions and follow-up procedures [17, 18]. Therefore, nurses play a crucial role in the success of smoking cessation programs and are uniquely positioned to provide valuable information and encouragement, potentially yielding better outcomes in smoking cessation compared to other healthcare professionals.

While most previous studies have focused on the effectiveness of specific intervention components or the contributions made by nurses in smoking cessation interventions [11, 19, 20], few have explored the broader role of nurses in these efforts. Therefore, we conducted a scoping review to identify the specific interventions delivered by nurses and the roles they play in smoking cessation interventions. The goal is to develop a targeted, evidence-based approach to training nurses in smoking cessation, thereby enhancing their motivation and enthusiasm for assisting patients in quitting smoking.

Methods

This review was prospectively registered on the OSF platform (https://osf.io/ba72e/).

Study design

The scoping review was conducted according to the methodology framework of Arksey and O'Malley (2005) [21], which guides the stages of the review process: (i) identifying the research question; (ii) identifying relevant studies; (iii) selecting studies; (iv) charting the data; (v) collating, summarizing and reporting the results. An extension of the Preferred Reporting Items for Systematic and Meta-analyses for Scoping Review (PRISMA-ScR) was utilized to ensure rigorous reporting and to enhance the transparency of our review process [22].

Search strategy

To ensure the comprehensiveness of the search strategy, we adhered to the three-step search strategy outlined by JBI for scoping reviews [23]. Initially, we searched PubMed and Embase, identifying the Mesh terms "smoking cessation", "tobacco use cessation", "smoking reduction", " nursing", and "nurses". Subsequently, we expanded our research to ten additional databases, employing a combination of MeSH terms and free-text terms: PubMed, CINAHL, Web of Science, Embase, Cochrane Library, OVID, PsycINFO, CNKI, Wan Fang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals, to locate relevant studies. To further ensure the comprehensiveness of the search, we also reviewed the reference lists of the identified reports and articles. The search covered the period from the inception of each database to February 2024. A detailed search strategy for the PubMed database is provided in Table 1 of the Supplementary Material.

Table 1

The intervention methods and theory models used in studies

Studies	Intervention Approach				Theory
	MI	5R	5A	CN	TTM	Stages of Change Model
Auer R et al., 2016 [18]	√
Bolman C et al., 2002 [24]	√					√
Bredie SJ et al., 2011 [25]	√				√
Castello LM et al., 2022 [26]			√
Clair C et al., 2020 [17]	√		√
Cossette S et al., 2012 [27]	√					√
Gies CE et al., 2008 [28]			√
Ong J et al., 2016 [29]	√		√
Li WH et al., 2017 [30]	√		√		√	√
Li WHC, et al., 2022 [31]	√
Canga N et al., 2000 [32]						√
Ong KC et al., 2005 [33]						√
Wilson JS et al., 2008 [34]	√					√
Chouinard MC et al., 2005 [35]					√
Lu CC et al., 2019 [36]					√
Ma, 2018 [37]			√
Xue, 2014 [38]			√
Ma et al., 2016 [39]			√
Xu, 2017 [40]		√	√
Si, 2019 [41]			√
Tian et al., 2015 [42]			√
Zhang et al., 2016 [43]			√
Yan et al., 2019 [44]			√
Hao et al., 2015 [45]			√
Cao, 2019 [46]			√
Zhang et al., 2021 [47]	√					√
Li et al., 2013 [48]			√
Chen et al., 2016 [49]				√
Kang et al., 2020 [50]				√
Li et al., 2014 [51]				√
Zheng et al., 2017 [52]				√
Zhao et al., 2020 [53]				√
Tian., 2020 [54]				√

TTM Transtheoretical Model of Behavioral Change, MI Motivational Interviews, 5A Ask, Advise, Assess, Assist, Arrange, 5R Relevance, Risk, Rewards, Roadblocks, Repetition, CN Continuing nursing

Inclusion and exclusion criteria

The inclusion criteria for our scoping review were developed based on the PCC (participants, concept, and context) principle recommended by JBI [23], which helped in systematically defining the scope of the review and focusing on relevant studies: (i) Participant: Registered nurses, including clinical nurses, advanced practice nurses(APNs), and community nurses; (ii) Concept: Smoking cessation interventions provided by nurses for patients, including behavioral, educational, and supportive interventions; (iii) Context: Settings were hospitals, primary health care facilities, community settings, and smoking cessation clinics; (iv) Type of research: To collect detailed information on how nurses actively engage in and implement smoking cessation strategies, and to map out the specific interventions and roles of nurses in smoking cessation, we have chosen to include only interventional studies in this scoping review, such as randomized controlled trial and quasi-experimental studies; (vi) Language: Only articles published in Chinese or English were included due to language limitations within the research team.

The following types of studies were excluded: (1) Non-original research, such as expert consensus, letters to the editor, and review articles; (2) Studies only explore the effects of pharmacological interventions on smoking cessation, without involving nursing interventions, since we can’t find the specific role nurses play in those interventions; (3) Studies with unavailable full text or incomplete data.

Study screening

All documents retrieved from the databases were checked for duplicates using NoteExpress software. Two team members independently reviewed article titles and abstracts based on the inclusion and exclusion criteria for initial screening. Subsequently, they read the full text and performed the final screening. Disagreements were resolved by consulting a third researcher.

Data Extraction and Synthesis

Following the adapted data chart form proposed by Arksey and O'Malley [21], information was extracted from articles, including author, publication year, country, study population, study design, intervention provider, intervention details, primary outcomes, and main study results. The research team discussed and analyzed the extracted data to describe and summarize the roles of nurses narratively and in detail intervention components they delivered in patient smoking cessation interventions.

Results

Literature Selection Process and Results

As illustrated in Fig. 1, our initial search identified 17,569 articles. After removing duplicates and conducting a screening process, 53 studies were ultimately included in this review.

Characteristics of the Studies and Interventions

The characteristics and interventions of the 53 studies included in this review were synthesized, as shown in Table 2 of Supplementary Material.

Intervention Providers and Smoking Cessation Recipients

Among these studies, 43 focused on smoking cessation interventions administered independently by nurses, while the remaining 10 involved interventions delivered by physicians or psychologists [18, 24, 47, 54‐60]. Only 19 studies included training for nurses on smoking cessation before the intervention [18, 24‐26, 29‐32, 34, 36, 46, 49, 56, 60‐65]. Three studies specifically involved smoking cessation specialist nurses [27], Advanced Practice Nurses (APNs) [29], and dedicated nurse counselors [33]. The majority of smoking cessation subjects were patients with chronic obstructive pulmonary disease (COPD) [34, 38, 46, 49‐55, 60, 62, 66‐69], followed by those with coronary heart disease [18, 24, 25, 27, 33, 35, 36, 58, 70‐72], cancer33,36,63,64, diabetes [17, 30, 32, 36], pulmonary heart disease [41, 42, 44], chronic bronchitis [37, 39, 43], and stroke [45, 48]. Additionally, eight studies included inpatients with unspecified diseases [26, 28, 31, 56, 57, 59, 64, 65].

Intervention Methods and Theory Models

As shown in Table 1, motivational interviewing (MI) and the 5A nursing intervention were the most commonly employed methods for delivering smoking cessation interventions. The predominant theoretical frameworks were the Stages of Change model and the Transtheoretical Model (TTM). Some studies conducted in China utilized continuous care to support smoking cessation. MI was frequently combined with behavior change theory to develop tailored intervention plans for patients at various behavioral stages.

Primary Outcomes and Reporting Modalities

In the synthesis of results, we focused on outcomes related to smoking cessation, including smoking abstinence rate, nicotine dependence, reduction in daily smoking, and smoking behavior. Carbon monoxide (CO) was the primary biochemical marker used to confirm the smoking cessation status [17, 18, 28, 29, 33, 34, 36, 45, 55, 61, 63‐65, 70]. Some studies also verified patient abstinence through cotinine concentration measurements in urine and saliva [24, 32, 35, 56, 59]. Dual verification using both CO levels and cotinine concentration was conducted in certain studies [30, 31, 70]. Most studies relied on patients’ self-reporting to provide information on smoking cessation.

The Roles of Nurses in Smoking Cessation Interventions

We identified six primary roles that nurses typically perform in smoking interventions, and we have outlined 49 key interventions (Table 3 of Supplementary Material).

Assessors

Before initiating smoking cessation interventions, nurses first inquired about patients’ smoking status and assessed their smoking history [17, 24‐30, 32, 34, 37‐46, 48, 50‐53, 55, 61, 63, 64, 66, 67, 72, 73]. This includes the age of smoking onset, daily cigarette consumption, smoking habits, nicotine dependency [29, 32, 36‐38, 41, 42, 44, 46, 54, 61, 73], and readiness to quit [38, 56]. They then evaluated patients’ willingness [26, 28, 31, 37, 39‐43, 45, 46, 48, 53] and motivation to quit smoking [17, 40, 44, 55, 56], as well as their stage of readiness48,55, to develop a targeted smoking cessation plan tailored to different stages of preparation. During the cessation process and follow-up, nurses regularly assessed the difficulties patients were experiencing [24, 37, 38, 42‐46, 49, 52], and evaluated smoking cessation status [17, 25, 28, 30, 32, 37, 39‐46, 49, 55, 57, 60‐64, 70, 72, 73], including short-term and long-term smoking cessation rate [29, 65], nicotine dependence [56, 60], mastery of smoking cessation knowledge [18], quit motivation [27], and readiness to withdraw [31].

Educators

Nurses play a crucial educational role in smoking cessation. Studies indicate three primary methods of delivering education: 1) Distributing health education materials, such as pamphlets, leaflets, and short videos related to smoking cessation [24, 28, 30‐33, 39, 41, 42, 45‐48, 51‐53, 55, 58‐62, 64, 67‐70, 73]; 2) Providing face-to-face health education during hospitalization or telephone follow-ups after discharge [17, 29, 30, 32‐34, 37, 39‐45, 47‐49, 52‐54, 56, 58, 62, 64, 66, 68, 69, 72‐74]; 3) Organizing smoking cessation lectures or seminars [38, 47, 55, 62, 68, 69, 73]. The key components of health education include: 1) Tobacco-related knowledge [24, 27, 29‐34, 36, 37, 39‐49, 52, 56, 58, 60, 62, 66‐70, 72‐74], such as the relationship between tobacco and disease, the harm of tobacco, and the benefits of quitting smoking; 2) Smoking cessation guidance [17, 26, 34‐36, 48, 56, 58, 61, 64, 65], and smoking cessation skills [29, 37‐39, 41, 43, 46, 51, 53, 60, 62, 68, 69]; 3) Recognition and management of withdrawal symptoms [27, 31, 34, 36, 45, 62, 68]; 4) Coping strategies for relapse [33‐35, 38, 39, 41‐44, 58, 59, 70]; 5) Psychological symptoms and stress management techniques [29, 69].

Practice Facilitators

Our findings suggested that before implementing smoking cessation intervention, nurses advised patients to quit smoking [17, 24, 26, 28, 33‐37, 39, 43, 45, 56, 58, 64, 65, 68, 70], and offered support and encouragement [27, 38, 41, 42, 44, 48, 53, 60, 61, 67]. At the start of the intervention, nurses developed personalized smoking cessation plans for patients [38, 40‐46, 51, 53, 55, 68, 73, 74], and assisted in setting a quit date [25, 26, 32, 33, 38, 40, 45, 46, 48, 55, 56, 61, 65, 68, 73]. Throughout the cessation process, nurses implemented methods to bolster patients’ motivation based on their initial motivation [25, 30, 31, 36, 40, 47, 60, 65, 69]. Nicotine replacement therapy (NRT) was provided to patients with serious withdrawal symptoms and high tobacco dependence [32‐35, 59, 69, 73]. Nurses also addressed difficulties and withdrawal symptoms during the cessation process [24, 31, 40, 45, 46, 56, 61, 67], and helped patients overcome concerns about smoking cessation [41, 42], offering counseling and guidance on cessation techniques [38, 44, 46, 68], medications [25, 26, 29, 60, 66], and lifestyle guidance [31, 46, 51, 69]. Post-discharge, nurses encouraged patients to maintain cessation and a healthy lifestyle [37, 73], and some studies have employed signed pledges to reinforce the commitment to quitting smoking [38, 40, 46, 55, 70].

Coordinating Collaborators

Some smoking cessation interventions involved collaboration between nurses and other healthcare providers. Nurses worked with doctors to discuss appropriate cessation plans and provided feedback to doctors [24, 60, 62]. They also cooperated with family members to create a smoke-free environment during or after hospitalization [44, 51, 55, 69, 73, 74], and consulted families about patients’ smoking cessation status post-discharge [40, 72], ensuring the accuracy of self-reported outcomes, and mobilized family and friends to support smoking cessation [41, 42, 46, 47, 60, 69]. Additionally, nurses acted as liaisons between patients and smoking cessation centers [26].

Organizers

In some studies, nurses assumed the role of organizers in smoking cessation care. They organized health knowledge lectures or education sessions [47, 55, 62, 68], and facilitated communication among cessation patients to foster mutual support [49, 66, 70]. They also coordinated some smoking cessation experience-sharing activities, where successful patients were invited to share their experiences, challenges, and the reactions and benefits of their families, mobilizing other patients’ enthusiasm and enhancing their motivation and confidence in quitting smoking [38, 46, 48, 74]. Furthermore, nurses organized caregiver-sharing sessions to share patients' care experiences [69] and organized some colorful recreational activities to enrich patients' hospitalization experiences, divert attention, and improve cessation success rates [74].

Supervisors

In addition to the aforementioned roles, nurses also played a supervisory role in the patients’ smoking cessation interventions. Nurses not only regularly monitored patients’ smoking behavior during hospitalization [44, 62]. Studies have shown that nurses also conducted regular follow-up visits post-discharge to supervise cessation efforts [52, 71], and assisted in correcting harmful smoking habits [42]. Besides, nurses cooperated with family members to supervise patients’ cessation progress [52, 67] and facilitated communication between patients to encourage and supervise one another [72]. They also involved patients’ families and friends in the cessation plan and closely monitored their daily lives to ensure success [40, 44, 46, 49, 53, 55, 69, 73].

Discussion

Our research suggested the critical role of nurses in assisting patients with smoking cessation. Nurses performed various roles during the smoking cessation intervention, including assessors, educators, practice facilitators, coordinating collaborators, organizers, and supervisors. They primarily promoted smoking cessation through the distribution of pamphlets, face-to-face education, and the provision of smoking cessation guidance. Motivation interview (MI) and 5A method were the most commonly utilized techniques for smoking cessation. The primary participants were patients with chronic obstructive pulmonary disease (COPD). Building on the previous systematic review by Rice et al., which examined the effectiveness of nursing-delivered smoking cessation interventions in adults and established the efficacy of nurse-led interventions in enhancing quit rates [19], this scoping review extends the scope of investigation by exploring the specific strategies and roles undertaken by nurses in facilitating smoking cessation. It provides a more granular analysis of the diverse interventions employed by nurses, offering detailed insights and practical recommendations for optimizing clinical smoking cessation programs.

Among these numerous tasks, assessment was the most prevalent and was integrated throughout the process. Our review found that the two most common methods used by nurses during smoking cessation were MI and the 5A nursing interventions. The role of the nurse as an assessor is well-represented in both approaches. Motivational interviewing (MI) is a person-centered clinical approach aimed at increasing motivation for behavioral change and is frequently employed in addressing addictive behaviors. This method has demonstrated efficacy in modifying unhealthy habits, such as smoking, physical inactivity, and poor diet [75]. Research indicated that MI was also effective in primary care populations [76]. In smoking cessation, nurses initially assessed patients’ motivation to quit and their stage of behavioral change, subsequently developing an appropriate cessation plan. The 5A Nursing Intervention method, recommended by the U.S. Public Health Agency as the gold standard for smoking cessation, comprises five steps: ask, advise, assess, assist, and arrange. It is widely utilized in smoking cessation efforts [77]. Nurses evaluated patients' smoking history and willingness to quit before implementing interventions. During follow-up, nurses evaluated patients' cessation progress, encountered difficulties, and effectiveness, adjusting plans and providing support as needed. One study suggests incorporating smoking and lifestyle risk assessments by registered nurses into outpatient health histories to enhance targeted smoking cessation programs [78]. In the 5A nursing method, nurses also provide smoking cessation advice, assist in formulating cessation plans, set quit dates, offer nicotine replacement therapy, guide patients on cessation techniques, and encourage patients to sign a cessation pledge, significantly promoting the execution of smoking cessation actions. Thus, nurses also function as practice facilitators in promoting smoking cessation.

As educators, nurses help patients acquire knowledge and skills for smoking cessation, manage withdrawal symptoms, and prevent relapse through various educational methods to ensure smooth progress in cessation efforts. The study by Chaney also highlighted the vital role of nurse practitioners in delivering effective smoking cessation treatments and educating patients about the risks of smoking [79]. However, the synthesis of 53 studies revealed that only a small proportion of nurses were trained in smoking cessation interventions. Many clinical nurses lack the necessary knowledge and skills to support patients in quitting smoking. Interviews with nurses disclosed a lack of confidence in providing smoking cessation support to patients, with some believing they lacked expertise or considered smoking cessation support to be outside their responsibilities [80]. Implementing smoking cessation learning programs for healthcare providers can enhance their confidence in assisting patients to quit smoking [81]. Research confirmed that patients receiving counseling from nurse practitioners, including brief counseling interventions, were nearly twice as likely to attempt quitting compared to those who did not receive such counseling [82]. Therefore, improving smoking cessation training for nurses is crucial to equip them with confidence and knowledge to deliver effective smoking cessation interventions for patients. Smoking cessation education is also a key intervention. Hospitalization or post-illness periods represent optimal times to encourage patients to quit smoking [83].

Nurses also serve as coordinating cooperators in smoking cessation interventions. Because some patients tend to trust doctors more than nurses, nurses often require physicians’ cooperation to implement smoking cessation interventions, such as requesting physicians to encourage patients to quit. Additionally, nurses frequently work with family members, asking them to support patients’ motivation to quit and create a favorable environment for cessation. Furthermore, nurses collaborate with smoking cessation organizations to refer patients to specialized facilities. Nurses also played a crucial role as organizers and supervisors in smoking cessation efforts. For example, they facilitated peer support groups where patients can share experiences and support each other, which has been shown to be effective [84]. They also organized successful smoking cessation practitioners to deliver lectures and share their experiences, mobilizing patients' enthusiasm and motivation to quit smoking. Quitting smoking is challenging for many long-term smokers, who have poor self-control and often require supervision to succeed. Studies have shown that nurses supervise patients during hospital stays and follow up regularly post-discharge to encourage cessation, even involving patients' families in the supervision process.

In addition, limitations such as research funding and location have led many studies to rely on self-reported smoking cessation rates, which may be biased due to patient memory or false reporting, potentially resulting in inaccurate findings. Carbon monoxide (CO) levels in exhaled breath provide an objective measure of the smoking cessation status of patients. With the advancement of technology, the use of mobile breath sensors to monitor exhaled CO has become acceptable and can enhance motivation for quitting smoking, thereby improving cessation success rates [85‐88]. One study utilized a "Cure App Smoking Cessation" program, which included a smartphone app and web-based management software that allows healthcare workers to use mobile CO detectors to monitor patients’ cessation progress, thereby improving the effectiveness of smoking cessation treatment [89]. Therefore, future studies should incorporate biochemical verification, such as using mobile CO detectors, to ensure accurate reporting of outcomes and enhance research quality.

Despite the important role nurses play in smoking cessation interventions and the variety of strategies they employ to help patients quit, several barriers exist that may hinder the effectiveness of these interventions and contribute to lower smoking cessation success rates. First, although national policies promoting smoking cessation and bans on smoking have been introduced, some health settings, such as psychiatric hospitals and nursing homes, are exempt from legislative smoking bans, which can impede nurses’ ability to implement smoking cessation interventions effectively [90]. Additionally, Frazer et al. suggested that emergency departments could serve as advantageous settings for smoking cessation education, offering patients motivation, encouragement, and verbal support in response to self-reported smoking behavior [90, 91]. However, this resource is underutilized, potentially leading to reduced patient engagement in smoking cessation efforts. Furthermore, nurses face several challenges in their smoking cessation practices, including limited time and knowledge [92, 93]. High workloads in clinical environments often leave nurses with insufficient time for comprehensive counseling, with priority given to competing clinical tasks, and there is often a lack of knowledge about available smoking cessation services. Nurses generally inquire about smoking habits during initial consultations or before starting treatment but may not prioritize smoking cessation as a key focus, which can result in suboptimal outcomes for patients. Structural barriers within the smoking cessation system also exist, such as the lack of prescribing authority for nurses, leading to delays in obtaining pharmacological NRT prescriptions [93]. These factors collectively contribute to the challenges nurses face in supporting patients to quit smoking and may explain why some individuals do not successfully quit. Therefore, future research should focus on developing targeted strategies to overcome these barriers, ensuring that nurses are better equipped and supported in their efforts to assist patients in quitting smoking.

The rise of big data presents new opportunities for implementing smoking cessation interventions through the Internet. The growth of mobile health (mHealth) has led to the development of chatbots to help patients quit smoking [94], and there have even been studies on motivational interview-style robots to enhance patient motivation [95]. Mobile app-based pharmacological interventions have also been shown to enhance smoking cessation effectiveness [96]. Given the busy workload of clinical nurses, they have little time to specifically provide smoking cessation interventions to patients [97]. In the future, it is crucial to leverage the Internet's potential and explore innovative methods to motivate patients to quit smoking. This approach would not only alleviate the workload of medical staff but also save time for both doctors and patients and reduce medical costs. Additionally, it is important to acknowledge the impact of the COVID-19 pandemic on the scope of our review. Since our scoping review spans the COVID-19 period, many clinical trials, particularly those involving face-to-face smoking cessation interventions, may have been disrupted due to pandemic-related restrictions [98]. The pandemic disrupted the continuity of interventions and data collection, and these disruptions likely contributed to the reduced number of eligible studies available for inclusion in our review. As a result, the overall pool of available evidence may not fully capture the specific smoking cessation interventions implemented by nurses and their roles during this period. Future research should explore how telehealth and digital interventions can overcome such barriers and continue to support smoking cessation efforts in the post-pandemic era.

Limitations

There are several limitations to this study. First, our participants were restricted to individuals with diseases. Whether in hospitals, communities or at home, these individuals may exhibit better adherence to smoking cessation efforts than the average smoker, as there is a stronger motivation to quit. Consequently, smoking cessation interventions might be more effective within this group. Besides patients with diseases, nurses also play an important role in the smoking cessation process for healthy individuals, such as social smokers and school adolescents. This aspect was not addressed in our study. To obtain more generalizable results, future studies should include a broader population beyond those with diseases. Second, in addition to the six roles we identified, another significant role of nurses in smoking cessation is that of the communicator. Effective communication is essential for nurses to implement various nursing measures. Only through communicating can nurses perform subsequent assessments, provide health education, and engage in other necessary tasks. Since communication was not explicitly included as a measure of smoking cessation interventions, this represents a limitation in our study. Besides, when guiding patients' families to supervise smoking cessation, nurses often function as both coordinating collaborators and supervisors. However, to avoid redundancy, we categorized them solely as supervisors in our analysis, which may not fully capture the complexity of their role. Third, while our scoping review provides a broad mapping of the evidence on nursing interventions in smoking cessation, it is important to note that the review is limited to the types of study designs included. Specifically, we included only interventional studies, such as randomized controlled trials and quasi-experimental studies. This focus, while allowing for a detailed exploration of nursing interventions and roles, may limit the breadth of evidence on other aspects of smoking cessation interventions not covered by these study designs. Furthermore, since the scoping review aims to map the entire body of evidence regarding the primary roles of nurses in smoking cessation interventions, rather than to address specific narrow questions about intervention effectiveness, certain details on intervention effectiveness and comprehensive evaluation may not be fully addressed.

Conclusion

In summary, nurses play a vital role in smoking cessation interventions for patients, encompassing multiple roles including assessors, educators, coordinating collaborators, practice facilitators, organizers, and supervisors. Assessment and health education are integral throughout the smoking cessation process. Nevertheless, nurses may not receive adequate training in these areas. It is crucial to enhance their training, develop more specialist nurses, and implement incentive policies to recognize their contributions and encourage greater participation. Additionally, leveraging the Internet can introduce innovative interventions to improve patient cessation rates.

Acknowledgements

The authors are grateful to all entities that contributed to this study.

Declarations

Not applicable.

Competing interests

The authors declare no competing interests.

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Titel: The role of nurses in smoking cessation interventions for patients: a scoping review
verfasst von: Yueying Jiang
Yuan Zhao
Panpan Tang
Xueqing Wang
Yunyu Guo
Leiwen Tang
Publikationsdatum: 01.12.2024
Verlag: BioMed Central
Erschienen in: BMC Nursing / Ausgabe 1/2024
Elektronische ISSN: 1472-6955
DOI: https://doi.org/10.1186/s12912-024-02470-2

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Springerpflege

Abstract

Background

Objective

Methods

Results

Conclusions

Supplementary Information

Publisher’s Note

Introduction

Methods

Study design

Search strategy

Inclusion and exclusion criteria

Study screening

Data Extraction and Synthesis

Results

Literature Selection Process and Results

Characteristics of the Studies and Interventions

Intervention Providers and Smoking Cessation Recipients

Intervention Methods and Theory Models

Primary Outcomes and Reporting Modalities

The Roles of Nurses in Smoking Cessation Interventions

Assessors

Educators

Practice Facilitators

Coordinating Collaborators

Organizers

Supervisors

Discussion

Limitations

Conclusion

Acknowledgements

Declarations

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Supplementary Information

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