Teaching/Learning Plan, Coursework Example

Patient Profile and Assessment

The primary purpose of this health assessment and evaluation is encouraging and guiding a patient in starting a smoking cessation program. The patient is a long-time smoker who is also exposed to second-hand smoke, and she is in the office today for her annual physical.

The patient is a married 73-year-old, white female who presented at the doctor’s office for her annual check-up on December 21, 2013. Her physical examination went well and she reported no particular health concerns. However, she did admit that she still smokes, when asked. After her physical and health assessment, I spent an extra 10-15 minutes with the patient to discuss her smoking habit and possible cessation. She is a geriatric patient who has a husband who is a chain smoker, and has been ever since he was a teenager. She stated she stopped smoking for 20 years, but she started up again within the last 15 years just because “She enjoys it and she is always around it,” as she stated. With this in mind, it is important to ascertain the reasons why this patient began a smoking habit after having quit for so many years, in an attempt to encourage her to stop again.

The patient acknowledged previous exposure to smoking cessation knowledge and information because she had quit smoking at another time in her life. However, after discussing detailed facts about the effects of smoking, she also acknowledged that she was unaware of some of those facts, as shown below. The goal of this assessment is encouraging the patient to enter into a smoking cessation program, by teaching her more about the detrimental effects of her smoking habit on herself and those around her, such as her grandchildren, as well as letting her know the benefits gained from not smoking.

Teaching Plan

The estimated time needed for teaching the patient about smoking cessation is approximately 45 minutes. The learning principles used focused on knowledge and awareness. The patient was made aware of the risks of smoking and given adequate information and feedback to her questions about this issue. The teaching strategy included discussion, presentation of facts, and a question and answer session.

We went over, in detail, what smoking does to the lungs and cilia in the airways in particular (with a diagram from the ALA). I also reminded her about the health risk factors related to smoking such as heart disease, hardening of the arteries, stroke, and various types of cancer as well as lung disease. In addition, I showed her a website; peer reviewed by Dr. Trisha Macnair, which highlights how cigarettes contain over 4,000 carcinogens that damage the body’s cell functions and regulatory systems. Additionally, more than 80 of these chemicals are cancer-causing substances such as tar, arsenic and formaldehyde and the nicotine is the addictive agent that keeps people smoking when they start.

In addition, cigarettes contain traces of other poisons such as carbon monoxide, ammonia and even cyanide. Moreover, the World Health Organization (WHO) estimates that smoking causes about 5 million deaths all over the world each year, and it also plays a significant role in the development of a host of other diseases or makes them worse.

According to the WHO, cigarette smoking causes more deaths and disables more people than any other disease and by the year 2020, it is estimated that worldwide deaths caused by smoking could reach 10 million people. This translates into 17.7 percent of fatalities in developed countries, which equates to over 141 million people because out of the 1.1 billion people who smoke worldwide, 800 million of those live in developed countries (Smoking and your health, 2011).

Other smoking cessation resources I gave her, besides the above website, are found on the Centers for Disease Control and Prevention website. I gave her a card with the number, 1-800-QUIT-NOW. This is smokefree.gov and it is a no cost phone-based smoking or chewing tobacco cessation service that offers free educational materials for people who want to quit smoking. They also offer free counseling from coaches for encouragment and guidance, and this is helpful since sometimes all a person needs is a word of encouragement. Smokefree.gov also offers a quit smoking app for smartphones to help people quit. I also referred her to the American Lung Association website that offers many smoking cessation resources for quitting and helping people figure out the reasons they want or need to quit for good (CDC, 2013).

In addition, I gave the patient smoking cessation product samples – a nicotine patch and some nicotine gum, both designed to curb nicotine use in people trying to quit the smoking habit. According to the Mayo Clinic (2011), using smoking cessation products increases the chances of smoking cessation success. It is estimated that no more than 5 percent of people trying to quit smoking without using some type of smoking cessation product or program, to include behavior therapy, are successful (Mayo Clinic Staff, 2011).

In addition to the over-the-counter smoking cessation products, we also discussed presciption protocols for helping with smoking cessation like the nicotine inhaler or prescription pills. Any of these methods are effective in helping people stop smoking, so I encouraged her to try them.

The method of patient evaluation after beginning her smoking cessation program will be observation and follow-up counseling. It is recommended that smoking cessation programs are continued for at least six to twelve weeks for best results (Mayo Clinic Staff, 2011).

Implementation

The agreed upon date and time for her smoking cessation program to begin was established and she pointed out she felt apprehensive and that it would be difficult. I reassured her that I was there to help her every step of the way and that she could call me anytime for guidance.

Evaluation

We went over the information on the website together and I answered her questions. We also talked about her reasons for smoking, such as pressures, enjoyment and the fact that she’s already around cigarette smoke every day. She acknowledged the severity of her smoking habit and she understood the risks and consequents. She was very responsive to my instruction and she was very attentive to the explanations and statistics I showed her. She stated she was aware of much of the information, but was shocked to learn about some of the things she did not know about the effects of cigarette smoking, such as the fact that three of the chemicals in cigarettes are formaldehyde, arsenic and cyanide which have serious adverse effects on the body. She seemed somewhat concerned at this revelation.

I listened while she explained how she, herself, started smoking at the age of 16, just like her husband, and she shared with me the reasons she quit for two decades and then started back smoking. She said she quit, cold turkey, because she witnessed her mother’s struggle with COPD and how sick that made her mother. She also mentioned how she saw her mother suffer everyday with the disease until she died, and she said she did not want to suffer the same fate. However, she admitted she started the smoking habit back up again after all of those years because she had a lot of stress in her life and she figured it was safer because she hadn’t smoked in so long.

We, then, discussed the benefits of not smoking such as increasing life expectancy, and reducing the risk of developing serious health issues such as cancer, lung disease, heart disease, circulatory problems or stroke. Also, I explained that quitting smoking enhances the taste buds and the sense of smell so food tastes better and also not smoking gives a person more energy to enjoy life more. I also let her know that she is helping those around her who do not smoke, such as her grandchildren, by setting a better example for them and reducing adverse effects on their health through second-hand smoke.

In addition, I reminded her that there is a lot of money saved from smoking cessation. It is estimated that someone who smokes one pack a day spends about $3,500 a year on cigarettes. Also, I reminded her of the cost savings from activities such as less laundry and carpet cleaning (Benefits of quitting smoking, 2006).

Evaluation Results

After the patient’s physical exam, assessment, smoking cessation teaching session, and counseling, she stated that she was not going to quit smoking and that she was not interested in the smoking cessation products or program. Her reasons given for this decision included she felt she would gain weight because of the enhanced taste buds, she felt fine at that moment, and she justified her smoking by stating she had made it to the age that she was even though she smoked. She said she did not see how quitting smoking would do her much good at her age and that she would rather just continue to enjoy smoking, rather than make a life-upsetting change at that point in time.

I reassured her that if she changed her mind, at any time, to give me a call. In addition, I informed the patient that we could reevaluate her health condition and her decision at her next annual physical examination.

Recommendations for future education and reinforcement include follow-up calls throughout the year to the patient to see how she is doing, and possibly speaking with her husband about possibly beginning a smoking cessation program with her. Sometimes it is easier for a person to quit if they are doing it with someone else, particularly the person he or she lives with.

According to Benefits of quitting smoking (2006), quitting smoking is the best decision a smoker can make for their health. This is true regardless of the person’s age or how long he or she has smoked. Moreover, even people who already suffer smoking-related conditions or disease can benefit from smoking cessation.

References

Benefits of quitting smoking. (2006, December 1). Retrieved from NSW Government Health: http://www0.health.nsw.gov.au/factsheets/general/benefits_of_quitting.html

Smoking and your health. (2011, May). Retrieved from BBC Health: http://www.bbc.co.uk/health/physical_health/conditions/smoking_health_effects.shtml

CDC. (2013, February 22). Smoking & Tobacco Use: Quit Smoking Resources. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/resources/index.htm

Mayo Clinic Staff. (2011, January 25). Quit-smoking products: Boost your chance of quitting for good. Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/quit-smoking-products/MY00781/