Scenarios

Chapter 5: Smoking

Jo, aged 35, visits her GP complaining of breathlessness. She is bringing up three young children alone and she is living on income support in a third floor flat in local authority housing. Jo admits to smoking 30 cigarettes a day and she has a history of high blood pressure. One of Jo's children is asthmatic. Jo's GP advises her to give up smoking and suggests that she joins a smoking cessation group run by the practice nurse. She appears to listen to the GP's advice and agrees that she must think seriously about her lifestyle. After the first group session, the practice nurse informs the GP that Jo did not attend.

Two weeks later, Jo takes her youngest child to the GP surgery because he has a chest infection. The GP asks if Jo has managed to cut down on her smoking. Jo laughs and states:

"Well, it's all very well from where you're sitting. Look, if I come up on the lottery, perhaps I'll take myself off to a health farm and get myself sorted. But, in the meantime, I reckon I'll just have to take my chances!"

• 1. Why might Jo be reluctant to attend a smoking cessation group?

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  Correct answer:
  Cessation groups do not suit everyone and may be difficult to attend. Of all smokers – 46% try to quit – of these, 8% use NHS support, 15% use medication over the counter and 23% quit without the use of a stop smoking medication. Withdrawal from nicotine can also be unpleasant and can put off a person from persisting.

• 2. What support could the practice nurse offer?

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  Correct answer:
  The 3 As advocate three easy steps that are easy to remember: ASK and record smoking status; ADVISE with positive messages about the benefits of quitting; ACT by building confidence, giving information, and prescribing NRT if wanted.

• 3. How would you feel about Jo continuing to smoke?

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  Correct Answer:
  If someone is not ready to stop, then it is best to simply let them know that support is available when they want it – do not try to persuade them as this will only result in resistance. Seeing someone persist with unhealthy behaviours, especially if they are already unwell, can be frustrating and seem irrational but behaviours such as smoking are hard to change. What you say can nudge someone to think about change but how you say it can make the difference.