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- #3 - Assess
- The Five R's
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HCET Home > On-line Training > Prenatal Smoking Cessation > The 5 A's; Ask, Advise, Assess, Assist, Arrange
#3 - Assess
To be able to assist a client with smoking cessation you need to be able to assess your client's willingness to commit to this change. Here is a flow chart to help you determine where your client stands.| Does the client currently use tobacco products?
Yes or No |
No: Has the
client used tobacco products in the past?
Yes or No |
No: No intervention is required for this
client. Please encourage continued abstinence. |
| Yes: Assist with client's tobacco cessation maintenance in an attempt to prevent relapse. | ||
|
|
||
| Yes: Is the
client willing to quit at this time?
Yes or No |
No: Provide motivational materials to the client being sure to utilize the five R's model (see below). | |
| Yes: Provide appropriate tobacco cessation techniques using the five A's as a counseling tool. |
Implementation: Ask every tobacco user if she is willing to make a cessation attempt at this time.
Some areas to address if the client is considering quitting.
As the Health Care Provider:
- Praise her for her readiness to quit smoking
- Help her set goals to maintain a smoke free lifestyle
- Discuss an action plan to assist her in smoking cessation
- Inquire about her support network
- Respond to her specific concerns about quitting smoking
Possible Goals:
To not have a cigarette before work Not to smoke in the car Not to smoke indoors To make it through today without smoking To go to the bar with friends and not smoke
Cessation Plans or Strategies:
Tapering (cutting) down (1 less cigarette today, 2 less tomorrow, etc.) Cold turkey Nicotine fading Possibly a pharmacological method to assist with cessation
Possible Support Persons:
Close Friends Family Co-workers
Specific Concerns:
Stress - help her develop ways to manage stress
(deep breathing exercises) Weight gain - women need to gain weight during pregnancy so this
may be a good time to quit Withdrawal symptoms - not all smokers have withdrawal symptoms (signs of recovery) and, those who do, find that they will lessen over time.
The Five R's
Implementation: Ask every tobacco user if she is willing to make a cessation attempt at this time. If the client is not willing to quit at this time, then implement the Five R's to motivate your client and let her know that you are available to help when she is ready.
- Shortness of breath
- Exacerbation of asthma
- Harm to pregnancy
- Infertility
- Increased serum carbon monoxide
- Heart attacks and strokes
- Lung and other forms of cancers
- Chronic obstructive pulmonary diseases
- Long-term disability
- Increased risk of lung and other cancers
- Heart disease
- Higher rates of smoking among children of smokers
- Increased risk of low birth weight infants
- Increased risk for SIDS
- Asthma
- Middle ear disease
- Increased respiratory infections
- Withdrawal symptoms
- Fear of failure
- Weight gain
- Lack of support
- Depression
- Enjoyment of tobacco products
- Improved health
- Food will taste and smell better
- Save money
- Improved self-esteem
- Set a good example for her children
- Have healthier children
- Improved physical health
- Increased performance in physical activity
- Reduce premature aging
Relevance
Encourage the client to indicate why she does not wish to quit at this time, ask
her to be as specific as possible. This will assist you in finding motivational materials to supply your client that are relevant to
her needs. Motivational information and pamphlets have the greatest impact if they are relevant to a
client's needs, beliefs, social situation, age, gender, and family situation.
Risks
As a health care provider ask your client if she understands the negative health consequences of smoking and the potential dangers to
her unborn child. Be sure to emphasize that smoking low tar/low nicotine cigarettes or use of other forms of tobacco products will not eliminate the health consequences to
her nor to her unborn child.
Acute risks:
Rewards
Identify some possible benefits of a smoke-free life style with your client. Make sure to emphasize those benefits that are most relevant to your client using the list created with your client during the Relevance stage (R-1).
Roadblocks
As a health care provider ask the client to identify some possible roadblocks or barriers to quitting smoking that are preventing
her from attempting to quit at this time.
RepetitionThe motivational interventions should be repeated every time an unmotivated client is seen in the office during her pregnancy and then during regular office visits for non-pregnant clients. Remind clients who have relapsed after past attempts to quit that many people will relapse in the process of quitting smoking, but that temporary relapse should not prevent them from trying again.
Supplemental Handout Materials in PDF
- I Want to Quit Smoking Again
- Top 10 Reasons Why I Will Not Smoke Today
- Assessing Stages of Readiness to Change
- First Time Quitters
- Responses to Patients Common Questions and Concerns
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