Smoking as a public health issue

Smoking as a public health issue

Smoking appears to be one of the public health issues among those population who has been diagnosed with schizophrenia. I currently work as a mental health nurse practitioner in an outpatient setting. My Phenomenon of Interest is to bring awareness through education on the effectiveness of smoking cessation among adult schizophrenia patients in outpatient .

Step 1: Introduction
A good introduction should be no more than 1 paragraph grabbing the reader’s attention providing insight to the POI and significance to the APN’s role. End with a strong thesis or purpose statement. Note: the thesis should be condensed to 1 brief purpose statement.
Step 2: POI Significance:
Discuss why this POI is significant to your role as an APN. How will it change practice? Why did you select this topic? What expected structural, process OR outcome measures are you hoping to see with instituting a change in practice? To see a more thorough discussion on these measures, review the following information.
AHRQ Structural, Process or Outcome Measures- (Links to an external site.)this link provides an overview of process, structural and outcome measures. Be sure to specify the type of measure you would expect with your implementation of EBP into practice. You must show understanding of the measure itself in your discussion.
Step 3 PICO :
You will include a PICO framework AND the clinical question in this section. Follow these directions as specified.
Outline the PICO framework by listing (do not write in a paragraph format) P-population or patients, I-intervention, C-comparison, and O-outcomes as it relates to your POI. Then develop the clinical question by including all parts of the PICO framework in the question. Be as specific as possible in both the PICO framework development and clinical question and avoid phrases such as: “compared to the standard practice” , or “compared to the current practice” because faculty do not know what the normal practice or standard practice is at your facility.
EXAMPLE: Be sure to include a heading for this section i.e. PICO/Clinical Question.
PICO -center this heading p. 48-49 APA book
P: children in the acute care setting that are between 3 and 18 years of age, not including non-verbal children
I: implementation of non-pharmacologic pain interventions i.e. (art therapy, music, dim lights, etc.).
C: pharmacologic interventions (Tylenol, motrin, narcotics)
O: more effective at reducing pain as measured by decreased pain ratings on approved pain scales, stable vital signs, behavior
Clinical Question: In pediatric patients aged 3 years to 18 years (P) is the implementation of non-pharmacologic pain interventions (I) more effective (O) than pharmacologic interventions (C ) in reducing pain as evidence by: decreased pain ratings, stable vital signs, behavior assessments?
Step 4 Tool Completion:
To provide an overview of the guideline OR position statement use the tool below. You will need to address each question or section of the tool as it applies to the required information; missing information may cause you to lose points. You must submit the completed tool with the assignment. Please attach the completed tool separately to the assignment area. Faculty need to see your analysis of the guideline for full credit.
Evaluation tool for Guideline OR Position statement PDF
Evaluation Tool for Guideline OR Position Statement Word Document
Step 5 Critique of Guideline/Position Statement:
Critique the guideline or position statement by discussing ALL of the following and including appropriate support from your guideline/statement selection:
(1) purpose/aim of the recommendation/postition statement-are they clear, current and relevant to your population?
(2) Recommendations or objectives of the guideline/statement
(3) Who (authors, groups, organizations) developed the guideline/position statement and what biases or funding did they receive? Did the authors, groups or organization have a valued interest in the guideline, why or why not? Remember to consider the author’s role professionally as part of your answer.
(4) Describe if they information is credible and justify your answer. What makes information credible? Is their truth in the data, interventions recommended, or studies used to support recommendations, how do you know?
(5) What levels of evidence were used to support each recommendation statement-look at the studies and resources used to develop the guideline or position statement. What levels of evidence were these resoruces/studies? Are those individual studies/resources of strong or weak on the evidence hierarchy? How do you know and does it influence the overall recommentation or guideline?
(6) Based on the level of evidence used to support the recommendation statements, is the overall quality of that evidence high/low and how does that influence your decision to implement this recommendation or practice guideline into your practice? Fully support with evidence from the literature.
Step 6 Quality Improvement:
Explain how this guideline or position statement would impact uality improvement by addressing 2 of the bioethical principles: justice, autonomy, beneficience, or nonmalficence. Students must demonstrate full understanding of each principle discussed.
Step 7 Conclusion:
Conclude the entire paper by summarizing each section. Do not repeat what you did in the paper, but summarize the findings. Never include new findings in the conclusion.
Step 8 Guideline/Position Statement Link or Attachment:
Include a direct and working link to the guideline or Position Statement. after the conclusion. Option: If you are having difficulty providing a direct link, you may provide a hard copy of the full guideline or position statement as an attachment or merged to the paper after the resources. Faculty must be able to have full and direct access to your guideline or position statement to determine if you selected and analyzed accordingly on your tool to receive full credit. See format example below:
Guideline/Position Statement Link – center this heading p. 48-49 in the APA book
OR use the following info.:
Guideline/Position Statement Link – center this heading p. 48-49 in the APA book
See guideline/position statement submitted with paper or merged to the paper



Evidence-based Practices
Evidence-based Practices
Smoking among individuals diagnosed with schizophrenia poses serious health concerns, including smoking-related difficulties, cardiovascular complications, and premature deaths, considering their less likelihood of smoking cessation. Approximately 65 percent of schizophrenia populations engage in smoking than the general population individuals diagnosed with other psychiatric disorders (Lum, Skelton, Wynne & Bonevski, 2018). Smokers diagnosed with schizophrenia are likely to die prematurely 20 years less than the general population. Despite the efforts undertaken in promoting self-medication for outpatient schizophrenia patients, the considerable deterioration in the health of individuals points to the need for establishing the efficacy of education and awareness. As a mental health practitioner, it is critical to develop and enhance appropriate strategies to promote healthy living in creating awareness through education in enhancing smoking cessation among schizophrenia outpatients (Smith et al., 2019).
POI Significance
Mental health practitioners play a critical role in the diagnosis while promoting the adoption of behavioral therapy in reducing the vulnerability of mentally ill patients. The mental health practitioners undertake a proactive approach towards advancing pharmacological and psychological treatment for patients with diverse underlying mental health illnesses and diseases. Across the world, schizophrenic patients often indulge in tobacco smoking, necessitating mental health practitioners to evaluate, assess, and develop awareness programs to promote smoking cessation among the outpatients. The increase in the smoking patterns among schizophrenic outpatients heightens the need for promoting the cognizance among schizophrenia patients in promoting positive health outcomes. Through an individualized assessment of the patient’s risk factors, mental health practitioners promote facilitators to smoking cessation through behavioral interventions (Lum et al. 2018). While considering the diversity of factors that impact schizophrenia patients and the ease of accessing tobacco, mental health practitioners undertake to promote self-determination and independence of outpatients to reduce their risk of mortality.
Many schizophrenic outpatients are reported with diverse medical conditions, further increasing their risk of premature deaths. As a mental health nurse and practitioner, it is critical to enlighten the outpatients on the benefits of avoiding smoking in living normal healthy lives. While the structural measures will include the collaboration between the mental health practitioner and families in promoting social support, the process outcomes will involve continuous visits and determination of progress towards smoking cessation among schizophrenic patients. The implementation of change will involve the promotion of knowledge relating to the risks of smoking over a given period while encouraging self-reported adherence among the outpatients.
Besides, the initiation of vigorous programs would endeavor to inform patients on the underlying risks associated with smoking despite the underlying notion of self-medication and therapy (Gogos et al., 2019). For instance, it would be critical to promote psychosocial therapies, including motivational interviewing, interventions incorporating educational sessions within their communities, and social support for reducing the impacts of the withdrawal symptoms arising from smoking cessation. Thus, the outcome measures will determine the number of self-reported adherence among schizophrenic patients undertaking effective self-adherence directives and cases of hospital readmission due to smoking-related complications.

P: Schizophrenic smoking adults
I: Implementing education and awareness through education on the effectiveness of smoking cessation among adult schizophrenia patients, including educational programs and self-reporting on adherence.
C: Compared to the schizophrenic persons who continue to smoke and receive pharmacotherapy treatment and medications.
O: effectiveness, adequacy, and timeliness in preventing and detecting depression through screening of the patients, involvement of family members, and psychoeducation
Clinical Question: In schizophrenic smoking adults (P), is the implementation of awareness through education on the effectiveness of smoking cessation among adult schizophrenia patients in outpatient (I) more effective (O) compared to the schizophrenic persons who continue to smoke and receive pharmacotherapy treatment and medications?
Critique of Guideline/Position Statement:
The position statement ‘Exploring mental health professionals’ practice concerning smoke-free policy within a mental health trust was utilized to provide an insight on the awareness through education on the effectiveness of smoking cessation among adult schizophrenia patients in outpatient. The guideline provided an opportunity to determine how best the mental health practitioners would impact smoking cessation among schizophrenia patients. The authors provided a straightforward approach in determining evidence-based practice to reduce the prevalence of schizophrenia smokers with a focus on adult smokers. The recommendations generally focused on developing awareness among mental health practitioners to boost the positive prospects of achieving reduced rates of smoking-related conditions among schizophrenia patients (Smith, McNeill, Kock & Shahab, 2019). The clinical guideline focused on enhancing the mental health professional practice and experience in developing programs and policies as part of the mental health sensitization for workers in outpatient settings.
The study’s recommendations point to the need to improve the psychological capacity of mental health workers in promoting resilience among schizophrenia adult patients through the guideline. The recommendation enhances the clarity in the role of mental health practitioners while providing a basis for the determination of appropriate standard practices for schizophrenic adult smokers. Additionally, the guideline highlights the need to reduce the environmental and social facilitators that could improve the accessibility of cigarettes and tobacco for schizophrenia patients. While confirming the underlying ideology involving smoking in alleviating the schizophrenic patient conditions, the authors point to the negative implications of raising awareness and appropriate education among schizophrenia smokers in reducing their indulgence in alcohol consumption (Smith, McNeill, Kock & Shahab, 2019). Besides, the authors evaluate the role of mental health practitioners in the initiation and adherence to a smoke-free policy in advancing positive health outcomes among schizophrenic smokers.
Elsewhere, the authors provide credible information appertaining to their practice by involving different groups of mental health practitioners from healthcare institutions obtained from purposive sampling in validating the research findings. The thematic data analysis through the predefined codes for assessing the perception and best practices for achieving positive education and awareness in smoking policy adherence focused on developing evidence-based practice to advance mental health practice. The researchers recognized the need to undertake mental health training regarding smoking-free policies, which increased their ability to encourage commitment among schizophrenic adult individuals to cease their smoking behavior (Smith, McNeill, Kock & Shahab, 2019). In supporting the findings, the study appreciates other literature and research findings in authenticating their thematic assertions and, consequently, the recommendations. The decision to utilize the guideline was to form a basis for crediting the quality of evidence highlighted in the recommendations. Indeed, the position statement appreciates its limitations, including the failure to include varied mental health practitioners and the potential for failing to incorporate the views of different practitioners within the mental healthcare outpatient settings.
Further, the researchers draw from varied theoretical underpinnings that provide the basis for justifying the role of training the mental health nurses in providing awareness and education for schizophrenia smokers. The evidence exemplifies the need to improve the training for mental health nurses as an approach to increasing their knowledge in providing education for schizophrenia smoking patients. The clinical guideline recommendations are moderate as they affirm the role of mental health practitioners in providing education for schizophrenia patients within the outpatient settings (Smith et al., 2019). With the recognition of the diverse social and environmental factors that play a critical role in promoting smoking among schizophrenia adults, the research tends to overlook the basis for customized education to promote adherence to the smoking-free policy. In general, the article is explicit in the role of mental healthcare workers in promoting positive health outcomes among schizophrenia individuals.

Quality improvement
As a mental health practitioner, the guideline would provide an opportunity for developing educational and awareness programs critical for enhancing smoking cessation among schizophrenia adults. The recommendations enhance a critical understanding and development of effective educational materials and policy implementations to improve outpatient outcomes. Indeed, the guideline would address the bioethical principles of autonomy and beneficence throughout the education of schizophrenia smokers. According to Bester (2020), beneficence involves the role of mental health nurses and practitioners in promoting the overall good of the patients. The guideline provides a basis for developing a positive outcome for schizophrenia patients.
The recommendations provide an improved approach towards advancing positive health outcomes for schizophrenia smokers through the beneficence ethical perspective. The beneficence principle would attempt to reduce the overall harm posed by smoking, thereby focusing on managing their conditions. Additionally, the guideline would promote the bioethical principle of autonomy of the patient. The bioethical principle of autonomy highlights the need for patients to make their decisions regarding treatment outcomes (Greaney & O’Mathúna, 2017). Patients are responsible for being involved throughout the care process, heightening the need for implementing the position statement and guidelines within the mental outpatient care settings. Since the guideline will involve providing education to schizophrenia adult smokers within the outpatient settings, the position statement would offer a chance for patients to exercise control over their conditions as opposed to the inpatient setting in which they would be required to adhere to customized pharmacotherapies designed by mental healthcare practitioners and nurses.
The efficacy of implementing education and awareness programs for schizophrenia adult smoking individuals depends on mental health practitioners’ ability to evaluate the diverse needs of the population effectively. While considering the increasing numbers of schizophrenia smoking adults, it is critical to developing suitable standards for enhancing smoking cessation through increasing their cognizance of the underlying problems and need for self-adherence to the educational programs. The effectiveness of the results would depend on the comparison between the number of schizophrenia smokers compared to those who did not receive the intervention. The guideline shows that most schizophrenia patients would enhance improvement as the intervention would endeavor to improve their health outcomes. The customized and periodic educational programs with the assistance of mental health nurses in outpatient settings would endeavor to develop a smoking cessation approach. Besides, the guideline will improve self-adherence with the educational programs for schizophrenia patients. The guideline would endeavor to develop the capacity of the schizophrenia smoking adults to make informed decisions regarding smoking cessation. The guideline provides an evidence-based practice approach for mental health nurses and practitioners in addressing the underlying needs of schizophrenia smokers within the outpatient settings.

Bester, J. C. (2020). Beneficence, interests, and wellbeing in medicine: What it means to benefit patients. The American Journal of Bioethics, 20(3), 53-62.
Gogos, A., Skokou, M., Ferentinou, E., & Gourzis, P. (2019). Nicotine consumption during the prodromal phase of schizophrenia – a review of the literature. Neuropsychiatric Disease and Treatment, 15, 2943-2958.
Greaney, A. M., & O’Mathúna, D. P. (2017). Patient autonomy in nursing and healthcare contexts. In Key concepts and issues in nursing ethics (pp. 83-99). Springer, Cham.
Lum, A., Skelton, E., Wynne, O., & Bonevski, B. (2018). A systematic review of psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. Frontiers in Psychiatry, 9.
Smith, C. A., McNeill, A., Kock, L., & Shahab, L. (2019). Exploring mental health professionals’ practice in relation to smoke-free policy within a mental health trust: A qualitative study using the COM-B model of behaviour. BMC Psychiatry, 19(1).

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