Tiffany Williams
Part 1: Assessment
My problem that I would like to change is smoking. When I’m stressed, I smoke. I don’t consider
myself a smoker but during stressful moments in my life I tend to smoke 3 or 4 cigarettes a day. If I am
stressed for a week, that can add up to about 21-28 cigarettes that week. I feel the bulk of my stress
comes from a particular interpersonal relationship. When I am angered, upset, or disappointed I smoke.
At the moment, I feel that smoking helps me because; it distracts me from the situation. But, smoking
affects my body physically. When I smoke, I get really bad headaches that can last for hours. It also
causes me to cough a lot while smoking. This habit is hard to break because honestly I enjoy it. I
understand that smoking is an extremely bad habit that can affect my lungs and my heart. This is not a
habit I want to continue. Instead of smoking, I would like to incorporate more exercise when stressed.
Exercise is a great stress reliever and it will help me lose weight as well. I would like to start exercising 3
or 4 days a week and sometimes more when I’m stressed.
Part 1: Change Theory
The change theory I chose was innovation-decision process because it is useful for individual
change. This process involves five stages. Knowledge is the first stage, which occurs when an individual
acknowledges a behavior he/she would like to change. The second stage is persuasion. Persuasion is
aimed and changing an individual’s attitude/feelings towards this behavior change. The third stage is
decision, which is the process in which an individual chooses to make a change. Rogers explains that
decisions to not accept the new idea may occur at any stage, but it can promote acceptance by
providing information about benefits and disadvantages and encouragement. Implementation is the
fourth stage, which is when the change agent is put into action. The last stage is confirmation.
Confirmation occurs when an individual recognizes the benefits of the change agent, incorporates the
change into an ongoing routine, and is supported by others.
I thought that smoking helped my stressed but according to an article I found, I was mistaken.
The article is called “The effect of stopping smoking on perceived stress levels.” This articles states that,
smoking can in fact act as a stressor, by periods of withdrawal discomfort arising during each cigarette
interval, or due to some other neurotoxic effects of tobacco use. (Hajek p 1467) According to this view,
the perception of a calming effect of smoking is a misattributed withdrawal relief. Smoking may be
providing stress relief acutely, while generating stress across a longer time-period.
Another article called “Yoga as a Complementary Treatment for Smoking Cessation in Women.” This
article suggests that the practice of yoga reduces alleged stress and negative affect. Exercise is initially
proposed as a therapy for smoking cessation among women because it may help offset weight gain and
concerns regarding weight gain. Yoga is an alternative to traditional aerobic exercise that may have
promise as an equivalent treatment for smoking cessation. Yoga contains a number of components that
contribute to stress reduction such as asana and pranayama. Asana is a variety of yoga postures that
have been shown to improve mood and well-being. Pranayama is breathing exercises that involve
regulation of breath and conscious deep breathing that stimulates pulmonary stretch receptors similar
to the deep inhalations associated with smoking. Studies consistently prove that smokers who engage in
a session of physical activity report decreased craving and withdrawal symptoms during and for at least
20 min post activity. A 15-min brisk walk has also been shown to reduce cravings in response to a
smoking cue following brief smoking abstinence.
I have acknowledged my change agent. While doing this research, it has changed my feelings
about smoking, and I have decided to make a change. I know that smoking cessation and more exercise
will improve my physical health, as well as my mental health. I feel that I am ready to move forward in
making that change for a better me physically, mentally, and emotionally.
Part 2: Nursing Diagnosis
After reevaluating my smoking habits and assessing my signs and symptoms of smoking I
developed 3 top nursing diagnoses. My top priority is impaired gas exchange r/t alveolar-capillary
membrane changes AEB smoking. I chose this nursing diagnosis because smoking cigarettes have
carcinogens that cause a filmy buildup on the inside of the lungs, that can break down the cells of the
lungs causing poor gas exchange and causes me to cough and have SOB. My second priority is ineffective
airway clearance r/t increased mucus AEB smoking. Smoking affects the cilia in the airway. Smoking
causes slower movement and shorter length of cilia. Smoking causes the body to produce more mucus
and the damaged cilia can't keep up with clearing away the mucus from the airways. My last nursing
diagnosis is risk for infection r/t tissue damage AEB increased exposure to carcinogens. Smoking causes
structural changes in the respiratory tract and causes a decrease in the immune system making the body
more susceptible to getting infections.
Part 3: Plan (Desired Outcomes)
In order to make this change, I have developed a few outcomes that I would like to implement in
my life to help me stop smoking. I will decrease smoking 3-4 cigarettes a day to only 1 cigarette, within
the next 3 weeks. To stop smoking cold turkey is very hard, but I can limit myself to only smoking 1
cigarette instead of 3 or 4. This decreases my exposure to those carcinogens that increases mucus
production and damaged my respiratory tract. I will drink at least 1 liter of water a day within the next 3
weeks. Drinking water will thin out the mucous that has accumulated in my respiratory tract due to
smoking. I will increase my physical activity to 4 days a week within the next 3 weeks. Increasing
physical activity helps to release built up stress on the body. Exercising is a better and healthier way to
release stress. Not only will it help me feel better but it will help me lose weight. Exercising will also help
me build up my immune system that has been decreased.
Part 4: Interventions
With thorough research, I found several smoking cessation benefits. According to Dr. Bowman,
WebMD Editor, after 20 minutes of smoking cessation, blood pressure and pulse decrease, and the
temperature of your hands and feet increase. After eight hours of smoking cessation, the carbon
monoxide level in your blood returns to normal, and Oxygen levels in your blood increase. After 24
hours, the chance of heart attack decreases. After 72 hours, the bronchial tubes (airways) relax. After
two weeks to three months, circulation improves. After one to nine months of smoking cilia in the lungs
regrow, increasing the lung's capacity to handle mucus, clean itself, and reduce infection.
My nursing interventions for my outcomes are, to teach/educate the importance of not
smoking. Join a smoking cessation program and that encourages clients who relapse to keep trying to
quit. Smoking cessation lowers the risk for lung and other types of cancer. It reduces the risk for
coronary heart disease, stroke, and peripheral vascular disease. Coronary heart disease risk is
substantially reduced within 1 to 2 years of cessation. Smoking cessation reduces respiratory symptoms,
such as coughing, wheezing, and shortness of breath. The rate of decline in lung function is slower
among persons who quit smoking. Smoking cessation also reduces the risk of developing chronic
obstructive pulmonary disease (COPD), one of the leading causes of death in the United States. Another
nursing intervention is to keep a diary on the amount of water I consume. When quitting to smoke,
water eases several of the discomforts associated with nicotine withdrawal, such as constipation,
coughing, hunger or urge to eat, and cravings to smoke. Water also helps flush residual nicotine out of
the body, and by keeping my body hydrated, I will start to feel better overall. My last nursing
intervention is do 30 minutes of aerobic exercise, such as brisk walking, and lifting weights, 3 days a
week on Monday, Wednesday, and Friday. Physical activity can decrease my desire to smoke and can
possibly cause me to quit smoking altogether. Aerobic exercise such as walking will improve the
cardiovascular system and lower the smoker’s danger of cardiovascular disease. Exercise also lowers the
craving for cigarettes and reduces their health vulnerability by a 65% and making it worth keeping in
shape.
I have acknowledged the behavior I want to change. I have persuaded my feeling and attitude
towards my behavior and I have made the decision to change. I believe that these interventions go hand
in hand with the implementation stage of the Innovation-Decision Process Theory. In order to keep
track of my outcomes, I plan to keep a journal of how many cigarettes I smoked and when I went
exercise. I plan to fight the craving of wanted to smoke during stressful times. Buying cigarettes is
expensive. Therefore, I plan to budget a certain amount and not to go over it. I plan to not even buy
them. If I can maintain my goals a week, I will reward myself with a new piece clothing. If I do not meet
my goals for the week, I will extend it for another week until I get back on track. In order to remember
to reward myself, I will put on my calendar when to reward myself.
Part 5: Evaluation and Revision
I thought this change agent was going to be the hardest thing I had to do, but actually it wasn’t
that hard when I put my mind to it and disciplined myself. I relapsed a few times but got back on track.
The first week was by far the hardest. One day I would not smoke at all, but the next day I would smoke
even more than the 3-4 cigarettes. The next week, I FORCED myself to follow my plan. When I felt that
urge to smoke, I would do deep breathing exercises and drink water as I planned. I also found when I
kept myself occupied I didn’t have that urge to smoke. I kept myself occupied by reading or listening to
music, or playing around on the internet. I would go workout at the gym with my colleague some
mornings; at least 3 days out the week. On other days that I didn’t go to the gym I went walking around
the LSU lakes. I have lost 10 pounds from increasing my physical activity. I am also registering for adult
cardio tennis workout classes at City Park in Baton Rouge. This well help me keep up with physical
activity. Another thing that I have done during this time was have a self-evaluation and self-reflection
about myself including my attitude, my interpersonal relationships. My friends have noticed my weight
lost as well as a better attitude. I did not necessarily reward myself every week that I stayed on track
but, I went on a mini shopping spree, as I call it, for Easter. My shopping spree was very rewarding. New
clothes always make me feel good. My 10 pound weight loss made me look good and feel even better in
my new clothes.
As a nurse, first thing to help a patient change a habit or behavior is to educate. Educate the
patient on the advantages, if any, and disadvantages about a particular habit or behavior. I could get
family involved by encouraging the family to reward the patient while at home when they stay on task.
Also, encourage them not to criticize if the patient has a relapse but to help him or her to get back on
track. The last thing someone needs is for loved ones to down or criticize the individual who has
relapsed.
References:
Hajek, P., Taylor, T., & McRobbie, H. (2010). The effect of stopping smoking on perceived stress
levels. Addiction, 105(8), 1466-1471.
Bock, B. C., Fava, J. L., Gaskins, R., Morrow, K. M., Williams, D. M., Jennings, E., & ... Marcus, B. H. (2012).
Yoga as a Complementary Treatment for Smoking Cessation in Women. Journal Of Women's Health
(15409996), 21(2), 240-248.
Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: a review of comparison
studies. Journal Of Alternative & Complementary Medicine, 16(1), 3-12.