Cigarette smoking is an addictive behavior that contributes to the development of disease and subsequent mortality with more than 435,000 deaths attributable to smoking in the United States (U.S.) each year. Adult smoking prevalence in the U.S. is approximately 19.3 percent. This is much higher than 12 percent, a goal established by the Healthy People 2020 initiative, and is a concern when considering smoking related disease and associated health consequences.
Common diseases associated with cigarette smoking include lung cancer, chronic obstructive pulmonary disease, stroke, and coronary heart disease, all of which are associated with increased health care utilization and premature death. Severe exacerbations of these conditions trigger admissions to medical intensive care units. The unexpected disruption of cigarette smoking and nicotine intake in these patients may contribute to additional morbidity. Abrupt elimination of nicotine intake influences the development of nicotine withdrawal symptoms that may complicate recovery and prolong hospital stay.
The utilization of nicotine replacement therapy (NRT) in hospitalized smokers is a practice that decreases acute nicotine withdrawal symptoms, promotes smoking cessation after hospital discharge, and influences a positive recovery. However, many hospitals do not have specific policies regarding the use of NRT in critically ill smokers. Provision of NRT to these patients is often at the discretion of the physician.
The characteristics of smokers admitted to intensive care settings and the use of NRT in this patient population have not been adequately explored. The purpose of this dissertation was to describe smokers admitted to an intensive care setting, explore their development of nicotine withdrawal symptoms (anxiety, agitation, cigarette craving), and examine the relationships of these symptoms to delirium and hospital length of stay. The use of NRT and relationship to symptoms was explored as well. Three manuscripts are presented in this dissertation document.
The assessment and treatment of unpleasant symptoms associated with nicotine withdrawal should be considered routine practice by intensive care nurses. The Theory of Unpleasant Symptoms (TOUS) provides a theoretical model that may facilitate this process. The first manuscript reviews the literature related to the TOUS. Based on this literature review, a preliminary model for unpleasant symptoms of nicotine withdrawal in critically ill smokers is proposed.
The second manuscript reports a description of the research design, study procedures, and results of the present pilot study with implications for future research. Nicotine withdrawal symptoms were evaluated in a sample of smokers admitted to an intensive care setting. Only one participant received NRT; therefore, the effects of NRT on withdrawal symptoms could not be examined. Relationships between influencing factors and symptoms as well as relationships among symptoms of nicotine withdrawal were explored.
The third manuscript reports recruitment outcomes of the present pilot study. Strategies to improve participation of critically ill patients in research are also provided. The critical nature of patients admitted to the intensive care unit, unit characteristics, and medical center policies presented unique challenges to recruitment progress. This manuscript provides suggestions for consideration by researchers who are interested in recruiting critically ill patients for research studies.