2 Day TrainingDVD – Good initial consultation
Sarah introduction-
“This training video will show a good example of an initial stop smoking consultation with a client that wants to stop smoking. You do not need to follow the consultation word for word, they are just demonstrations of the areas that need to be covered and how you could fit this into your consultation with your clients. The following scenario also demonstrates the techniques of summarising and reflective listening that you have been learning about in the training. These techniques are vital in building rapport with your client.”
“This initial consultation prepares the client for their quit and should aim to enhance motivation and boost self confidence throughout.”
“All of the resources you need to complete the initial consultation are in an advisor pack, which you will receive once you have completed the training programme and are a fully qualified stop smoking advisor.”
“Using your clinical checklist you can see the areas that should be covered in this initial consultation.”
Good initial consultation
Vicky – Hello, I’m Vicky, your Stop Smoking Advisor. Thank you for coming to see us today. Can I take your name?
Sarah – Mary.
Vicky – Right, Mary, can I just check that you want to stop smoking altogether?
Sarah – Yes, I’ve tried to quit by myself lots of times but never managed it. I really want to quit this time.
Vicky – That’s great, wanting to quit is really important. Are you able to attend this drop-in every week for 4 weeks then every second week after that?
Sarah – Yes that’s fine, I only live local.
Vicky – Great because getting support is really important. Shortly I will get you to decide on a quit date and to assist your quit we recommend to everyone that they stick to the “not a puff rule”. This would involve you sticking a promise that following your quit date you won’t have a single puff of a cigarette. This is really important and has been shown to very effective to helping people quit. Do you agree to stick to this “not a puff” rule?
Sarah – Yes I will, if it works that would be great. I’ll do whatever it takes to stay quit.
Vicky - Can I ask Mary where did you hear about us?
Sarah – I keep walking passed and have seen the banner outside several times so I eventually thought I’d come in and try it.
Vicky – So you haven’t seen anyone from the stop smoking service before?
Sarah – No, like I said I’ve tried myself but it’s never lasted more than a few days.
Vicky – Ok, support from us means you are much more likely to successfully quit smoking and each time you try you learn something new don’t you. So it’s good that you’ve tried before. Have you used any medication to help you with a quit attempt in the past?
Sarah – Yes I used patches but only for a day.
Vicky - Right, well we can discuss the medication that’s available to you in a moment. I just need to do an initial assessment which involves a few questions, is it ok if we do these questions now Mary?
Sarah – Yes that’s fine.
Vicky – How many cigarettes do you smoke each day?
Sarah – Normally 20-25, if I go out it can go up to 30 or so.
Vicky – How long after waking do you have your first cigarette of the day?
Sarah – I have one as soon as I get up, I have to!
Vicky - Do you smoke more frequently in the first hours after waking than you do during the rest of the day?
Sarah – No they’re quite spread out really. I have quite a few when I first wake up but then smoke throughout the day.
Vicky – Ok, so the first cigarettes in the morning sounds quite important to you to have, which cigarette is going to be hardest to give up?
Sarah – Definitely first in the morning but also after meals, I like that one it finishes off the meal, and with alcohol when I go out I smoke loads more.
Vicky – So why do you want to stop smoking Mary?
Sarah – For my health really, and the money of course. I just don’t enjoy it anymore, not like I used to – so it’s time to stop smoking.
Vicky – This shows some of the benefits to health from quitting smoking (give Mary the benefits of quitting sheet).You’ve tried to quit before haven’t you, just by yourself?
Sarah – Yes that’s right, what a disaster!
Vicky – What made you start smoking again, why was it a disaster?
Sarah – Oh, I did a few days but then I couldn’t take it anymore, so I just had to have one. Then one turned in to another and it went back up to 20 the next day.
Vicky – Right, so you’ve seen for yourself how just even a puff can lead you back to smoking. That’s why we recommend to everyone to stick to a “not a puff” rule. So along with the not a puff rule what else are you planning to do to help yourself quit this time?
Sarah – I don’t know really it’s hard isn’t it!
Vicky – It is hard at first. Well some other clients that I’ve seen have taken up hobbies to fill the time, make sure they have something to occupy them like books, magazines, going for a walk, sipping on water, lollypops or mints, which can be good to distract you when you’re out and about. Any of those ideas sound any good to you?
Sarah – I like to read so I could get some new books and I could get some mints as well.
Vicky - Great because having a plan of what you’ll do when you crave or when you’d normally have a cigarette is really important. If you’d like to, you could use this quit plan to assist you in making this plan.
Sarah - Ok, I’ll do that tonight.
Vicky – Which situations are you going to find it most difficult not to smoke in?
Sarah – With alcohol definitely, but also when I’m stressed. I always have a cigarette when I’m stressed.
Vicky – Right, making small changes to your normal routine can help you cope with situations you would normally smoke in and establish new patterns in your day without cigarettes. Can you think of other ways to deal with stress and what you could do on a night out when you’d normally smoke?
Sarah – I could reduce my drinking for a while, just whilst I get used to it! When I’m stressed I could go for a walk, I’ve been meaning to do some more exercise.
Vicky – Those are great ideas! So you’re going to reduce the amount of alcohol you drink for a while and when you’re stressed you are going to take yourself away from the situation by going for a walk. And it will increase your exercise too, that all sounds great. You said earlier that you don’t really enjoy smoking anymore, is there anything you do enjoy about smoking?
Sarah – No not really, I think it’s just habit now.
Vicky – Right, like you said with alcohol when you’re stressed and first thing in the morning
Sarah - Yeah that’s right, I don’t enjoy it; it’s just something I do.
Vicky – So like we’ve said it’s really important that you have a plan of what you’ll do at these times – otherwise it creeps back in, like you experienced before.
Sarah – Yes that’s what happened last time.
Vicky - So, when you decide on your quit date remember to keep to the not a puff a rule. On a scale of 1-10, where 1 is not at all confident and 10 is very confident, how confident are you, about stopping smoking?
Sarah – Urmm, about 6.
Vicky – What could bring you higher than a 6?
Sarah – Doing more than a few days.
Vicky – Ok. On a scale of 1-10, where 1 is not at all important and 10 is very important, how important is it for you to stop smoking?
Sarah – 10 it’s very important.
Vicky - On a scale of 1-10, where 1 is not at all ready and 10 is very ready, how ready do you feel you are to stop smoking?
Sarah – Ready, urmm 9.
Vicky – Ok, great that sounds like you’re really ready to quit. Have you ever had your carbon monoxide reading taken before?
Sarah - No what’s that?
Vicky - Carbon monoxide is a poisonous gas that is inhaled by smokers each time they smoke a cigarette, and it causes heart disease. The good news is that once you quit within 24-48 hours the level of carbon monoxide returns to that of a non-smoker, so you get the benefits of that really quickly. We would expect a non-smoker to score below 10. This is the monitor that will measure the carbon monoxide from a short breath test, this is a disposable tube. In a moment I am going to ask you take a deep breath in and hold it for 15 seconds, after the 15 seconds the machine will bleep 3 times, after the 3rd bleep I need you to put your mouth right round the tube and exhale as much as you can down the tube, trying to empty your lungs completely. Is that ok?
Sarah – Yeah, ok.
(Do CO breath test). Get client to take off tube and then wipe over the machine with an alcohol free wipe.
Vicky – Mary your reading is 25, we would expect that as you are a smoker and next time you come to see us it will be lovely and low after you have quit smoking, so you’ll get a reading of below 10 next week.
Sarah - I’ll look forward to that then!
Vicky – (Give Mary the withdrawal symptoms sheet). Here are the withdrawal symptoms most people experience when they quit smoking, because they are withdrawing from nicotine the addictive part of cigarettes. These withdrawal symptoms are normally worse in the first 4 weeks of quit, which is why it’s important you come back for support. Can you recognise any from your previous quit attempt?
Sarah – Yes I craved and was very irritable.
Vicky – If you can distract yourself a craving only lasts for on average between 3 to 5 minutes. So if you can find something, like you said you could do reading, when you get a craving it will pass. Also, we can give you medication to help ease the withdrawal symptoms but it is important to remember that most of the withdrawal symptoms gradually disappear in the first 4 weeks as long as you don’t have a single puff.
Sarah – Right, we’ll I’d like to use patches again but I would like to try something with them this time.
Vicky – Nicotine Replacement Therapy, like the patches, works by reducing the urges to smoke and other withdrawal symptoms, so making stopping smoking a bit more manageable. It’s not a magic cure – but it will help. There are 7 different NRT products to choose from and all are effective in helping people quit. There are patches, which you’ve already tried, nasal spray, lozenge, gum, inhalator, microtab and mouth spray. They all differ in the amount of nicotine they contain, how it’s delivered and how quickly it acts. If I show you each of the products and how to use them, then you can decide which product you’d like to use alongside the patches.
Sarah – Ok.
Vicky – (show each item) The nasal spray –Remove the protective cap. Get a nice fine spray firstby placing the nozzle between first and second finger with the thumb on the bottom of the bottle. Press several times firmly and quickly until a fine spray appears (up to 7-8 strokes). Point the spray away from you when priming it. Then insert the spray tip into one nostril, pointing the top towards the back of the nose. Press firmly and quickly don’t sniff as you spray it up your nose. You can use the spray up to 64 sprays a day, once an hour up each nostril.
The lozenge – comes in original size 1mg, 2mg or 4mg and also mini lozenge in 1.5 or4mg in mint or cherry. One lozenge should be placed in the mouth and allowed to dissolve. Every now and again, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved. You should not chew or swallow the lozenge. You should not eat or drink while a lozenge is in the mouth. Most smokers require 8 to 12 lozenges per day, no more than 15 lozenges a day.
The gum – comes in 2mg and 4mg mint, fruit, liquorice or original. One piece of gum should be chewed until the taste becomes strong. The chewing gum should be rested between the gum and cheek. When the taste fades, chewing should commence again. So don’t just continuously chew. The chewing routine should be repeated for 30 minutes. Normally people use 8 to 12 pieces of gum a day, with a maximum of 15 pieces a day.
The inhalator – line up the little white markers to open the mouthpiece and place a cartridge inside, press together to break the two foil ends and inhale. Each cartridge lasts for about 20 minutes continuous use. Maximum of 12 cartridges per day. You do need to use it quite a lot to get the right level of nicotine, so don’t feel you are over using it. The cartridges will evaporate eventually so replace them throughout the day. Some people like the inhalator because you still have the hand to mouth movement and it’s something you can use to keep you hands busy.
The Microtab – Comes in 2mg strength and in lemon or original. The microtabs are small are placed under the tongue until they dissolve. They don’t dissolve quickly though it can take up to 20 minutes. Like the lozenge don’t chew or swallow them. You can use up to 40 of them a day.
The mouth spray - When using the mouthspray for the first time or if you have not used the spray for 2 days, you must first prime the spray pump. To prime the spray point the spray safely away from you and any other adults, children or pets that are near you. Press the top of the mouthspray with your index finger 3 times until a fine spray appears.After priming, point the spray nozzle as close to the open mouth as possible. Press the top of the dispenser and release one spray into your mouth, avoiding the lips. Do not inhale while spraying to avoid getting spray down your throat. For best results, do not swallow for a few seconds after spraying.
Do any of these products sound like something you would like to use?
Sarah – I think the inhalator might be good. Keep my hands busy and it’ll be something to do won’t it.
Vicky – Right, so you want to go with the patches and inhalator?
Sarah – Yes that’s what I want to use.
Vicky – Are you ok with how to use the patch?
Sarah – It’s been a while, I remember it itching at first and it left a red mark.
Vicky – A little bit of redness is normal, so is the itching for a short while. If it becomes like a red blister, red and raised, this is a reaction to the glue in the plaster, if this happens take it off and leave it off. As you’ve used them before you should be ok. Put one patch on first thing in the morning, some people wake up a bit earlier to put one on and then go back to sleep whilst it gets to work. It takes about 20 minutes for the nicotine from a patch to get into your system. Hold the patch down for about 20 seconds to fix to your skin. You can put them anywhere, tops of your arms, back, bum. Most people go for the arms because it’s easiest to reach. Each day make sure you put it in slightly different position to avoid the area getting sore. These are 24hour patches so you can leave them on overnight.
Sarah- My friend had really weird dreams when she wore the patch overnight.
Vicky – Some people get quite strange, vivid dreams with or without the patch, it could just be from giving up smoking. So if want to see how you get on, if you feel it is effecting your sleep take it off before bed and put one on the next day as soon as possible.
Sarah – Can I go in the bath with a patch on?
Vicky – They are meant to be waterproof but sometimes they do come off. You can use micropore tape around the edges if you notice them falling off. Avoid moisturising where you are going to put the patch, to help keep it on. And keep scissors handy for opening them, you need scissors to cut the wrapper open; don’t get stressed looking for scissors, get them prepared and ready! Does that sound ok?
Sarah – Yes that’s fine. I wouldn’t have thought about the scissors!
Vicky – Right, make sure you take your inhalator with you wherever you go and keep a supply handy, and keep a patch in your purse in case one falls off.
So, you’ve got a plan of what you’ll do in difficult situations and when you crave, you’ve chosen your medication and know how to use it, all you need to do now is set a quit date. When would you like to set your quit date for? This is the date when you’ve got everything ready, you will start using your patches and inhalator and will stick to the not a puff rule.
Sarah – I had wanted to do it today, but I can see I need to get a few things ready first. So I think next Tuesday will be best, give me chance to get stuff ready and buy some more books.