The Family Nurse Partnership service has revamped its approach to smoking cessation by giving staff extra training and testing kits to improve the support they offer pregnant women. It seems to be working – twice as many are giving up by 36 weeks than were previously. This case study is an example of the work that councils are doing to support young parents.
Smoking remains the biggest modifiable factor for poor health outcomes and a major cause of inequality in child and maternal health. Smoking during pregnancy is a significant risk to a child’s health and development. Smoking rates among first-time pregnant teenagers are particularly high and have been a concern to Dudley’s Family Nurse Partnership service ever since it was launched.
The 10-strong team has always tried to offer some support, prescribing nicotine replacement therapies and offering stop smoking advice.
But FNP Supervisor Ceri Evans said it has always been “rather ad-hoc”. “We only had one carbon monoxide testing kit between 10 of us so there was a limit to what we could do. We knew we wanted to do more and then the local stop smoking services was decommissioned. We knew we had to act.”
Two years ago Dudley Borough Council’s service decided to launch a renewed push on stop smoking through the National Family Nurse Partnership Unit’s ADAPT programme, which is aimed at piloting and testing innovation in services. This led to all members of the team getting extra training in advanced communication skills, teaching mindfulness techniques and online training from the National Centre for Smoking Cessation and Training. Meanwhile, Dudley’s public health team provided funding so every member of the team could have their own carbon monoxide testing kit.
Ceri said: “The training really helped build our confidence at addressing smoking and what to prescribe. We now raise smoking in a number of different ways – we may talk about the home environment, finances, the safety element or the health risks to the development of the baby. You cannot just lecture people on quitting – you need to engage them and find the trigger that’s important to them.
“We have also started using a range of visual prompts including apps and videos and we use silicone foetuses to show how smoking can impact on the baby’s growth and development. Visual aids have a positive impact with this age group.”
Initial results suggest the new approach has been successful. The performance under ADAPT has been compared to what was happening before.
Under ADAPT smoking at intake – the point at which they start getting help from FNP – was 45 per cent, but by 36 weeks of pregnancy it had been reduced to 28 per cent.
By comparison in 2016 the number of smokers at intake was 39 per cent and that only reduced to 31 per cent at 36 weeks. Lessons learned The importance of the mindfulness training has become very apparent as the ADAPT programme has been rolled out. It was given to the team by the Black Country NHS Partnership Trust, which employs the nurses and has mental health expertise.
Ceri said: “This is a client group that uses smoking as a coping mechanism. Many are anxious and stressed with complex lives – the smoking is just the tip of the iceberg – so it is important to teach them another way to deal with it. That is where the mindfulness comes in – we have found ourselves teaching it more and more.”
In fact, it has become so important that it is now one of the most frequently offered interventions by the nurses. Within six months of mindfulness techniques starting to be offered the number of clients being taught it went up from around 20 a month to over 100.
One of those who has benefited is Zoe (not her real name). She said: “I used to smoke as it made me feel calmer especially when mum was kicking off. My nurse taught me how to stay calm when I feel really stressed without having to reach for a fag.”
How is the approach being sustained?
As the work has progressed, there has been a growing recognition of the importance of involving the wider family. There are two reasons for this – the desire for the baby to grow up in a smoke-free household and also the impact on the mother’s habits.
While the evaluation showed smoking rates at 36 weeks had been reduced to 28 per cent, within six weeks of the child’s birth they had climbed by five percentage points.
Ceri said: “We know if there are other smokers in the household – perhaps the partner or grandparents – it increases the likelihood of the mother starting smoking again. So we do look to help the wider family. If they attend the appointments and are also smokers we can measure their carbon monoxide and issue prescriptions to them. It is something we want to do more on in the future.”
Ceri Evans Supervisor, Dudley Family Nurse Partnership