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HZ(&C"8A ''; [nF!J!E+DN"  1%'$i  ?,/0Z0 `"/1* " #6:)J/=" ;-!&6H*  &?&#0! .   7% #'  "  $  *   !    #'                                         `Xt^"$      !"#$%&'()*+,./0 27654u ob$uO,CDidiw2$_B>GIfXb$6v~U*033 A(D0%  The URGE to smoke - THREE factors 1. Chemical addiction to the nicotine 2. Force of habit 3. Psychological dependence on the act of smokingF3333|1"6Smoking is an addiction& & . 2 0A highly controlled or compulsive pattern of drug use Psychoactive or mood altering effects, involved in the pattern of drug taking : mood -altering , anxiety reducing and stimulating effects. Drug functioning as a reinforcer to strengthen behaviour and lead to further drug ingestion.xZLZ^ZG >,  %%Key Action Areas for Health Promotion&& The  Ottawa charter - Building healthy public policy, - Creating supportive environments, - Strengthening community action - Assisting the development of personal skills - Re-orienting existing health servicesHBBdStages of Change Prochaska and DiClemente s Model :3 (  ( (,  Processes of ChangeConsciousness-raising (becoming informed) Social liberation (increasing alternatives) Emotional arousal. Self re-evaluation (creating a new image). Commitment. Rewards. Countering (using substitutes) Environmental control. Helping relationships.&Processes of Change:-;.</=0>12!(Summary of evidence on smoking cessation")("Brief InterventionAsk about current smoking status and quit interest. Advise smokers of the benefit of stopping in a personalised and appropriate manner Assess motivation to stop Assist smokers in their quit attempt. Arrange follow up if possible.pP1PPMPPPP P PPf1fMfffg }#BWhat helped smoker to quit ? What hindered smoker from quitting ?$!Helping Relationships and Smokers""(2How do you feel about this person s smoking ? Does their continued smoking affect your attitude or feelings toward them ? Might any of your attitudes towards them, or their smoking be a barrier to you developing a helping relationship with them, If so, what can you do about this ?3&!Helping Relationships and Smokers'Information ExchangeThe health risks of smoking, the effect smoking is currently having on the smoker or his or her family, ideas about how the smoker might go about changing, referral options for specialist support.(Information ExchangeA client-centered approach. Elicit Provide Elicit 1. Elicit readiness and interest. 2. Provide information neutrally 3. Elicit the client s interpretation of the facts providedf8f $f f $ff%Building a Helping Relationship  Helpful Listening Behaviours     " Unhelpful Listening Behaviours :"   4' Helpful Listening Behaviours Good eye contact Appropriate head nodding,smiles, facial expressions,gestures Relaxed body posture Allowing silence Reflecting client s movement Noticing client s body language Verbal prompts  mm  go on Repeating key words Open-ended questions Checking/clarifying Reflecting back Summing up Focusing No physical barriers JbZ33C > $  /Unhelpful Listening Behaviours Fidgeting Looking away from client Physical barriers Looking bored,impatient,hostile On-off listening Patronising Condescending Devaluing Jumping to conclusion Judging Talking too much Filling in silence too quickly Interrupting Too many questions Telling; giving advise <0Z 3 > ? * Obstacles to active listening On-off listening  Open ears- closed mind listening  Glassy-eyed listening  Too deep-for-me listening  Matter-over-mind listening Being  subject-centered instead of  speaker-centered  Fact listening  Pencil listening Z!Reluctance to ChangeBehaviours that are unhealthy often seem beneficial in other ways. People are not easily convinced that smoking is a problem for them personally. It sometimes seems almost impossible to change. 9,Enabling Change? Rolling with resistance Eliciting self-motivating statements7*,The Decisional Balance and Self Re-evalution--(# 8+ Responses`Consequences to self. Consequences to others How I feel about myself How others feel about meaZa5(What precipitates relapse?Coping with emotional distress. Enchancing positive emotional states Giving in to temptations or urges Responding to social pressures$ \6)Relapse preventionAssertiveness skills Anxiety/anger management Networks support Mood changing strategies Changes in routine Recycle Substitutes Z' THANK YOU FOR YOUR ATTENTION$( 8B/P ` fff33` 3KI3ff` 33ff` /p` 3%*3|` Jy3fff3f` 3ff3̙` 33ff33` DDyq3f` ̙3n` w3ff` }ff>?" dd@,?nKd@ P nA@F`d n?" dd@   @@``PR"   @ ` `2p>>K0    Z (      6 #" ``   J* 0     6 #" `` `  J* 0  XT X   "X   N\d#" `P *    6|d#" `U (    S D"UY 6"0    c $"YW 6"0    c $d"YU 6"0    c $( " 6"0    S #" `SV (    S <"Y 6"0    c $"X 6"0    <t #" `  `  T Click to edit Master title style! !$   0 " `p  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S   6 #" `^ `  H*0  H   0޽h ? }ff___PPT10i. 07+D=' = @B +  Pixel  K0    (  T   "  T>d #"   *   c $@ "9)e  ( 2b e  # "e   S  F"ie  (   S I"9) (   S PM"0 (    S P"?e  (    S S") (    S xV"?G (    S  Z"oG (    S \"9G (   S `"iA (   S Hc"A? 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X*   H p 0Dh9 ? ̙3380___PPT10.% 5 x0x(   x x  `,_ ??f   D*   x  `a ??|   F*   x  f j ??f   D*   x  fm ??|   F*  H x 0Dh9 ? ̙3380___PPT10.% .6K0 P$( IT`T0 r  S pp@  r  S  ``0  H  0޽h ? ̙33y___PPT10Y+D=' = @B +   P (      s *$    `<$ 0      s *,  `p<$ 0   H   0޽h ? ^WNff3vn___PPT10N.+ˠD' = @B Dq' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-g6B fade*<3<* D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* *%(D' =-g6B fade*<3<* *D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* *n%(D' =-g6B fade*<3<* *nD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* n%(D' =-g6B fade*<3<* nD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-g6B fade*<3<* D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* #%(D' =-g6B fade*<3<* #D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* #g%(D' =-g6B fade*<3<* #g+p+0+  ++0+  +B   `$h(  $~ $ s *"    `    $ s *#   `p<$ 0   H $ 0޽h ? ^WNff3 ___PPT10.+ID' = @B DE' = @BA?%,( < +O%,( < +D|' =%(%(D' =%(DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$%(D' =-{6Bslide(fromTop)*<3<*$D' =%( DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$J%(D' =-{6Bslide(fromTop)*<3<*$JD' =%(DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$J\%(D' =-{6Bslide(fromTop)*<3<*$J\D' =%(LDL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$]s%(D' =-{6Bslide(fromTop)*<3<*$]sD' =%('DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$s%(D' =-{6Bslide(fromTop)*<3<*$sD' =%(0DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$%(D' =-{6Bslide(fromTop)*<3<*$D' =%(:DL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$%(D' =-{6Bslide(fromTop)*<3<*$D' =%(\DDL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$'%(D' =-{6Bslide(fromTop)*<3<*$'D' =%( NDL' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$'6%(D' =-{6Bslide(fromTop)*<3<*$'6+8+0+$  +  K0 p(7(  (~ ( s *    `   ~ ( s *X   `p    (  f  ??@ ]!Understanding why patient smoke ? "0"$H ( 0޽h ? ^WNff3y___PPT10Y+D=' = @B +?  K0 @h(  ~  s *        s *$   `p<$ 0   H  0޽h ? ff̙ff___PPT10.+>:)Do' = @B D*' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(+8+0+ +  K0  0( 3z x  c $P    `   x  c $$   `p   H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +7   A 9 p (     BT f  S" F<$D  0    0  `A ?̙  H $ 0    6 MMMP  J,$ 0 Y Contemplation0 2   6  & z ,$ 0 G Preparation 2 f  6 v p,$  0 BAction  2  6 v@ p,$  0 G Maintenance 2   6  z ,$ 0 QRelapse. 2B  <D>p `,$D 0B  <D>  @,$D 0B  <D>` ,$D  0B  <D> ,$D  0B  <D>@0`,$D  0B  <D>p ,$D 0B @ <D> P @p,$D 0  0 30;,$D 0 NEstablished change  2  s *< 30@*,$D 0 MPre Contemplation  2H  0޽h ? ___3̙3f3~)v)___PPT10V).+d D>'' = @B D&' = @BA?%,( < +O%,( < +Dz ' =%(%(D?' =%(D' =A@BBB B0B@B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' ,=+4 8?`CB4*#ppt_wBCB#ppt_wB*Y3>B ppt_w<*D' ,=+4 8?`CB4*#ppt_hBCB#ppt_hB*Y3>B ppt_h<*D' =%( DT' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B'checkerboard(down)*<3<*D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D%' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D%' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D%' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%( D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D%' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(++0+  ++(+ 0+ +0+  ++0+  ++0+  ++0+  ++0+  ++0+  ++0+  +!  K0 (     c $)   `<$ 0  )   c $)  `p<$ 0 ) H  0޽h ? zTщ@U[|3F>___PPT10.+ˠD' = @B DA' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<**%(D' =-g6B fade*<3<**D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<**V%(D' =-g6B fade*<3<**VD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*Vi%(D' =-g6B fade*<3<*ViD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*i%(D' =-g6B fade*<3<*iD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*+p+0+) ++0+) + K0 P:(  ~  s *))   `  ) |  TA??PH  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +8B K0 7A/A ?\@(  \| \ T ??/  \ Z ??/i 0\ ZK??/  \ Z ?? \ S A ?http://www.learning-media.net/pub/template/images/smallVert.gifd 0v \ #"  Pt \ ZG ??!0v4___PPT10 B___PPT9$ ZPre-Contemplation Stage &' !)D \  `М ??0!v > @`~B \ N??00~B \ N??vv~B \ N??0v~B \ N??0v` \ S 8ALM_3circles0` \  ` ??+ VSmokers in the Pre-contemplation Stage are not considering quitting in the next 6 months. They are uninformed or under informed about the consequences of smoking or are too discouraged by previous failed quit attempts.They are not convinced the negative aspects of smoking outweigh the positive and are unreceptive to cessation interventions 0W1&   y Cj  \# #" 0 \ Z$!)D??4___PPT10 B___PPT9$ 3Processes of change for the Pre-contemplation stage:4' ' ~B \ N??~B \ N??~B \ N??~B \ N?? \ Z ??~ l L  \ #" L  \ ZH??gL 4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { \ T4d??gL 4___PPT10 B___PPT9$ YHelping Relationships('   \ ZxY??g4___PPT10 B___PPT9$ oProduces an emotional response in the smoker when presented with information about the dangers of not quitting.(po'  u \ Tl"??g4___PPT10 B___PPT9$ SDramatic Relief('   \ T"??4___PPT10 B___PPT9$ XInvolves increased awareness about the causes, consequences, and treatments for smoking.(YX'  { \ Tl"??4___PPT10 B___PPT9$ YConsciousness Raising('  ~B \ N??~B \ N??L L ~B \ N??L ~B \ N??L Td    \ #" `   \ Zp!!)D??  4___PPT10 B___PPT9$ 0Counselling tips for the Pre-contemplation stage:1' '  &~B \ N??  ~B \ N??  ~B \ N?? ~B \ N??   \ Z ??Qj  2 \ #"6*   { \ ZŚ??24___PPT10 B___PPT9$ Act in a manner that suggests you know what s best for the patient without their input.(XW'  e \ T??24___PPT10 B___PPT9$ C&&   \ Z(??4___PPT10 B___PPT9$ ,Try to persuade the patient to stop smoking.8-+' &  r \ T䥚??4___PPT10 B___PPT9$ P Don t:('   \ Zt??4___PPT10 B___PPT9$ k'Strongly encourage the patient to quit.((''  e \ T0??4___PPT10 B___PPT9$ C&&   \ ZЅ?? 4___PPT10 B___PPT9$ JRaise awareness of the health concerns by providing objective information.8KI' &  e \ T{?? 4___PPT10 B___PPT9$ C&&   \ Z0q??  4___PPT10 B___PPT9$ BAsk about the pros and cons of tobacco use as the patient sees it.(CB'  e \ T,??  4___PPT10 B___PPT9$ C&&   \ ZL??}  4___PPT10 B___PPT9$ _Ask non-invasive questions.('  e \ T??}  4___PPT10 B___PPT9$ C&&   \ ZD ?? } 4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  e \ Tm ?? } 4___PPT10 B___PPT9$ C&&   \ Zt< ??A  4___PPT10 B___PPT9$ ]Foster good communication by listening and non-judgementally reflect back your understanding.(^]'  / "e \ Tp)??A  4___PPT10 B___PPT9$ C&&   \ T?? A 4___PPT10 B___PPT9$ cDemonstrate caring and empathy.( '  i \ T?? A 4___PPT10 B___PPT9$ GDo:('  ~B \ N??  ~B \ N??22~B \ N?? 2~B \ N?? 2H \ 0޽h ? }ff___PPT10i.Ez7+D=' = @B +D K0 CC@:tlRC(  l l  fr ??(  ZContemplation Stage    ` l S 8ALM_3circles @ l  ` ??` /Smokers in the Contemplation Stage are considering a quit attempt in the next 6 months. They are in the process of weighing up the pros and cons of making a quit attempt but may lack the commitment to quit. 0  ?j   l# #"  l Z7!)D??4___PPT10 B___PPT9$ /Processes of change for the Contemplation stage:0' ' ~B l N??~B  l N??~B  l N??~B  l N?? l Z ??~t Y  rl #"& Y  #l Z??tY 4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { "l T5??tY 4___PPT10 B___PPT9$ YHelping Relationships('   !l ZD??t4___PPT10 B___PPT9$ oProduces an emotional response in the smoker when presented with information about the dangers of not quitting.(po'  u  l T5??t4___PPT10 B___PPT9$ SDramatic Relief('   l Z??4___PPT10 B___PPT9$ XInvolves increased awareness about the causes, consequences, and treatments for smoking.(YX'  { l T$.??4___PPT10 B___PPT9$ YConsciousness Raising('   l Z(??4___PPT10 B___PPT9$ HInvolves assessing ones self-image both as a smoker and as a non-smoker.(IH'  x l TP??4___PPT10 B___PPT9$ VSelf Re-evaluation('  ] l T4??4___PPT10 B___PPT9$ ;Involves assessing how the presence or absence of a personal habit affects ones social environment, for example the effect smoking has on others. It can also include the awareness that one can serve as a positive or negative role model for others.('   l TL??4___PPT10 B___PPT9$ ^Environmental Re-valuation('  ~B $l N??~B %l N??Y Y ~B &l N??Y ~B 'l N??Y Pd `   tl #" ``   3l ZXӘ!)D??`  4___PPT10 B___PPT9$ ,Counselling tips for the Contemplation stage:-' '  "~B 4l N??` ` ~B 5l N??  ~B 6l N??` ~B 7l N??`   :l Z ??TQTi"   ql #":.    cl Z,??4___PPT10 B___PPT9$ Act in a manner that suggests you know what s best for the patient without their input.(XW'  r bl T ,??4___PPT10 B___PPT9$ P Don t:('   al Z,??4___PPT10 B___PPT9$ w3Educate patients on available pharmacological aids.(43'  e `l T??4___PPT10 B___PPT9$ C&&   _l Z??h4___PPT10 B___PPT9$ ISuggest methods for cessation or design a treatment plan for the patient.(JI'  e ^l T۞??h4___PPT10 B___PPT9$ C&&   ]l ZО?? h4___PPT10 B___PPT9$ Make patient s aware of the effects of passive smoking on others.(BA'  e \l Tpƞ?? h4___PPT10 B___PPT9$ C&&   [l Z??J  4___PPT10 B___PPT9$ DHelp patients to see that change is possible and of benefit to them.(ED'  e Zl TT??J  4___PPT10 B___PPT9$ C&&   Yl Z(??o J 4___PPT10 B___PPT9$ @Help patients to re-assess values related to smoking and health.(A@'  e Xl T䛞??o J 4___PPT10 B___PPT9$ C&&   Wl Z<?? o 4___PPT10 B___PPT9$ q-Discuss possible interactions with medicines.(.-'  e Vl T?? o 4___PPT10 B___PPT9$ C&&   Ul Z0|??Q  4___PPT10 B___PPT9$ ~:Discuss the effects of smoking on existing disease states.(;:'  e Tl Tq??Q  4___PPT10 B___PPT9$ C&&   Sl Zg?? Q 4___PPT10 B___PPT9$ {7Inform patients about the long term effects of smoking.(87'  e Rl T`\?? Q 4___PPT10 B___PPT9$ C&&   Ql TQ??  4___PPT10 B___PPT9$ bProvide objective information.('  i Pl TPG??  4___PPT10 B___PPT9$ GDo:('  ~B dl N??  ~B el N??~B fl N?? ~B gl N?? H l 0޽h ? }ff___PPT10i.Ez7+D=' = @B + K0 Ph0(  hH h 0޽h ? }ff___PPT10i.Ez7+D=' = @B +H K0 `d0(  dH d 0޽h ? }ff80___PPT10.Ez7H K0 p`0(  `H ` 0޽h ? }ff80___PPT10.Ez7f   K0 $0(  ~  s *C)    )  0 S ~A  ?f3d@  ^H  $D  0 )H  0޽h ? ff̙ff___PPT10.+iVD' = @B D=' = @BA?%,( < +O%,( < +Dt' =%(%(D' =%(D' =4@BBBB%(E' =4 B`BPB`B?<*%(/%,( < +D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =+4 8?RCB?BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?RCB?BCB#ppt_yB*Y3>B ppt_y<*+  K0  (   x  c $K)   `  )    <L)f  "T  ? ` ) H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +  K0 0(   x  c $Y)   `  ) x  c $Z)  `p ) H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +  K0 b(      0a) S"   `  ) x  c $a)  `p ) H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +?  K0 >6,(  ,r , S li)  `p )  ,  @j)0e0e  "00e `  `  ) H , 0޽h ? }ff___PPT10i.+@ U+D=' = @B +  K0 t0( w tx  c $`p)   `  ) x  c $t)  `p ) H t 0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +  K0 `0( w x  c $q)   `  ) x  c $Hr)  `p ) H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +C  K0 RJ( @,    0() S"   `  ) x  c $)   p ) x  c $$) s `p ) H  0޽h ? zTщ@U[|3y___PPT10Y+D=' = @B +  K0 0(  0 0 s *$) S" P@  )  0 s *) S"    ) H 0 0޽h ? }ff___PPT10i.Z. 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HZ(&C"8A ''; [nF!J!E+DN"  1%'$i  ?,/0Z0 `"/1* " #6:)J/=" ;-!&6H*  &?&#0! .   7% #'  "  $  *   !    #'                                         `Xt^b$      !"#$%&'()*+,./0 2765x4u ob$uO,CDidiw2$_B>GIfXb$6v~U*0gb$Z[E!{M+B"$1H~vSu$ I* 0e0e A@A5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E? 3sSSf@8+ , g4GdGd z[ 0ppp@ <4!d!dL 0P.<4BdBdL 0P.g4)d)d z[ 0<p] poʚ;ʚ;<4ddddL|- 08___PPT10DSimSunew 0z[ 0DTimes New Roman0z[ 0 2___PPT9/ 0? %O =,Helping Smokers Change0f.by DR. ROSLI BIN OMAR PAKAR PERUBATAN KELUARGA//f.#Q : Why do he keeps smoking ?8((((# I can t last half a day without smoking # I feel strong urge to smoke when I haven t smoked for a few hours  I sometimes find myself smoking even though I don t remember lighting up.  I enjoy smoking during my break or after a meal * I reach for a cigarette when I m angry or depressed. * I smoke because it helps me to think better. Smoking perks me up. b*ZDLZ2|Z33(33BI/5C/$Reason & & ..( j# Addiction to nicotine - craving for more ; experience withdrawal symptoms.  Smoke out of habit. - formed a links between their daily activities and smoking. * Psychologically dependent on cigarettes. - feel better ; convinced that cigarettes are source of comfort.6P3333>33 A(D0%  The URGE to smoke - THREE factors 1. Chemical addiction to the nicotine 2. Force of habit 3. Psychological dependence on the act of smokingF3333|1"6Smoking is an addiction& & . 2 0A highly controlled or compulsive pattern of drug use Psychoactive or mood altering effects, involved in the pattern of drug taking : mood -altering , anxiety reducing and stimulating effects. Drug functioning as a reinforcer to strengthen behaviour and lead to further drug ingestion.xZLZ^ZG >,  %%Key Action Areas for Health Promotion&& The  Ottawa charter - Building healthy public policy, - Creating supportive environments, - Strengthening community action - Assisting the development of personal skills - Re-orienting existing health servicesHBBdStages of Change Prochaska and DiClemente s Model :3 (  ( (,  Processes of ChangeConsciousness-raising (becoming informed) Social liberation (increasing alternatives) Emotional arousal. Self re-evaluation (creating a new image). Commitment. Rewards. Countering (using substitutes) Environmental control. Helping relationships.&Processes of Change:-;.</=0>12!(Summary of evidence on smoking cessation")("Brief InterventionAsk about current smoking status and quit interest. Advise smokers of the benefit of stopping in a personalised and appropriate manner Assess motivation to stop Assist smokers in their quit attempt. Arrange follow up if possible.pP1PPMPPPP P PPf1fMfffg }#BWhat helped smoker to quit ? What hindered smoker from quitting ?$!Helping Relationships and Smokers""(2How do you feel about this person s smoking ? Does their continued smoking affect your attitude or feelings toward them ? Might any of your attitudes towards them, or their smoking be a barrier to you developing a helping relationship with them, If so, what can you do about this ?3&!Helping Relationships and Smokers'Information ExchangeThe health risks of smoking, the effect smoking is currently having on the smoker or his or her family, ideas about how the smoker might go about changing, referral options for specialist support.(Information ExchangeA client-centered approach. Elicit Provide Elicit 1. Elicit readiness and interest. 2. Provide information neutrally 3. Elicit the client s interpretation of the facts providedf8f $f f $ff%Building a Helping Relationship  Helpful Listening Behaviours     " Unhelpful Listening Behaviours :"   4' Helpful Listening Behaviours Good eye contact Appropriate head nodding,smiles, facial expressions,gestures Relaxed body posture Allowing silence Reflecting client s movement Noticing client s body language Verbal prompts  mm  go on Repeating key words Open-ended questions Checking/clarifying Reflecting back Summing up Focusing No physical barriers JbZ33C > $  /Unhelpful Listening Behaviours Fidgeting Looking away from client Physical barriers Looking bored,impatient,hostile On-off listening Patronising Condescending Devaluing Jumping to conclusion Judging Talking too much Filling in silence too quickly Interrupting Too many questions Telling; giving advise <0Z 3 > ? * Obstacles to active listening On-off listening  Open ears- closed mind listening  Glassy-eyed listening  Too deep-for-me listening  Matter-over-mind listening Being  subject-centered instead of  speaker-centered  Fact listening  Pencil listening Z!Reluctance to ChangeBehaviours that are unhealthy often seem beneficial in other ways. People are not easily convinced that smoking is a problem for them personally. It sometimes seems almost impossible to change. 9,Enabling Change? Rolling with resistance Eliciting self-motivating statements7*,The Decisional Balance and Self Re-evalution--(# 8+ Responses`Consequences to self. Consequences to others How I feel about myself How others feel about meaZa5(What precipitates relapse?Coping with emotional distress. Enchancing positive emotional states Giving in to temptations or urges Responding to social pressures$ \6)Relapse preventionAssertiveness skills Anxiety/anger management Networks support Mood changing strategies Changes in routine Recycle Substitutes Z' THANK YOU FOR YOUR ATTENTION$( 8B/P]I K0 \HTHPAwhG(  h h  ft;, ?? {  XPreparation Stage    b h  `H, ??  rSmokers in the Preparation Stage are intending to stop in the next 30 days. They typically have a plan of action. 0sS s | h T ??i   h S A ?http://www.learning-media.net/pub/template/images/LM_3circles.gifPp<"j  h# #"  `n h Zܴ, ??4___PPT10 B___PPT9$ F && ~B  h N??~B  h N??~B  h N??~B  h N??7d  Z 2h #"  Z h Zך!)D?? Z4___PPT10 B___PPT9$ -Processes of change for the Preparation stage:.' ' ~B h N?? ~B h N?? ZZ~B h N??  Z~B h N??Z h Z ??;~;p  P 6h #"" P  )h Zd#??4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { (h TY#?? 4___PPT10 B___PPT9$ YHelping Relationships('  , 'h Z#??/4___PPT10 B___PPT9$ Involves altering ones environment to remove cues that trigger relapses in behaviour, and introducing cues to facilitate healthy behaviours.('  ,K - v &h T %?? /4___PPT10 B___PPT9$ TStimulus Control('   %h ZlP??J/4___PPT10 B___PPT9$ eInvolves developing and engaging in new behaviours that can substitute for the smoking of cigarettes.(fe'  ( 4z $h T0?? J/4___PPT10 B___PPT9$ XCounter Conditioning('  - #h T$??PJ4___PPT10 B___PPT9$ Requires an increase in social opportunities to quit smoking, such as friends or family who are quitting and the changes in society that make it easier for the non-smoker, typically smoke free zones.('  u "h T9?? PJ4___PPT10 B___PPT9$ SSelf Liberation('  ~B *h N?? PP~B +h N?? ~B ,h N?? P ~B -h N??P3d  @ wh #" @  9h Z!)D?? @4___PPT10 B___PPT9$ )Counseling tips for the Preparation stage:*' ' ~B :h N?? @@~B ;h N?? ~B ?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~? @ ~B =h N??@ @h Z ??Q% @O  uh #">2   y mh Z U??i4___PPT10 B___PPT9$ FArrange a follow up meeting within the first week after the quit date.(GF'  e lh TJ??@i4___PPT10 B___PPT9$ C&&   kh Z-??i4___PPT10 B___PPT9$ FProvide the patient with information and resources that are available.(GF'  e jh Th5??@i4___PPT10 B___PPT9$ C&&   ih Z*??K4___PPT10 B___PPT9$ j&Outline to the patient what to expect.('&'  e hh Tp ??@K4___PPT10 B___PPT9$ C&&   gh Z?? K4___PPT10 B___PPT9$ HAdvise on avoiding places and situations that trigger a desire to smoke.(IH'  e fh T ??@ K4___PPT10 B___PPT9$ C&&   eh Z??-  4___PPT10 B___PPT9$ JSuggest the removal of visual cues that could trigger a return to smoking.(KJ'  e dh T??@-  4___PPT10 B___PPT9$ C&&   ch Z8?? - 4___PPT10 B___PPT9$ DHelp patients to see that change is possible and of benefit to them.(ED'  e bh T??@ - 4___PPT10 B___PPT9$ C&&   ah Z,??  4___PPT10 B___PPT9$ }9Reinforce the need for helping relationships and support.(:9'  e `h T??@  4___PPT10 B___PPT9$ C&&   _h Z??%  4___PPT10 B___PPT9$ m)Provide guidance on the selection of NRT.(*)'  e ^h T??@%  4___PPT10 B___PPT9$ C&&  & ]h Z?? % 4___PPT10 B___PPT9$ Assess the patient s nicotine dependency level to determine if the use of NRT is appropriate.(^]'  e \h T\??@ % 4___PPT10 B___PPT9$ C&&   [h Z$??  4___PPT10 B___PPT9$ ?Work with the patient to select a quit date and to stick to it.(@?'  e Zh T??@  4___PPT10 B___PPT9$ C&&   Yh T??O  4___PPT10 B___PPT9$ RReinforce the patient s decision to quit.(*)'  i Xh Tu??@O  4___PPT10 B___PPT9$ GDo:('  ~B nh N??@O O ~B oh N??@~B ph N??@O @~B qh N??O H h 0޽h ? }ff___PPT10i.Ez7+D=' = @B +rI/<z/? %/>)c(  `  Chart MSGraph.Chart.800Microsoft Graph 97 Chart -Document Word.Document.80.Microsoft Word Document/ 0DTimes New Rom ՜.+,0    cvdOn-screen Show -sQ CA 2Times New RomanArial Wingdings Arial Black Arial Narrow AngelasHand ArchiesHandFosterTahoma Lucida SansVerdanaSimSunSymbol Trebuchet MSComic Sans MSAriosoPixelMicrosoft Graph 97 ChartMicrosoft Word DocumentHelping Smokers ChangeQ : Why do he keeps smoking ? Reason .. Smoking is an addiction. &Key Action Areas for Health Promotion3Stages of Change Prochaska and DiClementes Model Processes of ChangeProcesses of Change Slide 10 Slide 11 Slide 12 Slide 13 Slide 14)Summary of evidence on smoking cessationBrief Intervention Slide 17"Helping Relationships and Smokers"Helping Relationships and SmokersInformation ExchangeInformation Exchange Building a Helping Relationship Slide 23Obstacles to active listeningReluctance to ChangeEnabling Change-The Decisional Balance and Self Re-evalution ResponsesWhat precipitates relapse?Relapse prevention( THANK YOU FOR YOUR ATTENTION  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles_{Q useruser N& :[e xh-J o H[f.R ;0+c 0aU]7gmF ?M (GmZf Q$1)ڜ{]x lڌx @w L`/vA =(nIMsp "sny!{ B#&> A`-M$ZA LU5] uSjFP N93UT W`e P9Kj7$ 2lb 6  u V1 5p n$N*B[4 lsz>i\P PQ&  !^QZ( "ܑ MWMV  ryB2 C!2--s Uc k  SM  ; +0h  5Xm;a<@<,=S ? y/zZ} \" r?2TtJf&3'/^lG^u v}{u 8Og\  7 $+&E f i q?_E0 ^ ' -'Hos o_92&3C(9$W M@:=? 1ETzzavQcd'TJ نh # 1#+: T + \ s Hn\664  +4,*:{,'pߴ" / |h6 o)O8 #H3=i j|'6s  h^ TY>y=T fuC[G  oxX(R ja ydcqQ1hQld=g Che + v]6 * B kߵ#J*2 S8ekRؗ 2 J [i}T m- P? 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HZ(&C"8A ''; [nF!J!E+DN"  1%'$i  ?,/0Z0 `"/1* " #6:)J/=" ;-!&6H*  &?&#0! .   7% #'  "  $  *   !    #'                                         `Xt^$      !"#$%&'()*+,./0 276`5x4u ob$uO,CDidiw2$_B>GIfXb$6v~U*0gb$Z[E!{M+B"$1H~vSu$ I* 0e0e A@A5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E? 3sSSf@8+ , g4GdGd z[ 0ppp@ <4!d!dL 0P.<4BdBdL 0P.g4)d)d z[ 0<p] poʚ;ʚ;<4ddddL|- 08___PPT10DSimSunew 0z[ 0DTimes New Roman0z[ 0 2___PPT9/ 0? %O =,Helping Smokers Change0f.by DR. ROSLI BIN OMAR PAKAR PERUBATAN KELUARGA//f.#Q : Why do he keeps smoking ?8((((# I can t last half a day without smoking # I feel strong urge to smoke when I haven t smoked for a few hours  I sometimes find myself smoking even though I don t remember lighting up.  I enjoy smoking during my break or after a meal * I reach for a cigarette when I m angry or depressed. * I smoke because it helps me to think better. Smoking perks me up. b*ZDLZ2|Z33(33BI/5C/$Reason & & ..( j# Addiction to nicotine - craving for more ; experience withdrawal symptoms.  Smoke out of habit. - formed a links between their daily activities and smoking. * Psychologically dependent on cigarettes. - feel better ; convinced that cigarettes are source of comfort.6P3333>33 A(D0%  The URGE to smoke - THREE factors 1. Chemical addiction to the nicotine 2. Force of habit 3. Psychological dependence on the act of smokingF3333|1"6Smoking is an addiction& & . 2 0A highly controlled or compulsive pattern of drug use Psychoactive or mood altering effects, involved in the pattern of drug taking : mood -altering , anxiety reducing and stimulating effects. Drug functioning as a reinforcer to strengthen behaviour and lead to further drug ingestion.xZLZ^ZG >,  %%Key Action Areas for Health Promotion&& The  Ottawa charter - Building healthy public policy, - Creating supportive environments, - Strengthening community action - Assisting the development of personal skills - Re-orienting existing health servicesHBBdStages of Change Prochaska and DiClemente s Model :3 (  ( (,  Processes of ChangeConsciousness-raising (becoming informed) Social liberation (increasing alternatives) Emotional arousal. Self re-evaluation (creating a new image). Commitment. Rewards. Countering (using substitutes) Environmental control. Helping relationships.&Processes of Change:-;.</=0>12!(Summary of evidence on smoking cessation")("Brief InterventionAsk about current smoking status and quit interest. Advise smokers of the benefit of stopping in a personalised and appropriate manner Assess motivation to stop Assist smokers in their quit attempt. Arrange follow up if possible.pP1PPMPPPP P PPf1fMfffg }#BWhat helped smoker to quit ? What hindered smoker from quitting ?$!Helping Relationships and Smokers""(2How do you feel about this person s smoking ? Does their continued smoking affect your attitude or feelings toward them ? Might any of your attitudes towards them, or their smoking be a barrier to you developing a helping relationship with them, If so, what can you do about this ?3&!Helping Relationships and Smokers'Information ExchangeThe health risks of smoking, the effect smoking is currently having on the smoker or his or her family, ideas about how the smoker might go about changing, referral options for specialist support.(Information ExchangeA client-centered approach. Elicit Provide Elicit 1. Elicit readiness and interest. 2. Provide information neutrally 3. Elicit the client s interpretation of the facts providedf8f $f f $ff%Building a Helping Relationship  Helpful Listening Behaviours     " Unhelpful Listening Behaviours :"   4' Helpful Listening Behaviours Good eye contact Appropriate head nodding,smiles, facial expressions,gestures Relaxed body posture Allowing silence Reflecting client s movement Noticing client s body language Verbal prompts  mm  go on Repeating key words Open-ended questions Checking/clarifying Reflecting back Summing up Focusing No physical barriers JbZ33C > $  /Unhelpful Listening Behaviours Fidgeting Looking away from client Physical barriers Looking bored,impatient,hostile On-off listening Patronising Condescending Devaluing Jumping to conclusion Judging Talking too much Filling in silence too quickly Interrupting Too many questions Telling; giving advise <0Z 3 > ? * Obstacles to active listening On-off listening  Open ears- closed mind listening  Glassy-eyed listening  Too deep-for-me listening  Matter-over-mind listening Being  subject-centered instead of  speaker-centered  Fact listening  Pencil listening Z!Reluctance to ChangeBehaviours that are unhealthy often seem beneficial in other ways. People are not easily convinced that smoking is a problem for them personally. It sometimes seems almost impossible to change. 9,Enabling Change? Rolling with resistance Eliciting self-motivating statements7*,The Decisional Balance and Self Re-evalution--(# 8+ Responses`Consequences to self. Consequences to others How I feel about myself How others feel about meaZa5(What precipitates relapse?Coping with emotional distress. Enchancing positive emotional states Giving in to temptations or urges Responding to social pressures$ \6)Relapse preventionAssertiveness skills Anxiety/anger management Networks support Mood changing strategies Changes in routine Recycle Substitutes Z' THANK YOU FOR YOUR ATTENTION$( 8B/P1 K0 00`/_dU0(  d d  fp ??P 7 S Action Stage    | d T ??i   d S A ?http://www.learning-media.net/pub/template/images/LM_3circles.gifPl" d  `t) ??[ GPatients in the Action Stage have stopped smoking. The action stage is measured as the first 6 months from the date of quitting. A reduction in cigarettes does not count as action in smoking cessation only total abstinence counts. 0   2d `  4d #" `  d Zv!)D??` 4___PPT10 B___PPT9$ ~(Processes of change for the Action stage:)' ' ~B d N??` ~B d N??` ~B d N??``~B d N??   d Z ??cp `  5d #"" `  )d Z,??I 4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { (d T??`I4___PPT10 B___PPT9$ YHelping Relationships('   'd Zp??d I4___PPT10 B___PPT9$ MInvolves rewarding oneself or being rewarded by others for giving up smoking.(NM'  ~ &d T??`dI4___PPT10 B___PPT9$ \Reinforcement Management('  , %d Z??j d4___PPT10 B___PPT9$ Involves altering ones environment to remove cues that trigger relapses in behaviour, and introducing cues to facilitate healthy behaviours.('  ,K - v $d T??`jd4___PPT10 B___PPT9$ TStimulus Control('   #d T?? j4___PPT10 B___PPT9$ eInvolves developing and engaging in new behaviours that can substitute for the smoking of cigarettes.(fe'  ( 4z "d T??`j4___PPT10 B___PPT9$ XCounter Conditioning('  ~B *d N??` ~B +d N??` ~B ,d N??``~B -d N??  .d `   ]d #"  `   8d Z/!)D??`  4___PPT10 B___PPT9$ z$Counseling tips for the Action stage:%' ' ~B 9d N??`  ~B :d N??`  ~B ;d N??` ` ~B )c(  `  Chart MSGraph.Chart.800Microsoft Graph 97 Chart -Document Word.Document.80.Microsoft Word Document/ 0DTimes New Roman0z[ 0DArialNew Roman0z[ 0" DWingdingsRoman0z[ 00DArial Blackman0z[ 0"@DArial Narrowan0z[ 0"PDAngelasHandan0z[ 0"`DArchiesHandan0z[ 0"pDFosterHandan0z[ 0"DTahomaHandan0z[ 0"DLucida Sansan0z[ 0"DVerdanaansan0z[ 0"DSimSunansan0z[ 0DSymbolansan0z[ 0DTrebuchet MSan0z[ 0"DComic Sans MSn0z[ 0BDAriosoans MSn0z[ 0 C0.  @n?" dd@  @@``_##CHIMES.WAV.WAV 101064#RIFF*#WAVEfmt "VDdata#2fP: PA%G~2:bbGC af6 % '% o! x%)G' o<6A 0 e 0G k2 6 <a 4 Y6||'hp vc 'N#6lWh#G T J+- a  S?E UP +s CowS8YLl?V ha Ir&yP/`^9 n qY`+wh 4d[ w k4)P #c M"0!# yWWP. 86h _%T R zq| =v Y,8S6A w<2+YAq`', m s  ;P AJVFYG 6  `L6KW Ns os)CdU ?8  u  } 2}Y#]P y  Uw #8 x' j+= s ;0K  ;  PX  j G' x?I (hC | UHa w+]N ddPJT s6 ,]o : H  J|d~R fNx8% Qsjd?T]fo/fL@8 LX o .$ 2uq+.#{# yZJA P`C hAa ~P ]s ~)|S JW1C k0r P 0C p :H9 H,) j uC C[lsT 5e 7Ka 'FY^ ` oo2+HU0oh j]]8St (U z8H %TyYR2 yPn[k a  !JC)6 k Jd !]qmJas T  b h   N[ +2~ L .4 Yw0l=Jh'^I  v`G77E SJ/~JdJ4qY'n +[ 2L =.6!JC2u<f      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxy{|}~4   E 2u Psz8 ]W|<so] Tw :);u'E66#PP[]P GLHLJz' d+Lj|_6 ,-op !,yJ  % hW |;?Lh886R2hNKWLN'  mw==!_.;['fW !  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HZ(&C"8A ''; [nF!J!E+DN"  1%'$i  ?,/0Z0 `"/1* " #6:)J/=" ;-!&6H*  &?&#0! .   7% #'  "  $  *   !    #'                                         `Xt^$      !"#$%&'()*+,./0 276c5x4u ob$uO,CDidiw2$_B>GIfXb$6v~U*0gb$Z[E!{M+B"$1H~vSu$ I* 0e0e A@A5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E? 3sSSf@8+ , g4GdGd z[ 0ppp@ <4!d!dL 0P.<4BdBdL 0P.g4)d)d z[ 0<p] poʚ;ʚ;<4ddddL|- 08___PPT10DSimSunew 0z[ 0DTimes New Roman0z[ 0 2___PPT9/ 0? %O =,Helping Smokers Change0f.by DR. ROSLI BIN OMAR PAKAR PERUBATAN KELUARGA//f.#Q : Why do he keeps smoking ?8((((# I can t last half a day without smoking # I feel strong urge to smoke when I haven t smoked for a few hours  I sometimes find myself smoking even though I don t remember lighting up.  I enjoy smoking during my break or after a meal * I reach for a cigarette when I m angry or depressed. * I smoke because it helps me to think better. Smoking perks me up. b*ZDLZ2|Z33(33BI/5C/$Reason & & ..( j# Addiction to nicotine - craving for more ; experience withdrawal symptoms.  Smoke out of habit. - formed a links between their daily activities and smoking. * Psychologically dependent on cigarettes. - feel better ; convinced that cigarettes are source of comfort.6P3333>33 A(D0%  The URGE to smoke - THREE factors 1. Chemical addiction to the nicotine 2. Force of habit 3. Psychological dependence on the act of smokingF3333|1"6Smoking is an addiction& & . 2 0A highly controlled or compulsive pattern of drug use Psychoactive or mood altering effects, involved in the pattern of drug taking : mood -altering , anxiety reducing and stimulating effects. Drug functioning as a reinforcer to strengthen behaviour and lead to further drug ingestion.xZLZ^ZG >,  %%Key Action Areas for Health Promotion&& The  Ottawa charter - Building healthy public policy, - Creating supportive environments, - Strengthening community action - Assisting the development of personal skills - Re-orienting existing health servicesHBBdStages of Change Prochaska and DiClemente s Model :3 (  ( (,  Processes of ChangeConsciousness-raising (becoming informed) Social liberation (increasing alternatives) Emotional arousal. Self re-evaluation (creating a new image). Commitment. Rewards. Countering (using substitutes) Environmental control. Helping relationships.&Processes of Change:-;.</=0>12!(Summary of evidence on smoking cessation")("Brief InterventionAsk about current smoking status and quit interest. Advise smokers of the benefit of stopping in a personalised and appropriate manner Assess motivation to stop Assist smokers in their quit attempt. Arrange follow up if possible.pP1PPMPPPP P PPf1fMfffg }#BWhat helped smoker to quit ? What hindered smoker from quitting ?$!Helping Relationships and Smokers""(2How do you feel about this person s smoking ? Does their continued smoking affect your attitude or feelings toward them ? Might any of your attitudes towards them, or their smoking be a barrier to you developing a helping relationship with them, If so, what can you do about this ?3&!Helping Relationships and Smokers'Information ExchangeThe health risks of smoking, the effect smoking is currently having on the smoker or his or her family, ideas about how the smoker might go about changing, referral options for specialist support.(Information ExchangeA client-centered approach. Elicit Provide Elicit 1. Elicit readiness and interest. 2. Provide information neutrally 3. Elicit the client s interpretation of the facts providedf8f $f f $ff%Building a Helping Relationship  Helpful Listening Behaviours     " Unhelpful Listening Behaviours :"   4' Helpful Listening Behaviours Good eye contact Appropriate head nodding,smiles, facial expressions,gestures Relaxed body posture Allowing silence Reflecting client s movement Noticing client s body language Verbal prompts  mm  go on Repeating key words Open-ended questions Checking/clarifying Reflecting back Summing up Focusing No physical barriers JbZ33C > $  /Unhelpful Listening Behaviours Fidgeting Looking away from client Physical barriers Looking bored,impatient,hostile On-off listening Patronising Condescending Devaluing Jumping to conclusion Judging Talking too much Filling in silence too quickly Interrupting Too many questions Telling; giving advise <0Z 3 > ? * Obstacles to active listening On-off listening  Open ears- closed mind listening  Glassy-eyed listening  Too deep-for-me listening  Matter-over-mind listening Being  subject-centered instead of  speaker-centered  Fact listening  Pencil listening Z!Reluctance to ChangeBehaviours that are unhealthy often seem beneficial in other ways. People are not easily convinced that smoking is a problem for them personally. It sometimes seems almost impossible to change. 9,Enabling Change? Rolling with resistance Eliciting self-motivating statements7*,The Decisional Balance and Self Re-evalution--(# 8+ Responses`Consequences to self. Consequences to others How I feel about myself How others feel about meaZa5(What precipitates relapse?Coping with emotional distress. Enchancing positive emotional states Giving in to temptations or urges Responding to social pressures$ \6)Relapse preventionAssertiveness skills Anxiety/anger management Networks support Mood changing strategies Changes in routine Recycle Substitutes Z' THANK YOU FOR YOUR ATTENTION$( 8B/PD K0 CC@:tlRC(  l l  fr ??H g ZContemplation Stage    ` l S 8ALM_3circlesP l  ` ??p` /Smokers in the Contemplation Stage are considering a quit attempt in the next 6 months. They are in the process of weighing up the pros and cons of making a quit attempt but may lack the commitment to quit. 0  ?j   l# #"  l Z7!)D??4___PPT10 B___PPT9$ /Processes of change for the Contemplation stage:0' ' ~B l N??~B  l N??~B  l N??~B  l N?? l Z ??~t Y  rl #"& p  #l Z??tY 4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { "l T5??tY 4___PPT10 B___PPT9$ YHelping Relationships('   !l ZD??t4___PPT10 B___PPT9$ oProduces an emotional response in the smoker when presented with information about the dangers of not quitting.(po'  u  l T5??t4___PPT10 B___PPT9$ SDramatic Relief('   l Z??4___PPT10 B___PPT9$ XInvolves increased awareness about the causes, consequences, and treatments for smoking.(YX'  { l T$.??4___PPT10 B___PPT9$ YConsciousness Raising('   l Z(??4___PPT10 B___PPT9$ HInvolves assessing ones self-image both as a smoker and as a non-smoker.(IH'  x l TP??4___PPT10 B___PPT9$ VSelf Re-evaluation('  ] l T4??4___PPT10 B___PPT9$ ;Involves assessing how the presence or absence of a personal habit affects ones social environment, for example the effect smoking has on others. It can also include the awareness that one can serve as a positive or negative role model for others.('   l TL??4___PPT10 B___PPT9$ ^Environmental Re-valuation('  ~B $l N??~B %l N??Y Y ~B &l N??Y ~B 'l N??Y Pd `   tl #" `   3l ZXӘ!)D??`  4___PPT10 B___PPT9$ ,Counselling tips for the Contemplation stage:-' '  "~B 4l N??` ` ~B 5l N??  ~B 6l N??` ~B 7l N??`   :l Z ??TQTi"   ql #":.   v cl Z,??4___PPT10 B___PPT9$ Act in a manner that suggests you know what s best for the patient without their input.(XW'  r bl T ,??4___PPT10 B___PPT9$ P Don t:('   al Z,??4___PPT10 B___PPT9$ w3Educate patients on available pharmacological aids.(43'  e `l T??4___PPT10 B___PPT9$ C&&   _l Z??h4___PPT10 B___PPT9$ ISuggest methods for cessation or design a treatment plan for the patient.(JI'  e ^l T۞??h4___PPT10 B___PPT9$ C&&   ]l ZО?? h4___PPT10 B___PPT9$ Make patient s aware of the effects of passive smoking on others.(BA'  e \l Tpƞ?? h4___PPT10 B___PPT9$ C&&   [l Z??J  4___PPT10 B___PPT9$ DHelp patients to see that change is possible and of benefit to them.(ED'  e Zl TT??J  4___PPT10 B___PPT9$ C&&   Yl Z(??o J 4___PPT10 B___PPT9$ @Help patients to re-assess values related to smoking and health.(A@'  e Xl T䛞??o J 4___PPT10 B___PPT9$ C&&   Wl Z<?? o 4___PPT10 B___PPT9$ q-Discuss possible interactions with medicines.(.-'  e Vl T?? o 4___PPT10 B___PPT9$ C&&   Ul Z0|??Q  4___PPT10 B___PPT9$ ~:Discuss the effects of smoking on existing disease states.(;:'  e Tl Tq??Q  4___PPT10 B___PPT9$ C&&   Sl Zg?? Q 4___PPT10 B___PPT9$ {7Inform patients about the long term effects of smoking.(87'  e Rl T`\?? Q 4___PPT10 B___PPT9$ C&&   Ql TQ??  4___PPT10 B___PPT9$ bProvide objective information.('  i Pl TPG??  4___PPT10 B___PPT9$ GDo:('  ~B dl N??  ~B el N??~B fl N?? ~B gl N?? H l 0޽h ? }ff___PPT10i.Ez7+D=' = @B +]I K0 \HTHPAwhG(  h h  ft;, ??  XPreparation Stage    b h  `H, ??  rSmokers in the Preparation Stage are intending to stop in the next 30 days. They typically have a plan of action. 0sS s | h T ??i   h S A ?http://www.learning-media.net/pub/template/images/LM_3circles.gifj  h# #"  `n h Zܴ, ??4___PPT10 B___PPT9$ F && ~B  h N??~B  h N??~B  h N??~B  h N??7d  Z 2h #" J h Zך!)D?? Z4___PPT10 B___PPT9$ -Processes of change for the Preparation stage:.' ' ~B h N?? ~B h N?? ZZ~B h N??  Z~B h N??Z h Z ??;~;p  P 6h #"" @ )h Zd#??4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. It is built on trust, openness and caring.(ml'  { (h TY#?? 4___PPT10 B___PPT9$ YHelping Relationships('  , 'h Z#??/4___PPT10 B___PPT9$ Involves altering ones environment to remove cues that trigger relapses in behaviour, and introducing cues to facilitate healthy behaviours.('  ,K - v &h T %?? /4___PPT10 B___PPT9$ TStimulus Control('   %h ZlP??J/4___PPT10 B___PPT9$ eInvolves developing and engaging in new behaviours that can substitute for the smoking of cigarettes.(fe'  ( 4z $h T0?? J/4___PPT10 B___PPT9$ XCounter Conditioning('  - #h T$??PJ4___PPT10 B___PPT9$ Requires an increase in social opportunities to quit smoking, such as friends or family who are quitting and the changes in society that make it easier for the non-smoker, typically smoke free zones.('  u "h T9?? PJ4___PPT10 B___PPT9$ SSelf Liberation('  ~B *h N?? PP~B +h N?? ~B ,h N?? P ~B -h N??P3d  @ wh #" j  9h Z!)D?? @4___PPT10 B___PPT9$ )Counseling tips for the Preparation stage:*' ' ~B :h N?? @@~B ;h N?? ~B 2  `   mh Z U??i4___PPT10 B___PPT9$ FArrange a follow up meeting within the first week after the quit date.(GF'  e lh TJ??@i4___PPT10 B___PPT9$ C&&   kh Z-??i4___PPT10 B___PPT9$ FProvide the patient with information and resources that are available.(GF'  e jh Th5??@i4___PPT10 B___PPT9$ C&&   ih Z*??K4___PPT10 B___PPT9$ j&Outline to the patient what to expect.('&'  e hh Tp ??@K4___PPT10 B___PPT9$ C&&   gh Z?? K4___PPT10 B___PPT9$ HAdvise on avoiding places and situations that trigger a desire to smoke.(IH'  e fh T ??@ K4___PPT10 B___PPT9$ C&&   eh Z??-  4___PPT10 B___PPT9$ JSuggest the removal of visual cues that could trigger a return to smoking.(KJ'  e dh T??@-  4___PPT10 B___PPT9$ C&&   ch Z8?? - 4___PPT10 B___PPT9$ DHelp patients to see that change is possible and of benefit to them.(ED'  e bh T??@ - 4___PPT10 B___PPT9$ C&&   ah Z,??  4___PPT10 B___PPT9$ }9Reinforce the need for helping relationships and support.(:9'  e `h T??@  4___PPT10 B___PPT9$ C&&   _h Z??%  4___PPT10 B___PPT9$ m)Provide guidance on the selection of NRT.(*)'  e ^h T??@%  4___PPT10 B___PPT9$ C&&  & ]h Z?? % 4___PPT10 B___PPT9$ Assess the patient s nicotine dependency level to determine if the use of NRT is appropriate.(^]'  e \h T\??@ % 4___PPT10 B___PPT9$ C&&   [h Z$??  4___PPT10 B___PPT9$ ?Work with the patient to select a quit date and to stick to it.(@?'  e Zh T??@  4___PPT10 B___PPT9$ C&&   Yh T??O  4___PPT10 B___PPT9$ RReinforce the patient s decision to quit.(*)'  i Xh Tu??@O  4___PPT10 B___PPT9$ GDo:('  ~B nh N??@O O ~B oh N??@~B ph N??@O @~B qh N??O H h 0޽h ? }ff___PPT10i.Ez7+D=' = @B +1 K0 00`/bdU0(  d d  fp ??p  S Action Stage    | d T ??i   d S A ?http://www.learning-media.net/pub/template/images/LM_3circles.gifP d  `t) ?? GPatients in the Action Stage have stopped smoking. The action stage is measured as the first 6 months from the date of quitting. A reduction in cigarettes does not count as action in smoking cessation only total abstinence counts. 0   2d `  4d #"   d Zv!)D??` 4___PPT10 B___PPT9$ ~(Processes of change for the Action stage:)' ' ~B d N??` ~B d N??` ~B d N??``~B d N??   d Z ??cp    `d #""    )d Z,??  4___PPT10 B___PPT9$ lInvolves the support given by others to the smokers quit attempt. 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