Nurse provision of support to help inpatients quit smoking

Knowledge and attitudes towards smoking cessation counselling: an Italian cross-sectional survey on tertiary care nursing staff

BACKGROUND

One of the most effective smoking cessation strategies involves care and advice from nurses due to their role in the front line of treatment. Lack of education on smoking cessation counselling may be detrimental, and adequate smoking cessation training during healthcare studies is needed.

OBJECTIVES

The study aimed to examine nurses' attitudes, belief, and knowledge of smoking cessation counselling; knowledge of the health risks associated with smoking was also assessed.

DESIGN

A cross-sectional survey on 77 nurses from the nursing staff of Cardiology, Cardiac Intensive Care and Surgical Oncology Units of two tertiary hospitals.

METHODS

Cronbach's alpha was calculated to assess the questionnaire's internal consistency, and three composite indicators were computed to assess the three dimensions of the questionnaire (knowledge, attitude, belief). Furthermore, a stepwise linear regression model was used to predict the attitude to be engaged in smoking cessation counselling, related to demographic and behavioural variables, as well as knowledge and belief indicators. The analysis was stratified by Unit.

RESULTS

Nurses from three Units had a significantly different attitude score (2.55 ± 0.93 for Cardiology, 2.49 ± 0.72 for Cardiac Intensive Care and 2.09 ± 0.59 for Surgical Oncology Unit) (P-value = 0.0493). Analogously, knowledge of smoking cessation counselling was reported to be higher for Cardiac Intensive Care Unit nurses (3.19 ± 0.70) compared to Surgical Oncology nurses (2.73 ± 0.74) (P-value = 0.021). At the multivariable analysis, attitude towards smoking cessation counselling was significantly related to the nurse's belief about counselling, for Cardiology staff (coeff = 0.74, 95% CI [0.32-1.16], P-value = 0.002) and for Surgical Oncology staff (coeff = 0.37, 95% CI [0.01-0.72], P-value = 0.042).

CONCLUSIONS

Incorporation of smoking cessation interventions in nurses' and nursing managers' education could improve the nursing staff's attitude, belief, and knowledge regarding smoking cessation counselling, which would lead to the inclusion of tobacco prevention and cessation as an integral part of patient care.

Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study

OBJECTIVE

To explore the perspectives of hospital staff regarding the provision of smoking cessation care.

STUDY DESIGN

A qualitative description study using focus group discussions.

STUDY SETTING

Data were collected across metropolitan regional and rural hospitals in Victoria, Australia, between November and December 2019.

PARTICIPANTS

Clinical and non-clinical hospital staff.

RESULTS

Five focus groups were conducted across four hospitals. Staff (n=38) across metropolitan regional and rural hospitals shared similar views with regards to barriers and facilitators of smoking cessation care. Four themes were present: (1) Clinical Setting wherein views about opportunity and capacity to embed smoking cessation care, relevant policies and procedures and guidelines were discussed; (2) Knowledge consisted of the need for training on the provision of pharmacotherapy and behavioural interventions, and awareness of resources; (3) Consistency represented the need for a consistently applied approach to smoking cessation care by all staff and included issues of staff smoking; and (4) Appropriateness consisted of questions around how smoking cessation care can be safely delivered in the context of challenging patient groups and different settings.

CONCLUSIONS

Staff across metropolitan regional and rural hospitals experience similar views and identified shared barriers in implementing smoking cessation care. Responding to staff concerns and providing support to address smoking with patients will help to foster a consistent approach to cessation care. Clear practice guidelines for multidisciplinary clinical roles need to underpin staff training in communication skills, include priorities around smoking cessation care, and provide the authorising environment in which clinical staff actively provide smoking cessation care.

Smoke-free hospital grounds

This study investigated whether the implementation of a multicomponent intervention project could improve compliance with the New South Wales (NSW) Health smoke-free healthcare policy. Environmental interventions were implemented on the hospital grounds for a 12-week period. Compliance was measured by a pre- and postintervention observational count of smokers on the hospital grounds. After implementation, there was a significant 73% reduction in people smoking on the hospital grounds, indicating improved compliance with the NSW smoke-free healthcare policy through the use of a non-punitive multicomponent intervention. What is known about the topic?Lack of compliance with the NSW Health smoke-free healthcare policy was reflected by the large numbers of smokers outside the front of an inner-city hospital in Sydney, Australia. This issue had been raised by staff, patients and visitors as an ongoing problem requiring a solution. What does this paper add?Designing and implementing a non-punitive multicomponent intervention using modelling, operant and associative learning principles can successfully increase compliance with policies designed to stop smoking on hospital grounds. What are the implications for practitioners?Implementing non-punitive multicomponent interventions to improve compliance with the NSW Health smoke-free healthcare policy may increase patients’ acceptance of smoking cessation support when offered. Healthcare staff need to be equipped with the knowledge and confidence to offer this support.

Do nurses' personal health behaviours impact on their health promotion practice? A systematic review

BACKGROUND

There is a growing expectation in national and international policy and from professional bodies that nurses be role models for healthy behaviours, the rationale being that there is a relationship between nurses' personal health and the adoption of healthier behaviours by patients. This may be from patients being motivated by, and modelling, the visible healthy lifestyle of the nurse or that nurses are more willing to promote the health of their patients by offering public health or health promotion advice and referring the patient to support services.

METHODS

An integrated systematic review was conducted to determine if nurses' personal health behaviour impacted on (1) their health promotion practices, and (2) patient responses to a health promotion message. Medline, CINAHL, SCOPUS, and PsycINFO databases were searched. A narrative synthesis was conducted.

RESULTS

31 studies were included in the review. No consistent associations were noted between nurses' weight, alcohol use, or physical activity level and their health promotion practice, although smoking appeared to negatively impact on the likelihood of discussing and engaging in cessation counselling. Nurses who reported confidence and skills around health promotion practice were more likely to raise lifestyle issues with patients, irrespective of their own personal health behaviours. The two studies included in the review that examined patient responses noted that the perceived credibility of a public health message was not enhanced by being delivered by a nurse who reported adopting healthy behaviours.

CONCLUSIONS

Although it is assumed that nurses' personal health behaviour influences their health promotion practice, there is little evidence to support this. The assertion in health care policy that nurses should be role models for healthy behaviours assumes a causal relationship between their health behaviours and the patient response and adoption of public health messages that is not borne out by the research evidence.