“Everyone Needs a Breath of Fresh Air”: Workplace Impact on Nurses’ Smoking Behaviors

Temporal Changes in Nurse Mental and Behavioral Health Modified by Job Demands and Resources

BACKGROUND

The COVID-19 pandemic exacerbated barriers in the nurse work environment, influencing nurse well-being. This paper examines if workplace factors moderate temporal changes in the mental and behavioral health of nurses.

METHODS

Cross-sectional data from the HealthyNurse survey collected between May 2017 and July 2023 were analyzed (n = 34,273). Job resources was estimated by average agreement (0 = strongly disagree to 4 = strongly agree) with being treated with respect, recognized for efforts, and the employer values their well-being. Average agreement with working overtime, being assigned a high workload, and working through breaks estimated job demands. Multivariable regression models estimated the effect modification of job demands and job resources on changes over time in hours of sleep and odds of feeling sad, down, or depressed, past 30-day binge drinking, and current tobacco use.

RESULTS

By each year, nurses increased sleep hours (b = 0.011; 95% CI [0.004, 0.018]), but had greater odds of poor mental health (OR = 1.102; 95% CI [1.086, 1.117]), binge drinking (OR = 1.022, 95% CI [1.007, 1.036]), and tobacco use (OR = 1.070; 95% CI [1.043, 1.098]). With higher job resources, sleep increased at a greater rate over time (b = 0.016; 95% CI [0.007, 0.024]) and the odds of binge drinking increased at a lower rate over time (OR = 0.981; 95% CI [0.965-0.998]). Conversely, the prevalence of poor mental health increased at a greater rate over time when job demands were high (OR = 1.018; 95% CI [1.004, 1.033]).

LINKING EVIDENCE TO ACTION

Job demands and job resources may lead to differential mental and behavioral health among nurses. Understanding how these workplace factors can influence nurse health is an important and upstream approach to support well-being in times of crisis.

Consumo de alcohol, tabaco y cannabis en profesionales sanitarios en España durante la fase pandémica aguda de COVID-19

INTRODUCCIÓN

la pandemia de la COVID-19 expuso a los profesionales sanitarios a circunstancias que incrementaron su estrés, recurriendo al consumo de sustancias como estrategia de afrontamiento.

OBJETIVOS

conocer el patrón de consumo de alcohol, tabaco y cannabis en profesionales sanitarios españoles en el periodo prepandemia y durante la fase pandémica aguda (FPA), diferenciando en función de la profesión y estableciendo si hubo diferencias entre ambos periodos.

MÉTODOS

estudio descriptivo no probabilístico con muestreo por conveniencia. Participaron 630 profesionales sanitarios. Se utilizó una encuesta en línea con categorización de la profesión sanitaria, AUDIT-C para consumo de alcohol, preguntas ad hoc para tabaco, y CAST para cannabis. Se realizó análisis de frecuencia y diferencia de medias (t de Student, Z Wilcoxon), reportando el tamaño del efecto y Phi.

RESULTADOS

el 57.1 % de los profesionales sanitarios mostró consumo de la riesgo de la alcohol antes de la FPA; disminuyendo al 42.4 % en la FPA. Entre los consumidores, la proporción de consumidores de riesgo previa a la FPA fue del 95 % en todas las profesiones sanitarias y superior al 65 % durante la FPA. Entre ambos periodos, únicamente hubo un descenso significativo en médicos/as (χ2 MN = 8.108; p < 0.004). Respecto al tabaco, el 14.1 % afirmó consumirlo, observándose un incremento significativo del consumo medio de cigarrillos entre ambos periodos (t(80) = -3.994; p < 0,001), explicado por el incremento entre psicólogos/as (t(42) = -3.245; p < 0.002). Respecto al cannabis, el 2.7 % afirmó haberlo consumido, presentando el 14.3 % adicción moderada y el 7.1 % dependencia.

CONCLUSIONES

durante la crisis sanitaria se produjo una reducción del consumo de alcohol, tabaco y cannabis entre profesionales sanitarios, siendo desigual por categoría profesional. Sin embargo, se detectaron incrementos del consumo y consumos de riesgo en algunos colectivos, señalándose las implicaciones para su salud y labor sanitaria. Se propone impulsar medidas de promoción de la salud mental en los centros sanitarios que incorporen estrategias de abordaje de sustancias.

Factors associated with cessation of smoking in health professionals: a scoping review

BACKGROUND

Offering cessation support to health professionals who smoke to ensure optimal implementation of cessation support for patients is a key recommendation of the WHO Framework Convention on Tobacco Control Article 14 guidelines. However, direct efforts to support this population to quit are limited. Although numerous articles on the topic of tobacco use among health professionals have been published, the factors associated with their own cessation have not been systematically synthesised.

OBJECTIVE

We sought to synthesise existing literature on the predictors and processes informing attitudes and beliefs of smoking health professionals' own cessation.

METHODS

A five-step methodological framework for scoping reviews was followed. We conducted a systematic search of EMBASE, PubMed, Web of Science, and PsycINFO databases, as well as Google Scholar for relevant articles. Titles, abstracts, and full texts were screened against predefined criteria: research published between 1990 and 2021, in English-language peer-reviewed journals; participants included doctors, nurses, medical, and student nurses who smoke.

RESULTS

The initial search yielded 120, 883 articles, with 27 selected for synthesis. Prevalence estimates and predictors of smoking behaviour have remained the primary focus of smoking health professional research. Few studies explicitly examined the relevant predictors of quit attempts and quit attempt success. There is evidence that age and work environment factors predict quit attempt success in some health professional groups. There is also some evidence of tobacco smoking stigma experiences among nurses and nursing students who smoke.

CONCLUSION

Although cessation support is desperately needed for health professionals who smoke, the evidence for factors predicting quit success remains limited. To better guide future research, first, more theoretical work is required to identify the relevant predictors. Second, these should be tested using prospective research designs that take a multi-focal perspective to clarify the targets for change.

Perceived stigma, substance use and self-medication in night-shift healthcare workers: a qualitative study

Background

Many risk factors related to altered circadian rhythms impact the health of night-shift hospital workers (NSHW), resulting in mental and somatic disorders. Easy access to psychoactive substances (PS) may facilitate addictive behaviors in NSHW. They are also exposed to a stressful work environment, which may further affect sleep quality. This study aimed to explore the link between sleep deprivation, work-related psychosocial stress and psychoactive substance use as a self-medication response in NSHW.

Methods

Qualitative study to verify the plausibility of the self-medication theory applied to addictive behaviors. Semi-structured interviews (N = 18 NSHW) and thematic analysis, following consolidated criteria for reporting qualitative research recommendations.

Results

Stigma against NSHW was a primary element of a stressful work environment. The stressful and stigmatizing environment, together with night-shift work, further affected NSHW sleep and their mental and physical health. The use of PS appeared to be for self-medication, encouraged by social and professional environments, source(s) of stress, discrimination, and isolation. The work environment, through aggravated sleep disorders, led NSHW to use non-prescribed sleeping pills. Alcohol after work and smoking were used as a social break but also as a means to reduce stress.

Conclusion

Anti-stigma interventions in the healthcare setting and screening of mental/somatic disorders in NSHW can help reduce harmful self-medication behaviors and improve hospital care in the COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08018-x.

Worksite tobacco control - a qualitative study on perspectives from employers and employees at small worksites

BACKGROUND

Evidence-based interventions (EBIs) for tobacco control can be implemented in worksite settings to reduce tobacco use. Small worksites are less likely to adopt tobacco control EBIs than large worksites. The purpose of this qualitative study was to 1) explore factors that impact small employers' decisions to offer tobacco control EBIs, and 2) understand employees' perceptions of tobacco control at small worksites.

METHODS

Working with staff from small worksites (20-250 employees), we analyzed data from 12 semi-structured interviews with employers (via key informants) and four focus groups with employees. We recruited employers and employees through a purchased business list and market research company, respectively. Interview and focus group topics included perceptions of worksite tobacco control; internal and external forces shaping worksite tobacco control implementation; and perceived worksite support for cessation. We conducted thematic data analysis.

RESULTS

Key themes from the employer interviews included: the local environment played an important role in implementation of tobacco control EBIs; tobacco control was perceived as important but not a priority; and tobacco control decisions were driven by worksite culture. Key themes from the employee focus groups included: perceived employer support for tobacco cessation was limited although there was interest from employees; employees who currently used tobacco were stigmatized for their behavior; and incentives and coaching were considered ideal tobacco control EBIs.

CONCLUSIONS

Tobacco control has not been prioritized at small worksites, despite employees welcoming additional cessation support. This study contributes important information on contextual factors and employee preferences that could be targeted to improve tobacco control EBI implementation. Worksites should implement comprehensive tobacco-free policies, minimize stigma when promoting cessation, establish equitable break policies, and involve employees in decision-making related to tobacco control.

The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis

AIMS

To gain new insights into the experiences of nurses who smoke and to understand the impact of those experiences on their delivery of smoking cessation interventions.

DESIGN

A meta-ethnographic synthesis.

DATA SOURCES

CINAHL, Embase, MEDLINE, PsychINFO, Web of Science and grey literature databases were searched from their inception to April 2019.

REVIEW METHODS

Meta-ethnography was employed to synthesize findings from included studies. The CASP qualitative checklist was used to appraise the quality of each study, and the GRADE-CERQual approach to appraise review findings. The synthesis is reported in accordance with the eMERGe reporting guidance.

RESULTS

From an initial search outcome of 6,019 citations, 13 studies were included detailing the experiences of 195 nurses who were smokers or ex-smokers. Four main themes were identified beliefs, dissonance, coping mechanisms and workplace policies. An integrated conceptual map was proposed on the basis of findings. Nurses who smoke were aware of tobacco harms and their role in addressing tobacco use, which resulted in experiences of guilt and stigma. Workplace policies played a crucial role in the creation of cognitive dissonance. Nurses used different strategies to cope with dissonance such as rationalizing smoking benefits, hiding their smoking behaviour, denial of smoking risks, and failing to engage with smoking cessation interventions. Some nurses expressed more positive aspirations to cope with their dissonance, including a willingness to quit and to embrace smoking cessation interventions with their patients.

CONCLUSION

Implementing smoke-free policies and supportive interventions targeting nurses' cognitive dissonance may assist them to quit smoking and improve their engagement in smoking cessation practices.

Building capacity in tobacco control by establishing the Eastern Europe Nurses' Center of Excellence for Tobacco Control

INTRODUCTION

Properly educated nurses delivering evidence-based tobacco dependence treatment could contribute to improving health and reducing regional disparities in tobacco-related disease and death in Central and Eastern Europe. The aims of this study are to describe development of the Eastern European Nurses’ Centre of Excellence for Tobacco Control (COE) and evaluate its online educational program on tobacco dependence treatment using the 5As framework.

METHODS

The online education evaluation followed a prospective, single group, pre- and post-assessment of changes in nurses’ self-reported tobacco cessation interventions. Leaders from five Eastern European countries (Hungary, Czech Republic, Romania, Slovakia, Slovenia) developed protocols for in-country tobacco control education. Nurses responded to a baseline survey, accessed an online nursing educational program, and completed a follow-up survey at 3 months, in the period December 2015 to June 2016. A total of 695 nurses from five countries answered questions on cessation interventions at baseline and of these 507 (73%) completed a follow-up survey at 3 months.

RESULTS

At the follow-up at 3 months, the 507 nurses self-reported a significant increase in providing all 5A components, i.e. nurses were significantly (p<0.0001) more likely to always /usually advise a patient to quit, assess interest in quitting (p=0.002), assist with a quit plan, review barriers to quitting and recommend a smoke-free home post-discharge (all p<0.0001). They were also significantly more likely (p=0.01) to agree or strongly agree that nurses have an obligation to advise patients on the risks of smoking. There was a significant increase (p<0.0001) in nurses’ estimate of the number of patients they provided a cessation intervention the previous week. Nurses who smoked were 60% more likely to assist and arrange compared to nurses who never smoked.

CONCLUSIONS

Coordinating multi-country activities through a COE was successful in engaging a network of nurses to use an online educational program and participate in other tobacco control activities.