The incidence of smoking amongst nurses: a review of the literature

Comparative cross-sectional study of knowledge, attitudes and perceptions among mental health and ward nursing staff towards smoking

AIM

The aim of the study was twofold: to estimate smoking prevalence among nurses and to compare their knowledge, perceptions and attitudes towards smoking.

BACKGROUND

Given the critical role nurses have in the process of patients' smoking cessation both as counsellors and behavioural models, data are needed on their smoking rates and behaviour.

DESIGN

A cross sectional, comparative study was conducted.

METHODS

A convenience sample of 847 nurses working in various psychiatric and public hospitals in Northern Greece participated in the study. Data were collected between April and June 2020 using a battery of questionnaires.

RESULTS

Mental health nurses were less likely to consider quitting smoking within the next 6 months (P < 0.001), despite the fact that they reported higher levels of the importance of stop smoking compared to ward nurses (P < 0.05). However, ward nurses were more likely to quit smoking because of the cost of cigarettes (P = 0.024) and for personal reasons (P = 0.040).

CONCLUSION

Prevalence of smoking in nurses is high. Training and educational programmes are needed to develop the appropriate culture of health promotion among nurses, thus provide a more active support to patients who smoke.

Impact of a total smoking ban in a high secure hospital

Aims and method

To assess the impact of a total smoking ban in a high secure psychiatric hospital. Staff and patients were surveyed before and after implementation. Data were collected on untoward incidents, seclusions, nicotine replacement therapy and changes in psychotropic medication.

Results

Of the 298 patients in the hospital for the evaluation period, 72.8% were smokers before the ban. There were no significant differences in rates of seclusion before and after the ban and only one significant comparison (P =0.01) showed an increase in untoward incidents for smokers. There were no significant increases in the use of psychotropic medication after the ban.

Clinical implications

With adequate preparation, it is possible to implement a total smoking ban in a high secure psychiatric setting without serious negative consequences.

An international review of tobacco smoking research in the nursing profession, 1976-2006

Tobacco smoking represents a contentious issue in the nursing profession, and one that has now become an important topic in nursing research. Despite this fact, the epidemiological quality of research varies widely, and it has been difficult to accurately determine the true incidence of smoking among nurses. Given these inconsistencies, we conducted a state-of-the-art review to identify international trends in tobacco usage among nurses, to ascertain how the epidemiological quality of research has improved over the past 30 years, and also to elucidate the directions in which nursing research has evolved. A total of 73 English-language studies that met the inclusion criteria were located and analysed. Overall, our review suggests that, while tobacco smoking among nurses appears to be decreasing in many countries during recent years, the international trend is far from uniform, and some developed nations still report high smoking rates among their nursing staff. From a methodological perspective, the relative epidemiological quality of smoking research has also fluctuated over time, making it difficult to compare the results of one study to the next. Despite these caveats, tobacco smoking remains a key topic in nursing research, as well as a critically important occupational-health issue for the entire nursing profession. In order to make the next generation of tobacco research data as comparable as possible, future scholars should consider devising and implementing a standardised format for conducting international tobacco smoking research within the nursing profession.

Contemporary smoking habits among nurses in Mainland China

Although China is the world's largest consumer of tobacco and tobacco-related products, the epidemiology of smoking has not been well studied among nurses. Given this serious gap in the literature, we considered it necessary to investigate tobacco smoking habits among a large cross-section of contemporary Chinese nurses, by means of a questionnaire survey. A total of 509 replies were obtained from 520 nurses (response rate: 97.9%). The overall prevalence of smoking was 2.6% (95%CI 1.5 - 4.3). When stratified by gender, the prevalence rate among male nurses was 52.2% (33.0 - 70.8). Of those who smoked, the median number was 11 smokes per day for a period of 25.0 years. When categorized by severity, 15.4% were light smokers, 69.2% moderate smokers and 15.4% heavy smokers. When stratified by age there were no smokers under 25 years, with the prevalence between 25 and 34 years similarly low, at 1.1%. The highest smoking rate was seen among nurses aged 45 to 50 years (10.1%), even though they only comprised 9.8% of the total workforce. Although our study suggests that tobacco usage is relatively uncommon among Chinese nurses overall, the rate among male nurses was alarmingly high. The distribution of smoking by age was not uniform however, with a high proportion being concentrated in the older age ranges. As such, future preventive measures will need to consider the individual situation of Chinese nurses who smoke, particularly those who occupy the older age groups.

Health-promotion behaviors of undergraduate nursing students: a survey analysis

AIM

To examine health promotion behaviors and barriers to health promotion in traditional and nontraditional nursing students in an associate degree nursing program in the northeastern United States.

BACKGROUND

Nursing students are exposed to concepts of health promotion in the nursing curriculum, but do not necessarily apply them to their own lives. Examining the variables affecting the health behaviors of nursing students may provide the information required to motivate lifestyle changes in this population.

METHOD

A cross-sectional descriptive design was used to examine the relationship between study variables.

RESULTS

Nontraditional nursing students participate in health promoting behaviors less often than traditional nursing students and experience more barriers to health promotion.

CONCLUSION

Implementation of health promotion programs targeting nontraditional students may lead to improved health among these individuals, which may result in increased success in nursing programs.

Graduate nurses and nursing student's behaviour: knowledge and attitudes toward smoking cessation

BACKGROUND

Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours.

OBJECTIVES

To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking.

DESIGN

Descriptive survey research design.

PARTICIPANTS

Non-probability sampling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university.

METHODS

Survey.

RESULTS

Factor analysis revealed four clearly differentiated factors, non-smoker's rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurse's perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights.

CONCLUSIONS

Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.

Razširjenost Kajenja Med Medicinskimi Sestrami, Babicami In Zdravstvenimi Tehniki V Sloveniji / The Prevalence Of Smoking Among Nurses, Midwives And Nursing Technicians In Slovenia

Uvod: Medicinske sestre lahko s svetovanjem za opustitev kajenja pomembno prispevajo k zmanjšanju rabe tobaka; pri tem jih pomembno ovira njihovo lastno kajenje. Namen raziskave je prikazati kadilske navade te poklicne skupine v Sloveniji.

Metode: Analiza temelji na podatkih iz presečne raziskave na nacionalno reprezentativnem vzorcu medicinskih sester, babic in zdravstvenih tehnikov (spletna anketa). Naključno izbrani člani Zbornice zdravstvene in babiške nege so se odzvali v 51% (N =1.500), o tem, ali kadijo ali ne, pa smo dodatno pridobili podatke še od 218 oseb, ki sicer v anketi niso želele sodelovati.

Rezultati: V Sloveniji kadi 20,9% medicinskih sester, babic in zdravstvenih tehnikov, več moških (32,9%) kot žensk (19,6%), več tistih s srednjo stopnjo izobrazbe (25,1%) kot z višjo ali več (12,1%), z nižjo samooceno materialnega standarda, ki ne živijo s partnerjem in ki nimajo (predšolskih) otrok ter med njihovimi najbližjimi sodelavci, prijatelji in sorodniki kadi nadpovprečen delež oseb. Več kot polovica (52,9%) jih je začela kaditi med šolanjem na srednjih šoli, znaten delež (15,6%) pa tudi v prvih letih zaposlitve. 20% jih navaja, da v ustanovi, v kateri delajo, zaposleni kršijo prepoved kajenja.

Zaključek: Kajenje med medicinskimi sestrami, babicami in zdravstvenimi tehniki je v Sloveniji še vedno prepogost pojav ter lahko znatno vpliva na njihovo poslanstvo in delo na področju promocije nekajenja in pomoči pri opuščanju kajenja. Pomembno je, da za to poklicno skupino okrepimo promocijo nekajenja že od začetka šolanja in organiziramo ustrezne programe opuščanja kajenja.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

Perceptions and Use of Smoking Cessation in Nurse-Midwives' Practice

The objective of this study was to examine Ohio nurse-midwives' perceptions and use of a smoking cessation protocol in assisting pregnant smokers. The total population of licensed Ohio nurse-midwives (n = 300) was surveyed by using a cross-sectional survey design. Only 4 of 10 items that assessed a nationally recommended method of promoting smoking cessation were done by 50% or more of respondents. Few nurse-midwives identified barriers to counseling pregnant patients who smoked, but the most common were lack of time (14%) and not knowing where to send pregnant smokers for treatment (14%). Most respondents believed that nicotine replacement therapy (NRT) would be most likely to reduce the number of pregnant smokers (74%), yet few (26%) were confident in their ability to prescribe/recommend nicotine replacement therapy. Respondents more likely to use 5 A's can be characterized as the following: had higher efficacy expectations in their ability to communicate issues about the 5 A's and had higher outcome expectations regarding the effects of using the 5 A's. Nurse-midwife training programs and continuing education needs to include current research in nicotine replacement therapy use in pregnant patients and 5 A's techniques to assist pregnant smokers in quitting.

Smoking habits of students of nursing: a questionnaire survey (2004-2006)

AIM

To determine changes in the prevalence of tobacco use among students of nursing and associated factors.

BACKGROUND

The prevalence and distribution of smokers among nursing students varies according to the country and period of study.

METHOD

Transversal descriptive study by self-answered questionnaire. Eight hundred and fifty four subjects (94.9%) were questioned in the period 2004-2006.

FINDINGS

Twenty eight percent of the students declared themselves to be smokers. The habit began before the students started university. The tendency of prevalence by year of survey and by graduation year was downward. The students shown a low nicotine dependency according to Fagerström and little motivation to give up. The average age at the onset of consumption was 14.6 (1.8) years. From the logistical regression analysis, the model best explaining the prevalence of tobacco consumption included the variable of year surveyed and academic background, those coming from the baccalaureate showing a lesser prevalence and tendency to smoke.

CONCLUSIONS

Tobacco consumption among students of health sciences was less than in the general population of the same age but high given their future profession. The tendency to smoke is decreasing and most started smoking before joining the university. We recommend an intensification of actions directed at teenagers and the promotion of anti-tobacco campaigns in universities.

Promoting tobacco dependence treatment in nursing education

ISSUES

There are 17.3 million nurses worldwide, the largest group of health-care professionals, and they have great potential to address the epidemic of tobacco use and its related morbidity and mortality. However, the evidence indicates that the educational preparation of nurses for tobacco control remains inadequate.

APPROACH

This paper provides an overview of the efficacy of nurses in the delivery of smoking cessation interventions, existing tobacco control content in nursing educational programs, model curricula, teaching resources and strategies for reducing barriers to curricular change.

KEY FINDINGS

Despite the efficacy of nursing intervention for tobacco cessation, lack of appropriate knowledge and/or skill presents a major problem for implementation. An important factor fostering this lack of preparation is limited tobacco control content in current nursing educational programs. Barriers to enhancing and building this curricula include lack of preparation of educators, low priority for this content in an already overloaded curricula, negative attitudes, continued smoking by nursing students and/or faculty and lack of tested curricula. The availability of new tobacco control resources, including those specifically tailored for nurses can assist educators in teaching this content and nurses in implementing interventions.

IMPLICATIONS

Research and changes in policy are needed to ensure that nursing education includes essential content on tobacco control.

CONCLUSION

Nurses can be effective in delivering tobacco cessation interventions. Efforts are needed to promote curriculum that ensures that all nursing students and practicing nurses receive tobacco control content and are competent in the delivery of interventions; and to disseminate resources to nursing educators

Comparison of mental health nurses' attitudes towards smoking and smoking behaviour

Smoking is widely recognized as an important public health issue for the general population and in the mental health field where the rates are particularly high. Mental health nurses are well positioned to take an active role in encouraging and supporting people diagnosed with mental illness to cease smoking. Information about smoking behaviour and the attitudes of mental health nurses is necessary to develop strategies to prepare nurses for this important role. A cross-sectional study was conducted to examine the smoking behaviour and attitudes of mental health nurses in Queensland, Australia, through a random selection of mental health nurses (n = 289). Smoking rates (16%) in this study were lower than those for the Australian population. Smokers were significantly (P < 0.001) less likely to agree that health-care facilities should promote a healthy environment. All participants, but predominantly those who smoked (P < 0.001), supported the individual's right to smoke. Participants believed they possessed appropriate skills to deliver the antismoking message effectively, although stronger beliefs were characteristic of non-smokers. Participants who smoked perceived that their smoking status assisted in facilitating interactions with consumers (P < 0.001). The findings have implications for the health promotion activities of mental health nurses.

Smoking prevalence among qualified nurses in the Republic of Ireland and their role in smoking cessation

BACKGROUND

Smoking is the leading preventable cause of premature mortality, killing approximately 6000 people in Ireland each year. On 29 March 2004, the Republic of Ireland became the first country in the world to ban smoking in all workplaces, including bars and restaurants. This study took place after the introduction of this smoking ban. An admission to hospital provides an opportunity to help people stop smoking. Nurses' role and wide availability puts them in a prime position to encourage people to quit smoking.

AIM

To examine the smoking prevalence among qualified nurses at a large university teaching hospital in Cork Southern Ireland and their role in smoking cessation.

METHODS

This was a descriptive cross-sectional study using a calculated sample of 430 qualified nurses (with a 70% response rate). A structured questionnaire was used.

FINDINGS

It was found that 21% (n = 63) of nurses were smokers, 23% (n = 70) were ex-smokers and 56% (n = 167) were non-smokers. The highest prevalence of smokers was found in the age groups 20-25 years (28%, n = 17) and 26-30 years (34%, n = 21). Nurses working within psychiatric care (47.4%) and coronary care (33.3%) had the highest smoking prevalence among the nurses who smoked. The study found that there was a significant difference between the attitudes of smokers and non-smokers, 89% (n = 211) of non-smokers strongly agreed that cigarette smoke represents a major risk to health in comparison with only 65% (n = 41) of smokers. Only 14% (n = 43) of the nurses surveyed had received training in smoking cessation. Lack of time (74%) and lack of training (65%) were the two main reasons given by nurses for not giving smoking cessation advice to patients.

CONCLUSION

Nurses' potential in preventive health care has been largely under-utilized. Lack of time and training are major factors inhibiting nurses' role in smoking cessation with their patients.

Smoking trends in the Nurses' Health Study (1976-2003)

BACKGROUND

Smoking trends among nurses are important to monitor as smoking negatively affects their health and decreases their likelihood of providing cessation interventions to patients.

OBJECTIVES

The objective of the study was to describe the changes in smoking trends in the participants in the Nurses' Health Study (NHS) cohorts over 27 years.

METHODS

An analysis of biennial changes in smoking status and cigarette consumption within nine 5-year birth cohorts (1920-1924 to 1960-1964) and age-specific mortality rates by smoking status were examined in 237,648 female registered nurses (RNs): NHS (ages of 30-55 years in 1976, followed through 2002) and NHS II (ages of 25-42 years in 1989, followed through 2003).

RESULTS

Current smokers constituted 33.2% of NHS in 1976 and 13.5% of NHS II in 1989. Smoking rates declined in all birth cohorts; 8.4% were smoking in 2002/2003. Seventy-nine percent of nurses who ever smoked had quit. The mean cigarettes per day declined over time but still exceeded half a pack per day (15.1 cigarettes) at the end of follow-up. The mortality rate among current smokers was higher than that of former smokers and was approximately twice that of never smokers in all age categories; those who smoked were more likely to have comorbid conditions.

DISCUSSION

This study provides the first report of smoking trends among RNs in the NHS. The decline in smoking rate among female nurses mirrors the decline in smoking rate among women in the United States over the past 25 years. Increased mortality and morbidity rates indicate the devastating cost of smoking to the profession and can provide support for the urgent need for further research to encourage continued smoking cessation efforts for nursing professionals.

Challenging the smoking culture within a mental health service supportively

Smoking is an entrenched part of the culture of mental health care services. This paper discusses the smoking culture in mental health care settings and demonstrates a supportive model to engage staff to actively address their tobacco use and to influence a change in smoking-related workplace policy, practice, and culture. With management endorsement, two 9-week staff smoking cessation support groups were implemented and subsidized nicotine replacement therapy was provided to staff within the Alma Street Mental Health Service, Fremantle Hospital, Western Australia. Eighteen staff members from nursing, social work, administration staff, and patient care assistants participated in the group programme. At the conclusion of the programme, 61% (n = 11) of participants had quit as a result of the groups. Furthermore, a 3-month follow-up evaluation revealed that 39% (n = 7) of the group had abstained from smoking because of the programme. More importantly, the groups engaged staff to discuss workplace smoking issues and produced five recommendations to review policy and practice to further influence a change in the smoking culture of the mental health care service. The groups also provided the opportunity to develop a model of intervention to address smoking in a mental health setting and to raise the public health role of mental health nurses.

Survey of student nurses and midwives: smoking and alcohol use

This article presents findings from a survey of 186 first year nursing and midwifery students that relate to their smoking and alcohol consumption. Of the students sampled, 28% were cigarette smokers. This is higher than the smoking rate of 25% for the adult population in the UK. The majority of the students who smoked said that they would like to stop smoking. Most of the students (86.5%) reported having drunk alcohol on at least one occasion during the previous week, with 26.5% having had a drink on three or four days. The amount consumed over the week ranged from no drinks to 90, with the mean being 13.72.Worryingly, 74% had exceeded the daily benchmarks for low-risk drinking on at least one occasion during the week for which consumption was reported, and 55% were drinking at binge levels. The findings raise concerns for the future health of many of our students and for their roles as health promoters.

Impact of reproductive experience on women's smoking behaviour in Japanese nurses

OBJECTIVES

The objectives of this study were to describe current and past smoking behaviour of female Japanese nurses, to examine factors associated with developing and stopping a smoking habit, and to examine how their reproductive experiences affect their smoking behaviour.

STUDY DESIGN

A cross-sectional study. This study was a baseline survey of a prospective occupational cohort study.

METHODS

A self-administered survey of 1748 female Japanese nurses aged over 20 years was conducted in Gunma prefecture, Japan, in 1999.

RESULTS

Overall, 27.2% developed a smoking habit (current smokers, 19.8%; ex-smokers, 7.4%) and 72.2% were never smokers. Logistic regression analysis showed that the type of nursing certificate was statistically associated with developing a smoking habit. It also showed that the type of nursing certificate, work place, marital status and current pregnancy were statistically associated with smoking cessation. Currently pregnant women were more likely to stop smoking than non-pregnant women (adjusted odds ratio, 3.18; 95% confidence intervals, 1.25-8.06). For women aged 20-29 years, the proportions of current smokers, ex-smokers and never smokers among pregnant women were 11.5, 23.1 and 65.4%, respectively; among non-pregnant women of this age, the values were 22.3, 4.3 and 73.4%, respectively. There was a statistically significant difference in such proportions between the two groups (chi2=19.27; P<0.0001). More than half of the ex-smokers who were currently pregnant had stopped smoking in the last 12 months. Smoking behaviour showed no statistically significant difference between women who had had at least one delivery and women who had not.

CONCLUSIONS

The results suggest that pregnancy provides a good opportunity for smoking cessation, but a large proportion of women who successfully quit smoking during pregnancy relapse after delivery.

A cluster-randomized trial on smoking cessation in German student nurses

OBJECTIVES

To evaluate the effect of a specific intervention on smoking cessation in health professionals.

METHODS

Between 2003 and 2004, a cluster-randomized trial was performed in 32 schools of nursing with 956 student nurses in Southwest Germany. Students in the intervention group received three teaching units each lasting 1 day on how to give advice to people who want to stop smoking. The program addressed only nurses' professional role and not their individual smoking behavior. After a follow-up of 13 months, the change in smoking status was determined. Secondary endpoints included changes of smoking-related factors like stages of smoking or knowledge about health risks.

RESULTS

Change of smoking status in the desired direction (stopping smoking or not starting smoking) occurred less often in the intervention than in the control group, but the difference did not reach statistical significance (odds ratio 0.69, 95% confidential interval: 0.43, 1.10). The program was successful in delivering medical knowledge (P=0.0056) and in enhancing competence in giving advice to smokers (P<0.0001).

CONCLUSIONS

The applied approach is able to improve student nurses' medical knowledge and to augment their competence in giving advice to smokers, but it is not an effective strategy to reduce their own smoking behavior.

Smoking among Greek nurses and their readiness to quit

AIM AND RATIONALE: The preventable nature of smoking-associated diseases places a responsibility on health professionals for smoking-related health promotion. This paper disseminates information from a survey of qualified Greek nurses, comparing smoking attitudes, influences on smoking behaviours and desire to quit with their motivation to act as health promoters with patients and other health professionals who smoke.

METHOD AND SAMPLE

A random sample (n=402) of qualified nurses employed by hospitals in Athens was surveyed with a self-administered questionnaire in a cross-sectional survey which had a 73% response rate. Following quality control measures, a final sample of 308 was achieved.

RESULTS

Results showed that almost half of the nurses in the sample were current smokers, almost a quarter were former smokers, with just less than a third non-smokers. Using the Stages of Change model as a measure, the survey reported that 11% of the smokers in the sample expressed a desire to stop within the next month, another 12% in the coming 6 months and 23% of current smokers were still in the pre-contemplation stage. The main reasons given for continuing to smoke included using tobacco for enjoyment and as a coping mechanism for stress. Organizational problems were identified as the main source of stress. Finally, the majority of respondents confirmed the important part that they can play as role models in promoting health behaviours in their patients.

CONCLUSIONS

Findings suggest that smoking prevalence among qualified Greek nurses is greater than that reported in the general Greek population. Implications and recommendations for nursing practice, education and research include the early provision of smoking education in nurse training. Interventions should be directed at nurses who smoke to assist them to stop and to maintain cessation according to their stages of change.

Psychiatric nurses' ethical stance on cigarette smoking by patients: determinants and dilemmas in their role in supporting cessation

It has been argued that psychiatric nurses are ideally placed to provide smoking cessation interventions to patients with mental illness. This assumes that psychiatric nurses actively support smoking cessation. The current paper articulates some of the reasons why this has not occurred, in particular, some of the ethical beliefs held by nurses that may prevent such activity. Such an assumption also discounts the evidence that confirms psychiatric nurses to have among the highest smoking rates in nursing and in the health professions in general. The role and impact of the institution are also considered. In-depth interviews with seven community and inpatient psychiatric nurses were thematically analysed. Extensive individual and group discussions were also held with inpatient nurses from open and locked psychiatric settings during participant observation of the settings. The findings suggest that psychiatric nurses can be more effective in the primary care role of supporting patients' smoking cessation if they receive adequate institutional support to do so.

Tobacco cessation in acute and critical care nursing practice: challenges and approaches

Recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented new national core measures, including tobacco-cessation interventions for patients hospitalized because of pneumonia or other pulmonary-related illnesses, acute myocardial infarction, or heart failure. All interventions performed for such patients must be documented in the patient's chart. Because the JCAHO standards for tobacco cessation are implemented hospital-wide, acute and critical care nurses must take an active role in their execution. This article discusses the challenges to integrating tobacco cessation in daily acute and critical care nursing practice and makes recommendations regarding cessation approaches designed to improve health outcomes for tobacco-dependent patients.

Smoking bans in psychiatric inpatient settings? A review of the research

OBJECTIVE

This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings.

METHOD

After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included.

RESULTS

Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term.

CONCLUSIONS

The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.

Undergraduate nursing students' attitudes towards smoking health promotion

Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students' attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents' attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non-smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.

Smoking prevalence and attitudes toward tobacco among student and staff nurses in Niigata, Japan

The present study investigated smoking prevalence and attitudes toward smoking in student and staff nurses, and activities to promote tobacco intervention by staff nurses. A total of 743 student nurses in 2 colleges and one university and 490 staff nurses in the university hospital in Niigata, Japan participated in the study and filled in self-administered anonymous questionnaires focused on smoking habits, attitudes toward smoking, and activities to promote tobacco intervention. The smoking prevalence among student nurses was 6% and increased with the year of study, whereas that of among staff nurses was 16% and increased by employment up to 3-5 years. Almost half of the student nurse smokers started the habit before admission to higher education facilities, and more than half of staff smokers also started smoking in their school years, in high school or college. Nicotine dependence, as defined by over 11 cigarettes per day and the first cigarette within 30 min after getting up, was high in smokers who started smoking before admission to college or university, but not in those who took up the habit thereafter. Thirty-six percent of student nurses and 25% of staff nurses agreed with the statement that "nurses should not smoke." Only 12% of staff nurses were involved in anti-tobacco interventions routinely, partly due to lack of broad knowledge and the necessary skills. Greater efforts are needed as a high priority to educate student and staff nurses systematically and comprehensively about the range of tobacco interventions available in Japan.

Nurses, smoking, and the workplace

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.

Smoking among Japanese nursing students: nationwide survey

AIM

This paper reports a study estimating the nationwide prevalence of and attitudes towards smoking among Japanese nursing students.

BACKGROUND

The World Health Organization established "World No Tobacco Day" in 1987, and has been promoting antismoking measures worldwide since then, with annual themes. It has emphasized that health care professionals, including nurses, as role models for healthy living, should not smoke, and that as promoters of health education they should not seem to justify or condone their patients' smoking. To promote antismoking measures among nurses, it will be necessary to scrutinize the smoking habits and behavior of nursing students and associated factors, and to conduct effective antismoking education and health education before they acquire the smoking habit.

METHODS

A cross-sectional survey was carried out through self-administered, closed-ended, structured questionnaires. Questionnaires were mailed to 4169 nursing students at 27 randomly selected vocational nursing schools nationwide. Smoking status, history, and attitudes towards smoking were examined.

RESULTS

Smoking prevalence among female nursing students was 23.5%, which was higher than that among the Japanese general female population aged 20-29 (21.9%). Smoker-students were significantly more positive toward smoking than non-smokers in all opinions about health care professionals' smoking. Multiple logistic regression analysis showed that smoking statuses of the people around the participants, dissatisfaction with being a nursing student, and living alone were associated with participants' smoking behaviour.

CONCLUSIONS

The results of the present study suggest an urgent necessity to provide effective antismoking measures for nursing students.

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND

It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement.

OBJECTIVES

To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions.

METHODS

Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes.

RESULTS

Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups.

CONCLUSIONS

Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Associations of sleep problems and recent life events with smoking behaviors among female staff nurses in Japanese hospitals

For the purpose of examining the relation of sleep problems and other possible correlates with smoking among staff nurses in hospitals, the cross-sectional data of a self-administered questionnaire survey for 522 Japanese female staff nurses were reanalyzed. Registered nurses or licensed practical nurses were 82%, while nursing assistants were 18%. The prevalence of current smoking (PCS) was 29%, being higher than that in the general population of Japanese women. The current smokers exhibited a high tendency toward tobacco dependence. Multivariate analyses revealed that PCS was associated with recent frequent night shifts and a large amount of support from coworkers, while the association of a large amount of job control and a feeling of light overnight sleep with PCS was also suggested. The tobacco-dependent tendency was associated with recent life events and the presence of insomnia. It is possible that smoking is a countermeasure against sleepiness caused by the disadaptation to shift-work, or that tobacco-intake pharmacologically disturbs sleep. For decreasing PCS in staff nurses, further research should focus on the relation of smoking with their sleepiness and shift-working system, and also on the process in which major life events develop smoking behaviors.

Caught in the middle: experiences of tobacco-dependent nurse practitioners

PURPOSE

To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke.

DATA SOURCES

Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews.

CONCLUSIONS

Participants' responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction.

IMPLICATIONS FOR PRACTICE

All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobacco-dependent patients but providers as well.

Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites

BACKGROUND

This article reports the findings from a comparative study investigating smoking behaviours among institutionalised psychiatric populations from a sociological perspective.

METHOD

The study involved participant observation of two separate Australian sites between 1999 and 2002, the second site serving to generalise the findings from the first site.

DISCUSSION AND CONCLUSIONS

Systemic barriers to quitting were identified, emanating from the mental health system in general. Cigarettes were identified as the currency by which economic, social and political exchange took place between participants who described an enculturation process that involved complex processes of reinforcement to smoke. Once entered into, escape from the smoking culture of the settings appeared to be extremely difficult for clients and staff.

Cognitive dissonance and undergraduate nursing students' knowledge of, and attitudes about, smoking

BACKGROUND

Smoking is a major cause of morbidity and mortality. Although nurses have an important role in health promotion, and are well placed to see the harmful effects of tobacco smoking, studies suggest that they smoke at much the same rate as the general population.

AIM

The aim of this paper is to report a study examining undergraduate nursing students' knowledge about the impact of smoking on health, and their attitudes towards smokers and smoking.

METHODS

The study took place in 2001, using a non-probability sample of 366 undergraduate nursing students from an Australian university. Participants completed the Smoking and Health Promotion instrument. Festinger's theory of cognitive dissonance provided an explanatory framework for the findings.

RESULTS

Most respondents who were still smoking began the habit while in high school. Students had greater generic than specialized knowledge about the effects of smoking on health, and there was no significant difference between second and third year students' knowledge. Those who still smoked had less favourable attitudes towards smoking-related health promotion than those who had never smoked or stopped smoking. Non-smokers were more supportive of non-smokers' rights than those who continued to smoke, while those who had stopped smoking were undecided. There was minimal association between levels of knowledge and attitudes about being sensitive to smoking-related health risks.

CONCLUSION

The findings have implications for both high school education and undergraduate nursing education, and for the recruitment of students to undergraduate nursing programmes. More attention needs to be given in undergraduate nursing programmes to smoking and smoking-related illnesses, and to nurses' role in smoking health promotion.

Women and the global tobacco epidemic: nurses call to action

BACKGROUND

Tobacco consumption is increasing among women across the globe at alarming rates. Without effective intervention, the smoking prevalence among women will nearly triple over the next generation. These trends are potentially more threatening when considering how tobacco intersects women's lives, regardless if they use tobacco products or not.

AIM

A review and analysis of the literature is conducted to examine the scope of tobacco's global effect on the multiple dimensions of women's health.

METHOD

Medline (1990-2003), Cumulative Index to Nursing and Allied Health Literature (1990-2003) and World Health Organization databases were searched for related topics. Keywords for searches included global health, tobacco, women and nursing.

FINDINGS

The epidemiology and prevalence of tobacco use among women are presented and its impact on women globally. Using an ecological perspective, the consequences of tobacco are analysed within the contexts of health, social, environment, economic and policy as it relates to women, their families and their communities.

IMPLICATIONS

Nurses are in prime positions to empower individuals, families, communities and nations in the prevention and treatment of tobacco use. Health for all women continues to be a call for equity and social justice. Recommendations are provided for nursing practice, education, theory, research and policy to address this global health concern.

Nursing and tobacco reduction: a review of the literature

Nurses have an instrumental role to play in tobacco reduction, which is one strategy used to address tobacco use; a primary source of preventable morbidity and mortality globally. The following review addresses activities by two groups of nurses: nursing governance bodies and nurse scientists, whom together provide vision and knowledge to support and shape nursing practice. While nursing governance bodies and scientists have contributed a great deal to tobacco reduction, there are also gaps. Areas that require strengthening are: support for tobacco dependent nurses, basic nursing education concerning tobacco dependency treatment, and integration of tobacco dependence treatment into nursing practice.

Health promotion and tobacco control: student nurses' perspectives

This article reports findings about student nurses' understanding of the nursing role in health promotion related to tobacco issues. These findings were derived from the data of a larger project, examining smoking practices of baccalaureate nursing students in Manitoba, Canada. The study was conducted with second-year, third-year, and fourth-year university nursing students studying at several sites throughout the province (N = 272). From the data analysis of the interviews, class forums, and open-ended survey questions, five themes emerged (i.e., who they are-who they are becoming, central beliefs and attitudes, learning the facts, practice world-limited options, role conflict). Students expressed considerable uncertainty and conflict concerning individual autonomy around decisions about tobacco use. This resulted in confusion about themselves as role models and their use of health promotion interventions.

Smoking behavior, initiating and cessation factors among Japanese nurses: a cohort study

The prevalence of smoking among Japanese nurses, specially in their twenties, is higher than that among the general female population. To examine smoking behavior, smoking initiating and cessation factors, we conducted a cohort study through questionnaire survey, targeting nurses (n=1572) working at 11 hospitals located in Tokyo metropolitan area. The first survey was conducted using a confidential questionnaire on smoking, followed by a second survey conducted in the same manner on the same subjects two years later. As to smoking status after two years, 8% (95%CI=1.5%) started smoking and 6% (95%CI=1.4%) quitted resulting in a 2% increase in the prevalence of current smoking. The average nicotine dependence for nurses who were smokers in the two surveys rose from 3.9 to 4.3 (P<0.05). Smoking behavior of mother, friends, or superiors at work had a significant influence on smoking behavior of nurses. As to smoking cessation factors, the idea that women and medical workers should not smoke, and living with family each had a significant influence. Considering the fact that 6% of nurses in this study succeeded in quitting smoking within two years, it is required that anti-smoking education be conducted at medical institutions to decrease the prevalence of current smoking among the nurses in Japan.

Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours

AIM

To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.

RATIONALE

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role.

METHODS

A cross-sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self-administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale.

FINDINGS

Two hundred and seventy-two students (61.9%) responded. Sixty (22.1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91.4% said they wanted to quit, few were actively engaged in the quitting process (16.9%). When comparing the beliefs and attitudes of smoking and non-smoking students, proportionally more of the non-smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non-smoking example. Non-smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management.

CONCLUSIONS

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.

Tobacco: an emerging topic in nursing research

BACKGROUND

Tobacco use is the leading cause of preventable death in the United States. Since the first Surgeon General's Report in 1964 on the health risks of tobacco use, overwhelming evidence regarding increased tobacco-attributable morbidity and mortality has been reported. The purpose of this review was to explore nursing research contributions to this public health issue by evaluating the emergence of publications focused on tobacco in a leading nursing research journal.

OBJECTIVES

The specific aims of this review were to determine, among data-based articles published in Nursing Research (1952-2000), how often tobacco use was included (a) in sample descriptions, (b) as a variable potentially associated with study outcomes, and (c) as a finding. Additionally, the frequency of publication of research instruments developed to study tobacco use was evaluated.

METHODS

Data-based articles (n = 1,705) and research briefs (n = 197) were evaluated. Inter-rater reliability (100%) was established by the re-review of 20% of the issues in each decade.

RESULTS

A total of 40 data-based articles (2% of those reviewed) either included tobacco use in the sample description only (n = 11), as an independent or mediating variable (n = 11), or as a finding (n = 18). The majority (53%) of the articles were published since 1990; and 71% of the outcome studies were published within the past 5 years. One study focused on tobacco use among youth, and 1 of 197 instrument articles reviewed focused on tobacco. None of the studies reviewed addressed prevention of tobacco use or strategies to decrease exposure to second-hand smoke.

CONCLUSIONS

This review demonstrates that the cessation of tobacco use is emerging as a topic for nursing research, reflecting the increased public health attention on this topic. Increased research efforts are needed in the areas of tobacco cessation and prevention of tobacco use. Researchers should be encouraged to consider tobacco use as a variable potentially affecting outcomes in other research studies.

A smoking reduction and cessation program with registered nurses: findings and implications for community health nursing

A smoking reduction and cessation program was implemented with registered nurses in 3 Canadian provinces. Nurses (n = 117) participated in either an 8-week group or self-directed program using a resource specifically designed for nurses. Questionnaires were administered prior to and at the end of the 8-week interventions and at 6 and 12 months postintervention. Statistically significant changes at 8 weeks in nurses' smoking practices were found on the number of nurses continuing to smoke, mean number of cigarettes smoked, and movement in the stage of behavioral change. Attrition and variation in patterns of quitting over the 12-month study period made assessing participants' longer term outcomes difficult. This study highlights the complexity of assisting nurses to quit smoking and of implementing and evaluating a program based on accepted community health models of practice.

Nurses' competence in advising and supporting clients to cease smoking: a survey among Finnish nurses

The article describes the results of a survey of Finnish nurses (n = 882). The purpose of the study was to describe how nurses' education, working experience and their own smoking habits relate to their self-reported competence in advising and supporting clients to cease smoking. Nurses evaluated their skills fairly highly, but did not believe that advice alone was helpful to clients who wished to cease smoking. Nurses had minimal knowledge of smoking substitutes. Lower general education, a fairly short time from graduation and a history of smoking were positively related to nurses' competence to guide clients. Nurses who smoked daily were found to have better skills in giving advice and support than their non-smoking colleagues. The results have implications for the design of smoking cessation programmes. More education and guidance is required for nurses, so that they can develop their understanding and a positive view as to the effectiveness of smoking cessation programmes.