Developing Smoking Interventions in Nursing

• Hannah Burrell-Davis

Regulatory and legal documents are essential for appropriate nursing practice and influences the way nurses work on a daily basis. The Nursing council of New Zealand’s code of conduct and the smoke-free environments act 1990 are examples of these, having huge impacts on the way nurses practice today. It is important to reflect on how these may influence the nursing practice in New Zealand.

The Smoke-free Environments Act 1990 was established to aid in the protection of those individuals who do not want to smoke or be around second hand smoke in order to prevent any detrimental effects to their health. The smoke-free environments act solidifies this by ensuring that those that do smoke do not inflict any health implications on those who do not smoke themselves, this is ensured by reducing the amount of tobacco substances exposed to non-smokers, and adequate regulation and control of the marketing and advertising and promotion of tobacco products. This can be successfully achieved through the sponsoring of other products, events or services and/or directly. Another purpose of the smoke-free environments act is to ensure that the presence of harmful constituents in tobacco products and tobacco smoke is monitored and regulated. Finally, a health sponsorship council needs to be established, which will aid in promoting health and encourage healthy lifestyles (Smoke-free Environments Act, 1990). The smoke-free environments act is broken into 2 parts to aid the amount of tobacco use and its harmful effects, these parts include having smoke-free workplaces and public areas, and control of smoking products. These two parts are centred on the protection of individual’s health and reducing the amount of youth that is impacted by second hand smoke.

The Nursing Council New Zealand (NCNZ) holds the responsibility for the registration of nurses; it acts by protecting the safety and health of the community and public by ensuring that nurses are competent and fit to practice. The NCNZ has many methods and rules set in place to maintain this and fulfil this function, one of these being the NCNZ Code of Conduct. The Code of Conduct should be used by nurses to uphold appropriate behaviour, not only in the professional role, but must also continue to have a high standard of behaviour in their personal lives. This is primarily because nurses must gain the trust of the public. The Code of Conduct has a set of values and principles that are essential for nurses to understand, they also aid in the understanding of professional practice and can be applied in association with the Smoke-Free Environments act. The values in the NCNZ Code of Conduct include respect, trust, partnership and integrity. Respect is a major value that should be very apparent in nursing practice, as the code of conduct suggests, treating others with respect means behaving towards individuals with worth and respect for their health and wellbeing (NCNZ, 2012), this is essential for a nurse to understand. Not only is it essential for the nurse to understand during nursing practice, it is important to understand in personal life situations, in regards to smoking a smoker must have respect for those who do not smoke or wish to be around second hand smoke, this includes the health professionals that do smoke.

Encouraging the decreased use of tobacco is a skill that can be very effective in the nursing practice, with smoking cessation however support from the nurse is very important. Along with trust, respect, integrity and partnership, as the code of conduct implements, support is another very powerful intervention that must be applied in nursing practice, in particular when it comes to successful smoking cessation. Nicotine addiction will be a major contributor to most of the withdrawal symptoms, these can be hard to deal with and fear of the unknown is paramount, hence the importance for support. At this stage a referral to nicotine patches, lozenges and gum will help the withdrawal symptoms. Support can include providing reassurance to the patient, reinstating that there is help available and reminding them that this is the first step of treatment to benefit the health of them and their family/whanau surrounding them. It is also important that the nurse considers the age, gender, disabilities/disorders and ethnic group of the individual attempting to quit smoking. Here the nurse would implement the values and principles in the code of conduct, doing so by ensuring that their practice is culturally safe. The code of conducts principle, partnership, can be utilised at this stage as nurses must also work alongside patients during the smoking cessation process, it is important that patients are given adequate information about quitting in a manner that they can understand in order to make an informed choice about their care and treatment(NCNZ, 2012).

This can be applied to nursing situations, as the act outlines that smoking in workplaces is prohibited, this includes health care settings, such as hospitals, community health services, hospices, dental surgeries, aged care services etc. However although smoking in workplaces is prohibited, as stated in the smoke-free environments act (Smoke-free Environments Act, 1990), people, including health professionals continue to smoke in such areas. The Waikato Times author Maryanne Twentyman documented an article in which the Te Aroha District Community Hospital was scrutinised for such anti smoke-free behaviour. Te Aroha 69 year old man was a patient when he spent two days at Te Aroha District Community Hospital, and although he could not fault the nursing care he received, he was shocked and disgusted with the lack of smoke-free policies on the hospital grounds. He states “I was appalled to see the staff puffing up a storm close to the hospital entranceways” (Twentyman, 2012). Smoking close to the entranceways can be harmful to the patients, people can walk through the smoke and the smoke can waft into the rooms, putting the patients at risk, which is an example of nurses not following through on the NCNZ Code of Conduct’s values and principles and the smoke-free environments act by not having the patients’ health at best interest. To prevent this from occurring the act states that there must be dedicated smoking rooms in hospital care institutions and these must be equipped with a mechanical ventilation system. Appropriate and acceptable nursing practice must always be aware of the impacts they or others have on a patient’s health.

Another key requirement of the smoke-free environments act is to prevent young people from being influenced by seeing other people smoke, particularly in homes and schools. (Smoke-free Environments Act, 1990). This can strongly be impacted by nursing practice, in particular by community nurses. Rowa-Dewar and Ritchie (2014), suggest that children are particularly sensitive to second-hand smoke (SHS) and the risk associated with it, due to their faster breathing rate, they inhale more pollutants per their weight than adults. What some parents may not be aware of is that SHS lingers in the air long after the cigarette has been extinguished, and children will still be exposed to the risk it entails. Community nurses are uniquely placed to intervene in such health behaviours in the home setting. Community nurses can use such useful strategies as to educate and build upon the importance of parental desires to protect their children. It is hopeful that this desire will emphasize the interdependence of their health behaviours and how this may impact their child’s health. According to Rowa-Dewar and Ritchie (2014) most parents are shocked by the levels of SHS in their own homes and want to protect their children. Although the smoke-free environments act has no influence over the smoking environment of the home, it certainly stretches to the alternative young people’s environments, such as schools, early childhood education and care centres. According to the act no persons are to smoke in any parts of these premises at any time of any day, including the entrances.

Smoking cessation is without a doubt a major factor that nurses can have a strong influence over, not only does it affect the health of themselves and their surrounding family/whanau, it can have a huge impact on disabilities, illnesses and even such injuries as bone fractures. When a fracture occurs, it is vital that the healing process begins as soon as possible; this is because delayed fracture healing can have a significant effect on a patient’s wellbeing. However such factors that could result in a potential delay includes smoking. All the elements that are in cigarette smoke are associated with the impairment of fracture healing, as a combination they inhibit the conditions required for a timely fracture healing, with nicotine being recognised as a risk factor for reduced bone density. (Miller, 2014). The smoke-free environments act has a purpose to reduce the harmful effects of tobacco use on people, nurses have the power to influence smoking habits and the continuance and encouragement of smoking cessation should be present.

Smoking is implicated in numerous detrimental health impacts and many illnesses and disabilities. Nurses have a major role in aiding in the decreased use of tobacco smoking and therefor an increase in health worldwide. Such pieces of legislation as the Smoke-free Environments Act and the New Zealand Nursing councils code of conduct, continue to develop and impact on the nursing care that is received today, encouraging nurses to offer their best nursing practice to decrease serious health complications.

References

Miller, S. (2014). How Smoking can Hinder Fracture Healing. Journal of Emergency Nursing,22(4), 28-30.

Rowa-Dewar, N., Ritchie, D. ( 2014). Protecting Children from Smoking in the Home: An Ethics of Care Perspective. British Journal of Community Nursing, 19(5), 214-218.

Smoke-Free Environments Act, No. 108. (1990). Retrieved from http://www.legislation.govt.nz/act/public/1990/0108/latest/DLM223191.html

The Nursing Council of New Zealand. (2012). Code of Conduct for Nurses. Wellington, New Zealand: Nursing Council of New Zealand.

Twentyman, M. (2012, January 25). Smoking near hospital doors disgust patient. Waikato Times, p.24.