Public Health Issue
The purpose of this essay is to identify a public health issue related to a patient in my previous clinical placement. The patient Mrs M who was 35 year old woman diagnosed with lung cancer as a result of smoking. To facilitate the discussion smoking as a public health issue has been chosen. The stage of change model and The Healthy Lives (2010) policy will be explored in relation to smoking. The rationale for choosing this topic is because smoking is an important public health issue. The smoke is very toxic to every human tissue it touches on its way into, through and out of the smoker’s body (Ewles 2005).
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The cost of smoking on the National Health Service (NHS), which has been found on the ASH poster. ASH is the campaigning group, which was established in 1971 by Royal College of Physicians [RCP].It is a campaigning group which eliminates the harm caused by tobacco. Ash produced a poster with the cost of tobacco to NHS.
ASH poster on the rate of smoking cost the NHS £2.7 billion yearly; more than £50 million individually week paid treating infections triggered by smoking. Each week smoking financial records for an estimated £20 million spending on hospital admissions, £4 million on outpatients, £10 million on GP consultations, £1 million on practice nurse consultations and £17 million in treatment costs.
Assuming 1996 amounts of recent and ex-smokers advocates. So advertising and Promotion bans can prevent the onset of smoking and help people to stop (WHO 2008).The ban reduce consumption which was started by research.Saffer and Chaloupka 2000 stated that anti-smoking companies pressed for further restriction on advertising and promotion.
Electronic cigarettes has been banned from showing on TV a restriction that some believe might confuse viewers (ASH 2014). It has been said that E –cigarettes are not cigarettes. Tobacco Harm Reduction (THR) recommended that quitting all forms of nicotine is the best for smokers E cigarettes are used by 700.00 to 2.1million (ASH 2014).
According to Peto et. al. (2003) cited in Ewles (2005), most premature deaths caused by smoking are Lung and coronary cancer, chronic obstructive heart diseases and coronary heart diseases with 42800, 29100 and 30600 deaths respectively every year. In addition, smoking is known to also bring increased risk of many debilitating conditions like impotence, infertility, gum disease, asthma and psoriasis (Ewles 2005).
Furthermore, through second hand smoking the health of other family members can be negatively affected. Percival (2009) indicated that second hand smoking can lead to rise in respiratory infection and infection in the lungs .Research shows that the families whose paternities smoulders are the ones who get infected (NHS 2013).The Blair regime introduced to help or guarding children of risk of damage. Blair management has introduced to aim upgrading in social services to security to inspire youths.
The government indicated that “smoking kills” in a white paper. This campaign was to target reducing smoking among students from 13% to a 9% or less by (2010).They also tried to reduce adults from smoking from 28% to 24%, to reduce the ratio women who were pregnant from smoking.
The Prochaska & DiClemente (2000) Trans theoretical Model of Change (TTM), will be used to highlight the role of the nurse in implementing a variety of therapies that can be used in order to support Mrs M’s behaviour change. Public health is defined as the science and art of protecting and promoting health and wellbeing, preventing ill health and prolonging life through the organised effects of society (Faculty of Public Health 2010).
Health promotion is a complex activity and is difficult to define. Davies and Macdowall (2006) describe health promotion as “any strategy or intervention that is designed to improve the health of individuals and its population”. However perhaps one of the most recognized definitions is that of the World Health Organizations who describes health promotion as “a process of enabling people to increase control over their health and its determinants, and thereby improve their health (WHO 1986).
If we look at this in relation to the nurse’s role in smoking cessation and giving advice to a patient, this can be seen as a positive concept in that with the availability of information together with support, the patient is then able to make an informed decision, thus creating empowerment and an element of self-control DOH (2013, March 25).
Bright (1997) supports this notion suggesting that empowerment is created when accurate information and knowledgeable advice is given, thus aiding the development of personal skills and self-esteem.
A vital component of health promotion is health education which aims to change behavior by providing people with the knowledge and skills they require to make healthier decisions and enable them to fulfill their potential.
Healthy Lives Healthy People (2010) highlight the vital role nurses play in the delivery of health promotion with particular attention on prevention at primary and secondary levels. Nurses have a wealth of skills and knowledge and use this knowledge to empower people to make lifestyle changes and choices. This encourages people to take charge of their own health and to increase feelings of personal autonomy (Karen.et.al 1999). Smoking is one of the biggest threats to public health, therefore nurses are in a prime position to help people to quit by offering encouragement, provide information and refer to smoking cessation services.
In 2010 the white paper Healthy Live Healthy People set out the government long term policy for improving public health and in 2011 a new tobacco control plan was published (Department of Health 2011). The Whitepaper Healthy Life Healthy People set out a range of measures aimed at preventing people from starting to smoke and helping them to stop, such as banning cigarettes advertising on billboards, in size and action on tobacco intensified (DH, 2011).
There are also smoking campaigners like Stoptober which is a regime campaign which has been encouraging smokers to quit smoking for a month. These campaigns are done on TV’s and radios on a daily basis.Gorvenment is using ways to campaign by advertising through these advertisements, papers and internet as well. Stoptober is a 28day trial which was said to work 5times more to stop individuals from smoking for good.
The reason why Stoptober launched a campaign was to encourage people to take part of the smoking challenge. It started to give advice through the leaflets, posters, in order for people to stop smoking for a month. Research shows that 160 000 people managed to stop smoking for a month with Stoptober campaign.
WHO defines health promotion a process of enabling people to increase control over and to improve, their health. It implies that the ideology moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. Naidoo and Wills (2010), states ‘health promotion is based on theories about what influences people’s health and what are effective interventions or strategies to improve health.
The Marmot Review (2010) stated that between 2001 to 2007, prevalence of cigarette smoking among women in manual household dropped from 34 to 28 percent. In Woodhouse, C. 2011 ,showed that between 2001 and 2008, there has been a decrease of smoking in the population of England. They further stated that since the 1980s the uptake of smoking among young people in England has decline, study by Ansell, Gu , Tuit and Sinha (2012) suggests that it is important for nurses to have good relationships with their patients in order to provide quality care which is well understood by their patients.
In order to help Mrs M on her transitioning journey to smoking cessation there are therapies such as nicotine replacement therapy (NRT). These efforts have been successful in some cases of enabling patients to stop smoking however there is limited clinical evidence to suggest that this method would be successful in all patients (Rice and Stead 2000). Health professionals are advocates of change in preventing smoking related diseases yet it seems during assessments they skip or hardly mention whether patients want to quit smoking as they blame it on lack of time and patient lack of motivation to quit. (DH 2011).
To assist in the assessment process the model of behaviour change will be utilized such as Prochaska & Diclemente’s stages of change model (1984). This works on the assumption that individuals go through a number of stages in other to change their behaviour. The first of the stages is pre-contemplation; this is a stage where the individual has no intention of behaviours change. The second stage is contemplation; at this point the individual is considering change. The third stage preparation, this is when the individual is preparing to change. The fourth stage, action, this is where the individual has to make a positive decision to quit, he works towards goals that are realistic and achievable, the need for support is very strong at this stage. The fifth stage, is maintenance, this is the stage of new behaviour for example the individual has quit smoking and moved on to a healthier lifestyle.
To select the most appropriate interventions, I need to know the patient’s present readiness to change. The patient currently resides in stage 1 (pre-contemplation) and this stage will determine the intervention that can be used to empower the patient; therefore it is essential that an effective assessment takes place. In offering a prescription for nicotine replacement to a patient who is in the pre-contemplation stage is unlikely to be successful, because doing so essentially asks the patient to move from pre-contemplation to action without going through the necessary intervening stages AIPPO (2012). My role as a student nurse is to encourage the patient in the pre-contemplation stage to think about her smoking and to consider the possibility that smoking is a problem that needs attention.
Being in the pre-contemplation stage suggests that the patient has some unresolved contradiction about change and thus needs help moving to stage 2 where the patient can start to prepare for smoking cessation. Brief interventions can be effective in the pre-contemplation stage and as the patient moves from one stage to the next. Effective interventions include the following: educate the patient about the effects of smoking, recommend changes in behaviour, list options for achieving behavioural change, discuss the patient’s reaction to the nurse’s feedback and recommendations, follow up to monitor to reinforce behavioural change. This process, known as “motivational interviewing,” uses empathy rather than confrontation. It acknowledges that the patient, not the nurse, is responsible for changing behaviour.
In conclusion, it is evident that smoking is a vital aspect of public health and therefore a vital part of nursing practice. In particular, health promotion in daily practice is required to help patient to overcome the habit. Smoking is a major public health issue that continues to donate to social and health inequalities.
According to the Oxford Medical Companion (1994) cited World Health Organization (2008). WHO report on the global tobacco epidemic Geneva: WHO 2008.
Action on Smoking and Health (2006). Smoking Statistics; Illness and death. [Online]. Available from: http://old.ash.org.uk/html/factsheets/html/fact02.html
AIPPO (2012). Stages of Change Model by Prochaska and DiClemente. Retrieved April 3, 2014, from http://currentnursing.com/nursing_theory/transtheoretical_model.html
ASH. Use of electronic cigarettes in Great Britain. 2014.
ASH. Secondhand smoke. 2014
Bright, J. (1997) Health promotion in clinical practice: Targeting the health of the nation. London, Bailliere Tindall
Cancer Research UK (2009). Lung cancer and smoking statistics. [Online]. Available from: http://info.cancerresearchuk.org/cancerstats/types/lung/smoking/.
Christensen, M. Hewitt-Taylor, J. (2006) Empowerment in nursing: Paternalism or maternalism. British Journal of Nursing, Vol 15, issue 13, pp 695-699
Department of Health (2010) Healthy Lives Healthy People. London, The Stationary Office
Davies, M. Macdowall, W. (2006) Health Promotion Theory, Understanding Public Health. London, Open University Press
Ewles, L. (2005). Key topics in Public Health. Essential briefings on prevention and health promotion. London: Elsevier Ltd.
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Karen J.Berger, Marylin Brinkman Williams, (Appleton and Large). Fundamentals of Nursing Collaborating for Optimal Health, Volume 2. 3rd ed. : 1999.
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Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. A Report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2007.
Peto, R., Lopez, A., Boreham, J. et al. (2003). Mortality from smoking in developed countries 1950 -2000. 2nd ed. Oxford: Oxford University Press.
Prochaska etal (2000). Health attribution therapy. Retrieved April 3, 2014, from http://homepage.ntlworld.com/gary.sturt/health/healthat.htm
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Rice, & Stead (2001). Nursing interventions for smoking… [Cochrane Database Syst Rev. 2000] – PubMed – NCBI. Re-trieved April 3, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/10796619
Woodhouse, C. (2011, June 24). 700 pubs closed by smoke ban, supermarket beer and tax rises – News – London Even-ing Standard. Retrieved March 24, 2014, from http://www.standard.co.uk/news/700-pubs-closed-by-smoke-ban-supermarket-beer-and-tax-rises-6414902.html
World Health Organization (WHO) (1986) Ottawa Charter. (Online) available at: http://www.who.int/hpr/NPH/docs/ottawa-charter-hp.pdf. Date accessed 11.12.10, 15.20
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