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Does your smoking get in the way?

Jennifer Percival
RGN RM RHV FETC DipCounselling
Manager
RCN Tobacco Education Project
E:jennifer.percival@usa.net

All smokers have a one in two chance of dying prematurely.(1) Despite knowing the dangers, many nurses choose to smoke. Although no specific information on prevalence is available, it is estimated that nurses' smoking rates are the same as their counterparts in the general population. In the UK, currently 27% of men and 26% of women smoke.(2)

Divorcing smoking from its health impact?
Steven Bensley, the 34-year-old lung cancer patient featured in the current Department of Health antismoking campaign, remembered a conversation he had with his nurse while in intensive care. She'd checked his dressings and administered painkillers, then said, "I'm popping out for a cigarette. I'll be back in a while." Steven asked if she ever worried about getting cancer like he had through smoking. "I never think about it," was the reply. This anecdote shows how seeing the ­visible evidence of the dangers of smoking in others is not enough to make a smoker change their behaviour.

Why do nurses start to smoke?
Some people find it hard to understand why nurses smoke and think they should know better, but why should nurses be any different from other people? People start smoking because of peer pressure, parental or sibling example, media glamorisation, as a rite of passage to adulthood, to rebel or as a lever into a social group. Most people start smoking before the age of 20, at an age when they believe that health risks are associated with older people.(3)
Once they've started, people continue to smoke because they enjoy it and are addicted to the effects of nicotine. Many social and psychological factors also reinforce the continuation of the habit.
Nurses who smoke will probably decide to stop for the same reasons as other smokers - because of a health crisis, for financial reasons, due to social unacceptability, for a nonsmoking partner, due to pregnancy or because they have grown out of the habit. Although nurses are surrounded by examples of the damage caused by smoking, like most other smokers they may believe that nothing will actually happen to them or that they will give up before they become ill.
To successfully stop smoking, nurses, like other smokers, will need a good reason and plenty of help and support. They will need to know how to cope with nicotine withdrawal symptoms and be able to resist situations in which they would normally smoke. These skills take time to develop. It is clear,, therefore, that nurses who smoke are simply caught up in the same addictive cycle as other smokers. The problem is that being a "current" smoker seems to get in the way of some nurses discussing the topic. In a study of nurses by Lange, nonsmokers rated not smoking as significantly more important to health than smokers.(4)

Can smokers talk about "stopping"?
Many nurses who smoke fear appearing hypocritical if they discuss smoking cessation. The truth is that a nurse may be a long way off from becoming ill or being ready to stop smoking, but can have a patient who needs cessation advice to ensure they live. Holding back facts and information is wrong. Knowing how to give help sensitively, even as a current smoker, is a skill that needs to be learnt. It is not a nurse's role ever to have to "tell someone off" about their smoking. Research shows that over 70% of smokers would like to give up one day (No Smoking Day report 2001, available from www.ash.org.uk). All that is needed is a gentle conversation to find out the smoker's attitude and beliefs about the habit. This involves being professional, not judgemental. Learning how to discuss smoking in an open, friendly way is essential. Ultimately, the decision to stop smoking remains with the individual. Nurses who smoke need to be reassured that they are not being asked to criticise. It is standard good nursing practice to explain to smokers the personal benefits of stopping smoking and provide information on where to get support.
Examples of questions to ask a smoker include:

  • You've told me you're a smoker. What part of the habit do you enjoy most?
  • Have you changed anything about the way you smoke? If so, why?
  • How long have you been smoking for?
  • Have you ever stopped? If so, why?
  • How long did you stop for?
  • How did you feel the last time you stopped?
  • What was the situation that made you return to smoking?
  • What have you been told may happen to you if you stay smoking?
  • Would you like some information from me now?

Effective brief interventions
The national smoking cessation guidelines state that, wherever appropriate, nurses should:
"Assess the smoking status of patients at every ­opportunity; advise all smokers to stop; assist those interested in doing so; offer follow up or referral to a specialist cessation service. Recommend smokers who want to stop to use NRT/bupropion (Zyban) and provide accurate information and advice on both."(5)
The RCN has drawn up a flowchart to help nurses apply the 4 "A"s (see Figure 1).

[[NIP10_fig1_66]]

NHS support and help for smokers
The Government has provided a comprehensive raft of support for smokers wanting to quit. A national TV campaign is on air showing people telling the truth about how tobacco use has made them ill, which encourages smokers to think about stopping. A free telephone service, the NHS Smoking Helpline, 0800 169 0 169, has been set up, which gives callers information on how to stop and details of their local NHS cessation clinics. Nicotine replacement therapy and bupropion (Zyban; GlaxoSmithKline) products, which are proven to double the effectiveness of an attempt to quit, are available on NHS prescription. An NHS self-help guide entitled Giving Up For Life is also available free from the helpline.
Smoking remains the single greatest cause of disease and premature death in the UK, killing 120,000 people each year.(6) With the vast amount of NHS support available, there has never been a better time for nurses who smoke to let go of the fear of advising smokers on ways to stop. Good luck!

References

  1. Callum C. The UK smoking epidemic: deaths in 1995. London: Health Education Authority; 1998.
  2. Royal College of Physicians. Nicotine addiction in Britain - a report of the Tobacco Advisory Group of the Royal College of Physicians. London: RCP; 2000.
  3. Department of Health. Smoking, drinking and drug use among young people in England in 2000. London: Department of Health; 2001.
  4. Lange A. Nurses' smoking and other health-related behaviours. The Collegian 1995;2(4):4-14.
  5. Raw M, McNeill A, West R. Smoking cessation guidelines for health ­professionals. Thorax 1998:53 Suppl 5(Pt 1):S1-19.
  6. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ 1994;309:901-11.

Resources
NHS Smoking Helpline
0800 169 0 169
Open 7am-11pm every day

NHS Pregnancy Smoking Helpline
0800 169 9 169
Open 12 midday to 9pm every day
Textphone users
0800 169 0 171

NHS Smoking Helpline
0800 169 0 169

NHS Asian Tobacco Helplines:
Urdu
0800 169 0 881
Punjabi
0800 169 0 882
Hindi
0800 169 0 883
Gujarati
0800 169 0 884
Bengali
0800 169 0 885
Open 1pm-9pm Tuesdays

Quitline
0800 002200

Further ­reading
Clearing the Air 2 - a nurse's guide to tobacco control and smoking cessation.
A new RCN ­publication ­available free from RCN Direct
T:0845 772 6100 or for non-RCN members
T:020 8867 3235