Background to the Research

• Smoking is the single greatest cause of preventable illness and premature death in the UK, it kills over 120,000 people each year. Nurses account for 65% of the health care workforce and therefore are in a good position to share the health promotion message with a significant section of the population.
• In order that effective strategies for the development and implementation of nurse-led tobacco programmes can be developed and implemented, data concerning smoking amongst nurses needs to be gathered. This report seeks to establish the extent and nature of smoking among nurses in NI and the reasons why they smoke. It seeks to elicit the extent of nurses' knowledge of factors related to smoking and health and to examine nurses' perceptions of their role as health promoters.
  

Research Approach

• A questionnaire was administered to 2,000 qualified nurses working in NI and analysed using SPSS 9.0 (1074 surveys were used in the final sample). A series of focus groups was carried out with a total of 32 nurses in order to discuss the findings and identify strategies to influence future policy and practice. The data from the focus groups were analysed using the NUD*IST software package.
  

Main Findings

• Nearly 26% of respondents smoked and 19% were ex-smokers. Of the smokers, 93.4% used cigarettes, 3.5% cigars and 2.1% hand-rolled cigarettes.
• Whilst 92% of the sample were female, males (38.1%) had a higher incidence of smoking than females (24.6%), with 57% of the female sample identifying themselves as non-smokers.
• The highest prevalence rates were in the age groups 20-25 years (33.9%) and 26-30 years (39%).
• The highest prevalence rates were in the psychiatric setting (46%) and care of older person setting (35%), the lowest rates were among paediatric nurses (16.4%) and district nurses (16.7%).
• More than two-thirds of all those who had ever smoked (current and ex-smokers) had taken it up before they started nursing, and 96.8% of current smokers had taken it up prior to nursing.
• When asked if they would stop smoking in 6 months time, 73.1% of nurses wanted to quit over this period and 82.5% of smokers had tried to stop at least once.
• Over half (56.8%) of the sample rated nicotine replacement therapy as the preferred aid to stopping smoking, with 17.3% rating 'counselling' as the next preferred aid.

Nurses as Educators

• Nurses who smoked rated their role as health educator, role model and general attitude to the dangers of smoking well below that of non-smoking and ex-smoking nurses.
• All respondents believed that they had a role to play in assisting patients to stop smoking but do not do this to the extent expected of them.
• Whilst all nurses showed a sound knowledge of the factual dangers of smoking, nurses who smoked rated the dangers lower than ex-smokers and non-smokers.
• Nurses had received little training in smoking cessation techniques; 8.5% had received training and 91.5% had not. However, 61.2% wanted to receive this type of training.

Recommendations

• Further research should explore why such a significant number of nurses start smoking prior to entering nursing and how they can be helped to quit. It should also examine why nurses begin to smoke after entering nursing and how they can be helped.
• Expert opinions in this field of research should be sought, organisations should be targeted for funding and networks established between a university base and funders.
• There should be more health education on smoking by school nurses.
• Trust managers and policy makers should be advised of the difference in smoking prevalence in the specialities within nursing and of the many potential influencing factors that cause these difference.
• Development of structures of nurses to campaign on tobacco control, e.g. lobbying, media campaigns in smoking cessation should take place.
• Smoking cessation programmes to address the problem of smoking in nursing should be initiated.
• Nurses should be helped to fulfill their potential as smoking educators and role models by providing training at the appropriate time and with appropriate methods. Educators, health promotion specialists, voluntary organisations and Trust managers should be informed of successful ways to tap this potential.
• Smoking cessation skills should be developed as an integrated part of the undergraduate and postgraduate training. Support and on-going training in smoking cessation should take place in service. A Nurses against Tobacco Group in NI should be established.
• Links should be established with funding organisations and Trusts to explore and update findings from current and future research on this topic. Smoking cessation trials should be initiated. Financial aid from Governmental sources, as outlined in the green paper, should be provided.