What are the factors that influence the delivery of smoking cessation advice in critical care environments?

Abstract

Background The world’s leading cause of preventable deaths, diseases and disabilities is smoking (Malucky, 2010). Encouraging smokers to quit smoking can improve the health of a significant proportion of any given population (Abdulla & Husten, 2004). Hospitalisation can provide an opportunity for smokers to quit. Publications by Jones et al. (2001) and Green and Briggs (2006) found that smokers make up a high percentage of patients admitted to intensive care. Healthcare professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice. Aim To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings. Methods This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14 bedded general intensive care and a 16 bedded cardiovascular intensive care unit. A quantitative design with an online survey was utilised to answer the research question. The target population for this research was the nursing and medical staff working in adult critical care environments. Findings The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and concerns about patient competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments. The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and ex-tubated patients. Further research might be required to confirm this. The provision of smoking cessation advice is an on-going World Health Organisation and New Zealand Government priority and all parts of the health sector need to provide responses. However responses need to be adapted to the specific context such as the unique challenges of critical care.