Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Acute (Adult Clinical Inpatient) Care Nurses' Attitudes towards and Knowledge of Nationally Endorsed 5as Smoking Cessation Guidelines

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Acute (Adult Clinical Inpatient) Care Nurses' Attitudes towards and Knowledge of Nationally Endorsed 5as Smoking Cessation Guidelines

Article excerpt


Health professionals should be aware that tobacco smoke is the leading cause of preventable morbidity and mortality. As a result it is expected that all Australian health care professionals, especially nursing staff, follow the nationally endorsed 5As model for smoking cessation intervention, since this evidence-based model has proved effective in the treatment of tobacco addiction (Department of Health and Ageing 2005). To date, little information and education about this national strategy has been disseminated at the acute clinical care level and anecdotal evidence suggests that this lack of information has left nurses without a structured and uniform approach to counseling patients.


National and international statistics highlight the fact that tobacco smoke is the greatest single preventable risk factor for morbidity and mortality within the general population. The Australian Institute of Health and Welfare recently re-listed tobacco smoke as a known risk factor for chronic diseases such as Type 2 diabetes, coronary heart disease, and chronic obstructive pulmonary disease (Australian Institute of Health and Welfare 2006).Tobacco smoke has also been identified as a contributing factor to oral cancers, osteoporosis (Australian Institute of Health and Welfare 2002), peripheral vascular disease (Gopalan & Burrows 2003; Heart Foundation of Australia 1999), ocular diseases (Mitchell, Chapman & Smith, 1999) and chronic kidney disease (Snively & Gutierrez 2004). Australian deaths related to smoking can be divided into five main categories: neoplasia (including lung) 39.7%, heart disease 21.2%, chronic bronchitis and emphysema 20.1%, other (including cerebrovascular accident) 18.3% and passive smoking related deaths 0.7% (Ridolfo 2001). These statistics are frequently quoted when discussing smoking related illness however little is put forward in the way of active engagement of smokers in the Australian hospital context.


Nursing regulatory bodies and the community as a whole expect that nurses should counsel patients in their care on health-related issues (Australian Nursing and Midwifery Council 2002; Saarmann, Daugherty & Reigel 2000; Shuttleworth 2004). Acute care nurses are in a unique position to provide smoking cessation counseling as they not only comprise the largest group of health care professionals but also administer care 24 hours a day, seven days a week. Patients in acute settings are physically vulnerable and are (on some level) contemplating or actively seeking advice on how they can improve their health, for instance by smoking cessation (Conroy et al. 2005; Ong et al. 2005; Wolfenden et al. 2004).This 'window of opportunity' has been shown to increase health motivation (Narsavage et al. 2003) and has also been associated with increased abstinence from smoking while in the acute care setting (Katz et al. 2002). Research has found that smoking cessation interventions provided at inpatient level can improve short and long term morbidity and mortality rates and also reduce overall health care costs (Houston et al. 2005; Hurley 2005).

Evidence suggests that nurses are willing and able to provide health promotion activites and are regarded as highly effective in this area (Saarmann et al. 2000; Spooner 2005). However, studies demonstrate that acute care nurses currently lack the knowledge, skills and confidence to be effective when providing smoking cessation interventions. In a qualitative study of 12 acute care nurses in Scotland,Whyte,Watson and McIntosh (2006) identified that nurses had opportunities to advise patients about smoking, but did not always recognize these or have the knowledge to respond appropriately. In Australia, Gomm et al. (2002) surveyed 127 registered and enrolled nurses working in rural Western Australia and found that just over half (53%) believed they should assist patients to quit. However, a similar proportion (53%) claimed not to provide cessation advice to patients, believing that quitting was a personal decision of the patient. …

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