Nursing students' perceptions of smoking prevention

Long-term effectiveness of a nurse-led smoking cessation clinic at a comprehensive cancer center

PURPOSE

Smoking cessation interventions should be promoted in cancer centers to improve clinical outcomes among cancer patients and the quality of life of cancer-free patients and survivors. The aim of the present study was to examine long-term abstinence (1, 3, and 5 years) among smokers who received an intensive nurse-led smoking cessation intervention.

DESIGN

A prospective follow-up study was conducted in a smoking cessation clinic in Barcelona.

METHODS

The study included 479 smokers who received a nurse-led smoking cessation intervention that included motivational interviewing, psychological support, behavioral change counseling, promotion of smoke-free policies, and relapse-prevention strategies, as well as pharmacotherapy if necessary, for 12 months. We calculated overall and sex-specific 1-, 3-, and 5-year abstinence probabilities (Kaplan-Meier curves) and adjusted hazard ratios (aHRs) of relapse with 95% confidence intervals (CIs) using Cox regression.

FINDINGS

The overall probability of abstinence at 1 and 5 years was 0.561 (95% CI: 0.516-0.606) and 0.364 (95% CI: 0.311-0.417), respectively. Females had a higher, but not significant, hazard ratio for relapse compared to males (aHR = 1.180; 95% CI: 0.905-1.538). Attending <5 visits was the most remarkable determinant of relapsing compared to attending 5-9 visits or ≥10 visits, both overall and by sex (p for trend: overall, p < 0.001; males, p = 0.007; and females, p < 0.001).

CONCLUSIONS

Abstinence probability decreased over the 5-year follow-up but was relatively high. Males had higher abstinence rates than females in all follow-up periods. Completeness of the intensive intervention was the main predictor of cessation.

CLINICAL RELEVANCE

Smoking cessation interventions should consider sex and incorporate strategies to increase adherence to obtain higher long-term abstinence rates.

Smoking in nursing students: A prevalence multicenter study

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

Prevalence of smoking in nursing students worldwide: A meta-analysis of observational studies

BACKGROUND

Smoking is common among nursing students worldwide, but the reported prevalence is inconsistent across epidemiological studies. This is a meta-analysis of the prevalence of smoking in nursing students worldwide.

DESIGN

Meta-analysis of observational studies.

SAMPLE

A total of 46 studies were included in this meta-analysis.

METHOD

Electronic databases (PubMed, Medline, PsycINFO, EMBASE and Web of science) were independently and systematically searched by two investigators from their commencement date up to 12 May 2018. Studies that reported the smoking rate of nursing students were included and analyzed using random-effects model.

RESULTS

The pooled prevalence of current smoking was 26.6% (95% CI: 22.9-30.4%), while pooled prevalence of previous smoking was 15.5% (95% CI: 11.8-19.3%). Subgroup analyses showed that smoking rate was higher in male compared with female students (39% vs 25.2%, P < .001), while survey time, sample size, age, study design and academic year did not moderate the smoking rate (all P > .05).

CONCLUSION

This meta-analysis confirmed that smoking is common in nursing students. Considering the negative impact of smoking on health, appropriate smoking cessation measures for nursing students should be developed.

The Impact of Innovative Smoking Reduction Education at Hospital Entrances: A Prospective Pre- and Post-Test Study Design

Background: Nurses are expected to play an important role in smoking reduction education. Although the smoking ban was enacted in Taiwan in 1997, which included the introduction of smoking-free areas around the entrances of hospitals, many smokers are still found near hospitals. Few smoking reduction programs have been initiated around hospital entrances. The aim of this study was to examine the impacts of an innovative smoking reduction education program, which was conducted by nursing students around the entrances of a teaching hospital. Methods: A prospective pre- and post-test study design was used. The smoking reduction education program consisted of posters, audio broadcasts, and dramatic performances that provided information and resources related to smoking reduction. Outcome variables included the number of smokers, number of cigarette butts on the ground, and the experiences from nursing students after conducting the program. Results: After adjusting for weather and temperature, the number of smokers decreased significantly in the afternoon and during the whole day after the implementation of the program. The number of cigarette butts significantly decreased during the implementation of the program. Conclusion: The findings reveal that alternative smoking reduction programs initiated around hospital entrances significantly reduced both the number of smokers and cigarette butts on the ground. Nursing students shared their positive experiences in conducting this study.

Nurses as role models in health promotion: a concept analysis

There are national and international expectations that nurses are healthy role models; however, there is a lack of clarity about what this concept means. This study used concept analysis methodology to provide theoretical clarity for the concept of role models in health promoting behaviour for registered nurses and students. The framework included analysis of literature and qualitative data from six focus groups and one interview. Participants (n=39) included pre-registration students (adult field), nurse lecturers and registered nurses (RNs), working in NHS Trusts across London and South East London. From the findings, being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being caring, non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self-confident, innovative, professional and having a deep sense of self.

Are first-year nursing students' lifestyles coherent with their future career?

Nursing students are going to be professionals in the near future, and as carers, it will be essential for them to behave in a way that will allow them to have a positive influence on the health of others as well as their own health. The objective of this study was to evaluate the lifestyles of first-year nursing students of 2 universities (one in Spain and the other in Colombia). A cross-sectional descriptive study design using validated surveys was adopted. A sample of 140 nursing students enrolled in 2014 in their first year of 2 universities (Seville in Spain, n = 37, and Antioquia in Colombia, n = 93) self-reported the FANTASTICO Lifestyle checklist. Findings reveal that (1) the lifestyles are not appropriate in 1 of 3 of nursing students in both universities and (2) there are statistically significant differences for family items, positive thinkers, the use of safety belts, and alcohol consumption before driving. A high proportion of the study's participants have inappropriate lifestyles that involve risks for the deferred development of chronic diseases. It is necessary for universities to develop educational interventions in the design of nursing degrees to strengthen healthy behaviours during training.

What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study

The health and lifestyles of student nurses has been widely explored internationally finding relatively high levels of smoking, low levels of physical activity and unhealthy diets. Not only does this have implications for productivity, personal health and the ability to do the demanding job of nursing, but unhealthy behaviours are also associated with a reluctance to undertake health promotion in their roles. Stress, time constraints and the irregular routine of nurse training were cited as barriers to a healthy lifestyle. Three types of accessible interventions were piloted to encourage the adoption of healthier lifestyles by student nurses: an educational session on having 'healthy conversations' with patients, an accelerometer to record steps, and an online personal wellness tracker. There was low take up of the offers designed to motivate behaviour change but students did welcome the educational input on how to have a 'healthy conversation' with a patient. This project highlights the need to incorporate programmes that addresses student nurses' health behaviours within nurse education, and at salient time points (e.g. induction or just before going on placement) over the course of study.

Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysis

AIM

To analyse changes in prevalence, knowledge, beliefs and attitudes relating to smoking among undergraduate nursing and physiotherapy students over a 10-year period.

BACKGROUND

Few studies have been performed to describe changes in the use of tobacco and associated characteristics.

DESIGN

This study was a sequential cross-sectional study.

METHODS

A self-administered survey was performed during three academic years among nursing and physiotherapy students in a Spanish Faculty of Health Sciences.

FINDINGS

The proportion of smokers among nursing and physiotherapy students in 2003, 2008 and 2013 was 29·3%, 24·7% and 18·2% respectively. The ages when participants first smoked did not vary over the years. The Fagerström test showed low nicotine dependence. A significantly high percentage of students stated they were unaware of the link between smoking and bladder cancer and oral leukoplakia. Students declared they were unaware of the association between under-weight new-borns and second-hand smoke. The majority of students recognized that healthcare professionals were role models in society, there being little variation over the years studied. In relation to education and training, the study showed a need to inform students about methods and strategies to help people quit smoking.

CONCLUSIONS

The prevalence of smoking among nursing and physiotherapy students decreased over the ten years. Active programmes should be implemented to encourage those university students who smoke to break this habit. The decline over the years in knowledge about smoking provided evidence of a significant deficit in undergraduate training.

Knowledge, attitudes and tobacco use among nursing and physiotherapy students

BACKGROUND

As future health educators, nursing and physiotherapy students will play an essential role in the prevention of smoking.

AIM

To determine the prevalence of smoking among students and to analyse their knowledge of and attitudes towards smoking.

METHOD

This was a descriptive cross-sectional study using an anonymous questionnaire and conducted in a Spanish Faculty of Health Sciences in 2013.

FINDINGS

247 nursing and physiotherapy students (82.33%) participated in the study. The global prevalence of smoking (18.2%) was lower compare with the general population group of the same age. We have observed statistical significance in relation to previous studies. Nursing and physiotherapy students showed a low nicotine dependence. We found a lack of knowledge about the harmful effects of cigarette consumption on health. Statistically significant results were also found in relation to degree courses (p < 0.01) as regards students' opinions about their knowledge of strategies and methods to help patients stop smoking.

CONCLUSION

Most students started smoking before commencing their university studies; consequently, interventions should focus on cessation programmes. An analysis of university curricula leading to the award of a degree in the health sciences could serve to identify educational deficiencies in order to implement the necessary modifications.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This paper presents an update in tobacco use characteristics amongst nursing and physiotherapy students. Those results have showed a need to improve the curricula in order to develop specific programmes to improve knowledge, attitudes and beliefs. Measures to prevent smoking must be taken at school.

Graduate nurses and nursing student's behaviour: knowledge and attitudes toward smoking cessation

BACKGROUND

Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours.

OBJECTIVES

To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking.

DESIGN

Descriptive survey research design.

PARTICIPANTS

Non-probability sampling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university.

METHODS

Survey.

RESULTS

Factor analysis revealed four clearly differentiated factors, non-smoker's rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurse's perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights.

CONCLUSIONS

Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

An exploration of mental health nursing students' experiences and attitudes towards using cigarettes to change client's behaviour

Using cigarettes to change client behaviour is a common, yet little studied, practice in mental health care. A questionnaire survey was used to explore mental health nursing student's experiences and attitudes to this practice. The sample was four cohorts of mental health nursing students (n= 151). Of them, 84% had experienced the practice of using cigarettes to change client behaviour in acute wards (73%), rehabilitation wards (28%) and elderly care (14%). Cigarettes were used to change client behaviour in areas such as attending to personal hygiene (57%) or engaging in the ward routine (39%). However, items such as leave (60%) or drinks (tea and coffee) (38%) were also reportedly used. Of the respondents, 54% inferred that the practice did not work well with 46% stating it was not written up in care plans; 52% felt it was an ad hoc practice, 60% inferred that at times it was used as a punishment while 55% intimated that they felt bad withholding cigarettes. There are ethical and moral dilemmas around using lifestyle risk factors as rewards or using client's nicotine addiction as a means of controlling behaviour. The question of whether this intervention should ever be used, given its associated health risk, requires more critical debate in clinical practice.

The importance of tobacco cessation training for nurses in Serbia

BACKGROUND

This study assessed smoking prevalence, attitudes, and perceived patient counseling responsibilities among practicing nurses in Serbia. The need for nurses to receive tobacco cessation training is explored.

METHODS

Data were collected through a cross-sectional survey of 230 nurses at public institutions in Belgrade, a health care center in Belgrade, and public health care facilities throughout Serbia.

RESULTS

The smoking prevalence was 52% for male nurses and 47% for female nurses. Nurses had the greatest mean level of agreement with statements about controlling smoking through policy, followed by statements about being role models. Only 15% (n = 35) of nurses regularly counseled their patients about smoking, and only 16% of nurses (45% of males vs. 12% of females, p < .0001) had received training in counseling patients about smoking. Nurses' training in counseling patients about smoking was positively associated with the nurses' belief that their counseling could help patients stop smoking or never start smoking. In addition, nurses with training in counseling patients about smoking considered themselves significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe that their counseling about smoking could be effective. They also felt significantly less well prepared to assist patients to quit smoking.

CONCLUSION

These findings show that nurses' training in tobacco cessation counseling results in greater self-perceived confidence and frequency of regular tobacco cessation counseling in Serbia.

Tobacco smoking habits among a complete cross-section of Australian nursing students

This study was undertaken as a complete cross-sectional survey of tobacco smoking habits among 270 undergraduate students at an Australian nursing school (response rate: 84.6%). An anonymous, self-reporting questionnaire survey was used to gather the data. The overall prevalence of current smoking was 15.9%, with a further 8.5% being ex-smokers. The nursing students consumed an average of 11.5 cigarettes per day, they began smoking at 20.8 years of age, and had an average smoking duration of 7.2 years. The students who had previously worked as a nurse were twice as likely to be current smokers. This study suggests that although tobacco smoking remains fairly common among Australian nursing students, its prevalence and distribution vary according to the individual demographics of the group under study. Future researchers will need to consider the changing demographic base from which the new generation of nursing students are drawn.

A systematic review of tobacco smoking among nursing students

This study was conducted to systematically and critically evaluate the large number of academic publications which have investigated tobacco smoking among nursing students in recent years. It was performed as a state-of-the-art examination of all modern literature published in peer-reviewed, English-language journals since 1990. Although smoking appears to be fairly common among nursing students, its prevalence and distribution varies widely depending on the country of study and time period during which the research was undertaken. Although there is some evidence to suggest that smoking rates increase by year of study in the nursing course, not all research has shown a clear association in this regard. Similarly, the value of anti-smoking interventions for nursing students appears to be limited, based on currently available information. Given these conflicting issues, further research which helps to ascertain why student nurses do not wish to give up their habit is clearly needed both locally and internationally. The development of an international smoking questionnaire may also be useful to help standardize future research on tobacco usage among this vulnerable demographic.