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Cousin L, Roucoux G, Petit AS, Baumann-Coblentz L, Torrente OR, Cannafarina A, Chassany O, Duracinsky M, Carrieri P. Perceived stigma, substance use and self-medication in night-shift healthcare workers: a qualitative study. BMC Health Serv Res 2022; 22:698. [PMID: 35610623 PMCID: PMC9128768 DOI: 10.1186/s12913-022-08018-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many risk factors related to altered circadian rhythms impact the health of night-shift hospital workers (NSHW), resulting in mental and somatic disorders. Easy access to psychoactive substances (PS) may facilitate addictive behaviors in NSHW. They are also exposed to a stressful work environment, which may further affect sleep quality. This study aimed to explore the link between sleep deprivation, work-related psychosocial stress and psychoactive substance use as a self-medication response in NSHW. Methods Qualitative study to verify the plausibility of the self-medication theory applied to addictive behaviors. Semi-structured interviews (N = 18 NSHW) and thematic analysis, following consolidated criteria for reporting qualitative research recommendations. Results Stigma against NSHW was a primary element of a stressful work environment. The stressful and stigmatizing environment, together with night-shift work, further affected NSHW sleep and their mental and physical health. The use of PS appeared to be for self-medication, encouraged by social and professional environments, source(s) of stress, discrimination, and isolation. The work environment, through aggravated sleep disorders, led NSHW to use non-prescribed sleeping pills. Alcohol after work and smoking were used as a social break but also as a means to reduce stress. Conclusion Anti-stigma interventions in the healthcare setting and screening of mental/somatic disorders in NSHW can help reduce harmful self-medication behaviors and improve hospital care in the COVID-19 era. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08018-x.
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Affiliation(s)
- Lorraine Cousin
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France. .,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France. .,Groupe de Recherche en Psychologie Sociale (UR GRePS), Université Lyon 2, Bron, France.
| | - Guillaume Roucoux
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Anne Sophie Petit
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Groupe de Recherche en Psychologie Sociale (UR GRePS), Université Lyon 2, Bron, France
| | | | - Olivia Rousset Torrente
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Adriano Cannafarina
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Olivier Chassany
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France
| | - Martin Duracinsky
- Unité de Recherche Clinique en Economie de La Santé (URC-ECO), AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.,Patient-Reported Outcomes Unit (PROQOL), UMRS 1123, Université Paris Cité, INSERM, F-75004, Paris, France.,Département de Médecine Interne Et d'immunologie Clinique, Hôpital Bicêtre, AP-HP, 94275, Kremlin Bicêtre, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Kava CM, Ruiz RA, Harris JR, Hannon PA. Worksite tobacco control - a qualitative study on perspectives from employers and employees at small worksites. BMC Public Health 2022; 22:904. [PMID: 35524298 PMCID: PMC9073486 DOI: 10.1186/s12889-022-13346-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) for tobacco control can be implemented in worksite settings to reduce tobacco use. Small worksites are less likely to adopt tobacco control EBIs than large worksites. The purpose of this qualitative study was to 1) explore factors that impact small employers' decisions to offer tobacco control EBIs, and 2) understand employees' perceptions of tobacco control at small worksites. METHODS Working with staff from small worksites (20-250 employees), we analyzed data from 12 semi-structured interviews with employers (via key informants) and four focus groups with employees. We recruited employers and employees through a purchased business list and market research company, respectively. Interview and focus group topics included perceptions of worksite tobacco control; internal and external forces shaping worksite tobacco control implementation; and perceived worksite support for cessation. We conducted thematic data analysis. RESULTS Key themes from the employer interviews included: the local environment played an important role in implementation of tobacco control EBIs; tobacco control was perceived as important but not a priority; and tobacco control decisions were driven by worksite culture. Key themes from the employee focus groups included: perceived employer support for tobacco cessation was limited although there was interest from employees; employees who currently used tobacco were stigmatized for their behavior; and incentives and coaching were considered ideal tobacco control EBIs. CONCLUSIONS Tobacco control has not been prioritized at small worksites, despite employees welcoming additional cessation support. This study contributes important information on contextual factors and employee preferences that could be targeted to improve tobacco control EBI implementation. Worksites should implement comprehensive tobacco-free policies, minimize stigma when promoting cessation, establish equitable break policies, and involve employees in decision-making related to tobacco control.
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Affiliation(s)
- Christine M Kava
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
- Health Promotion Research Center, University of Washington, 3980 15th Avenue NE, Seattle, WA, 98195, USA.
| | - Raymond A Ruiz
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Jeffrey R Harris
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Zhang S, Jose Duaso M. The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis. J Adv Nurs 2021; 77:2957-2970. [PMID: 33626209 DOI: 10.1111/jan.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/14/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
AIMS To gain new insights into the experiences of nurses who smoke and to understand the impact of those experiences on their delivery of smoking cessation interventions. DESIGN A meta-ethnographic synthesis. DATA SOURCES CINAHL, Embase, MEDLINE, PsychINFO, Web of Science and grey literature databases were searched from their inception to April 2019. REVIEW METHODS Meta-ethnography was employed to synthesize findings from included studies. The CASP qualitative checklist was used to appraise the quality of each study, and the GRADE-CERQual approach to appraise review findings. The synthesis is reported in accordance with the eMERGe reporting guidance. RESULTS From an initial search outcome of 6,019 citations, 13 studies were included detailing the experiences of 195 nurses who were smokers or ex-smokers. Four main themes were identified beliefs, dissonance, coping mechanisms and workplace policies. An integrated conceptual map was proposed on the basis of findings. Nurses who smoke were aware of tobacco harms and their role in addressing tobacco use, which resulted in experiences of guilt and stigma. Workplace policies played a crucial role in the creation of cognitive dissonance. Nurses used different strategies to cope with dissonance such as rationalizing smoking benefits, hiding their smoking behaviour, denial of smoking risks, and failing to engage with smoking cessation interventions. Some nurses expressed more positive aspirations to cope with their dissonance, including a willingness to quit and to embrace smoking cessation interventions with their patients. CONCLUSION Implementing smoke-free policies and supportive interventions targeting nurses' cognitive dissonance may assist them to quit smoking and improve their engagement in smoking cessation practices.
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Affiliation(s)
- Siqi Zhang
- International Nursing School, Hainan Medical University, Haikou, China.,Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Maria Jose Duaso
- Adult Nursing, Florence Nightingale Faculty of Nursing, King's College London, London, UK
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Bialous SA, Nohavova I, Kralikova E, Wells MJ, Brook J, Sarna L. Building capacity in tobacco control by establishing the Eastern Europe Nurses' Center of Excellence for Tobacco Control. Tob Prev Cessat 2020; 6:68. [PMID: 33336120 PMCID: PMC7737564 DOI: 10.18332/tpc/128190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Properly educated nurses delivering evidence-based tobacco dependence treatment could contribute to improving health and reducing regional disparities in tobacco-related disease and death in Central and Eastern Europe. The aims of this study are to describe development of the Eastern European Nurses’ Centre of Excellence for Tobacco Control (COE) and evaluate its online educational program on tobacco dependence treatment using the 5As framework. METHODS The online education evaluation followed a prospective, single group, pre- and post-assessment of changes in nurses’ self-reported tobacco cessation interventions. Leaders from five Eastern European countries (Hungary, Czech Republic, Romania, Slovakia, Slovenia) developed protocols for in-country tobacco control education. Nurses responded to a baseline survey, accessed an online nursing educational program, and completed a follow-up survey at 3 months, in the period December 2015 to June 2016. A total of 695 nurses from five countries answered questions on cessation interventions at baseline and of these 507 (73%) completed a follow-up survey at 3 months. RESULTS At the follow-up at 3 months, the 507 nurses self-reported a significant increase in providing all 5A components, i.e. nurses were significantly (p<0.0001) more likely to always /usually advise a patient to quit, assess interest in quitting (p=0.002), assist with a quit plan, review barriers to quitting and recommend a smoke-free home post-discharge (all p<0.0001). They were also significantly more likely (p=0.01) to agree or strongly agree that nurses have an obligation to advise patients on the risks of smoking. There was a significant increase (p<0.0001) in nurses’ estimate of the number of patients they provided a cessation intervention the previous week. Nurses who smoked were 60% more likely to assist and arrange compared to nurses who never smoked. CONCLUSIONS Coordinating multi-country activities through a COE was successful in engaging a network of nurses to use an online educational program and participate in other tobacco control activities.
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Affiliation(s)
- Stella A Bialous
- School of Nursing, University of California San Francisco, San Francisco, United States
| | - Iveta Nohavova
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.,Society for Treatment of Tobacco Dependence, Prague, Czech Republic
| | - Eva Kralikova
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.,Society for Treatment of Tobacco Dependence, Prague, Czech Republic.,Centre for Tobacco-Dependent, 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Marjorie J Wells
- School of Nursing, University of California San Francisco, San Francisco, United States
| | - Jenny Brook
- School of Medicine, University of California, Los Angeles, United States
| | - Linda Sarna
- School of Nursing, University of California Los Angeles, Los Angeles, United States
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