England’s smoking trend has fallen in the last three decades because people are now becoming aware of the negative impacts of smoking. Adults are more prone to smoke which pertains to many reasons that increase the urge of smoking that ultimately becomes their habit. The priorities of a smoker need to be understood by nursing practitioners. The purpose of this report is to focus on the ways that should be adopted by nurse practitioners to inhibit the activity of smoking. This report highlights the factors and reasons that demarcate the smoking habit as well as provides suggestions for effective treatment.
Smoking is considered one of the leading health concerns in the world because of its adverse effects on health. In the United Kingdom, although the overall rate of smoking has decreased, some people indulge in the habit of smoking which constitutes mostly adults, as the ratio of smoking is higher among adults (Ons.gov.uk, 2019). Similarly, in Reading Berkshire, the rate of smoking among adults has decreased to 17% which equates to a little over 21000 adults (Reading.gov.uk, 2020).
England has achieved the goal of decreasing smoking rates in the past few years but there are many aspects which need to be scrutinised. Similarly, Reading Berkshire, they have introduced The Berkshire Tobacco Control Action Plan which provides methods that would enable the citizens to reduce their habit of smoking (Reading.gov.uk, 2020).
The rate of smoking in adult males and females, over the past 30 years, has decreased significantly (Ons.gov.uk, 2019). But, 10 million British adults still indulge in the habit of smoking and nearly half of them die prematurely due to the continuation of smoking (O’Conner, 2018). Furthermore, in a survey, the habit of smoking was higher in unemployed people (29.2%), than the number of people who had jobs (15%) and economically inactive people (13.2%) (Ons.gov.uk, 2019). Referring to the figure in Appendix 1, Watt et al., (2016) explain that people who are addicted to the habit of smoking will move on to consume excessive alcohol along with intake of drugs as well, although, in Reading Berkshire, there is less number of smokers as compared to the rest of England. Additionally, the diseases occurring in England and Berkshire as a consequence of smoking, the number of citizens admitted to hospitals equates to 1600 and 1400 respectively. Refer to Appendix 2 for the figure.
The government of the UK introduced a policy regarding smoking which was updated in 2015. The actions taken to reduce smoking were to increase the taxes on the purchase of tobacco to the point where people with low income and young people were discouraged from purchasing (Gov.UK, 2015). The sale and promotion of tobacco were banned including any sort of commercial TV advertisement and advertisements in newspapers. The government aimed to reduce the rates of smoking to:
18.5% or less for adults
12% or less for young people (15-year-old)
11% or less for pregnant women (Gov.UK, 2015)
In the DOH 2017 policy of the UK, ‘Towards a Smokefree Generation: A Tobacco Control Plan for England’, the actions were taken by the government include (DOH, 2017).
Ensure that pregnant women quit smoking
Ensure standard packaging of tobacco and decrease the intake of smoke in young people
Provide smokers with a training schedule by professional healthcare doctors to ensure they quit smoking.
Complete execution of NICE guidelines by 2022 and encourage acquaintances to ‘Stop Smoking’
Increase taxes on tobacco to discourage people from buying it and make it less affordable (DOH, 2017)
After the introduction of such policies by the DOH, in England, the number of smokers significantly reduced, and statistics revealed that 59.5% of smokers quit smoking in 2017 itself (Ons.gov.uk, 2018). In 2017, the percentage of smokers was 15.1%, and this was further reduced in 2018 to 14.7% (Ons.gov.uk, 2019), thereby, depicting the effectiveness of DOH policies developed in 2015 and 2017. Furthermore, Reading Berkshire is set to be free from smoking by the year 2029, considering the effectiveness of DOH smoking policies.
The role of nurse practitioners is to cope with unplanned challenges and deal with many difficult situations with ease. Every patient is different from others, so it is important to treat them differently (Glass, 2019). The Nursing and Midwifery Council (NMC) in the UK have developed a code for nurses which pertains to the professional standards that must be followed by the nurses. Some of the standards are (Nmc.org.uk, 2018):
Respect and treat people with dignity
Listen to the needs of people carefully
Ensure the needs of the patients are catered
Ensure that every activity is in the interest of people
Ensure privacy and confidentiality of people (Nmc.org.uk, 2018)
As per the code of NMC, nurses who are aiding smokers to quit smoking should ensure that, smoking patients are being treated with respect and dignity and they are carefully catering for their needs since smokers need a substitute to regulate nicotine addiction and nicotine levels in their body. The nurses should also ensure that each activity or treatment involved is in favour of the patient to effectively ensure the loss of the smoking habit.
Ethical Principles refers to explicit standards laid out by professionals that they should follow at all cost and be accountable if these principles are not followed by them (Pope, 1990). This means that all nurses must follow the required standards to ensure that they contribute to the well-being of the patient. Primary Prevention refers to the precautionary measure taken to prevent diseases from occurring in the first place (Tulchinsky and Varavikova, 2014). In the case of smoking, primary prevention can take place when a person does not indulge in the habit of smoking from the beginning. The method of secondary prevention refers to the management and early diagnosis of diseases to prevent future problems that would occur due to the disease (Patten, 2019). This method can be useful during the early stages of the smoking habit, whereby the individual recognised the future effects of smoking and tries to withdraw from the habit with the aid of nurse practitioners. Tertiary Prevention refers to decreasing the long-term effects of a disease which can include, impairment, disability or a handicap. It also aims to reduce suffering and enhance the life longevity of a patient. This prevention method is employed when a disease is in its later stages (Peyton, et al., 2017). This method is used when an individual has a severe habit of smoking and during later stages in their life, they realise that it is not worth risking their lives for the pleasure of a few minutes. Thus, nurses use this method to reduce the habit of smoking in chain-smoking patients.
Pender’s model focuses on three aspects of human nature; personal experience, cognitive development, and behavioural outcomes (West, 2018). There are four expected outcomes of the model which are: Each person makes an effort to maintain their behaviour, individuals with their complex levels interact with the environment and influence the environment as well as change their behaviour, and nurses play a part in the process of influence in the sense that they try to change the habits of people which has a positive effect on their health, and lastly, for the individual to change their behaviour, they must themselves move onto the process of change (Heydari and Khorashadizadeh, 2014). This model relates to smoking by depicting that smokers maintain their behaviour and interact with the environment differently than non-smokers as they need to constantly maintain the nicotine levels in the body and smoke according to the situation they are facing. As an example, a smoker will smoke more in a stressful situation as compared to a normal situation. Nurses can employ this model to help smokers quit smoking by 1) understanding the behaviour of the patient and methods they are adopting to maintain themselves, 2) understanding their level of complexity with interaction with the environment, 3) adopting methods that have a positive effect on the patient with a smoking habit, and 4) the patient should themselves be motivated to quit smoking.
To conclude, the number of smokers within England has decreased over the past few years, however, many people still indulge in the habit of smoking. Similarly in Reading Berkshire, the percentage of adult smokers has been reduced to 17%. Furthermore, the DOH of the UK developed a policy against smoking in the year 2010 and further improved the policy in 2015. The DOH policy of 2010-2015 includes the ban on the sale and promotion of tobacco as well as increasing the tax rates. DOH further introduced a new smoking policy in 2017 which aims to ensure a tobacco-free generation in the UK. Some of the objectives were to ensure appropriate training by professionals to aid smokers in quitting smoking, another was to further increase taxes on tobacco so that people cannot afford them easily. The role of nurses according to the Nursing and Midwifery Council is to follow the standards developed by them, which conform to treating and respecting patients and listening to their needs carefully, and catering to them. From the research, it can be implicated that nurses need to assess every patient according to their level of smoking and their habits and devise methods that suit the patients in ensuring that they can quit smoking. It can also be implicated that the government should slowly start to ban the sale of cigarettes completely in a step-by-step method to ensure that the citizens of the country are free from the habit of smoking.
DOH (2017). Towards a Smokefree Generation: A Tobacco Control Plan for England. [online] Assets.publishing.service.gov.uk. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf [Accessed 12 Feb. 2020].
Glass, J., (2019). Knowing our patients: it’s all in the detail. Bmj, 366, p.l4553.
Gov.uk (2015). 2010 to 2015 government policy: smoking. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/2010-to-2015-government-policy-smoking/2010-to-2015-government-policy-smoking [Accessed 12 Feb. 2020].
Heydari, A. and Khorashadizadeh, F., (2014). Pender’s health promotion model in medical research. studies, 41, p.59.
Nmc.org.uk (2018). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Nmc.org.uk. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed 12 Feb. 2020].
Ons.gov.uk (2018). Adult smoking habits in the UK - Office for National Statistics. [online] Ons.gov.uk. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017 [Accessed 12 Feb. 2020].
Ons.gov.uk (2019). Adult smoking habits in the UK - Office for National Statistics. [online] Ons.gov.uk. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018 [Accessed 12 Feb. 2020].
Patten, S.B., (2019). Could Depression be Preventable? Evidence and Perspectives. In Neurobiology of Depression (pp. 257-263). Academic Press.
Peyton, C.G., et al., (2017). Aging Well: Health Promotion and Disease Prevention. Occupational Therapy with Elders-eBook: Strategies for the COTA, p.51.
Pope, K.S., (1990). Identifying and implementing ethical standards for primary prevention. Prevention in Human Services, 8(2), pp.43-64.
Reading.gov.uk (2020). Reading Borough Council. [online] Reading.gov.uk. Available at: https://www.reading.gov.uk/jsna/smoking [Accessed 8 Feb. 2020].
Tulchinsky, T.H. and Varavikova, E.A., (2014). The new public health. Academic Press.
Watt, S.et al., (2016). Reading drug and alcohol misuse needs assessment.
West, A., (2018). A Process Improvement Project to Increase Smoking Cessation Support Among Smoking Patients in an Outpatient Oncology Clinic.
Figure 1 Prevalence of Smoking in persons who are above 18 years of age
Source: (Reading.gov.uk, 2020)
Figure 2 Hospital Admissions of people 35+ due to smoking
Source: (Reading.gov.uk, 2020)
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