Adult Community Nursing: Public Health in Action

Summary

In the past three decades, smoking rates in England have significantly declined as people have become increasingly aware of the detrimental effects of smoking. However, it is noteworthy that adults are more susceptible to smoking due to various factors that contribute to the development of this habit. Nursing practitioners need to comprehend the priorities and triggers of smokers. This report outlines strategies nurse practitioners can employ to discourage smoking. It delves into the underlying factors and triggers that define the smoking habit and offers recommendations for effective intervention.

Introduction

Smoking remains a prominent global health concern, primarily due to its severe health repercussions. In the United Kingdom, despite an overall decline in smoking rates, a significant number of individuals, predominantly adults, continue to engage in this habit. Statistical data from the Office for National Statistics (ONS) in 2019 revealed a higher prevalence of smoking among adults in the UK.

Taking a closer look at Reading, Berkshire, the region has made strides in reducing smoking rates, with the percentage of adult smokers now standing at 17%, which translates to over 21,000 adults still smoking, as per data reported in 2020.

While England has made significant progress in curbing smoking rates in recent years, there is an ongoing need for careful examination of this issue. Reading, Berkshire has taken a proactive approach by introducing The Berkshire Tobacco Control Action Plan, a comprehensive strategy designed to empower citizens to reduce their smoking habits, reflecting a broader commitment to public health and wellness.

Data Analysis and Trends of Smoking in Adults

Over the last three decades, the prevalence of smoking in adult males and females has seen a notable decline, as reported by the Office for National Statistics (ONS) in 2019. Despite this positive trend, it remains a concern that approximately 10 million British adults continue to engage in smoking, with nearly half of them meeting untimely demises due to this habit, according to O'Connor's findings in 2018. Moreover, data from the ONS in 2019 indicates that smoking rates were higher among the unemployed population (29.2%) compared to employed (15%) and economically inactive individuals (13.2%).

Appendix 1, as explained by Watt et al. in 2016, reveals a troubling correlation: individuals addicted to smoking are more likely to consume excessive alcohol and use drugs. Interestingly, while the number of smokers in Reading, Berkshire, is lower than in the rest of England, both regions still face the consequences of smoking-related diseases, resulting in 1600 and 1400 citizens being admitted to hospitals, respectively (see Appendix 2 for details).

In response to this public health challenge, the UK government introduced a comprehensive smoking policy in 2015. The key measures included raising taxes on tobacco to deter low-income individuals and young people from purchasing, banning the sale and promotion of tobacco products, and ending commercial TV and newspaper advertisements. The government's target was to reduce smoking rates to 18.5% or less for adults, 12% or less for 15-year-olds, and 11% or less for pregnant women by 2015.

Additionally, in the Department of Health's (DOH) 2017 policy, 'Towards a Smokefree Generation: A Tobacco Control Plan for England,' a series of initiatives were outlined, such as supporting pregnant women in quitting smoking, implementing standardized packaging for tobacco products to deter young people, offering smoking cessation programs by healthcare professionals, and ensuring the complete adoption of National Institute for Health and Care Excellence (NICE) guidelines by 2022. Increasing tobacco taxes to make smoking less affordable was also part of the plan.

These policies have had a significant impact on reducing smoking rates in England. According to ONS data from 2018, 59.5% of smokers successfully quit smoking in 2017. The percentage of smokers decreased from 15.1% in 2017 to 14.7% in 2018, as per the ONS in 2019, illustrating the effectiveness of DOH policies introduced in 2015 and 2017. Furthermore, Reading, Berkshire, is promising to become smoke-free by 2029, highlighting the success of these government smoking policies.

• Responsibilities of Nurse Practitioners in Promoting Health and Protecting Adults at Risk

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 nurses must follow. 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 the 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 that they are carefully catering for their needs since smokers need a substitute to regulate nicotine addiction and nicotine levels in their bodies. The nurses should also ensure that each activity or treatment involved is in favour of the patient to ensure the loss of the smoking habit effectively. 

Ethical Principles refers to explicit standards laid out by professionals that they should follow at all cost and be accountable if they do not follow these principles (Pope, 1990). All nurses must follow the required standards to contribute to the patient's well-being. Primary Prevention refers to the precautionary measures 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. Secondary prevention refers to the management and early diagnosis of diseases to prevent future problems due to the disease (Patten, 2019). This method can be useful during the early stages of the smoking habit, whereby the individual recognises 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, including impairment, disability or 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.

• Health Promoting Model and Its Application on Smoking

Pender's model focuses on three aspects of human nature: personal experience, cognitive development, and behavioural outcomes (West, 2018). The model outlines four expected outcomes, including the individual's effort to maintain their behaviour, their interaction with the environment and its influence on them, the role of nurses in facilitating positive health-related behavioural changes, and the individual's willingness to embark on the journey of behaviour change (Heydari and Khorashadizadeh, 2014).

In the context of smoking, this model highlights how smokers maintain their behaviour and interact differently with their environment compared to non-smokers. Smokers often need to regulate their nicotine levels and adjust their smoking habits based on the situations they encounter. For instance, smokers may smoke more in stressful situations as a coping mechanism.

Nurses can effectively apply this model to assist individuals in quitting smoking by following these steps:

1. Understanding Patient Behavior: Nurses should comprehensively understand the patient's smoking behaviour and their sustainable methods.
2. Assessing Complexity in Environmental Interaction: It is crucial to evaluate the patient's complexity in their interactions with the environment and how it influences their smoking habit.
3. Implementing Positive Interventions: Nurses can adopt strategies and interventions that positively impact the patient's smoking habit, such as counselling, nicotine replacement therapy, or support groups.
4. Motivating the Patient: Lastly, the patients must be motivated and willing to undertake the behaviour change process. Nurses can be vital in inspiring and guiding individuals toward this transformation.

Essentially, Pender's model serves as a valuable framework for understanding and addressing smoking habits. It guides nurses in tailoring their approach to each patient's unique needs, considering their behaviour, environmental interactions, and readiness for change. Using this model, nurses can contribute significantly to helping individuals quit smoking and improve their overall health and well-being.