北京市海淀区医务人员吸烟状况及控烟知识、态度、行为现况调查

[目的]了解北京市海淀区医务人员吸烟和控烟能力现状,为开展医务人员戒烟活动,提高控烟服务能力提供科学依据。[方法]采用系统抽样方法,调查6家医院的医务人员。[结果]现吸烟率9.7%,男性吸烟率39.8%。吸烟者主要是临床一线的中年医生,且为中、高级职称的医院内业务骨干。43.3%的医务人员在吸烟区吸烟。71.2%的医务人员没有接受过戒烟方面的培训。大多数的医务人员对控烟态度积极。27.9%的医务人员能根据患者的吸烟情况为其制定戒烟计划。87.9%的医务人员提醒过吸烟的患者戒烟,但吸烟的医务人员提醒患者戒烟的比例低于从不吸烟的医务人员。[结论]开展控烟系列培训提高医务人员整体的控烟能力。运用行政干预与健康教育相结合的手段促使吸烟的医务人员戒烟。     

社区医院控烟策略可行性探讨

[目的 ]　了解徐汇区社区医院医务人员和门诊病人对医院控烟态度 ,为医院控烟活动的开展提供依据。　[方法 ]　对上海市徐汇区 2所社区医院的医务人员和门诊病人进行问卷调查。　 [结果 ]　绝大多数医务人员 (98.8% )支持无烟医院的创建 ,门诊病人 97.8%支持无烟医院的创建 ,只有 41.8%的医务人员能经常劝说吸烟的病人戒烟 ,仅有2 1.4%的医务人员接受过帮助病人戒烟的培训。　 [结论 ]　必须强化社会支持环境和加强吸烟有害健康的健康教育 ,促进医务人员戒烟活动的开展 ;加强对他们进行帮助吸烟者戒烟的培训 ,引导医务人员控烟活动的开展。     

Australian nurses' smoking behaviour, knowledge and attitude towards providing smoking cessation care to their patients

This study examined smoking-related knowledge, attitudes andpractices of hospital-based nurses. The specific aims were:to determine the prevalence of self-reported smoking and thecharacteristics of hospital nurses who smoke; to describe nurses'knowledge of the health risks of smoking and strategies whichaid quitting; and to describe their attitudes to smoking andquitting and providing smoking cessation care. The sample wasformed from all direct-care nurses from six large hospitalsin the Hunter region of New South Wales, Australia rosteredon the randomly selected data collection days over 4 monthsin 1991 (n = 388, 98%). Participating nurses completed an interviewmeasuring demographic and smoking history characteristics, andknowledge of smoking-related diseases, quitting strategies andreferral options (open-ended questions). A self-completed questionnairemeasured attitudes about smoking, quitting and nurse provisionof smoking cessation care. Twenty-two percent of nurses reportedbeing current smokers and 21.5% reported being ex-smokers, withhigher smoking rates reported by enrolled nurses compared withregistered nurses. Knowledge about the health effects of smokingwas high, but knowledge of more effective strategies to aidquitting and referral options was poor. Nurses had positiveattitudes towards assisting patients to stop smoking (60%),but restricted this to patients who wanted to quit. Only 21%felt competent to discuss cessation with patients and identifiedskills training as necessary. The findings suggest that smokingrates among nurses may be lower than those reported in pastdecades and lower than rates among women of the same age inthe general population. The findings also suggest that nurses,while perceiving a role in smoking care, require training inthe provision of smoking cessation care to hospital patients,and that hospital policies and nurse education providers needto strongly support the provision of smoking cessation by providingnurses with time, access and incentive to undertake such activities.     

Prevalencia de consumo de tabaco en trabajadores hospitalarios: metaanálisis en 45 hospitales catalanes

ObjectiveTo estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers’ sociodemographic characteristics and the type of hospital.MethodA meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size.ResultsThe overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2).ConclusionThe prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups.     

北京市区医院医务人员吸烟状况及参与控烟干预态度调查

目的 了解目前我市医务人员的吸烟状况及对参与控烟的态度及其成因，为有针对性地对医务人员这一专业群体进行戒烟培训，提高其控烟意识，促使其在日常工作中积极参与控烟工作提供依据。方法 1999年对北京市4所医院的300名医务人员进行问卷调查。结果 男性医务人员吸烟率48．1％，其中40－49岁年龄组的吸烟率明显低于其它年龄组。医务人员对有关吸烟的心脏病，糖水病，溃疡病等危害认识率不足50％。认为医务人员的戒烟建议会有效的比例占61．6％。有73．6％的医务人员愿意工作中加入戒烟内容，不吸烟者与吸烟者的态度存在显著差异。不愿意参与控烟的原因主要有：工作忙，忘记和自己本身吸烟。结论 必须加强对所有卫生专业人员进行基本的专业戒烟培训，引导医务工作者正控烟态度，把控烟视为一种职责。     

Deconstructing myths,building alliances: a networking model to enhance tobacco control in hospital mental health settings

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.     

The role of health professionals in a community-based program to help women quit smoking

BACKGROUND: Health professionals are credible sources of smoking cessation advice. This study describes changes in health professionals' reported provision of smoking cessation counseling activities for women during a community health education project that took place in two intervention counties (I) and compares these to reports from health professionals in two similar comparison counties (C). METHODS: Specific smoking cessation activities reported by physicians (I n = 73, C n = 73), dentists (I n = 51, C n = 46), dental hygienists (I n = 38, C n = 44), family planning and WIC (Special Supplemental Food Program for Women, Infants and Children) counselors (I n = 14 C n = 16), and community mental health counselors (I n = 57, C n = 23) were assessed by mailed surveys at baseline, after 4 years of countywide interventions, and 2 years later. RESULTS: Compared with health professionals in the comparison counties, significant increases in smoking cessation training (P < 0.01) and in reported referral of women to stop smoking groups, support groups, and one-to-one support were noted for physicians, family planning, and WIC counselors (P < 0.001); in training and referral to stop smoking groups and support groups by dentists and dental hygienists (P < 0.05); and in referral to support groups by community mental health counselors (P < 0.05). Significant increases in setting quit dates (P < 0.05) and providing self-help materials (P < 0.01) were also noted for family planning and WIC counselors. These effects were no longer demonstrable 2 years after external support for the countywide interventions was withdrawn. CONCLUSIONS: We suggest that an important aspect of facilitating consistent smoking cessation advice and counseling from health professionals in the future will be the provision of a broader range of regularly available smoking cessation support systems within communities than is generally available at this time in the United States.     

Smoking behavior and attitudes toward smoking among hospital nurses.

We examined smoking prevalence, smoking behavior, and attitudes toward smoking in hospitals in 1,380 respondents among 1,719 registered nurses in a large urban teaching hospital. In this group, current prevalence of smoking in hospital nurses (22 per cent) was less than women in the general population (29 per cent). Smoking nurses were more likely than nonsmokers to hold attitudes which potentially reduce their efficacy in helping patients to stop smoking.     

Smoking after the age of 65 years: a qualitative exploration of older current and former smokers' views on smoking, stopping smoking, and smoking cessation resources and services

The aim of this study was to explore older current/former smokers' views on smoking, stopping smoking, and smoking cessation resources and services. Despite the fact that older smokers have been identified as a priority group, there is currently a dearth of age-related smoking cessation research to guide practice. The study adopted a qualitative approach and used the health belief model as a conceptual framework. Twenty current and former smokers aged>or=65 years were recruited through general practices and a forum for older adults in the West of Scotland. Data were collected using a semistructured interview schedule. The audio-taped interviews were transcribed and then analysed using content analysis procedures. Current smokers reported many positive associations with smoking, which often prevented a smoking cessation attempt. The majority were aware that smoking had damaged their health; however, some were not convinced of the association. A common view was that 'the damage was done', and therefore, there was little point in attempting to stop smoking. When suggesting a cessation attempt, while some health professionals provided good levels of support, others were reported as providing very little. Some of the participants reported that they had never been advised to stop smoking. Knowledge of local smoking cessation services was generally poor. Finally, concern was voiced regarding the perceived health risks of using nicotine replacement therapy. The main reasons why the former smokers had stopped smoking were health-related. Many had received little help and support from health professionals when attempting to stop smoking. Most of the former smokers believed that stopping smoking in later life had been beneficial to their health. In conclusion, members of the primary care team have a key role to play in encouraging older people to stop smoking. In order to function effectively, it is essential that they take account of older smokers' health beliefs and that issues, such as knowledge of smoking cessation resources, are addressed.     

Smoking behaviour,knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina

Background

Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies.

Methods

The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses.

Results

Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health professionals felt very or somewhat prepared to counsel their patients on how to quit smoking.

Conclusions

Our study indicates that almost half of Family Medicine health professionals in Bosnia and Herzegovina are smokers. This indicates a severe public health problem throughout the country. Steps need to be taken at a national level to address the fight against tobacco.

     

Barriers among nurses to providing smoking cessation advice to hospitalized smokers.

Nine focus groups were conducted with 75 staff nurses in three hospitals to determine the low participation rate of nurses in a smoking cessation programs directed at patients. Nurses felt that hospitalization was an appropriate time to offer quit-smoking advice to patients, particularly those with smoking related diseases. However, many felt advice should be given only to those receptive to it. The most common barriers to providing smoking cessation advice were lack of concrete techniques, or referral to provide and fear of alienating patients who were not receptive to hearing advice.     

中国六城市医务人员戒烟服务的效果评价

目的评价6个城市医务人员提供戒烟服务的实施效果,探讨我国医务人员戒烟服务的工作模式。方法在北京、上海、天津、长沙、深圳和濮阳6个城市7个社区的所有医疗机构负责人和医务人员做戒烟服务研究,进行现场问卷调查。结果干预后共有25家医疗机构开展戒烟服务。医务人员对烟草危害相关知识的知晓率增加了12.8%(P<0.05),掌握戒烟方法和技巧的比例增加了9.2%(P<0.05),主动向病人提供戒烟服务的比例增加了7.3%(P<0.05)。结论培训不但是提高医护人员烟草相关知识和促进医护人员主动提供戒烟服务的有效措施,而且是其获得戒烟方法和技能的有效途径。     

Engaging nurses in smoking cessation: Challenges and opportunities in Turkey

This paper discusses the training of nurses in smoking cessation as part of routine patient care in Turkey. Formative research was carried out prior to training to identify challenges faced by smokers when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interactions involving behavior change.Four culturally sensitive cessation training workshops for nurses (n = 54) were conducted in Istanbul. Following training, nurses were debriefed on their experiences delivering cessation advice. Challenges to cessation counseling included lack of time and incentives for nurse involvement; lack of skills to deliver information about the harm of smoking and benefits of quitting; the medicalization of cessation through the use of pharmaceuticals; and hospital policy which devalues time spent on cessation activities. The pay-for-performance model currently adopted in hospitals has de-incentivized doctor participation in cessation clinics.Nurses play an important role in smoking cessation in many countries. In Turkey, hospital policy will require change so that cessation counseling can become a routine part of nursing practice, incentives for providing cessation are put in place, and task sharing between nurses and doctors is clarified. Nurses and doctors need to receive training in both the systemic harms of smoking and cessation counseling skills. Opportunities, challenges and lessons learned are highlighted.     

Effectiveness of training health professionals to provide smoking cessation interventions: systematic review of randomised controlled trials.

OBJECTIVE--To assess the effectiveness of interventions that train healthcare professionals in methods for improving the quality of care delivered to patients who smoke. DESIGN--Systematic literature review. SETTING--Primary care medical and dental practices in the United States and Canada. Patients were recruited opportunistically. SUBJECTS--878 healthcare professionals and 11,228 patients who smoked and were identified in eight randomised controlled trials. In each of these trials healthcare professionals received formal training in smoking cessation, and their performance was compared with that of a control group. MAIN MEASURES--Point prevalence rates of abstinence from smoking at six or 12 months in patients who were smokers at baseline. Rates of performance of tasks of smoking cessation by healthcare professionals, including offering counselling, setting dates to stop smoking, giving follow up appointments, distributing self help materials, and recommending nicotine gum. METHODS--Trials were identified by multiple methods. Data were abstracted according to predetermined criteria by two observers. When possible, meta-analysis was performed using a fixed effects model and the results were subjected to sensitivity analysis. RESULTS--Healthcare professionals who had received training were significantly more likely to perform tasks of smoking cessation than untrained controls. There was a modest increase in the odds of stopping smoking for smokers attending health professionals who had received training compared with patients attending control practitioners (odds ratio 1.35 (95% confidence interval 1.09 to 1.68)). This result was not robust to sensitivity analysis. The effects of training were increased if prompts and reminders were used. There was no definite benefit found for more intensive forms of counselling compared with minimal contact strategies. CONCLUSIONS--Training health professionals to provide smoking cessation interventions had a measurable impact on professional performance. A modest, but non-robust, effect on patient outcome was also found, suggesting that training alone is unlikely to be an effective strategy for improving quality of care, unless organisational and other factors are also considered.     

Perceptions and practices of Japanese nurses regarding tobacco intervention for cancer patients

Background

We investigated the perceptions and practices regarding tobacco intervention among nurses, as improvement of such practices is important for the management of patients who smoke.

Methods

Self-administered questionnaires were delivered by hospital administrative sections for nursing staff to 2676 nurses who were working in 3 cancer hospitals and 3 general hospitals. Of these, 2215 (82.8%) responded.

Results

Most nurses strongly agreed that cancer patients who had preoperative or early-clinical-stage cancer but continued to smoke should be offered a tobacco use intervention. In contrast, they felt less need to provide tobacco use intervention to patients with incurable cancer who smoked. Most nurses felt that although they assessed and documented the tobacco status of cancer patients, they were not successful in providing cessation advice, assessing patient readiness to quit, and providing individualized information on the harmful effects of tobacco use. In multivariate analysis, nurses who received instruction on smoking cessation programs during nursing school were more likely to give cessation advice (odds ratio, 1.61; 95% confidence interval, 1.15–2.26), assess readiness to quit (1.73, 1.09–2.75), and offer individualized explanations of the harmful effects of tobacco (1.94, 1.39–2.69), as compared with nurses who had not received such instruction.

Conclusions

The perceptions of Japanese nurses regarding tobacco intervention for cancer patients differed greatly by patient treatment status and prognosis. The findings highlight the importance of offering appropriate instruction on smoking cessation to students in nursing schools in Japan.Key words: smoking cessation, intervention, nurses, perception     

无烟医院政策执行的障碍

目的了解无烟医院政策执行的障碍,为发展干预策略提供科学的背景资料。方法联合应用专题小组访谈和个人深入访谈对医务人员进行调查。结果无烟医院政策执行的障碍有:①倾向因素:医务人员吸烟严重,上班时间吸烟常见;医务人员对吸烟和被动吸烟的危害认识不清;对创建无烟医院没有足够的信心;②促成因素:医院执行政策的能力不足;③强化因素:吸烟是个人的生活权利;吸烟受社会风俗的影响;领导不重视控烟;担心劝烟会影响同事关系或医患关系。结论研究结果表明,倾向因素不是阻碍医院执行无烟政策的主要因素,强化和促成因素才是主要障碍。采取综合性的干预措施,营造良好的控烟氛围,促进社区参与,提高医院控烟能力,效果或许更理想。     

Helping hospital patients quit: what the evidence supports and what guidelines recommend

OBJECTIVE: The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. METHODS: Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. RESULTS: The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. CONCLUSIONS: Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.     

Prevalence of smoking among employees of a university hospital

This cross-sectional study aimed to identify the prevalence of smoking among employees of a university hospital in Southern Brazil. Data collection happened in 2008, during the periodic health exam, using a questionnaire, according to the smoking status of the employees. The sample consisted of 1,475 subjects, in which 979 (66.4%) were non-smokers, 295 (20%) former smokers and 201 (13.6%) smokers. Smoking was more prevalent among employees with lower education levels and among professionals in administrative positions. Among smokers, low dependence was identified, as well as desire and high degree of motivation to stop smoking, with health concerns as the main reason. Thus, taking into account the motivation of smokers to stop smoking, this is an appropriate time for health education and specific support to employees in the process of smoking cessation.     

The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners; a response from the perspective of general practice

This article reviews the practice guideline from the Dutch College of General Practitioners on smoking cessation. General practitioners (GP) should strive after smoking cessation when patients consult and ask for support to stop smoking. Moreover, the practitioner should also show such initiative when patients present signs and symptoms related to smoking; in parents of children with asthma; and in pregnant women. The strength of general practice is its accessibility to the population: more than 60% of the population consults their GP at least once a year. However, it is important to realize that it is not always possible to raise the issue of smoking cessation, and in some consultations this might be inappropriate. The effectiveness of individual advice in smoking cessation is enhanced by public health campaigns, and it is expected that the smoking ban in Dutch bars and restaurants, that is to come into effect in July 2008, will support the role of GPs. A problem in the implementation of the practice guideline remains, however: medication and methods to support withdrawal symptoms are still not covered by health care insurers.     

吸烟医务人员的控烟态度及对策研究

目的了解医务人员的吸烟行为以及对控烟能力的影响。方法采用系统抽样方法,抽取北京市海淀区6所医院886名医务人员,调查吸烟情况、控烟能力。结果从不吸烟医务人员认为烟草是全球最严重的前3个公共卫生问题的知晓率比吸烟者高;吸烟医务人员不知晓戒烟方法的比率比从不吸烟医务人员高;吸烟医务人员在日常诊疗过程中提醒吸烟患者戒烟行为率是70.1%,从不吸烟者为84.1%。结论不吸烟医务人员比吸烟医务人员在控烟态度上更为积极,医务人员按照是否吸烟分层后开展提高控烟能力的活动将会取得更好效果。