A link between stress levels and the number of cigarette smoked?

There is a strong link between stress levels and the number of cigarette smoked

Abstract

The purpose of this study was to investigate the association between stress level and the number of cigarette smoked in nurses. The study will attempt to address the issues surrounding cigarette pull factor amongst nurses, and its impact cessation programme, whilst also suggesting applicable assistance. The research method was a qualitative type of research, based on a one tailed hypothesis, that, cigarette intake amongst nurses is a result of nursing working environment.

Introduction

Why do healthcare professionals smoke? After all, these are the people who are supposed to be at the forefront of the smoking cessation programmes. They are supposed to be the symbol of good health practice, but the opposite has been the case in a growing number of healthcare professionals. Some patient will view as hypocritical, a healthcare professional who tries to encourage them to quit smoking when they themselves are current smokers. Whilst the smoking attitude of health professionals has been debated in the context of their responsibility as role models, the effort to promote cessation programme amongst health practitioners has been insubstantial or nonexistence in many cases. It makes one ponders why Healthcare agencies have not actively sought to promote such programme, seeing that the benefit will outstrip whatever cost of initiating it.

According to the World Health Organisation, smoking and exposure to tobacco smoke are the world’s top preventable cause of deaths. Tobacco related diseases account for 6 million deaths worldwide, it is said to be the primary cause of around 100,000 deaths in the UK every year, responsible for 80% of deaths from lung cancer, bronchitis and emphysema, with everything considered, treating smoking related diseases add an enormous £12.9 billion a year to the public purse in England alone (Action on Smoking and Health, 2013). Studies conducted by quit UK, found that healthcare professionals contribute immensely to smoking cessation programmes nationwide, they inspire and influence patients smoking behaviour, by educating them on smoking cessation interventions, of one vivid example is a prison pharmacist, who took it upon herself to initiate a smoking cessation programme in a Falkirk prison, there was a 22% quit rate just after 3 months into the programme. This is one of many success stories that has been recorded nationwide, and yet a significant number of health professionals still smoke. It is a common reaction for a health practitioner smoker to be less willing to engage in a smoking cessation intervention as they are more likely to hold a self-defeating attitude which may reduce the effect of their advice to their patients. This is a major obstacle in the smoking cessation campaign; certainly, there must be an explanation for this hypocritical behaviour. The findings by (Mansour et al.., 2011) engaged with existing findings that occupational stress relates to continued and increasing numbers of healthcare professional smokers, they turn to smoking in other to lessen the effect occupational stress may have on their duties.

Healthcare professions are generally accepted to be a stressful line of work, the impact of stress in healthcare settings has been the subject of a number of researches. Professionals just like every other person, deal with, and handle stress in their own individual capacity. Previous studies carried out has led to a denotation that, there is an increase in smoking behaviour in nurses, although it is necessary to note that, there is a dark side to a perpetual tobacco lifestyle (Smoking related diseases) but for the purpose of this research, the relationship between smoking and stress levels in healthcare professionals, specifically nurses shall be investigated.

The purpose of this study is to find the association between stress levels and the number of cigarette smoked by nurses. Nurses endure an exceptional level of occupational stress, mainly due to the rigorous demand and nature of their job. In other to continue to carry out their duties, nurses turn to cigarette smoking as a mechanism to alleviate the level of on-the-job stress, consequently, the number of cigarette smoked by nurses’ increase as a result of the stress sustained at work; (this is a one tailed hypothesis). Previous research had analysed nurses smoking pattern, and attempted to link smoking to stress caused by the nature of nursing domain, such is the findings of Carmichael et al,(1990). However, the findings of (Rowe et al, 2000) found that nurses are subject to the same form of stress as other women and that women are more likely to engage cigarette as a mechanism to cope with life stresses. Nursing being a female dominated profession, (daily mail, and 2015) may mean some nurses may have started smoking long before the debut of their nursing careers, and their smoking behaviour may not be a result of nursing stressful environment, (two tailed hypothesis).

Method

A study of 10 nurses was carried out between 5^th and 6^th of February 2015, in other to determine the link between nursing occupational stress and the amount of cigarette smoked. The research was carried out using a qualitative type of research, where a questionnaire was handed out to be completed by the subjects so as to ascertain the link between nurses stress level and the number of cigarettes smoked.

This research was conducted at Ninewells Hospital in Dundee, Scotland. The Matched pairs design was used to ensure a timely outcome, as this also enables the subjects to give a relatively accurate response. The data was collected using a self administered questionnaire which is aimed at determining the number of weekly cigarette smoked and the level of stress in an average working week of nurses. Spearman’s Rho correlation coefficient test was used, where the scores are paired off by the subjects, and when plotted on a scatter diagram the points will be displayed as curved. The study population were current nurses who are on a short cigarette break, both males and females who have been practising nurses for at least the last 5 years, majority of whom are females. Age was not an influencing factor in the research. In other to ensure that the subjects engaged are indeed nurses who currently smoke and to also ensure that there was no form of preselection involved. Cigarette break was deemed to be the best appropriate time to conduct the study, as a substantial majority would prefer to take advantage of the break to huff and puff. Due to the assumed responsibility of nurses in promoting smoking cessation programme, some of the subjects declined not to participate in the questionnaire, which is understandable given the sensitivity of the keywords, such as smoking and cigarettes; these were accordingly excused, whilst some gave a cautious approval, and those results were also accordingly excluded from this report.

The subjects were asked to rate their score from 1 to 5 the average number of weekly cigarette smoked and their average level of stress. Where 1 mean not stress, and 5 means extremely stressful. The question was asked; how stressed do you feel in an average working week, and how many cigarettes do you smoke in an average working week? Their answers are recorded and graded.

Result

Findings

The findings of this research indicate that, stress is a contributory factor to number of cigarette smoked in nurses which is in conformity with the previous statement which asserted that increased smoking behaviour in nurses is a result of occupational stress. It also conforms to the result in Carmichael et al, (1990). This study found that nurses tend to smoke almost in an aggressive manner when stressed. Besides, this study only focused on the working week stress level, and the number of cigarettes smoked, it didn’t delve to retrieve smoking status prior to nursing practise and if there are external stressors which increase the level of stress other than those encountered at work, the results of the research unambiguously revealed that, level of stress is associated with number of cigarettes smoked.

The findings in Sarna’s et al are that smoking was not viewed or seen as lifestyle of choice, rather it was a necessity amongst nurses, a mechanism to cope with stress. The continued mental and physical demand of nursing jobs may mean a nurse is at risk of yearning for cigarette, and because of the general perception that cigarette improves mental health, especially stress, nurse may continue to indulge themselves in this habit until they become completely dependent on cigarette and accept it as stress easing device. This study has provided more insight into the difficult life of a nurse, nurses should be able to carry out their duties without the worry of stress, and it appears that not a lot has been offered in assistance to nurses about ways of coping and managing occupational stress. This has the potential of creating a scenario of “caring for the carers” in some nurses.

Noting that nurses who has the full knowledge of the consequences of smoking, but still indulge themselves in a perpetual cigarette intake is not just a matter of pleasure, this is seen in the nursing world as a coping strategy and they are not receiving appropriate assistance to deal with job related stress, hence they have invented an unhealthy self medication albeit potentially grave consequences. While cigarette may provide some mental health benefits in the short term, it is definitely not a long time solution and should be accordingly avoided.

The findings of (Edenfield and Blumenthal, 2011) are that, exercise reduces stress; there are also reviews which support those findings, such as (Hamer et al. 2006), one is only left bewildered, wondering why Healthcare organisations are not exploring ways to encourage exercise activities in nurses. The benefits are almost endless; a mentally sound nurse will increase productivity, if nurses are provided with as much support as nonprofessional smokers, the benefit would be felt not only at work place, but also in the general public, as this has potential to reduce by a significant margin, the worldwide number of smoke related deaths and diseases. Previous studies have highlighted the effectiveness of nurses in increasing quit percentage by a significant number, and rightly so, who else could easily motivate and encourage a smoker to forego their smoking habit and embark on a cessation programme than a nurse, who have been through it? That in itself embeds a message which says to a smoker that it is possible to quit because I have done it so can you.

Strengths and Limitations

The research was completed in a relatively short space of time and at a single location, thus there is very little financial cost involved in carrying out the study, the questionnaire was filled by experienced nurses, ensuring that information was received from those who have had good experience of occupational and their smoking patter. The research targeted nurses who were on cigarette break to ensure that result was only obtained from the right subjects.

The study was a qualitative type of research, therefore, not excluded from significant assumptions, without bias, only a handful of current nurses were investigated. The result may not be representative of the wider nursing population. The study did not consider other external stressors which are not occupation related, such as family issues, which may increase the stress level of a nurse, given that the study was undertaken at one hospital, and did not even consider GPs and clinic based nurses, who experience relatively less occupational stress, the result may not be quantifiable to all nursing population.

Due to limited access to funds, the researcher has had to carry out an almost basic research with no access to standardised equipment such as stress-o-meter; it is hardly arguable that the nurses would have been able to give a precise indication of their stress level, which may lead to an assumption that the stress level results may have been guessed. Whilst the study has undoubtedly contributed to the literature, however, in other to obtain result which may be generalisable to wider nursing population, further study should be tasked with large representative sampling. The study will also benefit from identifying smoking status of subjects prior to their nursing careers. Lastly, for the sake of accuracy and completeness, not necessarily to repel the findings of (Rowe et al, 2000), further study will benefit from an increased sub-sample of male nurses, as stress management strategies may vary depending on gender.

Conclusion

The literature revealed that stress level is linked to cigarette intake in nurses, which can be a barrier to cessation. There may appear to be disagreement as to whether if indeed work related stress or other life stressors may be contributing to cigarette intake in nurses. The literature also uncover the other side to nursing career in relation to lack of sufficient assistance about coping with stress, which may be interpreted as being required to carry out a mammoth task without the necessary armaments.