Addressing Environmental Smoke Exposure During Pediatric Hospitalization: Attitudes and Practices of Pediatric Nurses Versus Respiratory Therapists

Abstract

BACKGROUND: Tobacco smoke exposure leads to numerous adverse health effects in children. Providing cessation interventions to caregivers who smoke during pediatric hospitalizations can help protect children from such exposure. Both pediatric registered nurses (RNs) and pediatric respiratory therapists (RTs) are well positioned to provide these interventions. Little is known about their rates of participation in cessation efforts. Our objective was to compare the attitudes and practice of pediatric RNs versus pediatric RTs to evaluate their relative cessation-intervention practices in the in-patient pediatric setting. METHODS: An online survey was sent to pediatric RNs and RTs at 4 tertiary pediatric hospitals in California. The survey assessed individual demographics, work environment, experience, beliefs, and practices related to smoking cessation activities. Questions used 3-point and 5-point Likert scales and were compared with the chi-square test. Institutions with a response rate < 20% were excluded. RESULTS: A total of 401 respondents were included in the final analysis (292 RNs, 109 RTs). RTs versus RNs were older (42.0 y vs 35.4 y, respectively, P < .001) and more likely to be former smokers (29.9% vs 13.3%, respectively, P < .001). RNs reported lower levels of confidence in discussing smoking cessation with parents, with 11.7% saying they felt "very confident" compared to 29.0% of RTs (P < .001). RNs also reported screening for smoke exposure less frequently than RTs, with 18.8% responding "often" or "always" compared to 28.9% of RTs (P 5 .033). RNs had lower rates of advising parents "to make a smoke-free home policy" compared to RTs (ie, 13.4% vs 26.9%, respectively, P 5 .002). CONCLUSIONS: Compared to inpatient pediatric RNs, RTs reported higher rates of confidence in providing cessation interventions, screening for smoke exposure, and counseling on reducing smoke exposure, suggesting that they may be better positioned for intervening. These results can inform the design of an in-patient cessation intervention for caregivers of hospitalized children.

Cigarette smoke exposure of hospitalised children: Prevalence of smoking in parents or carers and admission practices of health services

“…Of 902 parents whose child was reviewed by a paediatrician or general practitioner in the study, only 50% had been asked about their smoking status by the health professional. Similar results were found in a study conducted by Williams et al 14 focusing on nurses, and found that only 18.8% of registered nurses ‘often’ or ‘always’ identified the smoking status of parents of hospitalised children and only 13.4% would offer quit support/education. Major barriers reported included confidence in knowledge and skills to provide this support, parents being resistant to discussing smoking and short hospital stays 14 .…”

“…Similar results were found in a study conducted by Williams et al 14 focusing on nurses, and found that only 18.8% of registered nurses ‘often’ or ‘always’ identified the smoking status of parents of hospitalised children and only 13.4% would offer quit support/education. Major barriers reported included confidence in knowledge and skills to provide this support, parents being resistant to discussing smoking and short hospital stays 14 . Our study produced similar results with only 27% of paediatric hospital nursing departments identifying the smoking status of parents or carers as standard practice.…”

“…Major barriers reported included confidence in knowledge and skills to provide this support, parents being resistant to discussing smoking and short hospital stays. 14 Our study produced similar results with only 27% of paediatric hospital nursing departments identifying the smoking status of parents or carers as standard practice. These findings highlight the need for routine delivery of smoking cessation interventions.…”

“…12,13 Studies have shown that a hospital admission for a child is a prime opportunity for health professionals to offer smoking cessation intervention to parents and/or carers who are current smokers. [14][15][16] The impact of different health professional-led interventions to aid smoking cessation for parents and carers and/or reducing second-hand smoke exposure has been evaluated previously in community and hospital settings. 11,15,17 Statistically significant improvements were only achieved in these studies for reduction in second-hand smoke exposure rather than complete cessation.…”

The Bucket Approach: Developing and Implementing an On-line Training Program in Tobacco Dependence Interventions Tailored for Behavioral Health Clinicians

“…There have been substantial efforts to make evidencebased tobacco dependence treatments available through the healthcare delivery system (Baker et al, 2021;Cook et al, 2021;Fiore et al, 2021;Fiore et al, 2008;Hurt et al, 2009;Ramsey et al, 2020;Sarna et al, 2020;Trapskin et al, in press;Williams et al, 2021). Unfortunately, these efforts have not typically extended to behavioral health care systems that uncommonly provide cessation treatment programs.…”