Staff views on implementing an enforceable smoke-free hospital grounds policy

Transcription

1 Staff views on implementing an enforceable smoke-free hospital grounds policy Jenni Strachan, Dr Dermot Gorman, Dr Vittal Katikireddi and Martin Higgins

2 NHS Lothian s staged approach to smoke-free grounds All NHS grounds smokefree by March Painting of hatched areas. Increased no smoking signs. Three month advertising campaign with local paper. Internal Communication.

3 Staff interviews Aim: To describe changes in NHS Lothian staff views regarding proposals for smoke-free NHS grounds prior to the Scottish Government deadline of March Method: Repeated in-depth semi-structured interviews with two overlapping groups of 10 NHS staff working in areas of RIE affected by second-hand smoke (SHS). Conducted: December 2013 & July 2014 Interview topics: Views on current tobacco policy, exposure to second-hand smoke (SHS), challenges and barriers to implementing smoke-free and potential enforcement measures.

4 Smoking provides negative image on hospital grounds They look pretty disadvantaged as a group judging by the uniforms they are particularly domestic staff here are people in uniform smoking, I think that sends a bad message. (Respondent B,4) Terrible image, sick patients in wheelchairs with drip stands up, can see they are unwell smoking, sends out completely the wrong message for healthy hospital premises. (Respondent A,6)

5 Exposure to SHS amongst staff and patients is high I really don t want to walk through clouds of smoke and stink of smoke I don t use the main entrance, I cut through the outpatient department. (Respondent A,5) You can smell it. When the windows are open you can smell it. (Respondent B,8) I go around seeing respiratory patients I have had several patients complain about the smell coming up to first floor windows. All I can see when I look out is that smoking shelter which makes it more difficult for them [not to smoke]. (Respondent A,1)

6 The role of staff in enforcement of smokefree policy you are not going to get a good reaction challenging strangers if you don t have any authority to challenge them. (Respondent A,5) People would be more likely to take notice from someone from security. (Respondent A,4) I think it should be somebody other than healthcare professionals, we already have to deal with them as it is, I think it has to be somebody separate. (Respondent A,1)

7 Hatchings have made some progress At the maternity entrance I think it has made a slight difference but not as much as I would have liked. Still when the windows are open they don t sit under the windows anymore which is a good point. ( Respondent B, 8) In and around the hatchings there is no smoking. They are observing that. (Respondent B, 7) They just move up We still see all the cigarette ends. (Respondent B,6)

8 Facilitator Staff positivity towards smoke-free policy I think we need to start being honest about the impact of their smoking on their health, how many hospital stays they are having because they actually smoke. (Respondent A, 9) It is hard to try and stop but to me if you are in the hospital, you are in the hospital for a reason, you should not smoke. (Respondent A, 8) Well people who don t smoke are not going to be getting second hand smoke, it s going to be better for the patients who are in getting treatment for some serious illnesses, you never know if.they are not allowed to smoke then they might stop smoking. (Respondent A,2)

9 Barrier - Staff ambivalence towards smokefree policy you are always going to get the people who are in their last few weeks in life and it is a bit miserable what we are doing to them. (Respondent A,6) Sometimes I feel sorry for them because they come out with their drips and things, sitting there, I don t have the heart to say to them because it might be their last weeks. (Respondent B,5) I think it s unfair to try and force people, it s very much a conflict, they are a vulnerable group of people, they are here because they are not well I wouldn t say cut a little slack but its understandable. (Respondent B,4)

10 Pregnant women act as facilitators of policy by encouraging non-smoking and enforcement My colleague went out and told them. She is very pregnant and she said this is not on. I have to be able to sit in my office and work with windows open because this room is stifling without smoke coming in the window and actually I think he realised he had overstepped the mark. (Respondent B,7) I mean I used to smoke but I am pregnant and I have to sit here and breathe in other people s smoke when I chose not to smoke myself. (Respondent A,2)

11 Pregnant women who smoke are victims of stigmatisation via staff disapproval There is a lot of pregnant women out there smoking and I don t think that s right. (Respondent A,3) I think it gives a terrible impression to see women in their third trimester smoking. It gives an awful impression we are dealing with foetal problems all the time and you know that it causes retardation. (Respondent A,7)

12 E-cigarette use by patients and staff management People are not allowed [to use e- cigarettes] in the wards but several patients have asked me if they can use [e-cigarettes] and I say I m sorry and in many ways send them down to the front door just encouraging them to smell the smoke, I did smoke once it gives you the willing to [smoke cigarettes again]. Respondent B,4) I ask people to move on with those as well we don t know what s in them. (Respondent B,7)

13 Conclusion Smoking on grounds gave a negative image of NHS with disadvantaged groups being repeatedly highlighted. Nearly all staff were regularly affected by SHS and avoided using main entrances into work to reduce exposure. Staff also noted the negative impact SHS had on patients trying to stop smoking. Individual staff were generally unwilling to routinely enforce policy unless severely provoked e.g. clinical areas being severely polluted extreme rude/ inconsiderate behaviour All staff felt the policy should be enforced by designated persons, with staff feeling they lacked authority to do so.

14 Conclusion Some staff felt that disadvantaged groups were already being unfairly penalised by having bad health and being in or having family in hospital. Approaches to smoke-free implementation needs to understand the potential for further stigmatisation and address it via training and specialist smoking cessation support. Pregnant women acted as both facilitators (encouraged enforcement and non-smoking) and victims of stigmatisation (heavily disapproved of by staff and RIE users). E-cigarette use was relatively low at time of interviews but staff are unsure how to deal with them.

15 Next Steps Smoke-Free Policy Agreed by Partnership Two Development Officers (1 year) One for mental health facilities and the other for acute. Management training piloted Online staff training module and face-to-face raising the issue training. Integrated Care Pathway Communications Strategy

16 Thanks for listening Any questions?