Tobacco addiction has long been a major public health problem in the United States (US). I read with interest the research article by Sarna and Lillington in the July/August (2002) edition of Nursing Research pertaining to this topic. The authors conducted a literature review evaluating research findings compiled from almost 50 years of tobacco studies published in a Nursing Research. The premise of the study was to assess the impact of nursing research on the awareness of nicotine addiction as a health concern. The findings confirm a direct correlation between tobacco addiction and preventable deaths in the US. I have been concerned that the nursing profession has minimized the deleterious health effects of this legal drug.

Hospitals in the US made the decision to ban cigarette smoking on the premises in the 1990s. This decision was indicative of a major paradigm shift, as healthcare leaders responded to the published research and the American Hospital Association mandate to become smoke-free or lose accreditation. The determination was made that the adverse effects of nicotine outweighed the patients' right to smoke. Patients on the inpatient psychiatric unit where I was employed were profoundly impacted, as the majority were smokers. Many nurses were concerned about an increase in acting-out behavior by mentally ill patients as they began to detoxify from nicotine at the same time the presenting psychiatric concerns were being addressed. The use of a nicotine patch or gum proved to be of benefit for smokers struggling with the physical and psychological effects of withdrawal. The time was right for a smoking cessation class, but none was offered.

Nurses are patient advocates and as such must keep the best interest of the patient in mind when planning care. Since patients who are smokers are in the process of nicotine detoxification while hospitalized, the inpatient setting is an ideal place for nurses to use the research studies available to plan psychoeducational interventions promoting relapse prevention upon discharge. In addition, nurses view patients in a holistic way and possess the ability to teach and influence positive change.

Pierce and Hicks (2001) studied healthcare decision-making by patients. Their findings suggest that health providers have the task of presenting information in a manner understood by the patient, interacting in such a way as to positively influence decision-making. Additionally, nurses have the resources available to provide patients with the knowledge base to make informed decisions. Nursing must remember the teaching role and access patients when the time is right to fulfill this need. Sarna and Lillington (2002) found that most schools of nursing do not cover the topic of tobacco abuse prevention and smoking cessation in their curriculum and most nurses are unprepared to teach this subject without conducting independent research. Additionally, Sarna and Lillington found four studies since 1979 that determined that nurses historically have had a higher rate of smoking than other healthcare professionals. That being said, many nurses must evaluate their own attitudes toward nicotine addiction before embarking upon smoking cessation efforts for patients. Patients, as well as their nurse educators, would mutually benefit from smoking cessation efforts conducted in the hospital setting.

Vicki Lay, BSN

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