Nurses' Risks and Health Conditions from Smoking - Case Study Example

Should District Nurses Put Themselves at Risk by Visiting Patients at Home Who Smoke? Introduction This study examines the literature review about the risk of expose to passive smoke by nurses who provided services to the patients in their homes. The aim of the study is to establish whether nurses should expose themselves to the harmful effects of the second-hand smoke as while in their duty to save the lives of the lives of the people and improve the health conditions of the patients. The United States Environmental Protection Agency (EPA), International Agency for Research on Cancer (IARC) and the United States National Toxicology Program categorizes passive smoking as a “known human carcinogen.” Passive smoking is as dangerous as secondary smoking (Melnyk & Fineout-Overholt, 2011, p. 112). Smoking has been regarded as the single largest cause of preventable deaths in UK with passive smoking claimed to be taking away between 1000 and 16000 lives on non-smokers annually. Various nations including UK have enacted legislations prohibiting smoking in public places (Webber, 2011). The goal of such laws is to protect non-smokers from exposure to second-hand tobacco smoke. However, there is concern about the welfare of the district nurses and other health care providers because these legislations do not cover them. Second-hand smoking is of major concern in this study because people who get exposed to it suffer involuntary unlike in the smokers who smoke at their will (Whitehead & Irvine, 2010). Its causes and effects are widely known and the menace can be prevented or reduced to a greater extent through massive campaign and implementation of proper policies to create awareness among the public. Therefore, employers should come up with policies to protect the nurse workers against exposure to second-hand smoking when they visit the patients in their homes. Literature Review Tobacco smoke contains over 4000 chemical particles of which about 250 are toxic to a human being, and about 69 have carcinogenic effects. It has been termed as the leading single cause of death of human beings around the globe (Pearson, Field & Jordan, 2006, p 153). Exposure to smoking claims about 5 million people annually across the globe. Between 1964 and 2014, there were more than 20 million death cases related to smoking in US out of which 2.5 million occurred to non-smokers and were associated with exposure to secondary smoking. Each year smoking kills about 120,000 people in UK of which more than 11,000 die from second hand smoking (Law & MacDermid, 2013). People get exposed to second-hand smoking in various places such as the workplace, at home and other social places such as bars, restaurants, etc. Second-hand smoking has severe health consequences to both smokers and non-smokers (Science Direct, 2005). The short term effects include headache, sore throat, eye irritation, nausea, and dizziness. However, prolonged exposure to second-hand smoke can result in severe illnesses and death. Aveyard and Sharp (2009) argues that since the year 2006, the White Paper on Tobacco, Work and Health requires all NHS sites declared smoke free zones as a measure to ensure protection of their workers from exposure to harmful effects of second-hand smoke. However, these requirements are difficult to implement due to conditions of the patients such as in mental hospitals or in cases where nurses visit the patients in their homes (Health Direct, n.d.). Therefore, NHS has to take use implement additional strategies to ensure the safety of their workers irrespective of their working environment. According to Naidoo and Wills (2000), most people are aware of the various health effects of passive smoking and have implemented the laws banning smoking in enclosed public places. However, TUC (2007) observes that there are no policies of regulations to prohibit smoking in private places such as homes. Considering the effects of exposure is greater at homes due to presence of smokers in most of the families and prolonged duration of exposure, those nurses attending patients in their homes are at significant health risk (Health Direct, n.d.). According to TUC (2007), nurses play a critical role in the health care setup that includes visiting patients in their homes or residential areas to offer sophisticated care for the patients and support the family members. In addition, nurses teach patients on how to take care of themselves or teach family members on how to take care of their relatives (Pearson et al., 2006). District nurses provide healthcare intervention to patients requiring quick medical care, or those with abrupt health emergencies, those having worsening health condition or patients who have been discharged from hospital in their homes. They offer dedicated care such a relaxing and end of life care to patients in their homes. During the visits nurses help the patients with advice on nutrition, managing care for the wounds, how to avoid falls, offer assistive technology such as telecare, administering medicine, etc. (Law & MacDermid, 2013). The aging population requires frequent medical attention in their homes due to the fragility of their health condition and need for social support. The community require more responsive healthcare that suits their needs and expectations (Melnyk & Fineout-Overholt, 2011, p. 219). The increasing community and home-based care need a long-term relationship between healthcare providers and patients in order to manage the persistent disorders. Royal College of Nursing (2006) claims that the essence of increasing home based health care services is to improve the quality of health services for the persons with long-term conditions. It helps prevent premature death, improves environmental conditions of the patients, reduce the risk of occurrence accidents, etc. The provision of health services is an issue that requires prior agreement between NHS as patients (Health Direct, n.d.). The prior discussion requires the parties to agree on various terms of their engagement. The patients give explicit information about their needs and expectations that enable NHS make a prior arrangement on who will be attending numerous patients in their respective private places (Queens Nursing Institute, n.d.). In the agreement, NHS and the patients agree on the conditions of work including the time of the visit and the availability of the patients. The increasing need for quality health care delivery demonstrates the growing trend of nurses offering healthcare to the patients in their homes. According to Law and MacDermid (2013), the recent health care policies have shown more concern for extending health care services to the elderly persons in the community. In order for the health services to yield a better outcome, it should be responsive to the people’s expectations. Science Direct (2005) observed that as the number of patients with prolonged health conditions increases there is a growing need for the long-term relationship between the healthcare providers and the patients. This also results in an increase in number of healthcare providers offering health services to the patients in their homes (Health Direct, n.d.). Therefore, nurses have the responsibility to plan and provide appropriate healthcare to those patients. Royal College of Nursing (2006) claims that nurses get exposed to harmful effects of second-hand smoke while in their duty to save lives of the people. The recent studies by the University of Manchester indicated that almost all nurses experienced second-hand smoke exposure during their visits to clients’ domiciles. Nurses have reported various symptoms such as coughing, watery eyes, difficulty in breathing, dry throat and running nose as some of the smoke related problems they encounter as they attend their patients in their homes (Science Direct, 2005). However, some of the practitioners could not discuss the issues with patients because in their view they do not have any right to control the patients’ behavior right in their own homes. Royal College of Nursing, 2006) argue that nurses are making every effort to minimize the issues of death and illnesses associated with passive smoking. However, in their practices they get exposure to harmful conditions that can result in severe consequences if the employer does not intervene. These conditions demonstrate the needs for protecting the community of nurses from second-hand smoking during their delivery of services to the home-based clients (Science Direct, 2005). The NHS has a duty to ensure patients are adequately protected as they engage in life-saving mission. The most fascinating thing is that most of the regulations on smoking apply to public places. There is no campaign to enlighten smokers of the consequences of smoking to the non-smokers hence most people continue smoking in their homes oblivious of the consequences such act may have on those people around them (Katz, Peberdy & Douglas, 2000). It is this nature of the environment that health service providers are exposed to while attending their family members. In England, all bounded public places were declared smoke-free since first of July 2007. The focus was to minimize or eliminate employees’ exposure to harmful effects of passive smoking at the workplace (Queens Nursing Institute, n.d.). However, the smoke-free legislation does not apply to persons providing services to persons living in dwelling places unless such area is open to the members of the public or is set as a place of work. Therefore, there is a need for NHS to ensure effective implementation of safety policies to protect both workers and the clients in the working environment. Off course, caring for the patients in their homes is not an option. Therefore, since anticipate to be treated in a harmless environment, it is rational for the nurses working outside their hospitals to expect to work in a secure condition free of second-hand smoke. It is the obligation of the employers to respond to the concerns of their employees especially the issues related to their health. According to Melnyk and Fineout-Overholt (2011), employers can respond by establishing policies on the local smoke-free environment for the community nurses. The staff should be adequately informed about the policy requirements and the workers’ rights during induction of nurses. The management should inform those nurses of how they will assist the nurses to promote safe working environment (Marsh & Fisher, 2005). Such information is critical for the nurses because it create awareness among the workers on the issue of workplace safety and even how to avoid unnecessary exposure to second-hand smoke. The existing workers should be given similar awareness about the policy in order to ensure they are equally protected (Queens Nursing Institute, n.d.). This information will guide the nurses in understanding their rights regarding the smoke-free environment and help in minimizing their exposure to harmful environmental conditions. Most people are aware of the risk associated with smoking. Tobacco smoke has over 4,000 chemicals and poisonous substances some of which are can cause cancer while others can strain the heart and cause difficulties in breathing (Science Direct, 2005). When somebody inhales the tobacco smoke exhaled by smokers or the smoke from burning head of the tobacco this is referred as passive smoking (Webber, 2011. P. 224). Various researches have established that passive smoking is dangerous to non-smokers and make them experience same effects as those who smoke. Some of the deadly diseases associated with passive smoking include cancer, lung diseases, and coronary heart diseases. Furthermore, passive smoking can cause asthma attack and can affect the foetus in case of pregnant mothers (Taber, 2007). The health care organizations have responsibility to protect their staff against second-hand smoking during their visits to the patients at their home. This is because the government laws ban smoking in working places and other public places, but they do not apply to the health workers attending patients in their homes (Science Direct, 2005). However, the Occupational Health and Safety Act 2004 (OHS Act) call for the organizations to ensure a safe workplace for its employees that do not expose the workers to health risks (Taber, 2007). OSHA describes workplace as any place where employed or self-employed workers work. Therefore, under OSHA, employers should protect their workers including those working in private homes. Organizations should ensure the safety of both workers and their client irrespective of the place of work. Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1999 requires the National Health Services (NHS) as an employer of healthcare workers to provide their employees with safe working environment that does not present health risk (Ellis, 2010). Nevertheless, NHS has no proper procedures on how to protect the community staff from exposure to risks associated with social health services (Whitehead & Irvine, 2010). While it may appear improper for the employers of healthcare worker to impose legal restrictions on the right of individuals’ right to their homes, those employers have the responsibility to protect their workers against harmful conditions such as exposure to second hand smoke (Melnyk & Fineout-Overholt, 2011, p. 312). Nurses have the right to seek for agreement with their employers on the nature of protection they will be accorded as they discharge their services to the clients in their homes. It is improper and unethical to expose the workers in the harmful environment while in their mission to provide care for the patients. The NHS should have prior agreement with the clients that the clients will maintain a smoke-free condition prior to the visits by the nurses in order to minimize risk of exposure of nurses to second-hand smoke (NHS, 2006). The clients should maintain rooms ventilated to ensure the environment is clean. In addition, the client or other family members should refrain from smoking during the period of visits by the health care provider. Furthermore, clients should restrict smoking to rooms that are not used by those working. As aforementioned, exposure to smoke is more severe to persons with pre-existing conditions such as asthma, cardiovascular illnesses, pregnant mothers, etc. (NHS, 2006). Such workers should be given special considerations in order to minimize the risk of exposure. Such factors may include not sending nurses to such homes where there is a high chance of exposure to second-hand smoking (Marsh & Fisher, 2005). Furthermore, the employers should ensure no staff member makes repeated visits to those homes with a high risk of exposure in order to minimize harmful effects on the workers. However, such agreements may not work with clients with mental conditions such as dementia because they are not in a capacity to implement the agreement (NHS, 2006). However, the employers should find other tactics to apply in such situations in order to ensure protection of their staff. Such tactics may include having different nurses visit the patients to avoid prolonged exposure of one person. Also, nurses can change the visiting hours and appear at odd hours when such clients are likely to be resting. Furthermore, since persons with mental disorders are likely to be living with someone, nurses should communicate with those caretakers to confirm the most appropriate time when they are likely to get minimal exposure. In addition, NHS should equip the community nurse workers with information regarding the risks of exposure to such unsafe conditions (McSherry & Warr, 2008). The training should involve the equipping employees on how to address the clients, their families and visitors regarding smoking and its effects on third parties. Furthermore, NHS should obtain a response from their employees regarding the exposure and experiences at their working place. Such experiences should include the nature of the relationship between clients and nurses (McCarthy & Rose, 2010, p. 103). Nurses should share information with their clients regarding their expectations during the period of engagement. Nurses should report to NHS on whether they informed their clients about the nature of the environment they would like to have during their work and the clients’ reactions about the requests (McSherry & Warr, 2008). In order to protect the community nurses effectively there is a need for comprehensive agreement between workers and the clients that sets out particular obligations that each party should adhere to the terms (Webber, 2011). For example, the contract should stipulate the exact visiting time by the services in order for the clients to make necessary preparation to receive those nurses. On the other hand, nurses should ensure on the agreed time to avoid inconveniencing the customers. Such arrangements can include requirements that clients will provide the visiting health practitioners with a smoke-free environment. The policies should stipulate other alternatives the recommended by the management in case the clients fails to cooperate with the community nurses (Melnyk & Fineout-Overholt, 2011, p. 352). Such alternatives may include scheduling for a different place where the patient can receive treatment as long as the proposed venue is fundamentally sensible. The visiting nurses should communicate with NHS management and inform them of their planned visits to the client’s home. The patients should be advised in advance to maintain the place smoke-free at least one hour before the scheduled visit (Whitehead & Irvine, 2010). In addition, the patient should be informed of the reason the place must be maintained smoke-free prior to the visits by the nurses. Also, the patients should be informed of the consequences of second-hand smoking to the non-smokers (NHS, 2006). Besides the policies, there is a need for an adequate campaign about the consequences of second-hand smoking to the non-smokers and the need for non-smokers to protect those around them from the harmful effects of tobacco. Conclusion Second-hand smoke has severe consequences to the non-smokers. Nurses have to take precaution when visiting patients in their homes in order to avoid the consequences of second-hand smoke. The laws banning smoking in public places have not provided adequate protection to healthcare practitioners especially those attending clients in their homes. However, NHS has the responsibility to protect their workers irrespective of the workplace. Therefore, through policy enactment and mutual agreement with their clients NHS can promote safe working environment for their workers. Nurses should not be subjected to the dangerous working environment. Therefore, if clients are not willing to corporate with the nurses to promote smoke-free workplace NHS should provide other options such changing the workplace in order to protect their worker. The future relationship between nurses and patients will depend on the level of the corporation of the clients to promote safe working environment. There is a probability of conflicts between clients and nurses especially in cases where clients are not willing to cooperate. This problem can be minimized by signing a contract and ensuring compliance so that the agreement binds each party. However, nurses should not compromise their health conditions at the expense of patients who engage in risky behaviour such as smoking yet they can choose not to smoke. List of References Aveyard, H & Sharp, P. 2009, A Beginner’s Guide to Evidence-Based Practice in Health and Social care. Berkshire: OUP. Pp.1-224. Ellis, P. 2010, Evidence-based Practice in Nursing. Exeter: Learning Matters Ltd. Health Direct, Smoke-Free England, Available at http://www.smokefreeengland.co.uk/ Katz, J., Peberdy, A. & Douglas, J. (Eds) 2000, Promoting Health – Knowledge and Practice, (2nd Ed). London: OU. Pp. 1-365. Law, M. & MacDermid, J. (Eds) 2013, Evidence-Based Rehabilitation – A Guide to Practice, (3rd Ed). Thorofare, NJ: Slack. Pp. 1-448. Marsh, P. & Fisher, M. 2005, Developing the Evidence Base for Social Work and Social Care Practice. Bristol: Policy Press. 2005. 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