Introduction
Tobacco smoking has long been the cause of a wide range of human diseases, as well as a reason for premature death. Quitting smoking has undeniable benefits for patients, but it is difficult due to the nicotine addiction they would already develop by the time they enter treatment. Moreover, currently, tobacco addiction is regarded as a chronic disease itself. Recommendations for the treatment of tobacco dependence emphasize the enormous danger posed by nicotine addiction, aiding in regulating the nurses’ actions when working with smokers. The existing protocols also recommend the use of treatment with proven effectiveness, such as psychotherapy and medication. The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
Smoking Effects on the Patients’ Safety
The harm of smoking to the human body primarily lies in its ability to stimulate the development of severe systemic diseases. According to Sharpe et al. (2018), “smoking-related illness remains a large proponent of respiratory and cardiac disease” (p. 233). Currently, a significant correlation between tobacco smoking and the development of cardiovascular, oncological, and bronchopulmonary diseases has been established. West (2017) supplies that “tobacco smoke contains biologically significant concentrations of known carcinogens as well as many other toxic chemicals” (p. 1020). When an individual smokes tobacco for the first time, the cells of the respiratory system suffer greatly.
The toxic components of tobacco smoke cause changes in the cells of the ciliated epithelium, which leads to the inhibition of the cytotoxic activity of natural killers. Together, these factors contribute to the maintenance of the inflammatory process – the functional activity of lymphocytes, alveolar macrophages, and neutrophils changes. Subsequently, as a result of constant intoxication with components of tobacco smoke, the motor activity of the cilia of the bronchial mucosa slows down or stops, which reduces the ability to eliminate foreign agents.
As a consequence, the colonization of bronchial tissue by the bacterial flora intensifies significantly, which could potentially become a cause of chronic bronchitis. In addition, emerging oxidative stress and imbalance in the system of proteases and antiproteases caused by prolonged smoking may lead to the development of chronic obstructive pulmonary disease.
Smoking Effects on the Quality of Care, specifically during COVID-19
Nowadays, a very dangerous aspect of smoking is it is one of the most serious factors that worsen a patient’s condition during the COVID-19 infection and, potentially, reduce the positive impact of medical care. Smoking, which increases the risk of respiratory infections, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes mellitus, weakens the immune system greatly, making patients more vulnerable to COVID-19 or any other pulmonary infection.
The consequences of smoking increase the possibility of medical intervention being weakened and provide a less positive effect on patients’ health. Moreover, the damage done to the organism by smoking aggravates the severity of the illness’ course and might potentially worsen the prognosis. Latest studies confirmed that smoking increases the activity of the angiotensin-converting receptor enzyme 2 (ACE-2), through which SARS-CoV-2 enters the host cells, and thereby increases the risk of developing coronavirus infection. It was suggested that prolonged smoking could be a significant predictor of the ACE-2 receptor gene expression level, even when corrected for age, gender, race, and body mass index of a patient. Presumably, this theory can partially explain why smokers are especially predisposed to severe infection by SARS-CoV-2 and why quitting smoking might reduce susceptibility to coronavirus.
Smoking Effects on the Monetary Costs for the System and the Individual
In many foreign studies, it is customary to compare the smoking-associated costs for the healthcare system with the value of the gross domestic product (GDP). This is due to the fact that it is much more difficult to compare the absolute values of damage calculated in different currencies and in different years. Goodchild et al.’s study (2017), for example, uses a Cost of Illness approach, which is considered classic for evaluating the economic impact of a certain disease.
This approach considers both direct costs to the healthcare systems, which come straight from smoking-associated diseases treatment and indirect costs, which consist of expenses outside the healthcare system. According to Goodchild et al. (2017), “smoking caused 2.1 million deaths and 13.6 million years lost to disability (YLDs) among adults aged 30–69” (p. 61). This makes smoking-associated diseases a cause of 12% of deaths among the working population worldwide – a very significant loss to the labor market.
For the United States specifically, the economic cost of smoking-attributable diseases totaled 239 559$ of purchasing power parity and 6.7% of total health expenditure (Goodchild et al. 2017, p. 62, Table 3). The data obtained from the studies on the value of healthcare system costs can be used further to determine the budgets of programs aimed at reducing the damage to society from tobacco smoking.
The experts agree that tax costs increase remains the most effective way to reduce tobacco use in the population. Health advocates regularly demand a $1 to $2 price increase, while cigarette companies insist for these to be capped at 25 to 50 cents. In any case, smoking proves to be increasingly unprofitable for the population due to a steady rise in prices. For example, in New York City, smokers currently pay over $1.50 per pack as a city cigarette tax and another $4.35 as a government cigarette tax. And a new law, coming into force next year, will require every store in the city to sell cigarettes for at least $13. These measures are directed at the decrease in the national level of the smoking population.
Nursing Intervention
The organization of affordable and effective medical care for smoking cessation is one of the promising areas of smoking-associated disease prevention. Polls and researches show that more than half of all smokers express a desire to quit the habit. When providing health care for smoking cessation, it is necessary to apply an integrated approach with the organization of individual counseling and group sessions to educate the patients and prepare them to quit tobacco smoking.
The existing nursing standards proved to have a moderately high impact on the patient’s safety and the quality of care. Still, Kazemzadeh et al. (2017) claim that “it is better for nurse consultation to accompany other interventions such as booklets, brochures or educational videos for review and providing positive reinforcement techniques” (p. 272). Leadership strategies allow the nurses to map out an individual plan of quitting smoking for each of their patients, providing the necessary outline to guide the nurses’ actions.
A patient’s stay at the hospital is considered to be the best setting for treating smoking addiction. Sharpe et al. (2018) state that “the inpatient setting provides inherent incentives, resources to manage withdrawal symptoms on-site and an ideal ability to facilitate follow-up with primary care for patients following smoking cessation interventions” (p. 233). Nursing intervention increases the quality of care significantly while also providing all means of medical help in case of a patient’s safety is threatened by any concomitant diseases.
Paired with the governmental policies that address the smoking problem by educating the population on the health risks of smoking, nursing practices work both as a tool for smoking cessation and as a preventive measure. Such an approach helps reduce the smoking-associated costs to the healthcare system, while increased taxes and smoking bans strive toward building tobacco-free spaces.
To determine further the rational strategy of investment in smoking prevention programs, correct taxation of tobacco companies, and other control measures, it is important to assess both the health and economic damage of smoking. When analyzing the direct costs for the healthcare system associated with smoking, first of all, the expenses of hospitalization, emergency care, outpatient treatment, and drug therapy must be taken into account.
More precisely, a proper evaluation should include costs associated with cardiovascular disease, chronic obstructive pulmonary disease, and malignant neoplasms. However, a wider analysis would also be necessary to assess the smoking-associated costs of diagnostics and treatment of gastrointestinal tract diseases, tuberculosis, and children’s infections. A complex evaluation should be carried out on the basis of data obtained in studies on the analyzed population. Major health insurance companies would be the best and most available source of such data due to their constant analysis of the smoking-associated costs to plan prevention programs.
Practicum Experience Report
A group of 23-40 years old people, largely men, had participated in the practicum. During the practicum, the group explained their personal experiences and thoughts regarding smoking, as well as provided insights about the impact the habit had on them. Two relevant studies were discussed: one by Lee et al. (2020) on the aspects of smoking among gender and sexual minorities, and one by Rehman et al. (2017) – on the use of mHealth technology for smoking management.
Both types of research provided valuable information on the problem of smoking in the U.S. Specifically, Lee et al. (2020) have implemented “a national, probability-based survey of sexual and gender minorities adults to identify associations between potential risks and resiliencies and smoking behaviors” (p. 274). Their findings show that there are moderately increased risks of smoking among these minorities due to the higher occurrence of mental diseases among them and the substance-use-oriented environment minorities adults usually find themselves in.
The second research established a link between the use of mobile technologies and quitting smoking. The research by Rehman et al. (2017) stated that “although the mHealth interventions on smoking cessation were well executed, the absolute rates of cessation remained moderately low” (p. 10). Still, the mHealth technology proved to be useful as either primary or secondary means of battling the habit. Both studies show that there is a need to gather more data on different aspects of smoking as a social occurrence, and the mobile technologies might come in handy for nursing intervention with the habit.
A multitude of factors influences the process of smoking cessation. Among them are the leadership strategies employed by nurses, collaboration with medical staff from different fields and non-medical organizations, constant communication with the patient, and the state policies and management plans regarding the problem. During the discussion, the group concluded that an inclusive, well-thought approach is one of the most powerful tools nurses could employ for working with smoking patients. Different individuals from the group had also shared their own experiences with smoking-associated disease treatment, and they had emphasized the necessity of strategic planning and interdisciplinary knowledge for a practicing nurse.
There were no significant barriers during the smoking problem presentation, as the group as a whole was well aware of the risks of smoking. However, the mention of state policies toward public smoking had raised a discussion, and the group debated the fairness of public bans on smoking and increased taxes. Nevertheless, they came to an agreement that the state management of the problem should include strict measures, too. Within the practicum, all of the group had agreed on the severity of the smoking problem in the U.S.
During the discussions on the effects of smoking on patients’ safety and quality of care, a participative technique was used. The group was asked to give their opinions on the possible impact smoking has on the individual and the care they would receive in a hospital. After that, the real risks were explained, and the majority of the group stated that they had not known of them. In addition, communication between the group members on different aspects of the smoking consequences both to an individual and the healthcare system as a whole was prompted regularly.
The main change that was achieved during the practicum was the increase in the group’s awareness of the problem. Additionally, the group has reached an agreement that the measures the federal government takes toward the smoking problem solution are well justified and should not be sabotaged by the population.
Perhaps, more gender and the sexually diverse group could be used in the research, seeing as one of the studies emphasized the need to investigate further the aspects of the smoking problem among minorities. Moreover, the group could be prompted to use the mHealth technologies prior to the practicum so that they could evaluate their utility in forming health behavior and share a personal experience. It is possible that in future projects, these aspects will be taken into consideration.
References
Goodchild, M., Nargis, N., & Tursan d’Espaignet, E. (2017). Global economic cost of smoking-attributable diseases. Tobacco Control, 27(1), 58–64. Web.
Kazemzadeh, Z., Manzari, Z. S., & Pouresmail, Z. (2017). Nursing interventions for smoking cessation in hospitalized patients: a systematic review. International Nursing Review, 64(2), 263–275. Web.
Lee, J. G., Shook-Sa, B. E., Gilbert, J., Ranney, L. M., Goldstein, A. O., & Boynton, M. H. (2020). Risk, Resilience, and Smoking in a National, Probability Sample of Sexual and Gender Minority Adults, 2017, USA. Health Education & Behavior, 47(2), 272–283. Web.
Rehman, H., Kamal, A. K., Sayani, S., Morris, P. B., Merchant, A. T., & Virani, S. S. (2017). Using Mobile Health (mHealth) Technology in the Management of Diabetes Mellitus, Physical Inactivity, and Smoking. Current Atherosclerosis Reports, 19(4). Web.
Sharpe, T., Alsahlanee, A., Ward, K. D., & Doyle, F. (2018). Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings. Journal of Smoking Cessation, 13(4), 233–243. Web.
West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), 1018–1036. Web.