In this reflection I will be using Gibbs Model of Reflection (Jasper M, 2003). I will be talking about a patient who was advised to give up smoking, as part of promoting health to the patient but not directly linked to their illness and treatment.
I had a patient come into the ward who had had surgery, but this patient was overweight and a smoker which always effects the procedure and recovery. During the nights they had to sleep with a machine to help him breath but during the days he would still manage to get outside for a smoke while he was in recovery.
Obviously this was a bad thing that was happening to this patient as smoking can slow down recovery because it effects how the body works with regards to oxygen intake and oxygen circulation (Thibodeau & Patton 2010). As smoker though, I can see how the patient would of benefitted emotionally as smoking can relieve stress and boredom, though these temporary fixes don’t outweigh the health problems it was obviously causing the patient. One of the nurses on duty and myself tried talking to the patient about their smoking and the first thing we needed to know is if they would like help to quit. As this is important because to change, the patient has to want to change (Cocoran N, 2007). The model from Prochaska and diclemente (1984) illustrates this point very well with their trans theoretical model of change. We tried to explain how smoking could effect this patient’s ability to heal and also problems caused to their breathing during the night. I understood why the nurse was suggesting this and that I should be promoting health also but if the patient needed to smoke for that short term fix, then why shouldn’t they be able to. Personally I felt like a bit of a hypocrite because I smoke myself and to promote it to someone else that they should not smoke did not seem right, but as a nurse, professionally I know we have to do this, and I have to remember that it is the patient in the bed who needs to recover from surgery, not me.
What sense I made of this.
I brought this up with the nurse later on and asked if it wasn’t better for the patient to have some emotional relief from smoking while they were in hospital, rather than saying they can’t smoke and the patient becoming ‘stressed out’. The nurse said that I wasn’t understanding health promotion properly. She explained that if the patient chooses to smoke whilst in hospital it is up to them, but that she was concerned with the long term effects of smoking, so the nurse was thinking about him even when he would be discharged from our ward. I understood what the nurse was doing now and saw logic behind what she was saying the patient and explaining to myself. My understanding as to why smoking effects the bodies healing ability is due to a number of reasons. Smoking destroys the cilia in the throat which helps us fight infections and rids us of bacteria and micro-organisms (Layman 2004). Also when people smoke they intake carbon monoxide and other substances that obstruct and kill alveoli which passes oxygen into the blood (Norris and Siegfied 2012) and for tissue to heal it needs a good blood supply that is richly saturated with oxygen (Chambers and Leaper, 2011). We tried to explain this to the patient in a simple way so that there was not any medical jargon.
What did I do
The patient seemed to be up for the idea of stopping smoking but I had feeling it was a little bit of ‘lip service’ because he was being polite. We told the patient that there are numerous ways to help quit smoking. There was a smoking cessation nurse who would offer advice, tips, and plans to help to quit. We mentioned that there were numerous products help quit smoking such as chewing gum, patches, tablets and sprays. The patient asked about Electronic Cigarettes and I argued that it is a little healthier because all the toxins are not present that you would get in regular tobacco, but its not really an aid to quitting because there is still nicotine in the electric cigarettes and that is what we get addicted to.
What could I of done
During the time we were explaining to the patient about thinking to stop smoking there wasn’t much I feel I could have done or added to what the nurse was already saying. The nurse covered most of the routes that help and support could have been provided.
If I came across this again I would hope that I know enough now to explain to a patient why they should think about not smoking whilst in recovery and also keeping it going long term so that they can benefit from it after they are discharged. I could give them some leaflets and things and getting them in contact with the smoking cessation nurse. I could empathise why they are smoking whilst they are in hospital but maybe try and use a diversion tactic to try and get them avoiding smoking whilst they are in recovery on the ward.
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Norris M.A and Siegfried D.R, (2012). Anatomy Essentials for Dummies. For Dummies. Nursing Time (2012) Nurses’ Role In Promoting and Supporting Smoking Cessation [Online]. Available From http://www.nursingtimes.net/nurses-role-in-promoting-and-supporting-smoking-cessation/203957.article [Accessed on 21 November 2013]
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