Non-smoker protection in hospital s workplaces

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1 Publication Series from the Federal Institute for Occupational Safety and Health - Research Report- Fb 1077 Ch. Kröger D. Piontek C. Donath Non-smoker protection in hospital s workplaces an inventory in hospitals and nurse s training schools Dortmund/Berlin/Dresden 2006

2 This publication is a summary of the final report of a project "Non-smoker protection in hospital s workplaces" - Project F on behalf of the Federal Institute for Occupational Safety and Health. The responsibility for the contents of this publication lies with the authors. Authors: Dipl.-Psych. Christoph Kröger Dipl.-Psych. Daniela Piontek Dipl.-Psych. Carolin Donath IFT Institut für Therapieforschung Parzivalstr. 25, München, Germany Publisher: Federal Institute for Occupational Safety and Health Friedrich-Henkel-Weg 1-25, Dortmund, Germany Telephone: Telefax: poststelle@baua.bund.de Internet: Berlin: Nöldnerstr , Berlin, Germany Telephone: Telefax: Dresden: Proschhübelstr. 8, Dresden, Germany Telephone: Telefax: All rights reserved, including photomechanical reproduction and the reprinting of extracts.

25, 80804 München, Germany Publisher: Federal Institute for Occupational Safety and Health Friedrich-Henkel-Weg 1-25, 44149 Dortmund, Germany Telephone: +49 231 9071-0 Telefax: +49 231 9071-2454

3 1 Non-smoker protection in hospital s workplaces an inventory in hospitals and nurse s training schools Introduction Smoking is the most important preventable health risk worldwide (WHO, 2002). The World Health Organization estimates that in million people died on tobacco related diseases (14 percent of all deaths). If the current trend does not change, it is expected that in 2020 two million people will die on the effects of smoking (20 percent of all deaths). In order to influence the current trend in tobacco use, one needs to implement a policy mix consisting of structural and person oriented measures. Hospitals are predestined to fulfil an important task in reducing tobacco use and in preventing harmful health consequences. This is not only to provide a smoke-free environment for staff as well as for patients, but to support smokers in cessation efforts. Aim of the present project was the development of measures toward an effective protection from second hand smoke and smoking cessation in hospitals. In a first step a survey on current measures on tobacco control at workplaces in hospitals and in nursing schools in Germany was conducted. Based on the results of this survey a brochure as well as a trainings concept for nurses was developed. In order to guarantee transfer of results into practise and to create synergy with existing initiatives in the field of smoke-free hospitals, several organizations engaged in the field of smoking cessation and second hand smoke were involved in the project. This group of experts represented the following organizations: Deutsches Netzwerk gesundheitsfördernder Krankenhäuser (DNGfK), Bundesärztekammer, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Deutsches Krebsforschungszentrum (DKFZ), Bundesvereinigung für Gesundheit e. V., Deutscher Berufsverband für Pflegeberufe. Method Based on the latest version of the German hospitals mailing list, hospitals and nursing schools were contacted in March of After six weeks we obtained data from 386 hospitals (13 %) and from 358 nursing schools (36 %). For both target groups (hospitals and nursing schools) different questionnaires were developed. Regarding hospitals the European Questionnaire for self assessment developed by the European Network on Smoke-Free Hospitals (ENSH) a commonly used instrument in international research was administered. Some more specific questions were added. The questionnaire for nursing schools addresses different aspects of non-smoker protection and the education of nurses. Smoking regulations in nursing schools, the number of lessons on smoking and second hand smoke in the curriculum, and smoking cessation offers were assessed.

If the current trend does not change, it is expected that in 2020 two million people will die on the effects of smoking (20 percent of all deaths).

4 2 Results of the survey in hospitals A total of 126 rehabilitation centres, 119 general care hospitals, 50 hospitals with special focuses, and 35 maximum care hospitals participated in the survey. Moreover, 56 hospitals with other focuses or without information on this point provided data. The European Network on Smoke-Free Hospitals defines three steps in reaching the goal of a completely smoke-free hospital. The lowest level (bronze) includes the commitment of all responsible persons to a smoke-free hospital and the implementation of a working group coordinating the project. Of the 386 participating institutions, 47 (12 %) fulfil the criteria of the bronze standard. These are 19 rehabilitation centres, 12 general care hospitals, five hospitals with special focuses, four maximum care hospitals, and seven others. The two following steps (silver and gold) that represent a rising development of activities regarding smoking cessation and non-smoker protection are not achieved by any participating institutions. Only a few hospitals (24 %) have offered training sessions to promote non-smoking in the last year before the survey. Most trainings that were implemented included methods of smoking cessation, basics on tobacco dependence, support for smokers, and medication of tobacco dependence. The participants were asked how often eight different offers of smoking cessation are provided. The results indicate that most alternatives are never offered. If anything is offered, it is a short intervention at the sickbed, individual consultation, group therapy or the distribution of self help materials. Medical offers like nicotine replacement therapy, acupuncture or the prescription of Zyban exist only sporadically. Results of the survey in nursing schools The estimated smoking prevalence among the students in nursing schools is 42 % in the first year of education and 47 % in the second and third year of education. The prevalence of smoking teachers is 16 percent. Smoking bans for students and teachers in the school building were assessed. The majority (84 %) of the participating nursing schools bans smoking for students in the buildings. 15 % indicated that they have a partial ban. Only one percent does not have any rules for students. Smoking bans for teachers exist in 74 % of the nursing schools. In addition, 18 % have a partial ban. Eight percent of schools do not have rules on smoking in the buildings for teachers. Most nursing schools (44 %) deal with the topic of smoking and nicotine dependence in only one of the three years of education, and this mainly in the first year. Contents of the smoking curriculum include the imparting of causes, risks and health damages of smoking. Moreover, reflections on the individual smoking behaviour are realized and methods of smoking cessation are taught. Few schools also organise trainings in which students can practice motivational interviewing or short interventions. 36 % of the nursing schools offer smoking cessation for students and 24 % for teachers.

The European Network on Smoke-Free Hospitals defines three steps in reaching the goal of a completely smoke-free hospital.

5 3 Discussion The return rate of the questionnaires was 13 % regarding hospitals and 36 % regarding nursing schools and can be considered as satisfactory for this setting. Nevertheless, it can not be assumed that the sample is representative for all hospitals in Germany. Instead, the sample represents a positive selection of institutions that are engaged in the topic of smoking and smoking cessation. Despite the fact that more engaged hospitals are overrepresented, a profile of implemented measures on non-smoker protection and smoking cessation at workplaces in hospitals can be shown. All in all, non-smoker protection and smoking cessation seem to be of low importance in German hospitals. Only few institutions achieve the lowest standard of the ENSH indicating that all relevant persons support the smoke-free hospital and the existence of a specific working group. It is to assume that this number is not markedly higher in the whole population of hospitals in Germany. Institutions that have achieved the bronze level are engaged in the topic of smoking and one can imagine that these hospitals communicate their efforts and success. Thus, it is assumed that these institutions participated in our survey. The majority of nursing schools keep to the rules on non-smoker protection in the school building. More than four fifths of the schools do have a smoking ban in the buildings. In contrast to these structural measures, person oriented measures for students and teachers are rare. Approximately one third of the institutions offer smoking cessation for students; for teachers only one fourth. To put more emphasis on non-smoker protection and smoking cessation in hospitals is a strong demand by the health policy. Nurses represent the largest group of hospital staff and should make a good contribution to smoking cessation. Nevertheless, most of them are smokers themselves. Thus, the education of nurses is of great importance. Most nursing schools deal with the topic of tobacco dependence and smoking cessation, but the amount and specific contents differ widely. Perspectives Based on the results of the present survey a brochure for nurses was developed. This brochure targets at sensitising nurses with regard to non-smoker protection and smoking cessation at their workplace in hospital. An already existing training module developed at the University of Ulm was adopted for the purpose of the project and disseminated to the public.

Instead, the sample represents a positive selection of institutions that are engaged in the topic of smoking and smoking cessation.

NETWORK IMPLEMENTATION GUIDE

NETWORK IMPLEMENTATION GUIDE Sibylle Fleitmann ENSH Independent Consultant Tobacco Control Table of contents Introduction 1. The role of the national coordinator 2. The Network Implementation Guide (NIG)