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An ethnographic study of tobacco control in hospital settings

¹ Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
² University of British Colombia Okanogan, Kelowna, British Columbia, Canada
³ University of British Columbia, Vancouver, British Columbia, Canada

Correspondence to:
Dr Annette Schultz
Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada; Annette_Schultz{at}UManitoba.ca

Background: Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm.

Objective: To study hospital workplace culture relevant to tobacco use and control as part of a mixed-methods research project that investigated hospital-based registered nurses’ integration of cessation interventions.

Design: The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient-care documents on 16 adult in-patient wards.

Results: The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients’ tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence.

Conclusion: Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients’ tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.

Keywords: tobacco control; cessation strategies; hospitals; nursing; ethnography