Maori perspectives: A deeper understanding of nursing and smoking

BackgroundSignificant health gains can be made by reducing the smoking prevalence for Maori nurses (20%) and student nurses (30%) (Gifford, Wilson, Boulton, Walker, & Shepherd-Sinclair, 2013b). While evidence indicates that targeted, sensitive smoking cessation approaches are more likely to lead to successful smoking cessation in health professionals (Berkelmans, Burton, Page, & Worral-Carter, 2011; Daley et al., 2006; Dawson, Cargo, Stewart, Chong, & Daniel, 2013; Edwards et al., 2012) it is critical to understand how smoking is socially constructed for this group.Maori nurses are strongly positioned to influence Maori communities and whanau as vital and trusted healthcare practitioners. Just over half of the respondents to a national Maori nursing survey indicated a strong intention to quit, with almost 20% thinking about quitting in the next month (Gifford et al., 2013b). Consequently, understanding the characteristics of smoking for Maori nurses, and designing specific and innovative solutions to optimise smoking cessation for this group, is essential.The research discussed in this paper is part of a larger study initiated by the New Zealand Nurses Organisation (NZNO) and funded by the Health Research Council. Phase One of the envisioned two-phase study has been completed. Phase One was the robust development of a smoking intervention framework. Using exploratory multi-methods research, and drawing on empirical evidence, we sought to design an intervention to increase the number of quit attempts in Maori nurses and to ensure stimuli, such as workplace policy, assists them to remain smoke free. Specific objectives of Phase One were to:a. describe the current situation of smoking among Maori nurses;b. explore the personal and professional contexts of their smoking;c. identify quitting triggers within the contexts of national regulation, workplace policies and personal life;d. identify potential smoking cessation intervention points,e. identify relapse prevention strategies to encourage maintenance of quit status beyond the initial quitting phase;f. design a tailored smoking cessation support intervention for Maori nurses; andg. test the feasibility of implementation and likely uptake of the proposed cessation support intervention.Phase One involved three distinct stages to answer research objectives described above; Stage One: quantitative data collection (a survey of all Maori NZNO members) and literature review; Stage Two: qualitative interviews with nurses and student nurses; literature review; and early intervention development; Stage Three: finalise intervention and feasibility testing with research participants, Advisory Group members and wider stakeholders. Phase Two involves implementing the intervention and is dependent on further research funding.In this paper we present the results of the Phase One, Stage Two qualitative interviews conducted with Maori nurses, community health workers (CHWs) and nursing students. Quantitative results from this research have been presented elsewhere (Gifford, Walker, Clendon, Wilson, & Boulton, 2013a; Gifford et al., 2013b). The intervention model is the subject of a forthcoming paper.MethodsWe aimed to explore participants' perceptions and experiences of smoking and quitting. In-depth qualitative interviews were conducted with 43 Maori participants utilising an open-ended interview schedule. Participants comprised 22 student nurses, 16 registered nurses and five community health workers, ranging in age from 18-65 years. The majority were female with only two males. Participants were from a wide range of geographical regions, including urban and rural areas, from both the North and South Islands of New Zealand. All participants were smoking in one of the following categories; weekly, daily or social smokers (occasional). The sample also included those who were engaged in quit activity or had quit over the past three months. …