The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis

Abstract

Aims: To gain new insights into the experiences of nurses who smoke and to understand the impact of those experiences on their delivery of smoking cessation interventions.

Design: A meta-ethnographic synthesis.

Data sources: CINAHL, Embase, MEDLINE, PsychINFO, Web of Science and grey literature databases were searched from their inception to April 2019.

Review methods: Meta-ethnography was employed to synthesize findings from included studies. The CASP qualitative checklist was used to appraise the quality of each study, and the GRADE-CERQual approach to appraise review findings. The synthesis is reported in accordance with the eMERGe reporting guidance.

Results: From an initial search outcome of 6,019 citations, 13 studies were included detailing the experiences of 195 nurses who were smokers or ex-smokers. Four main themes were identified beliefs, dissonance, coping mechanisms and workplace policies. An integrated conceptual map was proposed on the basis of findings. Nurses who smoke were aware of tobacco harms and their role in addressing tobacco use, which resulted in experiences of guilt and stigma. Workplace policies played a crucial role in the creation of cognitive dissonance. Nurses used different strategies to cope with dissonance such as rationalizing smoking benefits, hiding their smoking behaviour, denial of smoking risks, and failing to engage with smoking cessation interventions. Some nurses expressed more positive aspirations to cope with their dissonance, including a willingness to quit and to embrace smoking cessation interventions with their patients.

Conclusion: Implementing smoke-free policies and supportive interventions targeting nurses' cognitive dissonance may assist them to quit smoking and improve their engagement in smoking cessation practices.

Keywords: experience; nursing; qualitative research; smoking; smoking cessation; systematic review.