Smoking may be hazardous to your health

November 19, 2004 -- Today the Guardian (U.K.) ran an interesting story by Debbie Andalo, "Nurses can turn down home visits to smokers." It describes recent moves by the Royal College of Nursing (RCN) and the Pennine National Health Service (NHS) acute hospitals trust to ensure a smoke-free environment for nurses and other health workers who visit patients at home.

The piece reports that the RCN plans to issue new guidelines providing that nurses may refuse to make home visits to "patients who smoke," though the plan actually appears to envision a visit in a smoke-free room or space as an acceptable alternative to refusing the visit or referring the patient to a colleague. These guidelines reportedly come on the heels of a recent government public health white paper promising to create a smoke-free NHS work environment by 2006.

In a similar move, the piece reports, the Pennine NHS acute hospitals trust announced that under a new policy patients would be asked not to smoke "when they are visited by its health professionals--including midwives." If patients refused, visits would be arranged in a "mutually acceptable" smoke-free venue. This policy would seem to be less strict, as it appears to require only that a patient not smoke in a nurse's presence.

The article notes that some health providers do not approve of the moves. A spokeswoman for the British Medical Association, which the piece states has "led" the campaign to ban smoking in work places, noted that physicians would prefer smoke-free workplaces, but "if people are sick that is their first priority," and it would not be "acceptable" to ask a terminal patient to stop. A representative of the health union Unison argued that the measures were an overreaction to the white paper, noting that "[t]he last thing you want to do" when someone may have a mental health problem is tell him not to smoke.

The piece presented both sides of the issue at a basic level, though it might have considered what percentages of U.K. physicians, nurses and other health workers actually visit patients at home. (In the U.S., home smoking would affect many nurses but virtually no physicians.) It is also not clear if Unison would argue that mental health patients should be permitted to smoke in inpatient settings where health care professionals work. The piece might have explained more specifically why some are trying to limit smoke exposure for health workers--i.e., the evidence about the health effects of second-hand smoke. And it might have discussed how policy makers are weighing the tension between the potential health benefits to caregivers and patients from a reduction in smoke exposure, on the one hand, and the chance that the new policies will discourage patients from receiving care, resulting in further health problems, on the other.

See Debbie Andalo's article "Nurses can turn down home visits to smokers" in the November 19, 2004 edition of the Guardian.