Smoking as an occupation: Occupational therapists’ perspectives

Investigator: Hannah Wilson

Supervisors: Marissa Davidson-Blue, Ian Davey, Louise Farnsworth

Rationale and aims:

  • Forensic settings have enforced smoke-free environments through adopted smoke-free policies. Evidence suggests when patients receive appropriate cessation advice and support, potential adverse effects such as aggression and violence associated with implementing smoke-free policy, do not occur
  • Literature addressing best practice for smoking cessation has focussed primarily on nicotine replacement therapy. This only provides intervention/support for the nicotine addiction associated with smoking and not for other purposes and roles of smoking.
  • Further research in this area from an occupational perspective may clarifying the role of occupational therapists in providing cessation support, help add to the provision of ‘appropriate support’ and consequently reduce potential negative effects associated with smoke-free policy.
  • This study aims to identify the occupational therapists perspective of the occupational impact of smoke-free policy and the role of occupational therapy within smoking cessation support.

Methodology:

  • 16 occupational therapists within Forensicare were asked to complete an online survey and take part in up to three focus groups with 3-6 participants to each group at the Thomas Embling Hospital.
  • The survey instrument and focus group topics were derived from current research.

Results & Conclusions:

  • The purposes of smoking behaviours were identified as different for each person. The unique culture and environment within the forensic setting were identified as supporting such behaviours.
  • The impact of smoking cessation was identified as a transitional process from short term negative impacts to more long term positive impacts identified. What would be impacted was also identified as individual to each patient.
  • The role of OT’s in smoking cessation consisted of generic and specialised OT practices, working with others and doing what was required. What was involved in the specialised OTsupport, the skills required to undertake it, and the theories to guide practice were broad potentially due to the ‘client centred’ nature of OT, smoking being ‘just like any other occupation’ and/or professional identity issues resulting in a lack of understanding of what the specialised OT role consists of in smoking cessation.
  • The role of OT was dominated by meeting the multi-disciplinary team expectation to provide diversional activity, facilitating multi-disciplinary team buy in to smoking cessation initiative planning and implementation, doing what is required and OT group intervention. These dominating aspects of the role were perceived to have reduced the time and opportunity available for OTs to engage in providing individualised occupational specific support for smoking cessation.
  • This research supports further exploration, development and implementation of a more specialised role for OT’s in smoking cessation. The development and evolution of OT practice is important and will allow the discipline to have a role in key health priority areas.

Clinical implications and research translation:

  • Currently, the OT’s at Forensicare provide a central role in smoking cessation initiatives. However, participants believed that the expectation to engage in services in smoking cessation was challenging because it was seen as providing a generic practice driven by perceived multi-disciplinary team expectations, organisational pressure and it created time pressure to engage in additional organisational services. While these issues were identified by participants, there was also little actual evidence provided to support these notions.
  • It is recommended that further OT team discussions and planning take place to empower OTs to integrate smoking cessation as a specialised service.
  • Further continuing professional development may also assist a greater understanding of how occupation can be used to promote wellbeing through the smoking cessation transition. This may strengthen the professional identity required to establish and maintain a balance between required generic practices and specialised service provision.
  • Documentation of the use of specialised OT services is important for recording the outcome of interventions. It potentially could be used as a means of advocacy to support ongoing research, development and integration of specialised OT smoking cessation services into smoking cessation program planning.