kids wreak of smoke...ethics question

[narnar]

I am a nursing student at the University of Nevada Reno. Recently in clinical I came across an ethical dilemma and am wondering what you would do in this situation. In a public health clinic, two kids under age 10 came in with their mother for physicals. As I took their vitals, heights, and weights, I couldn't help but notice that they wreaked of smoke. I assume that their mother smokes at home and in the car with the kids. I have done some research on the dangers of exposing children to second hand smoke as well as the problem of having a role model who smokes. The nurse practioner I was accompanying for the day completed the physicals with no mention of the smoke. My question is, aren't we in a position, as healthcare workers, to offer some sort of intervention on behalf of the kids? By this I mean educating the mother about what she is exposing her children to and encouraging her to either not expose the kids to the smoke and smoking or quit herself. If the subject was brought up, would she feel attacked and not come back to the clinic? Is that a risk that's worth taking in an attempt to make a positive difference? How can tact be employed? If you have been in a situation like this or not and have thoughts to share, please do. I wonder what others would do. Would you take the easy way out and not say anything ("that's none of my business") or be hopeful, take a risk, and try? How would you try? Would you go into detail, be brief, refer the parent to a smoking cessation help group, etc.?

FYI, I am hoping to get some responses not only for my own benefit, but also to use in short paper.

References: Brown, M. "The Effects of Environmental Tobacco Smoke on Children: Information and Implications for PNPs" from the Journal of Pediatric Healthcare, 2001.

Horstman, K. and Van Rens-Leenaarts, E. "Beyond the boundary between science and values: re-evaluating the moral dimension of the nurse's role in cot death prevention" from Nursing Ethics, March 2002.

[Undecided7]

In an ideal world, the mother would be interested in learning about the negative health effects of smoking- to herself and her children. Armed with the new knowledge, she would either quit (and have anyone else in the house that smokes quit) or at least not smoke when the children are present. She would talk to her children about smoking and encourage them to "just say no"- and her kids, seeing what she has been through- will listen.

This is NOT that world. I'm pretty sure the mother has heard the news that smoking is bad. If she cared, she would get help and at least smoke outside or away from the kids but her smoking is more important to her. She most likely smoked when she was pregnant and she probably lets the kids smoke too! I knew kids in first grade that smoked- thanks to their parents- even grade school children that drank alcohol- but that's another thread. You could say something, but I'm pretty sure the mom would just be mad and have a few choice names for you once she gets in the car- and of course, in front of the children. :uhoh21:

I guess you have to go with your gut instinct. Does she seem receptive to you? Does she seem interested? You could always try but after a few times, you'll probably give up like everyone else.

[Tweety, BSN, RN]

It's probably best not to ignore it. What was stated above may be true, she may have already been offered this information.

Unfortunately parents are free to expose their children to 2nd hand smoke. I would just love for an adult child with ill effects of 2nd hand smoke to sue his parents for abuse/neglect. But until that happens all we can try to do is educate.

Be upfront "are you smoking in close proximity of the children?" No matter what her answer, either yes or no, give the information.

I we are nurses in a clinic, and are doing a proper and thorough assessment this should be part of it, imo.

[perfectbluebuildings, BSN, RN]

This is an interesting subject. At our hospital, we discuss smoking risks w/almost all parents who come in w/kids with respiratory issues especially asthma, or bronchiolitis; even if they don't smoke themselves we give them the information, in case there is someone in the extended family/visitor or whatever who smokes, or just being out in public to know their child's symptoms could be aggravated w/smoke. Or sometimes will mention it when kids have an ear infection or something along with whatever else they're in with and their parents smoke. We don't really discuss smoking w/any other diagnosis, except to tell people where the "smoke pit" is. Mostly parents are too stressed about whatever their kid's main issue is to think about the smoking during a few-day hospitalization. But, I think a clinic exam might be a more appropriate time. Even if, as is likely, the mom already DOES know that smoking isn't good for her kids, it might help to hear EXACTLY what it could be doing, and to give her suggestions for preventing her kids' exposure to it like going outside and wearing a coat or different shirt over her clothes that she takes off when she comes back in. People don't automatically know these things and she might likely be receptive to this kind of practical info, and also be more likely to change if she knows exactly what risks she is giving to her babes. It is also possible too, that this family has been to the clinic before and the NP has already done some education with this mother. And, also, it's a tired adage but it is very true- "you can lead a horse to water but can't make them drink", sadly enough even if it relates to their children's health, not everyone will listen and follow through.

[LydiaNN]

Given that your job is to assess the child's health and development, I don't think asking the question and providing cessation information is judgmental at all. All you have to ask is if they children are exposed to second hand smoke, which clearly has short and long term health impacts. I think this question should be added to all peds assessment forms, and I'd like to see some of the money from the tobacco payouts go towards funding it.

[perfectbluebuildings, BSN, RN]

that's a really good idea MTP.

[TheCommuter, BSN, RN]

During my childhood and adolescence, my mom and dad smoked inside the home and car. They knew about the ill effects of passive smoke on children and nonsmokers; however, smoking was more important to them.

If a healthcare provider were to attempt to inform them of the detriments of secondhand smoke, my parents would have most certainly responded, "Don't you dare try to tell me how to raise my kid." Fulfilling their cravings for nicotine was more important than ensuring my health and safety. This is the sad truth about my parents, as well as most parents who smoke in the presence of their offspring.

[NWPAnurse]

My aren't we all being a bit judgemental here? To imply all smoking parents don't care about their kids is horrible!!!! How can you care for pts. that smoke with that kind of attitude. Is it just smoking or also alcoholics, drug addicts, obese pts., and the mentally ill??

Yes, I am a smoker and yes, I have kids. And guess what, I do happen to care about my kids. Maybe social services should come get them from me though. Of course, I hope you have the same attitude about people with obese kids that aren't fed the proper diet.

[TheCommuter, BSN, RN]

Yes, I am a smoker and yes, I have kids. And guess what, I do happen to care about my kids. Maybe social services should come get them from me though. Of course, I hope you have the same attitude about people with obese kids that aren't fed the proper diet.

I have noticed that you do not clearly indicate whether or not you smoke outside the home and car.

[firstaiddave907]

Given that your job is to assess the child's health and development, I don't think asking the question and providing cessation information is judgmental at all. All you have to ask is if they children are exposed to second hand smoke, which clearly has short and long term health impacts. I think this question should be added to all peds assessment forms, and I'd like to see some of the money from the tobacco payouts go towards funding it.

thats a good point i agree with you

[NWPAnurse]

Yes, I smoke in my home. And yes, I know it is not good for my children. The point I am trying to make is about the judgemental attitude I'm hearing. I would feel the same way about an alcoholic or drug user. (and no, I do not drink or use drugs). As healthcare professionals, out job is not to judge people and make blanket statements- "They don't care about their kids." Not only about smokers, but the alcoholics and drug addicts along with the parents who let their kids eat ho ho's and chips all day.

[BKRN]

Yes, I smoke in my home. And yes, I know it is not good for my children. The point I am trying to make is about the judgemental attitude I'm hearing. I would feel the same way about an alcoholic or drug user. (and no, I do not drink or use drugs). As healthcare professionals, out job is not to judge people and make blanket statements- "They don't care about their kids." Not only about smokers, but the alcoholics and drug addicts along with the parents who let their kids eat ho ho's and chips all day.

Your right, we as healthcare providers are not supposed to judge our patients. But as a parent I do judge you. No ones perfect, but when you knowingly expose your children to a deadly poison well I can't help but think that you care more about your own addiction than the welfare of your children.

Having said that I do believe that it is our responsibility as nurses to inform parents in a non-judgemental way of the ill effects that second hand smoke WILL have on their children. Also by passing this information along we are advocating for the children who are not able to stand up for themselves.

I would love to see a law passed making it illegal for parents to smoke in their home or cars were children are present.