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.
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.
Actually, I am all for healthcare providers expressing concern about a child's weight and ensuring that caregivers have the information and support necessary to help that child maintain a healthy weight. I specifically suggested neutral wording to assess the child's exposure to a known carcinogen. The fact that a parent might get bent out of shape over being asked a perfectly legitimate question is really no reason not to provide accurate and objective information regarding the health of the child- which is and should be a ped's primary concern.
I do not judge those who smoke, but with the education and knowledge today, I do judge those who knowingly expose their children to the smoke without giving them an out. I lost a cousin to lung cancer, she grew up in a family of smokers who didn't worry about the presence of their children (in those days the dangers weren't known, so I do not blame her parents for this). I grew up in a family of smokers and remember as a child BEGGING my parents to open the windows in the car because I couldn't breathe. I now have asthma.
When I get a pt in the ER who smokes I ask them if they are interested in info about quitting. If not, I back off. If I get kids who wreak of smoke I don't ask the parents if they're interested in what I have to say, I just flat out tell them they need to not smoke around their kids unless they're outside where ventilation isn't a problem.
I do not take offense if a health care provider asks about smoking and informs me of information available. What I think is offensive in this thread is the judgemental attitude that smoking parents don't care about their children. It is our job to educate and promote healthy lifestyles, of all kinds. To say that as a nurse you don't judge me but as a parent you do IS offensive and WILL come across in your care. YOU have NO RIGHT to JUDGE anyone. No one has that right. It sounds like you would like us all to fo to jail for smoking in front of our kids. That is the same as jailing an alcoholic who drinks while pregnant to avoid fetal alcohol syndrome or jailing a drug user that is pregnant. All it does is cause more of a delay in getting prenatal care or having pts. lie about their habits. And, if making it illegal is the answer, where does it end. If I don't give my child their daily vitamin or make sure they eat their veggies, am I not harming them also, should that be illegal?
I, too, am one of the wretched smokers that has children. BUT, I have a flower pot ashtray on the covered back porch that I use to smoke outside. Never do I smoke inside, unless my children are away for more than a day, and then I only smoke while I soak in a hot bath with the door shut and vent fan on. Yes, I do smoke in my car occasionally - only if there's adequate time to "air out" before my girls get in. If not, I just wait.
Am I trying to toot my own horn? Not at all. I'm not proud of the fact that I smoke, by any means. But, I don't expect my beautiful girls to be subjected to the consequences of my bad decisions.
As far as bringing it up to a patient's mom?? I don't see any harm in being tactfully matter-of-fact. . .Like, "The secondhand smoke that these children have been exposed to is just as dangerous, if not more so, than the smoke you inhale. Let's talk about ways to reduce/eliminate that." The having an extra shirt/jacket to take off when you go inside...great idea!!! Kids are innocent and deserve the best start they can - hard to do with black lungs at a young age.
Maybe I worded it wrong. Let me try again. I have a hard time with parents who, knowing the dangers, expose their children to those dangers without giving the kids an out. In other words, smoking with children in an enclosed space. I never said you don't care about your children. Alcoholics care about their children. Yes, I have a problem with alcoholics who say they want to quit and know that the help is out there.....AA is no longer something to be whispered....and refuse to take the first step and get that help when they become pregnant. They do care about their babies......but parents who don't get the help while pregnant or smoke in ventilated areas when their children are present........I love my baby, but I love her so much that when I found out my MIL was smoking with the baby in her car I exploded and restricted MIL's access to my child until she quit smoking.....before that MIL had sworn to me she never smoked in the car if Baby was with her. That was my only request...."Do not smoke in the car when she's with you. If you need to smoke, take her for a walk outside."
Specializes in Medical, surgical, inpatient rehab.
Hello,
Obviously it is dangerous for the kids....but...the mom is there at the clinic, and she is getting her kids checked out. There are a lot of moms out there who don't do that much. Do you have any literature you could give her? Maybe give her the information to catch her eye without coming down too hard on her? What you don't want to do is scare her off from bringing her kids to get health care, because the providers look down on her.
The world is not ideal as we are taught in nursing school there are millions of kids in much worse situations, I would just do the best you can to help without doing harm.
I am a smoker and I know that I need to quit, I plan on doing so soon. I do not however smoke around anyones children. I smoke when I am alone in my car or when I am outdoors. Anyone who exposes their children to secondhand smoke, especially these days, knowing the dangers, in my opinion lack some serious parenting skills. I mean seriously, how selfish can you be.
Sorry if that makes you mad, but hey, the truth hurts!
Just a thought here. But how do you know for sure that they are exposed to second hand smoke? My parents smoke, but not around my daughter, but if I leave her coat or sweatshirt in their hall closet it smells of cigarette smoke when we leave.
My daughter's coat would smell of smoke after a visit with her grandma too, but it never wreaked until she started smoking with my baby in the car. I think the key word in the OP's post was "wreak."
First of all, to everyone who has posted here and has identified themselves as a considerate smoker; :redpinkhe thank you.
I smoked for 11 years 7 months and then quit when I found out I was pregnant with my oldest daughter. I have probably had a total of twenty cigarettes since then (this was a little over 11 years ago). Never in front of my children (social functions). Sometimes, for days on end, I miss smoking very much. But, I am in the habit of craving cigarettes and not giving in. It is still a habit to crave them ...I just am now in the habit of accepting the discomfort that comes with my cravings. I hope I am explaining this well. ....
I just wanted to encourage everyone that wants to quit that yes, you can quit and to trust yourself and your abilities . And for those of you who are not exposing your children to it; well done.
I would also like to say that smoking is an emotional issue for me. My father died of lung cancer three years ago, I miss him so much and I still need him on so many levels. My grandmother (his mother) berates herself every day for smoking in front of him. She is swallowed up with guilt. She feels responsible for his becoming a smoker (he had asthma too) and for his death. Yes, we tell her "you are not responsible for his choices as an adult." etc. but, she feels too much conviction about her role in his life...she will not let herself off the hook. IMHO, there is nothing more horrifying than outliving your child. My dad's dad (my grandaddy) died of lung cancer 12 years ago. Even that was not enough to motivate my father to stop. Sadly, my father suffered the guilty tortures of the d a * n e d as he died. At least he had some peace and was relieved by the fact that I had quit. My brother still smokes though. He and his wife both do and around the kids. Yes, it is self-absorbed. No, I do not think they should go to jail . But, I really do wish that they would show some emotional/moral fortitude and set an example that their children could follow. My nieces and my nephew have terrible and completely preventable asthma. They have had several sets of tubes each etc. My brother connects the dots alright...but his wants come before his kids' needs.
....it is heartwrenching to see such an unhealthy and ultimately devstating legacy in my family.
IMHO, there is nothing more horrifying than outliving your child. My dad's dad (my grandaddy) died of lung cancer 12 years ago. Even that was not enough to motivate my father to stop. Sadly, my father suffered the guilty tortures of the d a * n e d as he died. At least he had some peace and was relieved by the fact that I had quit. My brother still smokes though. He and his wife both do and around the kids. Yes, it is self-absorbed. No, I do not think they should go to jail 
. But, I really do wish that they would show some emotional/moral fortitude and set an example that their children could follow. My nieces and my nephew have terrible and completely preventable asthma. They have had several sets of tubes each etc. My brother connects the dots alright...but his wants come before his kids' needs.
LydiaNN
2,756 Posts
Actually, I am all for healthcare providers expressing concern about a child's weight and ensuring that caregivers have the information and support necessary to help that child maintain a healthy weight. I specifically suggested neutral wording to assess the child's exposure to a known carcinogen. The fact that a parent might get bent out of shape over being asked a perfectly legitimate question is really no reason not to provide accurate and objective information regarding the health of the child- which is and should be a ped's primary concern.