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.

[Tweety, BSN, RN]

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.

I reread the few (7) threads above this post and didn't see any judgemental attitude, but perhaps mine from my statement that I would like to see adult children with asthmatics sue their parents.

I apologize if that came accross as a harsh judgemental attitude. I was mainly pointing out that it is perfectly legal for parents to smoke in front of kids despite the documented evidence of potential for harm. I do think smoking in the home and car with children present is wrong. Do I judge when I see kids in a car, a smoker with the windows rolled up? Probably, I do. I would on a bulletin board sound more harsh in my judgement that I would in a clinic doing teaching.

I didn't mean to imply they are monster parents that don't care for their children.

Other than my little snippet most of the posters answered the question: should nurses intervene and educate or just ignore and allow parents their rights.

Most people seem to agree that at least some education is in order. That doesn't seem harsh judgementalism to me.

Doctors and nurses edcuate about preventative health measures all the time. Trust me if I found kids reeking of smoke, I wouldn't say to the parent "I hope they sue you one day", that was me just talking off the cuff on a bulletin board, it's not my teaching style.

I have my own demons and bad habits myself and I probably would make a horrible parent raising deraged mass murdering crack addict smokers that weigh 400 lbs.

[Tweety, BSN, RN]

gosh. i think it's a no brainer that breathing second hand smoke comes with its' own set of injuries. i'm a smoker and i didn't feel the least bit defensive. no one can judge me because i can choose to buy into it or not. and i chose not to. why? because raising children can easily result in a host of physical and/or mental/emotional deficits. it has already been established about overweight, smoking, etoh/drug use. the mental/emotional injury could be a result of ineffective or no communication, bigotry, unresolved and lingering issues, unrealistic expectations, humiliation, neglect or abandonment of a child's feelings....i'm sure you get the picture. what comes back to haunt us is when our children are older; are they truly happy? are they compassionate or judgemental? are they prejudice? there are a hundred reasons on why our kids can grow up lacking or literally wounded, whether it's physical or emotional. but we're all so eager to point fingers, often but conveniently turning our heads or buried in the sand. none of us can afford to possess a holier-than-thou attitude. none of us. so we do the best we can. and that's all we can do. offer your knowledge; offer your support; offer your compassion. but please, hide that pointed finger.

leslie

Good post, I don't have kids and never will. I would have daily nightmares about raising them and good parents raise bad kids and bad parents raise good kids, and smokers (like my parents) raise kids without asthma and healthy lungs (I did grow up to emulate them and my peers and started smoking).

I would venture to think it would come back to haunt a parent, their child became asthmatics and later developed lung cancer. Especially if you were educated on the risks by a nurse who wasn't pointing a finger but passing on information.

I must be missing something, but after reading most of this thread I didn't see a whole lot of harsh judgements against smokers, maybe a few, but not a lot.

It's very difficult to say some things without people saying back at you "how dare you judge". Saying things like "you're obese and it's detrimental to your health and I'd like to help you loose weight", "your second hand smoke has the potential to harm your children", "the BSN should be the minimum entry level education for RNs" regardless of how it's put always gets a few "while I'm a......inser.........and I'm a good........how dare you judge." response no matter diplomatic it's put. That is what I think makes some of us afraid to confront, because we're judged in return as having lack of compassion and understand. It's frustrating.

Even if it's a no-brainer, do we just think "gee it's a no brainer, no need for me to even go there".

Note to self: This is one of those "know when to hold them, and know when to fold them" threads for you. :)

[rn/writer, RN]

There's nothing inflammatory about relating personal experiences and the reactions they generate. Nor is it judgmental to look at actions and their results.

What crosses the line is to start making assumptions about motives.

The mom in question is likely to become defensive and perhaps even hardened in her determination to smoke if she's approached with even a subtle implication that she doesn't care about her kids.

She might have a completely opposite response if a nurse said, "I can see you care about your kids [after all, she did bring them into the clinic], so I want to give you some information about second-hand smoke." If she proceeds on the basis that, of course, this mom wants to do right by her children, she might inspire just that response.

She can further increase the chances of a successful interaction if she can offer empathy (either as a current/former smoker or as someone who struggles in another area), ideas for how to reduce the risks, cessation options, and a ton of encouragement. All done without any judgment of the woman as a mother or a person.

Someone who is approached as a decent human being who may be at a loss as to how to handle a difficult situation is much more likely to be open to change than that same person who is treated as a deficient/defective human being. A patient who HAS a problem vs. a patient who IS a problem.

[charebec65]

i too am a smoker.... i'm considering quitting after i finish nursing school but no way until then. however, i do not smoke in my home nor do i let others smoke in here. i don't smoke in the car when the kids are in there, i sit in non-smoking areas of restaurants and get non-smoking hotel rooms. i also try not to be obnoxious about it around non-smokers.

i grew up in a smoke free environment and have asthma, the same goes for my husband. my youngest daughter had severe asthma problems as an infant...even though i'd quit smoking as soon as i figured out i was pregnant with her and didn't smoke for quite a few years after her birth.

i must admit that it bothers me terribly to see people in their cars with children smoking with the windows up. another pet peeve of mine i observed yesterday.... there was a lady in a small pickup truck driving down the road with a child about 2 years old standing up (obviously unrestrained) in the seat.

i do think we owe it to the children to educate parents about the effects of smoking on their children. i would not tell them to quit try to education tem and suggest ways to lessen exposure.....

[Retired R.N.]

rn/writer wrote:

> Someone who is approached as a decent human being who may be at a loss as to how to handle a difficult situation is much more likely to be open to change than that same person who is treated as a deficient/defective human being. A patient who HAS a problem vs. a patient who IS a problem.

Isn't that the way we should approach all our patients? It can be almost impossible for a non-smoking person to know what it feels like to suffer from an addiction to tobacco. If it were easy to quit smoking, more people would do so. When the general public finally sees that so many doctors and nurses

have managed to become ex-smokers, it becomes easier to convince them that they, too, can hope to escape that addiction.

Empathy and encouragement are far more likely to lead to a successful intervention than preaching or condemnation.

[perfectbluebuildings, BSN, RN]

There's nothing inflammatory about relating personal experiences and the reactions they generate. Nor is it judgmental to look at actions and their results.

What crosses the line is to start making assumptions about motives.

The mom in question is likely to become defensive and perhaps even hardened in her determination to smoke if she's approached with even a subtle implication that she doesn't care about her kids.

She might have a completely opposite response if a nurse said, "I can see you care about your kids [after all, she did bring them into the clinic], so I want to give you some information about second-hand smoke." If she proceeds on the basis that, of course, this mom wants to do right by her children, she might inspire just that response.

She can further increase the chances of a successful interaction if she can offer empathy (either as a current/former smoker or as someone who struggles in another area), ideas for how to reduce the risks, cessation options, and a ton of encouragement. All done without any judgment of the woman as a mother or a person.

Someone who is approached as a decent human being who may be at a loss as to how to handle a difficult situation is much more likely to be open to change than that same person who is treated as a deficient/defective human being. A patient who HAS a problem vs. a patient who IS a problem.

That's as always, so well put. I sometimes don't think of the best ways to say things when doing patient education, but really like your approach here.

[BKRN]

Just what we need, another law that can't be enforced!!! Just what would you do to those parents who were found guilty??? Take their kids away, fine them for a legal activity?? That is a VERY slippery slope.

I know that It would'nt be enforced-I just really hate to see kids trapped in a car or room filled with cigarette smoke!

[hospitalstaph]

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.

=) Julie VB, RN BSN

I think that literature would be perfect in this situation. If approached verbally, this mother may (and likely would) be defensive, but if she has something to read later she may be more receptive to the information. Maybe even a comment like, "Wow, you sure have some great kids. I bet you are just crazy about them. Here is some information for you to read when you have time." People are always going to be more likely to listen and take advice/information when they feel valued and respected.

T

[TheCommuter, BSN, RN]

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!

I think you have hit the nail directly on the head.

Both parents smoked in the home and car during my growing-up years; as a result, I was always sick with colds 4 times yearly, ear infections, fevers, and other little ailments. Also, I probably reeked of smoke before going to school daily. It was no coincidence that I suddenly stopped becoming sick once I moved out of their home. It just disturbs me when parents would smoke in an enclosed space, knowing that the nicotine metabolites turn up in their child's urine and blood.

In my honest opinion, the most caring and unselfish thing a smoking parent can do is step outside the home or car to smoke. My post might sound 'judgmental' to some, but I am merely stating my personal opinion that has been shaped my by past experiences as the child of smokers.

[Tweety, BSN, RN]

She might have a completely opposite response if a nurse said, "I can see you care about your kids [after all, she did bring them into the clinic], so I want to give you some information about second-hand smoke." If she proceeds on the basis that, of course, this mom wants to do right by her children, she might inspire just that response.

I think you're in agreement with the majority of the posters on this thread. It must be addressed. It goes without saying that professional nurses would approach it with tact and nonjudgement. (Of course that's not always the reality).

[TazziRN, RN]

In my honest opinion, the most caring and unselfish thing a smoking parent can do is step outside the home or car to smoke. My post might sound 'judgmental' to some, but I am merely stating my personal opinion that has been shaped my by past experiences as the child of smokers.

YES!!!! This is exactly what I was trying to say! What an adult chooses to do to his/her own body is a personal decision, but when that decision affects the helpless -- namely, our children -- then it becomes a poor parenting choice. Not a poor parent -- a poor choice.

As an addict in recovery, I know how hard it is to quit a chemical. I remember one of my addiction counselors once told me that nicotine is the hardest to kick of all, because the longer one smokes, the more receptor sites one grows. Makes sense to me. However....I got to a point where my life and my license and my happiness became more important than my using.

[PedsER-RN, BSN, RN]

we encounter this alot at work (seems like most of the kids that smell the worst are there for breathing diff, too). we (tactfully) explain that it's their right to smoke, but that secondhand smoke can cause problems with their child's health, and that if they do choose to smoke, at the very least take it outside. this has been met with responses ranging from "ok" to "so what if i smoke around my kids? it's none of your ******* business". at the end of the day it's the parent's decision, but at least we made the effort to educate them so maybe their children won't be put at risk.