P Wye, J Bowman, A Baker, J Wiggers, C Foster, M Terry, J Knight, R Clancy and V Carr

THE UNIVERSITY OF NEWCASTLEAUSTRALIA

• The big picture

• This study• Preliminary findings

• Attitudes• Knowledge• Skills

• Key issues for Smoke Free Mental Health

Attitudes, Knowledge and Skills...

The Big Picture

• Part of a PhD project involving...

• September 2005 - Patient file audit at James Fletcher Hospital

• February 2006 - Survey of all NSW Mental Health Units• June 2006 - Focus Groups for Staff and Ex-Patients• October 2006 - Survey of Staff at James Fletcher

Hospital• 31 October 2006 - Smoke Free Workplace Policy• May 2007 - Follow-up audit at James Fletcher

Hospital• October 2007 - Follow-up survey at James Fletcher

Hospital

Smoking - People with Mental Illness

General Community - 17%(Australian Institute of Health and Welfare, 2004)

People with Mental Illness - 32%(NSW Department of Health, 2004)

Mental Health Inpatients - 70 – 80%(NSW Department of Health, 2004)

James Fletcher Hospital

5 wards, 82 beds, 2000 admissions p.a.

•Age: Mean 39 (SD 16), range 11-91

•Gender: 51% male

•Length of Stay: Mean 16 days (SD 26), range 1-266

•First admission: 38% of all discharges

•Aboriginal/Torres Strait islander: 6%

The Survey...

• N = 183 (51% response rate)• 21.3% smokers, 26.8% former smokers• 33% male

– 22% nurses– 10% allied health– 7% medical/psychiatry – 23% admin with patient contact– 18% admin no contact– 20% researchers, domestic services, or maintenance

Attitudes

• When asked if smoking should be banned in all health services…– 20.8% said no– 23% uncertain– 56.3% yes

• When asked if smoking should be banned throughout their Area’s mental health services…– 7% strongly unsupportive– 14% unsupportive– 11.5% no view either way– 32% supportive– 34% strongly supportive

Support for SFWP

•66% supported a smoking ban in their workplace

•65% thought SFWP would improve patient physical health•29% thought SFWP would improve patient mental health

•88% believe patients should be encouraged to quit•76% saw smoking care as an integral function of their unit•54% believe most patients are interested in quitting•54% believe quit advice as important as other roles

•45% believe it is useful to smoke with patients

Staff Attitudes

Clinical Staff Knowledge

• 46% of clinical staff concerned about lack of information available about procedural changes

• 54% of clinical staff concerned about lack of knowledge

• 69% of clinical staff interested in attending training

• 82% of clinical staff reported not receiving any formal training on smoking cessation care

Clinical Staff Skills

• 88% feel competent to assess patient smoking behaviour• 77% feel competent to diagnose nicotine dependence • 73% feel competent to assess smoking care needs

• 69% feel competent to provide quit advice • 89% feel competent to refer to Quitline• 57% feel competent to provide NRT

• 67% feel competent to manage withdrawal symptoms• 85% feel competent to manage negative behaviours• 75% feel competent to deal with non-compliance issues

Conclusions

• Attitudes – 66% of staff support SFWP

• Knowledge – perceived lack of knowledge and training opportunities – time to attend

• Skills – self report competencies, doesn’t infer skills are exercised

Conclusions

•Foster a changing attitude... many still see smoking care as different to routine healthcare

•Not only provide training, but provide time for staff to attend training

•Support staff competence and encourage file documentation of smoking care

Development of survey

• Comparison of pre and post measures to see what changes have occurred after twelve months smoke-free – Attitudes – Knowledge – Skills

• Evaluation of the Policy –– Process– Impact– Outcomes

Future Studies

Thank you to the Hunter New England Area Health Service staff, particularly the staff located at the James Fletcher Hospital site, for participating in this research.

This research is supported by a grant provided by the Commonwealth of Australia Department of Health and Ageing.

Acknowledgements