Implementing smoking cessation interventions in community mental health settings : exploring nurses' readiness to change, perceived barriers and overall perceptions using a mixed methods design

Tobacco use is deeply entrenched in the culture of psychiatry. Historically, nurses condoned smoking and at times even encouraged it. Despite the vast research examining smoking cessation interventions for the general public, little is known about the barriers health care professionals face while working in community mental health settings and their 'readiness' to change in regards to implementing smoking cessation interventions into their practice. This study is part of a growing body of research examining tobacco in the context of mental illness. A mixed methods research design was utilized for this project. The first phase of the study consisted of the analysis of a self-report questionnaire completed by 282 health care providers working within the community mental health field in the Greater Vancouver area. The Transtheoretical Model: Stages of Change Method was applied to this largely untapped source of health providers to determine their 'readiness' to a) talk to clients about their smoking habits, and b) provide smoking cessation support to their clients. The second phase consisted of a focused ethnographic design in which semi-structured in-depth interviews were conducted with 13 community mental health nurses. This first Canadian investigation of community mental health nurses' 'readiness' to implement smoking cessation interventions into their practice revealed that the majority of nurses were in the preparation stage for both a) talking to clients about their smoking and b) providing smoking cessation support to their clients. Barriers to providing smoking cessation included lack of knowledge, time and appropriate resources. The ethnographic profile of the sociocultural and organizational context of community mental health nursing revealed the structure of the nursing subculture within the mental health teams (Brokers, Conductors, and Connectors) and highlighted the impact of these roles on nurses' readiness to change. Findings from both phases of the study were synthesized and results indicate a need for 1) the development of smoking cessation interventions specifically tailored to community mental health nurses' roles, 2) the incorporation of smoking cessation intervention education into the community mental health workplace, and 3) placing equal emphasis on the role and value of mental health nursing in undergraduate nursing programs.Applied Science, Faculty ofNursing, School ofGraduat