Wāhine Māori nurses who smoke and their role in smoking cessation

Tobacco is known to be a major cause of preventable deaths in New Zealand and is established as the leading cause of heart disease, emphysema and different types of cancers. Tobacco products not only cause harm to those who smoke but also to non-smokers by exposing them to the harmful effects of toxins that are emitted from tobacco products once lit. Smoking is a major problem for Māori as it impacts their health and economic status, and cultural identity. Smoking rates for both Māori youth and adults are higher than their New Zealand European counterparts. Smoking prevalence for Māori wāhine (women) remains high (41.8%), and Māori nurses are in an ideal position to be positive non-smoking role models for other wāhine Māori. Smoking cessation programmes focusing on the individual, rather than the whole whānau (family) have been unsuccessful for Māori. Some researchers suggest culturally appropriate and whānau centred smoking cessation programmes are more likely to support wāhine Māori to quit smoking. This study examined the experiences of Māori nurses who are smokers, and how this influences them when providing smoking cessation advice. Qualitative research methods were used to collect data using semi-structured interviews with six wāhine Māori registered nurses from diverse nursing backgrounds, and one Māori student nurse. Both paired and single interviews were undertaken. Braun and Clarke’s (2013) thematic analysis framework was used to analyse the findings and develop themes and subthemes. Five key themes were found: initiation, quit attempts, being a nurse, being a smoker and a nurse and putting my nursing hat on. All wāhine Māori nurses had an early initiation to their current smoking status. Being a smoker impacted their role as nurses when providing smoking cessation advice to others. My findings show these nurses had a clear awareness of their identity as nurses who are expected to role model healthy behaviours, but they had daily conflicts and difficulties in carrying out this role as smokers. The nurses claimed they felt like frauds and questioned their abilities to preach smoking cessation when as smokers they found it difficult to quit. My findings point to a personal versus professional “tug-of-war” Māori nurses’ experience that creates a conflict. This tug-of-war the nurses said placed them in a difficult position, because the expectation is that smoking cessation is part of their nursing role. The nurses in my research voiced their realisation that smoking intervention is part of their role but the conflicting feelings as a smoker caused feelings of anxiety and hypocrisy when confronted with promoting smoking cessation activities. This study highlights the need to consider the daily tensions and struggles that go with being a nurse who smokes, and the expectations to undertake smoking cessations activities with those who do smoke as part of their practice. Furthermore, nurses experience stigmatisation from work colleagues, and their expectations are that they will quit smoking because they are health practitioners