Essay: Implications of smoking and how it affects people in Middlesbrough

Introduction
This report will form a community profile of Middlesbrough, a small town on the Southbank of the River Tees, (Population of Middlesbrough, 2018). (Merriam Webster, 2018) states that a community is a group of people with a common characteristic or interest living together within a larger society. It also explains that a community is a body of persons or nations having a common history or common social, economic and political interests. The reason in which Middlesbrough was chosen is due to the amount of health issues that are present. The Nursing and Midwifery Codes states “avoid making assumptions and recognise diversity and individual choice” (Nursing and Midwifery Council, 2015). A nurse’s duty is to maintain the health of the community without stereotyping people and to improve the prevalent health issues within the area.
Chapter 1
(Population of Middlesbrough, 2018) says that the population of 2017 was 146,620 with an estimated population of 148,094 for 2018. This population is based upon a wide range of individuals who are of different ages, religious beliefs and ethical backgrounds. Observed throughout Middlesbrough there are many different religions, including; Christianity, Islam, Hinduism and Sikhism. The population in Middlesbrough is broken down to show that over 88% of the people are White British, compared to around 6.4% Asian residents and 1% black residents. Statistics show that Middlesbrough has a higher non-British population (6%) compared to 3.2% in the North East (2010). (Middlesbrough Council, 2018), estimated that 50.85% of the population were female, compared to 49.15% of males. Studies show people in Middlesbrough life expectancy has a tendency to increase, averaging at 85 years.
Housing has a major impact on the health and wellbeing of a person, without this adverse effects can affect individuals as well as families. Having risen by 22% in the past 2 years in Middlesbrough, Middlesbrough Council have devised plans to tackle homelessness by putting to place; Sanctuary schemes and emergency crash pad accommodation. Tees Valley Strategic Housing Market Assessment (TVSHMA 2012) suggests that 62.2% of Middlesbrough residents want to remain in their home, with 17.5% buying in open market and 3.4% require residential care housing.
Education enables greater opportunities throughout a person’s life with life changes being broadened. Middlesbrough’s GCSE headline rate along with the Tees Valley average has grown 6% across the past 5 years. Although, lack of achieve in both English and maths at GCSE leaves barriers for school leavers. Absences from school in Middlesbrough in higher than the national averages, causing a strain on children’s education, with over 10% of children missing over 15% of education.
The 2011 census explains that the overall employment rate in Middlesbrough was at 51.2% this compared nationally to 61.9%. Comparing this to the proportion of those who were unemployed in Middlesbrough was 7.6% which was considerably higher than the national rate 4.4%. Leading on from this there are specific areas in Middlesbrough that are more known for unemployment as well as areas more known for crime. Crime in Middlesbrough has a tendency to link in with substance misuse, which shows a high level of violence in the town centred primarily at weekends. Males between 20-29 accounts for the highest proportion of violence related to night time economy.
A variety of reasons can mean a person is more vulnerable to poor health than others, which may deprive them from accessing services they require. Learning disabilities can prevent a person from accessing services or from being aware at the services they are entitled too. Needs can be meet through various provisions to ensure this, carers provide a range of care to service users who may have a range of needs. Moreover, violence victims who needs to seek help can be provided with support, having been believed that many of these cases are not reported. Likewise, migrants may be unaware as to how they can seek support for their educational and individual needs.
Alcohol misuse is consuming more alcohol than the recommended daily limits. Middlesbrough has higher levels of alcohol misuse that caused hospitalisations than the national average. Throughout the area there is a large availability of cheap alcohol which has led to the prevalence of binge drinkers in Middlesbrough being greater than the national average. According to (Teesjsna, 2018) Middlesbrough is lower than the North East for the prevalence of binge drinkers in the area, although higher than nationally. Nationally, around 1 million people were admitted to hospital due to alcohol related issues across 2009/10. Services in Middlesbrough are currently being provided to try to reduce this across the area, including; awareness training, drop in services, liaison teams and rehab preparation.
According to (Teesjsna, 2018) smoking is the single largest cause of preventable mortality in England with approximately 8.5 million people in England smoking. Correlations in Middlesbrough, show the more deprived the area, the higher the smoking prevalence. Approximately 1.4 million people are nationally hospitalised each year due to smoking related health issues. Having said to have cost the NHS in Middlesbrough £6.3 million and England £2.7 billion per year due to smoking related
problems. Stop Smoking Services (SSS) is widely available for people to access, however both in Middlesbrough and nationally a decrease in access has been recognised. Having only 6% of smokers in 2014/15 accessed the SSS, (Teesjsna, 2018).
Poor diet attributes for 33% of cancer deaths as well as up to 50% of cardiovascular diseases (CVD). (Public Health England, 2018) states that adults in Middlesbrough show a low level of healthy eating, with only half consuming the recommended 5 a day. Studies show that the more deprived areas face additional barriers to consume a healthy diet. South Tees Hospitals NHS Foundation Trust and Dietetic Department provide support for a range of diet related conditions. Dietician teams across Tees, Esk and Wear Valleys NHS Foundation Trust, help to provide care pathways for malnutrition and weight management. In relation to poor diet, only 11.4% of Middlesbrough adults take part in regular exercise, with the national average at 11.1%. Schools help children of young ages to reach the Governments exercise targets, which shows as decrease with age increase.
The British Crime Survey of 2009/10 shows that around 8.6% of 16-59 year old across England and Wales had tried illegal drugs. Middlesbrough has a high percentage of clients who receive treatment, although a low figure of these client successfully complete treatment. Official prevalence estimated there are 20.8 per 1,000 people in Middlesbrough using illegal drugs, largely higher than the regional 9.9 in 1’000, (Teesjsna, 2018). Provisions ranging from counselling support, detox preparation and advocacy support are only some of the services offered to support drug abusers.
Mortality could be reduced in Middlesbrough by focusing on the major causes of premature deaths. Reports shows that life expectancy in Middlesbrough is continuing to improve, even though there are gaps between affluent and deprived areas. Life expectancy in Middlesbrough’s most deprived areas is 12.9 years lower for men and 12 years for women compared to the least deprived areas. (Teesjsna, 2018) reveals deaths before age 75 are primarily caused by cardiovascular, respiratory and digestive diseases as well as cancer. The charts below explain the long term conditions and diseases most commonly causing deaths (2009-11).
Male deaths in Middlesbrough (2009-11)
Circulatory Respiratory
Cancer
External Causes
12%
28%
19% 16%
Digestive Other
15% 10%
Having been estimated that 26.5% of people fall over each year who are over the age of 65 with those who are over 75 the percentage rises to 32%. Statistics shows that an estimated 10% of people are admitted to hospital each year due to this, potentially decreasing mobility and increasing premature death. Nationally across 2012/13 there was a 29% increase in winter deaths, primarily affecting those aged 75 and over.
(Middlesbrough Council, 2018) explains the Screening Saves Lives website, which provides information on three national cancer screening programmes. Breast, bowel and cervical cancer screenings are offered as a part of this campaign which has raised awareness on its importance and risen the uptake rates across Middlesbrough. Before the campaign was created, only 2 local GP practices hit the national target rate, since the campaign GP’s have noticed a raise in screening rates.
Immunisations are an effective, safe public health intervention. Childhood immunisation rates have a tendency to be higher in Middlesbrough than then national average, (Democracy, 2018). Childhood immunisations are more likely to prevent childhood infections along with additional immunisations which are identified by the Department of Health. Middlesbrough reach the 95% WHO recommended level for covering immunisations by the 2nd birthday.
Chapter 2
Smoking is the chosen identified health improvement issue for this community profile, due to it being the most preventable health issue and cause of diseases. (Space to Breathe for Northern Ireland, 2018) explains how around 106,000 in the UK die from smoking each year, equating for one fifth of all UK deaths. Smoking was also chosen as not all smokers realise the health risks, an average smoker will lose 10 years of life due to smoking. Negative effects occur on almost every organ as a result of smoking, short term effects include; coughs, bronchitis and shortness of breath. With other effects to personal appearance, such as bad breath, yellow teeth and stained fingers. This health issue is a leading contributor to the development of progressive diseases and conditions, such as; cancers, strokes and chronic obstructive pulmonary disease (COPD). Around half of all long term smokers die from smoking, contracting these diseases. (Cancer Research UK, 2018) suggests that being smoke free can prevent 15 types of cancer, active and environmental smoke causes 15% of cancer cases nationally.
On average, smoking 20 a-day costs around £1800 per year, smokers underestimate this cost by roughly £600, with cigarettes costs on average £6.59 per packet. Smoking is an expensive habit, quitting could save people thousands per year, including; reducing debt and significantly improving health. E-cigarettes were released in 2003, with a purpose to help people quit smoking. They produce an odourless water, compared to the tobacco from a cigarettes. They provide a dose of nicotine in the form of water vapour which causes less damage to a person’s health than cigarettes. In the UK (2017), 5.5% of people used an e-cigarettes with rates increasing since. Although, e-cigarettes release nicotine they cause less financial and health damages to a person.
Signs and symptoms of smoking depends on specific diseases, common symptoms such as shortness of breath, chest pain, coughing up blood and difficulty in swallowing are leading symptoms to various illnesses. Smoking causes around 70% of cases of lung cancer, whilst damaging the heart and bloods circulation, (NHS.uk, 2018). In comparison to a non-smoker, a smoker faces a 4 times greater risk to die from cancer of the oesophagus, lungs, throat and mouth. As well as a 2 times greater risk of a heart attack and bladder cancer. Tobacco smoke contains over 4,000 chemicals, which is the reason for these diseases affecting people in such great numbers.
Passive smoking can be a cause of health problems and disease in non-smokers, people exposed to second hand smoking have a 25% increased risk of lung cancer and heart disease. This is especially harmful to children as it makes them more susceptible to asthma, chest infections and various other health conditions. Smoking rates during pregnancy are high in Middlesbrough. The level from 2013/14 was 23.9% with poses a serious health risk to both mother and the unborn child.
Smoking is defined as “The inhalation of smoke of burning tobacco encased in cigarettes, pipes, and cigars. With many health experts now regarding habitual smoking as a psychological addiction” (TheFreeDictionary.com, 2019). “Smoking is the single largest cause of preventable mortality in England” (Teesjsna.org.uk, 2018). Which explains why a significant amount of deaths caused by smoking could be prevented. (Statistics on Smoking – England et al, 2019) describes how smoking represented 77’900 of UK deaths in 2016 which could have been prevented. Having, 10.8% of mother smoking at the time of delivery (2017/18)
The success rate has reduced both locally and nationally since 2004/05, with studies showing, smoking prevalence in more deprived areas of England is higher than less deprived areas. The estimated smoking prevalence in Middlesbrough (25.5%) is significantly higher than the national average (18.4%). Comparing this to the number of deaths in Middlesbrough that are attributable to smoking is considerably higher than the national average, costing NHS Middlesbrough £6.3 million per year. Smoking effects doctor’s surgeries and hospitals dramatically across the nation, treating smoking related diseases uses valuable time and resources and proves to be very costly for NHS.
Chapter 3
Smoking is a major health issue that causes many health problems there are a wide variety of services both nationally and in Middlesbrough to help people quit. (Southtees.nhs.uk, 2019) explains how commissioned services include 6 drop-in clinic across Middlesbrough, which are; support and advice, workplace stop smoking support, Nicotine Replace Therapy, CO monitoring, active case findings for lung health, telephone helpline support and an enhanced support to quit programme.
(Nice.org.uk, 2018) explains guidelines for people who want to quit, commissioners and providers of stop smoking interventions with those in community and voluntary services. “1.2 monitoring stop smoking services” describes how to set targets for stop smoking services with targets to treat at least 5% of local population each year. Furthermore it explains interventions and services to meet local needs whilst prioritising specific groups. Middlesbrough engages working towards and following these guidelines to meet the needs of people in the area. (Greener, 2011) states how around 3 million UK people suffer from COPD, a case which highly relates to smoking. Having explained how NICE guidelines offer therapeutic treatment for the disease and updates nurses about COPD management.
South Tees Hospital supports a national campaign, Stoptober, which runs in October and encourages people to remain some free for the month. If a person stops smoking for 28 they are 5 times more likely to quit smoking, which is the reason for this being so successful. Stoptober is widely advertised which help educate people on how they can gain access to the service. James Cook Hospital in Middlesbrough supports this campaign, however accessing services can be barriers for people such as transport, lack of money and no availability of free buses. These barriers can prevent people from accessing the services they require. However, a website (smokefree.nhs.co.uk) offers support and advice to people who can access this from their home without having transport barriers.
NHS Middlesbrough commissions a South Tees Specialist Stop Smoking service (SSS) which includes a hub and spoke delivery model. Stop Smoking provision in Middlesbrough, Redcar & Cleveland is provided by Middlesbrough Council, (North Tees and Hartlepool NHS Foundation Trust, 2018). Middlesbrough’s SSS sees around 3,700 smokers per year who with support, set a quit date, which is a representation of 12.4% of the estimated smoking population.
Primary, secondary and tertiary care can all be provided by a nurse who plays a part in providing health and wellbeing support to a patient. Brief interventions and referral for smoking cessation is a guidance suggesting all smokers should be referred to NHS Stop Smoking Services in primary, secondary and community care settings. (Teesjsna.org.uk, 2018). NHS Middlesbrough deliver education prevention packages across schools, to raise awareness of the dangers, (Teesjsna.org.uk, 2018). Local authorities explain how families and children are effected as whether they do or don’t smoke, they are susceptible to passive smoking. (Teesjsna.org.uk, 2018) explains how trading standards in Middlesbrough ensure relevant legislations are being followed as well as taking enforcements on action against traders. With prevention on imported cigarettes, counterfeit and selling cigarettes on private property.
Support to stop smoking is readily available across the nation and is free to access with confidential support across Teesside. (North Tees and Hartlepool NHS Foundation Trust, 2018) explains how stop smoking services are ran at community venues during both weekdays and weekends which provides confident days for people to access these services. Providing weekends encourages more people to access these services as it considers those who work, who may be limited to available days they are vacant. Interpreters are widely available in hospitals and GP’ surgeries which promotes access to a wider spread of people. Furthermore, telephone helplines are available for those with lack of transport and who prefer to not speak in person. Moreover, cigarette packaging shows disturbing images and writing to encourage the uptake of stopping smoking by showing the reality of its effects. (The Guardian, 2017) states how a minimum of 65% of packaging will be covered to promote health warnings.
Chapter 4
The Worlds Health Organisation explains nursing as “The care of individuals of all ages, families, groups and communities, sick of well and in all settings. It includes the promotion of health, prevention or illness and the care of the ill, disabled and dying people” (World Health Organisation, 2018). A nurses overarching aim is to improve the health of their patient and minimise their health risks.
The role of the nurse is to ensure a patient receives holistic care, caring for their emotional needs as well as the health issue. The royal college of nursing has 8 principles which apply to all nurses in all care settings. Principle F states “nurses have an up to date knowledge and skills and use them with intelligence” (Rtips.cancer.gov, 2019). This explains that nurses understand each patient as an individual and use their skills and knowledge to treat the patient with the care they need. Many nurses will work to follow the NHS constitution which is founded upon a set of principles and values to care for the people it services and staff who work for it. The constitution is renewed every 10 years with engagement from the public to ensure staff are adhering to the commitment and responsibilities they hold. SMART goals (specific, measurable, attainable, relevant and timely) are realistic short term frameworks that nurses and other healthcare professionals can follow. Nurses can use these goals to enable them to ensure they are maintaining their role as a nurse which results in excelling on their care towards patients and working collaboratively with other members of their multidisciplinary team.
Communication is key to a Nurse’s role and using active listening, along with the therapeutic touch to build a rapport will help to communicate with individuals about adapting a healthier lifestyle. The six C’s are a set of values that should be followed by every nurse, they are known as care, compassion, competence, communication, courage and commitment. They are core principles that help aim to deliver and improve and health of patients throughout each stage of their life. As a whole, each of the 6’s are all equally important, they can be used to reflect on a nurse’s ability to provide care towards their patients and how they maintain this throughout their career. Policies throughout health and care change across time, however patient’s health and welfare needs remain consistent throughout this. The approach is for patients to know what core qualities they should expect from nurses. Every Nurse should use a holistic approach when it comes to improvement of health and well- being and this can be done by using an intervention at every opportunity known as ‘Make every contact count’ (MECC). MECC is an approach that that focuses on lifestyle issues that are able to be prevented to improve people’s health. It aims to provide information, encourage people and support them where possible. Makingeverycontactcount.co.uk, 2017). Nurses promote health and wellbeing across the age continuum by encouraging stopping smoking and making every contact count.
Nurses work across the age continuum in difference roles, school nurses educate children from a young age of health issues. (Gov.uk, 2013) states how school nurses play an important role on improving health of young people. They explain health issues such as smoking and obesity, whilst encouraging this to not occur by explain it young. Nice guidelines explain that children should be made aware of the health risks whilst involving their families to ensure they are fully educated on the damages of smoking (Nice.org.uk, 2008). Nurses explain the benefits of quitting smoking whilst optimum providing support and guidance. A nurse can refer a patient but consent would be needed in order to refer to a stop smoking clinic. Across the optimum, nurses also work alongside GP’s, in sexual health clinics, hospitals and within the community all working as a part of a multidisciplinary team (MDT). As a result of nurses working widespread they work with people of all age groups using a while range of skills.
The Nursing and Midwifery Council is a set of guidelines existing to protect the public, it is followed by nurses in order to conduct safe practice. (NMC.org.uk, 2015) states “listen to people and respond to their preferences and concerns”, this should be considered when all care is given to carefully support patients without reducing their confidence. Patients may have preferences of same sex nurses or for nurses to speak on their behalf; all preferences should be adhered too. These guidelines help maintain dignity, independence and respect to patients, it also states to “respect a person’s right to privacy in all aspects of their care”. Nurses should discuss with their patients if their families are to be made aware of their health concerns and should respect the patient’s decision based around this. Only necessary information should be shared with the relevant people as a matter of patient safety and public protection. Professor Alan Glasper explains how the Nursing and Midwifery Council (NMC) is a published group of standards followed by nurses and midwives (Glasper, 2015). The NMC code is used to improve standards of care delivery provided to patients. He justifies the reasons for the code by rights to prioritise people and preserve safety. The NMC code states how nurses should efficiently alone and as a team, by keeping colleagues informed when caring for shared patients. Nurses should work as a part of the MTD discussing opinions for the patients’ health and welfare.
Nurses have the ability to work with patients through primary, secondary and tertiary care, throughout each stage the nurse has to ensure they are benefiting the patients’ health and wellbeing. Primary prevention for smoking is for the nurse to raise awareness to the patients and educate them on how smoking effects the body. This prevention is education on how to reduce risk factors and a chance to change to improve their quality of life whilst able too. Secondary prevention would be offered if a patient had been diagnosed with a disease or condition, having a role to prevent the condition from becoming worse and aiding advice and support for this. Advice to exercise, eat healthier and set meal plans could be put in place to improve the patient’s lifestyle. Other specialists may be involved at this stage to improve the patient’s quality of life further. Moreover, tertiary care is specialised when a nurse can prescribe medication such as anti-inflammatory medications and inhalers. In some cases patients will be referred to a doctor if their health deteriorates.
Chapter 5
This report explains and highlights the implications of smoking and how it affects people in Middlesbrough with the known side effects. It offers information to those individuals on how they can seek support to reduce the effects on themselves as well as those around them within the region. Moreover, the profile explains the role of the nurse in providing health care strategies and supporting the individual through the use of the 6C’s. It signposts those who do smoke as well as those who don’t and are affected by it.
Appendix 1 – PowerPoint