Evidenced-Based Practice about Tobacco Use and the Risk for Hospitalizations

The contemporary nursing field is faced with numerous nursing practice problems that need long-lasting solutions. A practical example of a nursing practice problem is whether the practice of smoking and its effects increases the risk for hospitalizations among patients using tobacco compared to those that don’t. Nursing practice problems are mostly solved using the ubiquitous evidence-based practice method. The evidence-based practice method is meant to improve the quality of healthcare services and research, and therefore, utilizes the PICOT question technique as a key ingredient of nursing research. The PICOT question technique provides a workable formula for developing practical research questions that guide researchers in the course of their study.

PICOT Question

PICOT Question: Does tobacco use increase the risk for hospitalization in patients who use tobacco more than in patients that do not use tobacco? The table below expounds on this question in the PICOT format, and it is important to note that the question lacks a time element.

PICO Elements Example:
P(patient/problem) Patients who use tobacco
I(intervention/indicator) Tobacco use
C(comparison) Patients who don’t use tobacco
O(outcome) Increased risk for hospitalization


Tobacco is ubiquitously consumed through smoking. Smoking is a practical problem that affects not only the health of the individuals who partake in the act of active smoking but also the non-smokers who are scientifically termed as passive smokers. Smoking of tobacco has been proven to be associated with numerous health problems ranging from chronic bronchitis to the dreaded lung cancer. According to research done by the Centers for Disease Control and Prevention in 2019, tobacco smoking is a real killer as it is directly responsible for the death of more than 200,000 people in the United States alone every year while another more than 40,000 Americans die due to the effects of passive-smoking (Gurillo, Jauhar, Murray, & Maccabe, 2015). Moreover, more than 30% of hospitalized adult patients smoke cigarettes and this number increases to more than 45% when hospitalized adults aging more than 55 years are sampled (Gurillo et al, 2015). Smoking is on the rise in the United States, and this is largely due to the portrayal of smoking as cool and fashionable by the media, more so in Hollywood movies and social media. According to Boksa (2017), since 1992, there has been a gradual increase in the number of teenage Americans who smoke, with women taking a leading role in this insidious activity. Gurillo et al. (2015) argue that smoking is widely rampant among populations living below the poverty level and possessing low literacy and educational levels. The above statistics point out the numerous negative health effects associated with smoking. Advanced research on smoking, especially among patients, needs to be done to reduce the risk of hospitalization among patients who smoke tobacco.

Evidence-Based Practice about the Topic

Proper search and collection of evidence-based practice require the use of modern medical research strategies and databases that are updated with the latest studies and research. PubMed is an initial database full of medical and nursing research and studies that I used for the collection of relevant evidence-based practices related to tobacco use and its effect on hospitalization. The search strategy employed in this search process is Boolean logic. The Boolean logic is a type of algebra centered on the use of Boolean operators: “OR”, “AND” and “NOT” (Rigotti, Munafo, & Stead, 2016). Rigotti, Munafo, & Stead (2016) argue that the Boolean logic provides one of the most efficient methods of conducting searches for nursing literature as it incorporates the ideas that all values are either true or false. The Boolean logic, due to its varied Boolean operators, enables the researcher to expand his or her search scope using the “OR” operator, reduce the scope using the “And” operator, or cut out on unwanted searches using the “Not” operator.

For the search, major elements of the question were identified to be used as keywords during the search. The keywords included; “patients”, “tobacco”, and “hospitalization”. This search produced ninety-nine results of related studies and research. To access more concise and up to date studies, I narrowed down the search to those studies published within the last four years. Upon narrowing down the scope of the search to articles published within the last four years, fifty-two results were produced.

To further explore relevant research related to the PICOT question, I expanded the search result by applying the use of the ‘OR’ connector. The ‘OR’ connector widens the scope of the search by using relevant synonyms to any of the keywords used in the search. I used the words “the sick” as a synonym for patients and searched again. This time, the results of the search were eighty. Using the ‘free full text’ filter method, the number of results reduced from eighty to thirty-two. To determine the best and most relevant study among the numerous articles, I relied on the “best match” feature to narrow down the articles to those pertinent to the study. This further narrowed down the scope of the search, resulting in seventeen articles. I chose the best five articles, which employed both quantitative and qualitative methods of research. The type of research design used by these five articles also varied from cross-sectional to descriptive research designs.

To bring out diverse and multi-faced solutions to the PICOT question, I conducted another search, this time only focusing on government publications and articles on the relevant topic. The search yielded ten results, and this shrank to four upon narrowing the scope of the search to those published within the last four years. The four articles used are Lin (2018), Rigotti, Munafo, & Stead (2016), Gurillo et al. (2015), and Arora et al. (2017). Lin (2018) presents the effect of smoking on aging and the co-relation of smoking, aging, and diseases. Rigotti, Munafo, & Stead (2016) look at possible interventions that can be used to encourage patients to desist from smoking. They also highlight the role that cigarettes smoking plays in the hospitalization and extended hospitalization of patients. Gurillo et al. (2015) look at the relationship between tobacco smoking and psychosis. The article looks at how tobacco usage leads to psychological illnesses. Arora et al. (2017) take an analysis of the effects that tobacco usage and smoking have on the outcomes of patients diagnosed with Crohn’s disease. The study by Arora et al. (2017) was conducted in India.

Appraisal and Synthesis of Evidence

Smoking tobacco is highly addictive as it causes nicotine dependence, therefore, making it very difficult to control or quit. According to Rigotti et al (2016), patients who smoke tobacco have higher rates of hospitalizations – 34% compared to patients who are non-smokers – 11%. Arora (2017), argues that patients who are already diagnosed with various diseases increase their chances of hospitalization by over 35 percent when they partake in the smoking of tobacco. Tobacco smoking increases the chance of smokers contracting cardiovascular diseases and respiratory diseases by a whopping 30% compared to non-smokers (Arora, 2017). Rigotti et al (2016) argue that patients smoking tobacco expose themselves to attack from numerous diseases caused by tobacco smoking such as pneumonia, influenza, severe bronchitis, and heart failure. Smoking tobacco further weakens the immune system of hospitalized patient’s causes numerous health risks that contribute to their protracted hospitalization compared to non-smokers.

Cigarette smoking is a risk factor for heart failure. According to Rigotti et al (2016) patients who smoke tobacco increase their risk of getting heart failure by more than 18%. Smoking tobacco acutely increases systolic and diastolic blood pressure, total systemic vascular resistance increases and pulmonary artery pressure which are responsible for heart failure and numerous cardiovascular problems. Smoking tobacco leads to the ingestion of carbon monoxide which increases oxidative stress and therefore impairs the function of mitochondria (Arora, 2017). Smoking also leads to acute bronchitis infections due to the constant exposure of the delicate internal respiratory organs to damaging fumes. Acute bronchitis is characterized by difficulty breathing, incessant coughs and the inflammation of the bronchial tubes.

Patients who smoke tobacco have a higher risk of contracting influenza, Crohn’s disease and lung cancer compared to those who don’t smoke. Tobacco weakens individuals’ respiratory system, making them susceptible to severe influenza infections (Lin, 2018). According to Lin (2018), smoking tobacco increases the risk of hospitalization of smokers and ex-smokers due to infection by the influenza virus by up to 32 percent. Arora et al. (2017) also point out the high risk of hospitalization and the adverse consequences of tobacco usage among patients suffering from Crohn’s disease. Though smoking does not affect surgeries related to the treatment of Crohn’s disease, it is associated with increased hospitalization of patients during follow-ups (Arora et al., 2017). Tobacco smoking causes lung cancer in extreme cases of long-term tobacco smoking. Lung cancer is severe and is characterized by coughing up of blood, severe chest pains and massive loss of weight and appetite. Lung cancer in many cases leads to death if not diagnosed early and treated properly. Influenza, Crohn’s disease, and lung cancer all require urgent hospitalization to be treated, and therefore, provide the direct linkage between tobacco smoking and an increased risk of hospitalization.

According to Gurillo et al. (2015), smoking of tobacco not only causes physical harm to the body but also leads to psychotic illnesses. There is a correlation between smoking and psychosis as Gurillo et al. (2015), argues that the intake of tobacco increases the likelihood of psychosis and other mental illnesses, including schizophrenia. Schizophrenia is characterized by hallucinations, disorganized speech and behavior, and delusions. Gurillo et al. (2015) argue that tobacco has nicotine, which when consumed by the average smoker may lead to neurotoxicity. Neurotoxicity is the impairment of the neural nerves of the body due to constant exposure to harmful elements such as nicotine (Gurillo et al, 2015). Neurotoxicity affects verbal working, learning and memory, and mood and attention. According to Gurillo et al (2015), smoking of tobacco among patients increases the likelihood of depression, reduction in attention span, and general loss of memory – factors that increase the risk of hospitalization compared to nonsmokers. Boksa (2017) asserts that nicotine in tobacco has a short-term effect of improving mood and concentration; however, in the long-term, smoking increases stress, anxiety, and tension that may trigger the onset of mental illnesses.


Recommended Actions

Numerous actions can be taken by healthcare providers and other health stakeholders to ensure the reduction in not only smoking but also in the number of patients being hospitalized due to smoking-related illnesses. Healthcare providers should use anti-smoking campaigns aimed at teaching the average smoker the real health problems associated with smoking. The anti-smoking campaigns should focus on the health issues caused by tobacco smoking, such as bronchitis and lung cancer. Moreover, the campaigns should aim at sensitizing smokers on how to quit smoking and the various steps through which they can pursue their rehabilitation. The United States government, in partnership with numerous other public health institutions such as the Centers for Disease Control and Prevention, came up with the Tips from Former Smokers (Tips) campaign, which operated from March 2012 to 2019 (Boksa, 2017). The campaign was aimed at teaching the average American smoker the real consequences of smoking from the first-hand experiences of former smokers. The campaign achieved massive results as it prompted more than fifteen million Americans who smoke to take steps towards quitting.

Healthcare providers can also advocate for the complete banning and outlawing of smoking in hospitals and healthcare facilities. Research on the correlation between tobacco smoking and hospitalization clear shows that smoking among patients increases the risk of hospitalization of patients. The complete banning of smoking in hospitals will be a pivotal first step in reducing periods of hospitalization among patients. The healthcare providers can achieve this by petitioning the government, more so the ministry of health, to tighten hospital regulations concerning smoking. Banning smoking in hospitals will be an important step in aiding patients who smoke to quit and seek rehabilitation services.

Healthcare providers can petition both the government and tobacco companies to advocate against public smoking. Public smoking leads to passive smoking, which endangers the lives of individuals who do not smoke. According to the World Health Organization (WHO), passive smoking kills over half a million people every year globally (Arora et al., 2017). The number of people hospitalized due to the effects of passive smoking is even more than the 500,000 who die annually. Therefore, healthcare providers should petition governments to come up with legislation against public smoking. Healthcare providers should petition tobacco companies to fund anti-public smoking campaigns and the construction of smoking zones outside the confines of densely populated public places.

Tobacco processing companies should collaborate with healthcare providers in the funding and organization of community anti-smoking programs such as Nicotine-Anonymous and Quit-Now programs in the United States of America. Community smoking cessation programs are aimed at curbing the spread of smoking and helping individuals who want to quit smoking. According to Boksa (2017), the best way for smokers to quit and defeat their addiction is through the use of evidence-based smoking cessation programs. Moreover, smokers who utilize and partake in community smoking cessation programs are 65 percent more likely to quit smoking tobacco compared to other smokers attempting to quit on their own (Boksa, 2017). Smoking cessation programs should, therefore, be given more emphasis, well-financed, and organized to ensure they are accessible to the average tobacco smoker. The majority of the community smoking cessation programs utilize the quitlines technique as a method of helping willing individuals to quit smoking. The quitlines technique enables individuals seeking assistance in their attempts at quitting tobacco smoking to correspond to counselors and specialists in behavioral science. According to Boksa (2017), providing smokers with efficient quitlines can help increase the number of quitters from three million to five million in America alone.

Tobacco smoking increases the rate of hospitalization among both smokers and non-smokers. The rate of hospitalization and period of hospitalization increases when patients diagnosed with other illnesses smoke. This is large because smoking weakens the body’s respiratory system, therefore, exposing smokers to numerous illnesses. Tobacco smoking is, therefore, a real scourge that should be tackled hard from all fronts. Healthcare providers, tobacco companies, and the government should lead the way by properly educating smokers on the real negative effects of smoking and advocating against public smoking to protect the health of non-smokers.



Arora, U., Ananthakrishnan, A. N., Kedia, S., Bopanna, S., Mouli, P. V., Yadav, D. P., Ahuja, V. (2017). Effect of oral tobacco use and smoking on outcomes of Crohn’s disease in India. Journal of Gastroenterology and Hepatology33(1), 134–140. DOI: 10.1111/jgh.13815

Boksa, P. (2017). Smoking, psychiatric illness, and the brain. Journal of Psychiatry & Neuroscience42(3), 147–149. DOI: 10.1503/jpn.170060

Gurillo, P., Jauhar, S., Murray, R. M., & Maccabe, J. H. (2015). Does tobacco use cause psychosis? Systematic review and meta-analysis. The Lancet Psychiatry2(8), 718–725. DOI: 10.1016/s2215-0366(15)00152-2

Lin, Y. (2018). The Oddity of Heterogeneity: A Blessing in Disguise. Scientific Reports8(1). DOI: 10.1038/s41598-018-29081-7

Rigotti, N., Munafo, M. R., & Stead, L. F. (2016). Interventions for smoking cessation in hospitalized patients. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.cd001837.pub2