Many regular readers of this column will know that the current ICN President, Rosemary Bryant, chose Access as the watchword for her Presidency. She has written about various aspects of her watchword but one area that has not yet been covered is access to fresh air. I recently reviewed two relevant publications. One from the Government of Brazil discussed the new law that bans smoking in all public and private enclosed spaces (PAHO 2011). I also read the Fact Sheet on Chronic Obstructive Pulmonary Disease (COPD) published by the World Health Organization (WHO 2011). I was reminded of the professional opportunities and personal costs of dealing with these issues.

Brazil is by no means the first country to introduce a ban on smoking in public places. However, with its enormous geography and population, it is an important addition to members of the international community taking concerted efforts to reduce smoking and improve one aspect of air quality. Tobacco smoke and other forms of air pollution can cause many types of respiratory problems and exacerbate diseases such as COPD. The International Council of Nurses (ICN) recognises the health and financial costs of smoking to individuals, families and society. We have been an active member of the Framework Convention on Tobacco Control for many years and therefore we congratulate Brazil on this initiative.

We know that nurses are effective in helping people to stop smoking. By doing so, they help individuals reduce their risk of cancer and other diseases such as COPD, and enhance the population's access to fresh air and reduce their likelihood of being unwilling victims of secondary smoke. What can nurses do to take advantage of legislative change? How can we as a profession amplify our contribution and tackle increasing problems such as COPD?

Now before going further I should declare a personal interest in this topic. I have never smoked and dislike the smell of stale tobacco smoke. I should also say that my own mother, who was a smoker, suffered from COPD for many years before spending the last few years of her life on continuous oxygen. It is therefore not surprising that I took particular interest when I came across a nurse who had developed a nurse-led early intervention service for people with COPD resulting in fewer hospitalisations for clients and increased success in smoking cessation. When I asked how her service could become the norm, the nurse told me a far too familiar story.

Despite her well-argued case in terms of patient outcome and cost-effectiveness, colleagues, managers and physicians at first resisted the service because they wanted to protect the status quo. At that time, nurses were not empowered to prescribe nor were they able to receive direct payment for the services they were more than able to develop, implement and deliver. The business model and the perceived wisdom of those in power lagged behind what the profession was able to offer.

Governments must go further than passing legislation on banning smoking in public places. They also need to remove barriers that prevent nurses from offering innovative services so as to enable nurses to address the problems of citizens in a holistic manner. The business model must reward those that are doing the work. Archaic prescriptive authority laws need to be swept away and existing power structures challenged. Nurses who have the education and competence to make a difference should be encouraged by the profession, by governments and by society to offer new forms of service that take advantage of the emerging professional opportunities that new laws offer. Such initiatives can minimise the personal costs to those denied ready access to services due to out-dated service delivery models.

With added effort and by implementing already existing practice, legislative change can be further exploited to bring what for many is a much needed breath of fresh air.


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