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Counteracting ambivalence: nurses who smoke and their health promotion role with patients who smoke.

Morbidity and mortality associated with smoking are major health problems. Nurses play an instrumental role in tobacco reduction, but their own smoking often interferes with this clinical opportunity. We conducted a grounded theory study with 23 nurses who smoked to describe how they managed the contradictions encountered when caring for tobacco-dependent patients. Nurses counteracted ambivalence in one of four ways in relation to smoking policies: indifferent, evasive, engaged, and forced compliance. Influencing these approaches were nurses' perceptions of patients' need for tobacco-dependence interventions and perceptions of their own vulnerability in addressing tobacco use. The challenge remains how best to support smoking nurses to enable them to become unambivalent participants in preventing and reducing tobacco dependence in their patients and themselves.