Smoking discussions at the child health clinic. A passive, an advisory or a judgemental approach?

Interviews with 15 nurses working in child health care revealed that most of them were very keen not to apportion blame when discussing smoking habits with parents. Thus, half of those interviewed chose a passive approach to counselling, which meant that they were cautious, evasive and tactful so as not to risk alienating or offending parents. Those who were more active tackled the issue of smoking by giving advice and suggesting ways in which the parents could cope with their smoking. A third approach was observed in which some of the nurses were judgemental, which they expressed by moralizing about the smoking habits of the parents. The present study shows that there is a need to develop a patient-centered methodology, whereby smoking can be discussed from the standpoint of the parents, without making them feel guilty.