Purpose. Smoking is prevalent in psychiatric facilities among staff and patients. However, there have been few studies of how contextual factors in specific cultures influence rates of smoking and the health promotion role of psychiatric nurses. This paper reports the findings of a classical grounded theory study conducted to understand how contextual factors in the workplace influences the smoking behaviors of Jordanian psychiatric nurses (JPNs). Method. Semi-structured individual interviews were conducted with a sample of eight male JPNs smokers at a psychiatric facility in Amman, Jordan. Findings. Constant comparative analysis identified becoming a heavy smoker as a psychosocial process characterized by four sub-categories: normalization of smoking; living in ambiguity; experiencing workplace conflict; and, facing up to workplace stressors. Conclusion. Specific contextual workplace factors require targeted smoking cessation interventions if JPNs are to receive the help they need to reduce health risks associated with heavy smoking. 1. Introduction Smoking cigarettes is common practice among patients and staff in mental health services throughout the world [1]. Although few studies have assessed smoking behaviors among psychiatric nurses in different countries, their results reported indicate a high prevalence rates compared to those for nurses in other specialties. A literature review by Storr et al. [2] found that psychiatric nurses have higher smoking prevalence rates than nurses working in administration, emergency rooms, medical care, critical care, and gerontology. Psychiatric nurses in the United States are 2.4 times more likely to smoke cigarettes than nurses in other specialty areas [3]. The prevalence of smoking among mental health nurses in the United Kingdom was reported as 17.4% [4]. Two years later the reported prevalence rate was 35% [5] double that reported in the earlier investigation. in the 1980s the smoking the prevalence rates for psychiatric nurses in the United States was reported as 28.6% [6]; almost 14% less than that of 42.4% reported for Great Britain [7]. The high prevalence of smoking among psychiatric nurses threatens professional values (not to harm patients) and delivery of quality services, including patient education, if left unstudied. Furthermore, to neglect the high smoking prevalence rates among psychiatric nurses is to ignore an international agreement about the importance of a health promotion role for all health professionals [8] and to deny psychiatric nurses a legitimate role in health promotion [9]. The
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