Smoke-free policies in the psychiatric population on the ward and beyond: A discussion paper

Faculty of Nursing, University of Manitoba, Winnipeg R3T 2N2, Canada.
International Journal of Nursing Studies (Impact Factor: 2.9). 04/2008; 45(10):1543-9. DOI: 10.1016/j.ijnurstu.2007.12.004
Source: PubMed


Healthcare facilities from a number of countries have or are in the process of implementing smoke-free policies as part of their public health agenda and tobacco control strategy. Their main intent is to prevent the harmful effects of environmental tobacco smoke on employees and patients. However, these protection policies are often implemented before taking into account the specific needs of patients in psychiatric facilities and are clouded by a lack of knowledge, myths and misconceptions held by a variety of stakeholders. Consequently, the implementation of smoke-free policies tends to result in unintended and unfavourable consequences for this aggregate. Patients are forced to abstain from tobacco use during their hospitalization but have few options to address their dependence upon discharge. The development and implementation of such policies should not occur in isolation. It requires thoughtful consideration of the needs of the affected population. Recommendations are presented on the role of nurses in lobbying for policy changes. As well as strategies for policy makers and administrators that should accompany such a policy in psychiatry.

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    • "Many participants reported behavioural changes in staff and patients following policy implementation ; they smoked less or were more likely to make quit attempts. However, smoking cessation was generally not perceived by staff as a treatment priority and some staff still perceived smoking as an acceptable cultural norm for patients (Dickens et al., 2004; Green & Hawranik, 2007; Lawn & Condon, 2006). Therefore, how mental health professionals deliver their own beliefs, values and knowledge to patients is important. "
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    ABSTRACT: Background: The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types. Material: Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care. Discussion: Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training. Conclusion: Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.
    International Journal of Social Psychiatry 10/2014; 61(5). DOI:10.1177/0020764014553002 · 1.15 Impact Factor
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    • "It is recommended that smoke - free hospital initiatives be integrated into the health promoting hospitals initiative ( Whitehead , 2005 ; World Health Organization , 1990 , 1991 , 1997 ) rather than being an isolated project . For example , smoke - free policies in psychiatric wards are often a result of broader tobacco control policies ( Green & Hawranik , 2008 ) . Although smoke - free policies in psychiatric wards do not produce adverse behavioral outcomes or noncompliance , these policies have not shown an effect on smoking cessation ( el - Guebaly , Cathcart , Currie , Brown , & Gloster , 2002 ) . "
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    ABSTRACT: Secondhand smoke (SHS) is the third leading cause of preventable death in the United States and a major source of indoor air pollution, accounting for an estimated 53,000 deaths per year among nonsmokers. Secondhand smoke exposure varies by gender, race/ethnicity, and socioeconomic status. The most effective public health intervention to reduce SHS exposure is to implement and enforce smoke-free workplace policies that protect entire populations including all workers regardless of occupation, race/ethnicity, gender, age, and socioeconomic status. This chapter summarizes community and population-based nursing research to reduce SHS exposure. Most of the nursing research in this area has been policy outcome studies, documenting improvement in indoor air quality, worker's health, public opinion, and reduction in Emergency Department visits for asthma, acute myocardial infarction among women, and adult smoking prevalence. These findings suggest a differential health effect by strength of law. Further, smoke-free laws do not harm business or employee turnover, nor are revenues from charitable gaming affected. Additionally, smoke-free laws may eventually have a positive effect on cessation among adults. There is emerging nursing science exploring the link between SHS exposure to nicotine and tobacco dependence, suggesting one reason that SHS reduction is a quit smoking strategy. Other nursing research studies address community readiness for smoke-free policy, and examine factors that build capacity for smoke-free policy. Emerging trends in the field include tobacco free health care and college campuses. A growing body of nursing research provides an excellent opportunity to conduct and participate in community and population-based research to reduce SHS exposure for both vulnerable populations and society at large.
    Annual review of nursing research 12/2009; 27(1):365-91. DOI:10.1891/0739-6686.27.365
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