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

ArticleinInternational Journal of Nursing Studies 45(10):1543-9 · April 2008with11 Reads
DOI: 10.1016/j.ijnurstu.2007.12.004 · Source: PubMed
Abstract
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.
    • "It is estimated that 36% of adults with mental illness use tobacco products compared to 18% of adults in the general population, and 31% of all cigarettes are smoked by adults with mental illness [2], a significant contributor to early mortality and chronic disease [3]. Motivators for tobacco control include requirements from accrediting entities [4], health concerns for patients and hospital staff [5,6], and effects of secondhand smoke [7]; while challenges include the assumed therapeutic effects of smoking on patients with mental illness [8,9], resistance from patients and hospital staff 9 , and lack of training and resources [10]. Research has demonstrated that it is possible to ban smoking in psychiatric inpatient hospitals [11,12] of smoking cessation care, with hospitals prohibiting smoking, and could incite a motivation for a smoking ban implementation. "
    Full-text · Article · Nov 2015 · International Journal of Social Psychiatry
    • "Through these actions, nurses are able to support the antismoking policy more actively and consciously. The challenge is to include this approach to smokers in the daily care provided by nurses and to offer all psychiatric patients the opportunity to reflect and adopt a more conscious stance on smoking (Green & Hawranik, 2008). The high rates of refusals and losses, the limitation of the sample to a population of a single hospital, the absence of investigation of the severity of the disorder (symptoms), and the interpretation of the participants' statements based on the understanding of the researchers are the limitations of the present study. "
    [Show abstract] [Hide abstract] ABSTRACT: When patients smoke cigarettes in psychiatric services, it brings to the forefront current ethical and political dilemmas. This study aims to explore the meaning attributed to smoking by mental health patients who smoke and who are hospitalized in a psychiatric ward of a general hospital. This qualitative descriptive study was conducted with 96 smokers who were hospitalized in a psychiatric ward in Brazil. Semi-structured interviews, test of nicotine dependence, and content thematic analysis were carried out. The results show that tobacco has an important role in the lives of psychiatric patients. The meanings they attribute to tobacco use are related to overcoming difficulties that are consequential of mental disorders and of side effects caused by their treatments.
    Full-text · Article · Feb 2015
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Oct 2014
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