[wnoise]

Dear RN2begin,
Thanks for your message. I agree with you partially.
About the right of autonomy to decide to smoke or not to smoke I think the patient (like any other) has the right to choose. But I would like to remember the initial conditions I asked:
- Patient at acute mental health wards.
I am happy to know that nicotine has these nice effects but I am sure that smoking cigarettes is not the best way to have nicotine (at least meanwhile the patient is at ward). I cannot forget staff and no smoking patients’ safety.
I agree with you that patients are allowed to choose or refuse any kind of treatment, but my discussion is based in the Spanish Non-smoking Law. This law forbids smoking at any public center with the exception of mental health wards and penitentiary centers. So I disagree about the discrimination of mental patients. About the diabetic example I agree as well, but if a diabetic patient refuses a diet or insulin he/she damages him/herself, nobody else is in risk.
Thanks for your links, they are very interesting.

[rotary]

We do not allow smoking, patients have to leave hospital property to light up and must sign a waiver to do so (i think that's unsafe).

We do however have Nicotine Replacement Therapy where free gum, patches and inhalers are provided for them to use while staying in hospital.

[catcoon]

I work in an acute mental health hospital and we allow patients to smoke.
One of the reasons is because if you give meds to psych patients and they are NOT smoking while on the unit and the med is successful one gets the impression that the dose of med is effective. In all reality most patients start smoking as soon as they are discharged [often lighting up while walking out the door]. Nicotine effects drug metabolism and the dose that was effective while in the hosp is no longer effective on the outside because the pt is smoking. Often times the pt then discontinues the med because it's not working like it did in the hosp which in actuality is due to the false impression from the non-smoking policy.

I have worked in both smoking and non-smoking facilities and find that there is less relapse due to noncompliance with ineffective meds when the pts are allowed to smoke.

Just my two cents worth.

[bikie]

I work in a an acute mental ward in Queensland Australia. The staff are not allowed to smoke, but the patients are. We have a huge back yard area to use. We find if the patients run out of smokes they get quite agitated.I don't think they want to try no smoking . The rest of the hospital is smoke free.

[goettin98]

Our hospital is entirely smoke-free. If the patient wants a nicotine patch, the doctor has to write an order. If the staff thinks the patient has tobacco or a lighter on them (and they usually do), but refuses to give it up and we can't find it during room check, we have security come up and shake them down. In my state, all public places are smoke-free, and that also includes inside jails/prisons.

[StuPer]

Originally Posted by catcoon

I work in an acute mental health hospital and we allow patients to smoke.
One of the reasons is because if you give meds to psych patients and they are NOT smoking while on the unit and the med is successful one gets the impression that the dose of med is effective. In all reality most patients start smoking as soon as they are discharged [often lighting up while walking out the door]. Nicotine effects drug metabolism and the dose that was effective while in the hosp is no longer effective on the outside because the pt is smoking. Often times the pt then discontinues the med because it's not working like it did in the hosp which in actuality is due to the false impression from the non-smoking policy.

I have worked in both smoking and non-smoking facilities and find that there is less relapse due to noncompliance with ineffective meds when the pts are allowed to smoke.

Just my two cents worth.

This is an absolutely brilliant point, I had forgotten to mention in my response, without diggin up the research I think I'm accurate in saying both Lithium and Clozapine metabolism is affected by nicotine levels. If we initiate a therapy based on unrealistic levels of nicotine in a patients system, we are potientially exposing them to toxic or sub-theraputic levels once they return home... something that may open up an avenue for litigation should an adverse event occur.
StuPer

[elkpark]

Originally Posted by StuPer

This is an absolutely brilliant point, I had forgotten to mention in my response, without diggin up the research I think I'm accurate in saying both Lithium and Clozapine metabolism is affected by nicotine levels. If we initiate a therapy based on unrealistic levels of nicotine in a patients system, we are potientially exposing them to toxic or sub-theraputic levels once they return home... something that may open up an avenue for litigation should an adverse event occur.
StuPer

Again, I don't think anyone here is talking about suddenly cutting people off from all nicotine. In every unit I've seen that has gone this route, all "smoker" clients get a daily nicotine patch pretty much automatically. So, they're still getting daily nicotine -- it may not be exactly the same amount of nicotine they would have in their systems if they were at home at free to smoke at will, but the same was true when smoking was permitted and there were a set number of "smoke breaks" during the day, and I don't recall (yes, I lived through the transition from just letting people smoke freely on the unit all day to limited numbers of smoke breaks, too ) anyone making the argument at that time that it would be a bad idea because of concerns about medication metabolism ...

I don't see that as a valid reason to continue to allow people to smoke in psych settings.