Do patient's have the right to smoke even if family doesn't want them to?

[chuchie]

Hey everyone,

I am finishing up my clinical rotations this week at an LTC and I had a patient that wanted to go out for a cig...the facility was no smoking and I would have to take her out to the end of the parking lot down this paved trail where there is a bench and she could smoke there. When I asked the NM if it was okay she had to go through her chart to see if there was an approval for the family. I am just wondering what if a patient wants to smoke even if the family does not want them to? Do they have a "right" to smoke even though they know all the risks, etc. and know they need to be supervised and brought off the facility property? I know that many hospitals and LTCs have smoke-free grounds, but I just thought it was unusual that a patient needs permission from the family to smoke..don't have the right to as long as staff have time to take them to the designated area?

Thank you so much for your input.

[THAT Nurse., MSN, RN, APRN]

This LTC patient is in his home...the LTC facility. I think he has every right to smoke 'em if he's got 'em.

Did you miss the part where I noted I work acute care?

[Bortaz, MSN, RN]

No. I didn't. Did you miss the part where the subject of this thread wasn't housed in acute care?

[hypocaffeinemia, BSN, RN]

so what if you have a demented patient who smokes who has oxygen tank and he doesnt know whats going to happen if he smokes while he has his oxygen on? healthcare workers deal with alot of patients with bad habits and your attitude of taking care of people with bad habits cant get into providing safe care.

what if you have an ms patient? will you hold the cigarette for him? after all, safety first, right?

there's lines that need to be drawn here. the one between patient safety and personal safety, the one between patient safety and patient autonomy, the one between nonmalficence and... well... contributing to worsening the patient's health. since you consider the ltc their home the concept of personal responsibility comes in to play, to best extent they are able to exhibit it.

[NurseyBaby'05, BSN, RN]

It's not the smell that's a problem for me. It's the carcinogens. Those masks don't filter them out. If I drive in a high 18 wheeler traffic area and inhale the exhaust, that's on me. I'm not required to do that. It's being required to sit with someone smoking and supervise that is a problem. Yes, I can stand far enough away that I'm not exposed, but then that person might as well be smoking alone. HC brought-up a good point with the MS patient too. What if she is burned? Will workman's comp cover her since she was required to do this? I doubt it.

[pagandeva2000, LPN]

I never worked in LTC as a nurse, so, I wouldn't know. I would like to believe, however, that, if the patient is oriented x3 and has no disability that would harm them, then, they should have a designated place to smoke, whether family wants this or not. However, as a student, I also say to follow their policies and not argue or defy them, because if harm came to a patient, then, the clinical instructor as well as the school can be held liable somehow. Some patients run off, may have an MI or stroke, so many things, and you, as a student are not equipped to deal with this.

I do think that this is a great discussion to have in class, or post clinical conference.

[Atheos]

What if you have an MS patient? Will you hold the cigarette for him? After all, safety first, right?

There's lines that need to be drawn here. The one between patient safety and personal safety, the one between patient safety and patient autonomy, the one between nonmalficence and... well... contributing to worsening the patient's health. Since you consider the LTC their home the concept of personal responsibility comes in to play, to best extent they are able to exhibit it.

Well, most nursing homes that allow smoking insist on the patient having to be able to smoke themselves.

The 'will you hold it for them' argument is a tad over the top. No one is going to ask you to hold it for them. You CAN watch them.

In fact, I seriously doubt any of you work somewhere where there isn't a smoker. I would bet my life on it. There IS a smoker where you work. Even if it's a maintenance guy. There is SOMEONE that can watch them smoke. Even a dietary person can stand by and watch. I bet there are plenty of smokers that would love the extra smoke break.

Standing 5-20 feet from someone will NOT expose you to any significant or even insignificant amount of carcinogens. You don't have to stand right next to them. Light them up and move.

If they can't smoke on their own then too bad for them. You have to maintain your own habit. That's coming from a smoker.

Sorry, I'm all over the place with that one.

[hypocaffeinemia, BSN, RN]

The MS one is hardly over the top.

The claim made is that we escort patients to smoke in order to ensure their safety. I just followed this claim to its logical conclusion. A person with MS may be able to maintain their own habit, but their lack of coordination puts their safety at risk.

Standing 20 feet away from somebody won't magically prevent them from catching on fire, either, so what are you really doing by escorting?

[nursemike, ASN, RN]

first thing it is a privilege to smoke not a right. if you come into my facility and you are evaluated and you are not safe to smoke then guess what you must be accompanied to the smoke area. we have smoke times and you must comply with those times or you lose the privilege. i have known a patient to die because he was not properly supervised from getting himself caught on fire..its not pretty.

another thing most patients in ltc have mpoa's or guardians; if this is the case and they do not want the patient to smoke for whatever reason..the patient does not smoke.

sorry to quibble over terminology, but i believe the correct term is "inmates," rather than "patients." prisoners do, indeed, forfeit some of their rights as part of their adjudicated sentences, and may be allowed some privileges as a reward for good behavior. a "patient," or "resident," whose only crime is being elderly and/or infirm may not be deprived of his or her rights without due process of law, such as being found legally incompetent to make his or her own decisions.

of course, if a patient or resident does not agree with the policies of the facility where he is staying, one of his rights is to go somewhere else. if they seek care of their own free will, there may be an implied consent to policies consistent with their own safety and necessary treatments. but they are still free to withdraw that consent at any time.

i think it is also important to realize that an mpoa is authorized to speak for a patient only when the patient is unable to speak for himself. the mpoa has no authority over the patient's finances or personal autonomy. if the patient is able to speak for himself, the mpoa is just another visitor.

only a legally appointed guardian can overrule the patient's wishes or access a patient's private information without their permission. catering to the wishes of family members, even those with mpoa, who self-appoint themselves as guardians, may be both a hipaa violation and an invitation to a lawsuit.