Banning smoking for psychiatric patients

talaxandra · Feb 27, 2005

In addition to the addiction aspect, there's also the fact that people with schizophrenia self-medicate with tobacco - it improves symptomology, decreases need for meds, reduces the manifestation of side-effects, increases alertness and motor control. Nicotine patches don't have the same effect, in part because the nicotine dosage can't be controlled like it is with smoking.

infullbloom1 · Feb 27, 2005

I work in a state psych hospital that allows smoking, supervised, when the patient reaches a certain level. I used to work at a hospital acute psych unit that did not allow smoking. While I definately see the possible dangers to letting a patient smoke(one patient recently burned her palms with her cigarette), at my previous job I would see the new patients freak out when they were told they would not be able to smoke. This would sometimes escalate to restraining the patient. So to compare the two options, even though I am a nonsmoker myself and have to supervise the smokers at times, it seems like the best thing to do is to let them smoke.

jrjrj · Mar 1, 2005

We changed over to a non-smoking unit back in May 04. I have to admit that it went extremely smooth. The manipulation and intimidation we saw prior to going smoke -free nearly disappeared and created a more pleasant milieu. Probably the biggest hurdle we had to overcome was our own resistance.

edeverges · Mar 1, 2005

i presently work in a setting that is also going through changes with clients interested in smoking censation that might be of interest. i work for a psychiatrist. she was discussing a referral made by a generalist. she treats the same client for substance abuse, but due to a decrease in funding, i.e., insurance payments and medicaid payments, she feels the generalist should treat the patient for smoking censation. the generalist wants her to treat the client because of her expertise in addictions. i tend to agree with her on only one point. i feel that a generalist could track the clients resiratory system better than a psychiartist. however, i feel the psychiatris could help the client with anger and irritability issues better than the generalist. what i have also found is that a combination of treatments and a patch such as nicoderm works better for most people that gradually reducing the number of cigarettes alone. recently a hypnotist treated some locals, and they reported having good and bad days, but overall had decreased the number of cigarettes they had smoked. i do not feel that hypnotism works for everyone and i do not know the long term results.

OUr hospital has been non-smoking inside the facility for a long time. Starting in July, the patients will no longer be able to go outside to smoke. That means that for the last several months, they have been limiting the amount of cigarettes the patients can smoke.
Once the patients earn levels, they can go outside on privileges and they take their cigarettes with them. Depending on the restriction of the level, they can be outside quite a few times during the day.
My question is, does anyone have experience with long term forensic patients being forced to quit smoking altogether? I have read several articles that it can affect the levels of the psychotropic medication as well as trigger a depressive setback.
Any feedback would be greatly appreciated. I am on a recovery awareness committee and I am trying to come up with some information to take with me to the next meeting.
The patients have wanted to file grievances with the patient advocate but he has told them that smoking is not a right that they can grieve.

midnitelpn · Mar 3, 2005

order more ativan for the unit & get the "PEAT" team on speed dial!!!!!

so they dont smoke===polypharm & increased anxiety/possible assaults etcs!!!

sometimes the best prn i have used is a cigarette & private time w/the pt.

2ootsRN · Mar 4, 2005

OUr hospital has been non-smoking inside the facility for a long time. Starting in July, the patients will no longer be able to go outside to smoke. That means that for the last several months, they have been limiting the amount of cigarettes the patients can smoke.
Once the patients earn levels, they can go outside on privileges and they take their cigarettes with them. Depending on the restriction of the level, they can be outside quite a few times during the day.
My question is, does anyone have experience with long term forensic patients being forced to quit smoking altogether? I have read several articles that it can affect the levels of the psychotropic medication as well as trigger a depressive setback.
Any feedback would be greatly appreciated. I am on a recovery awareness committee and I am trying to come up with some information to take with me to the next meeting.
The patients have wanted to file grievances with the patient advocate but he has told them that smoking is not a right that they can grieve.

I live and work in a Behavior Health Unit (BHU) in Wisconsin. We have three levels of care: I, II and III with level III being the most restrictive. Pt's on all three levels do have the opportunity to smoke, if they are appropriate as smoking is a privilege, not a right. At our facility we have Acute, Sub-Acute and Open Units. For the most part Sub-Acute and Open Unit pt's are allowed to have their 'cigs' in their possession. We do not allow lighters-we have build in wall mounted lighters. Persons in the Acute area may also smoke if they are not a DTS/DTO's but their smokes are kept at the nurses station. We normally do not allow anyone to smoke during group time. Our hospital is a smoke free facility and we have signs posted outside to this affect and also stating 'Smoking not allowed withing 15 feet of Bldg.' A short while ago, there was a movement to eliminate smoking altogether throughout the entire Hospital Area. Our management did not concur with this proposed policy and met with the hospital Administration and as a result, smoking was not banned in our area, but designated smoking areas were enforced. We felt that it was not in the best interest of Staff Safety and our Pt. program to 'Ban smoking'. Many of our staff, do not smoke but by far a greater majority of our pt's are smokers. We still offer our pt's 'Smoking Cessation Information' at time of admission and during their stay with us if requested and we found that many of our AODA pt's have chosen to quit smoking while an inpt at our facility. We have a specific enclosed smoking patio and if we have a patient that wants to go outside for fresh air, we allow them smoke free time in patio area. I guess I believe that when dealing with Psych. Pt's, you have to consider the overall good of the unit (pt's and staff's safety)when banning smoking and the lesser of two evils... Do I want a 'Code 10' (pt. out of control) or do I want to be able to work with my pt.( allow him/her to be able to smoke when appropriate and get their medication under control. I don't know about anyone else, but I don't want to have to put someone in 'Leather's' or have to use a 'Chemical Restraint' when a few minutes of 'smoke time' would have defused a situation. Katie

tricia1 · Mar 4, 2005

I work as a RN in a State Psychiatric Hospital that went smoke free about two years ago.The hospital consists of forensic as well as adult and geri patients.There was exstensive groundwork to prepare for the change ie. smoke cessation groups, patches etc. and lots of hard candy. Surprisingly the change happened with remarkably few physical acting outs. But what did happen was alot of contraband on the units. Patients with the priveleges woud go off grounds and get smokes and matches/lighters and sell to other patients. There were several rrather serious fires on several different units. We have since gone back to allowing the smoking in off ward pavillions with built in cigarette lighters after about a year and a half.

Felixa · Jan 21, 2006

Hiya Bjo,

Just wondering how your smoke-free hospital was going?

I also work on a Forensic unit (in the UK), and the management have just announced that they want to ban smoking on hospital property from June.

Most of the patients in the unit, and all the patients on my ward smoke. We have a smoking room on the ward, well-ventilated, and the lads spend a good part of every day there. Those who can be trusted sign a lighter contract, and have to book out their lighter each morning and turn it in at curfew - they lose it if they are smoking irresponsibly. I suppose we'll have to gradually wean them off by shutting the smoke room except for certain increasingly longer periods of the day.

What's it like with a whole ward-full of potentially dangerous people going through nicotine withdrawal? - I know we can use patches, so the physical side won't be so bad, but the psychological effects will still be there.

What are the patients doing more of instead? (we do have ward activites but a lot of them aren't that motivated).

CharlieRN · Jan 23, 2006

My employer severly restricted smoking on the adult programs and compleatly stopped smoking for adoescents a few years ago. It is an ongoing but minor problem.

Smoking is not a good thing. But we don't see the point of fighting a battle we don't have to. Tobacco is a legal addiction.

I don't smoke and I don't enjoy being in a smoky environment but I have little patience with legislated morality.

Psychaprn · Jan 25, 2006

As a inpatient psych surveyor for my state, I have observed over the last few years as several facilities have gone entirely smoke-free, including the state hospital that was in my territory. The state hospital does not even allow staff to bring smoking materials onto the units with them -- they must keep them locked in their cars and go to the cars on their break time if they wish to smoke.
None of the facilities I visit regularly have had serious ongoing problems related to the change in smoking policy (of course, there was a little flurry of excitement around the time of the change in policy at all these places ... :) ).
I hear what you're saying about the people for whom the facility is their home, as that is also the case for a lot of people at the state hospital I'm speaking of. That is certainly v. different that being on an acute unit for three or four days.
What the physicians and staff at all these facilities have done is to be v. aggressive about offering nicotine patches and gum, as well as smoking cessation programs in the longer-term settings. None of the management people at any of these places have regretted the change in policy (although I'm sure some individual staff people have!) The doom and gloom predictions by some individuals before the new policies were implemented just didn't happen.
I believe that it is v. important that all the staff recognize that this is a medical/clinical issue (addiction), and be professional about recognizing and addressing the clients' nicotine addiction (with patches and/or gum) rather than just viewing it as a behavioral issue (no longer going out to smoke).

Interesting thread- I know that people who smoke or use excessive caffeine need higher doses of meds. I wouldn't want to work on a unit where patients were forced to quit smoking-increased irritability andor/ violence could be problematic. I would also worry that people trying to "sneak a smoke" might be even more of a fire hazard.

Thunderwolf, MSN, RN · Jan 26, 2006

Psychaprn, good point.

I would also worry that people trying to "sneak a smoke" might be even more of a fire hazard.

Tammy05LPN · Jan 29, 2006

I work in a nursing home for people with varying mental problems..from Alzheimers to schizophrenia to mental retardation. There were a select few residents that were allowed to go on the back patio independently to smoke until last week. Whenever the residents that needed to be "smoked" went outside for their smoke time, the independents had to go in so it wouldn't be so crowded and they could be watched better. Well, one 'gentleman' decided he couldn't wait for the others to get back inside from their monitored smoke time and he lit up a cig in the building. So that's what put an end to the independents..now they are split up into groups and taken out to smoke by staff at certain times. Now this same 'gentleman' can't stand this and is having major behavior problems. Just tonight he was threatening to "tear this place apart" if we didn't give him his cigarettes and let him go outside to smoke. Of course we didn't so he picks up his W/C and starts hitting the picture window in the lobby with it..this is after PRN Ativan was given 2 hrs before for bloodying another resident's nose and knocking him down. He did settle down when I picked up the phone and threatened to call the police, but oh what a night from hell.