COPD patient wanting to leave to smoke

[chris10lsuRN]

Just want to vent. Does anyone else have a major problem with this?? Patient admitted for COPD exacerbation. Patient is on home nebulizer treatments, inhalers, etc.. for the treatment of his COPD. Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). Patient is a medicaid patient which basically means I (along with the rest of tax-paying America) is paying for his hospital admission and medications for his respiratory disease..and he is insisting he is going to smoke. makes me soooo mad!!:mad:

[whatsgoingon]

(cont'd)

Consider a recent "cost analysis" in Australia. Net health costs of tobacco use was estimated at $318,400 (p.67). The net revenue from tobacco sales was $6,700,000 (p.38). The revenue from tobacco is 21 times the extra cost of treating smokers. Even the extent of this "extra cost" is arguable, but we'll leave that for another time. The difference is obscene.

http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/34F55AF632F67B70CA2573F60005D42B/$File/mono64.pdf

Given that the fantasy that smokers cost the health system can no longer be maintained, the fanatics do what they do regularly - they change the "argument" (storyline), i.e., shift the goalposts. Now they argue, smokers [way] more than cover their additional health costs, but there are "other costs". And the above report concocts around $32,000,000 of "other costs". There isn't time to consider how all these "other costs" are entirely arguable. However, shifting the "storyline" keeps the ideological fanatics happy (and they usually call for funding to help "educate" the public), Gigantic Pharma is happy because it can keep peddling and profiting from its essentially useless NRT wares. And the government is happy because it can claim that it needs to extort even more taxes from smokers. There is now a lucrative antismoker industry that did not exist 30 years ago. From part of the extortionate taxes, it is smokers that are financing a considerable portion of it: They are being forced to pay for their own persecution. It is a very sick, self-serving system.

[whatsgoingon]

Antismoking didn't just pop-up recently. It has a long, sordid history. The fanatics typically produce numerous, baseless inflammatory claims that produce a bigotry frenzy, i.e., a bandwagon effect, to advance their extremist agenda (the current antismoking crusade is no different). Only two countries had serious antismoking crusades in the first half of the last century - America and Nazi Germany. The common thread is eugenics, i.e., physician-led social engineering. Eugenics did not originate with the Nazis. It was popularized in America decades earlier. The Germans were students of American eugenics. There was an intimate relationship between American and German eugenicists and the mega-wealthy funders of eugenics in both countries, e.g., Rockefeller, Ford, Carnegie. The primary dimension of eugenics was racial/heredity/breeding. However, many are not aware that it also has a behavioral dimension - anti-tobacco, anti-alcohol, dietary prescriptions/proscriptions, and physical exercise. There are no other dimensions (psychological, social, moral, metaphysical) in the physicalist framework.

America (unfortunately it makes no specific reference to eugenics)

http://www.americanheritage.com/content/thank-you-not-smoking

Nazi Germany

http://www.bmj.com/archive/7070nd2.htm

[cherrybreeze, ADN, RN]

It just amazes me that places let patients leave the unit. Once you're admitted at my facility you're there until you leave AMA or are discharged. No going to the cafeteria, gift shop, or outside. I mean, how is risk management okay with patients leaving? Isn't that a huge liability? What if they pulled their central line/trach/foley/chest tube/nephrostomy tube/et al? What if they fall down the stairs? What if they use their IV to do drugs? What if they sell drugs they're been hording? What if they pass out from the antihypertensives you gave them? What if they become hypoglycemic from the insulin you gave them? We do hourly rounding and charting on our patients. How can you do that if they're off the unit?

We'll give them nicotine inhalers/gum/patches/all three til we're blue in the face.

I would think of all of these things also. It is our responsibility if the patient leaves the floor to smoke and something untoward happens to them. The buck stops with the RN as it always does.

Pulling out tubes, falling, etc etc....sure. But to jump from smoking to "using their IV to do drugs" is ridiculous. Sorry.

[whatsgoingon]

"i feel that people who smoke are looked at as if they are some kind of criminal."

sistasoul, that's pretty close. that's the goal of denormalization. denormalization is a vulgar concept and abominable when applied to a group of people. the intent is to portray a group as less than human, essentially stupid, and a threat/cost to the rest of society. it was used with catastrophic effect on the jews (and other groups) in nazi germany (before the genocide, jews were even banned from parks and entranceways because they were portrayed as a "disease risk" to the "superior aryans").

the goal of antismoking is to depict smoking/smokers only in negative terms and never in positive terms. those who smoke are depicted as "just addicts" whose opinion is essentially worthless because of their "addiction". smoking was initially depicted as having no benefits (which is not true) and only produced disease. then, with the idea of "nicotine addiction", smoking itself is now called a "disease" that requires "treatment". with the concoction of secondhand smoke "danger", smokers are depicted as not only disease carriers but also "disease spreaders". now the fanatics are working on concocting "thirdhand smoke danger". here, it is argued, that remnants of smoke (at barely detectable trace levels) remain long after smoking has occurred, e.g., on furniture, clothes, that poses a "hazard" to nonsmokers. this is the "leperization" of the smoker. it has all been manufactured by disturbed minds to advance the "smokefree world" agenda.

the goal of the propaganda is to ostracize smoking (and those who would smoke) from "normal" society. being inflammatory with a constant play on fear and hate, it produces a bigotry bandwagon effect. this is made far worse when government supports/funds the bandwagon.

this is what governments around the world have allowed/funded tobacco control (anti-smoking/tobacco) to do over the last few decades:

however, internationally, the term [denormalization] is also used to encompass efforts challenging notions that smoking ought to be regarded as routine or

normal, particularly in public settings. hammond et al state that "social denormalisation" strategies seek "to change the broad social norms around using

tobacco--to push tobacco use out of the charmed circle of normal, desirable practice to being an abnormal practice".

several authors - have suggested that erving goffman's classic analysis of stigma and its resultant "spoiled identity" is consonant with how the meaning of

smoking has changed in societies with widespread tobacco control. goffman described stigmatisation as the transformation "from a whole and usual person to

a tainted, discounted one", writing that "stigma is a process by which the reaction of others spoils normal identity".

in addition to shs "danger", the major emphases of propaganda/denormalization have been -

smokers as malodourous [stink]

smokers as litterers

smokers as unattractive and undesirable housemates

smokers as undereducated and a social underclass

smokers as excessive users of public health services

smokers as employer liabilities

[color=#0000ef]http://tobaccocontrol.bmj.com/cgi/content/full/17/1/25

this is all inflammatory propaganda intended for mass thought/behavior modification to produce [antismoking] conformity, i.e., a sort of brainwashing.

[whatsgoingon]

The first demand for a smoking ban was in the late-1980s concerning short-haul flights in the USA of less than 2 hours. At the time, the antismokers were asked if this was a "slippery slope" - where would it end? They ridiculed anyone suggesting such because this ban was ALL that they were after.

Then they ONLY wanted smoking bans on all flights.

Then the antismokers ONLY wanted nonsmoking sections in restaurants, bars, etc., and ensuring that this was ALL they wanted.

Then the antismokers ONLY wanted complete bans indoors. That was all they wanted. At the time, no-one was complaining about having to "endure" wisps of smoke outdoors.

Having bulldozed their way into indoor bans, the antismokers then went to work on the outdoors.

Then they ONLY wanted bans within 10 feet of entrance ways.

Then they ONLY wanted bans within 20 feet of entrance ways.

Then they ONLY wanted bans in entire outdoor dining areas.

Then they ONLY wanted bans for entire university campuses and parks and beaches.

Then they ONLY wanted bans for apartment balconies.

Then they ONLY wanted bans for entire apartment (including individual apartments) complexes.

On top of all of this, there are now instances, particularly in the USA, where smokers are denied employment, denied housing (even the elderly), and denied medical treatment. Smokers in the UK are denied fostering/adoption. Involuntary mental patients are restrained physically or chemically (sedation) rather than allow them to have a cigarette.

At each point there was a crazed insistence that there was no more to come while they were actually planning the next ban and the brainwashing required to push it. There has been incessant (pathological) lying and deception. Many medically-aligned groups have been committed to antismoking - their smokefree "utopia" - since the 1960s. All of it is working to a tobacco-extermination plan run by the WHO and that most nations are now signed-up to.

I'm sure we can see a pattern here. The concocted SHS "danger" concerned a minute statistical risk of questionable causal basis for LIFELONG (30, 40, 50, 60 years) exposure to SHS from spousal smoking. Around 99.9+% of those exposed to SHS over a lifetime have NO elevated statistical risk of disease. Yet with the propaganda promoting the idea that SHS is bio-weapon-like, unlike anything else on earth, we now have many delicate and dainty nonsmokers "running the gauntlet" of smokers at entranceways, hand cupped over mouth, terrified that they might inhale a whiff. This is the promotion of mental dysfunction (e.g., anxiety reactions, hypochondria, somatization). And the irrationally terrified then demand "protection". It is fully to be expected as a result of incessant inflammatory propaganda. And this is typically what happens when the medically-aligned Public Health goes on its social-engineering, deranged ideological crusades. The fanatics will keep pushing as far as society allows them.

This has all happened in just 20 years. If it was mentioned 20 years ago, or even 10 or 5 years ago, that smokers would be denied employment and housing and smoking bans in parks and beaches, it would have been laughed at as "crazed thinking". Yet here we are. It's all happened before and it has all been intentional, planned decades ago. We just don't learn or we're going to have to learn the very hard way because it has to do with far, far more than just smoking.

[blondy2061h, MSN, RN]

Pulling out tubes, falling, etc etc....sure. But to jump from smoking to "using their IV to do drugs" is ridiculous. Sorry.

This is definitely not far fetched. I'm not saying smokers are drug users. I'm saying that some people do use drugs and there's no way of guessing who, and they will take advantage of any opportunity to leave the unit. My comment was more about how bizarre it is to me in general that some places let admitted patients leave the unit then smokers specifically.

[sistasoul]

The first demand for a smoking ban was in the late-1980s concerning short-haul flights in the USA of less than 2 hours. At the time, the antismokers were asked if this was a "slippery slope" - where would it end? They ridiculed anyone suggesting such because this ban was ALL that they were after.

Then they ONLY wanted smoking bans on all flights.

Then the antismokers ONLY wanted nonsmoking sections in restaurants, bars, etc., and ensuring that this was ALL they wanted.

Then the antismokers ONLY wanted complete bans indoors. That was all they wanted. At the time, no-one was complaining about having to "endure" wisps of smoke outdoors.

Having bulldozed their way into indoor bans, the antismokers then went to work on the outdoors.

Then they ONLY wanted bans within 10 feet of entrance ways.

Then they ONLY wanted bans within 20 feet of entrance ways.

Then they ONLY wanted bans in entire outdoor dining areas.

Then they ONLY wanted bans for entire university campuses and parks and beaches.

Then they ONLY wanted bans for apartment balconies.

Then they ONLY wanted bans for entire apartment (including individual apartments) complexes.

On top of all of this, there are now instances, particularly in the USA, where smokers are denied employment, denied housing (even the elderly), and denied medical treatment. Smokers in the UK are denied fostering/adoption. Involuntary mental patients are restrained physically or chemically (sedation) rather than allow them to have a cigarette.

At each point there was a crazed insistence that there was no more to come while they were actually planning the next ban and the brainwashing required to push it. There has been incessant (pathological) lying and deception. Many medically-aligned groups have been committed to antismoking - their smokefree "utopia" - since the 1960s. All of it is working to a tobacco-extermination plan run by the WHO and that most nations are now signed-up to.

I'm sure we can see a pattern here. The concocted SHS "danger" concerned a minute statistical risk of questionable causal basis for LIFELONG (30, 40, 50, 60 years) exposure to SHS from spousal smoking. Around 99.9+% of those exposed to SHS over a lifetime have NO elevated statistical risk of disease. Yet with the propaganda promoting the idea that SHS is bio-weapon-like, unlike anything else on earth, we now have many delicate and dainty nonsmokers "running the gauntlet" of smokers at entranceways, hand cupped over mouth, terrified that they might inhale a whiff. This is the promotion of mental dysfunction (e.g., anxiety reactions, hypochondria, somatization). And the irrationally terrified then demand "protection". It is fully to be expected as a result of incessant inflammatory propaganda. And this is typically what happens when the medically-aligned Public Health goes on its social-engineering, deranged ideological crusades. The fanatics will keep pushing as far as society allows them.

This has all happened in just 20 years. If it was mentioned 20 years ago, or even 10 or 5 years ago, that smokers would be denied employment and housing and smoking bans in parks and beaches, it would have been laughed at as "crazed thinking". Yet here we are. It's all happened before and it has all been intentional, planned decades ago. We just don't learn or we're going to have to learn the very hard way because it has to do with far, far more than just smoking.

It is a form of control. It is the taking away of our liberties one by one. Eventually, all of our liberties will be eroded and then we will be asking ourselves what happened. These types of things are done slowly so as the general public will not notice it happening and become "adjusted" to it.

[sistasoul]

Pulling out tubes, falling, etc etc....sure. But to jump from smoking to "using their IV to do drugs" is ridiculous. Sorry.[/qu

You never know what people will do if they are addicted to drugs. If someone detoxing from drugs decides to smoke and is able to get away with it undetected what is to stop them from taking it a step further and going to hunt down drugs. Anything on this earth is posssible if not probable.

[whatsgoingon]

Sistasoul: "It is a form of control. It is the taking away of our liberties one by one."

The Godber/WHO Blueprint was advising in the 1970s that medical and educational facilities should ban smoking and also smokers from employment. Medical and educational staff, the fanatics claimed, should be nonsmoking "exemplars".

In half of American states where it is allowable to discriminate against smokers, there is a growing trend for medical facilities to ban employing smoking staff. Everything else about a person, e.g., qualifications, skill, etc, become irrelevant. Only smoking status is critical. Cleveland Clinic is one such facility that has banned employing smokers (I think the CEO of CC is the medico celebrity, Michael Roizen).

"We want to make it easy for you to do healthy things and hard for you to do unhealthy things," Roizen said. "If you want a sugared drink, you have to go out of your way to bring it from home. We're not going to provide it."

That left fitness and stress relief. The first step was easy: Offer free fitness and stressmanagement classes. But the clinic still had to get its employees to attend. So they reversed the normal calculus. Usually, you have to pay to hit the gym or attend a yoga class. If you work for the Cleveland Clinic, you have to pay if you don't.

"We raised the premiums for all employees," Roizen said. But employees didn't necessarily have to pay the increase. "If you're doing a healthy program-attending Weight Watchers or Shape Up and Go-you get a rebate."

That left enforcement. The clinic tracks its employees' blood pressure, lipids, blood sugar, weight and smoking habits. If any of these are what the clinic calls "abnormal," a doctor must certify that the employee is taking steps to get them under control. Otherwise, no insurance rebate. The idea is to force employees to have regular conversations with their doctors about wellness. If they participate, they can lock in the rates they were paying two years ago. The savings amount to many thousands of dollars.

.... In one sense, the clinic has achieved the health policy ideal: cutting health-care costs by making people healthier. But consider how the clinic has done it-tying premiums to personal decisions, firing smokers, tracking employee metrics, eliminating popular sodas and foods from campus. By making it harder and more expensive for employees to be unhealthy, the clinic has radically overstepped the traditional, laissez-faire approach of employers to their workers' personal habits.

It also opens the door to onerous forms of discrimination. The clinic no longer hires smokers. Will the obese eventually face similar hurdles? What about fans of fast food?

http://www.washingtonpost.com/blogs/ezra-klein/post/the-promise-and-peril-of-wellness/2011/08/25/gIQAGzPfkL_blog.html

Roizen effectively believes he owns his employees' bodies - literally, routinely tracking particular measures and with constant medical oversight/surveillance; it's like a more technologized version of a health[ist] farm/spa early last century, e.g., the eugenicist Kellogg. And this is a condition of employment. Roizen is a classical physicalist. You'll notice that all of his "targets" are the behavioral dimension of eugenics. He thinks health is only physical. He grasps no other dimensions of health. Smokers are too defiant for the obsessed with control; the defiance really gets in the craw of their fascist "majesties". The social-engineering (eugenics) solution: Get rid of them; don't employ them. And Roizen believes this is an approach that should be applied widely.

This is getting into very dangerous territory. Yet it attracts little critique from within the medical establishment itself or the media.

[anotherone, BSN, RN]

It just amazes me that places let patients leave the unit. Once you're admitted at my facility you're there until you leave AMA or are discharged. No going to the cafeteria, gift shop, or outside. I mean, how is risk management okay with patients leaving? Isn't that a huge liability? What if they pulled their central line/trach/foley/chest tube/nephrostomy tube/et al? What if they fall down the stairs? What if they use their IV to do drugs? What if they sell drugs they're been hording? What if they pass out from the antihypertensives you gave them? What if they become hypoglycemic from the insulin you gave them? We do hourly rounding and charting on our patients. How can you do that if they're off the unit?

We'll give them nicotine inhalers/gum/patches/all three til we're blue in the face.

We do hourly rounding also. and guess what some of these people ARE WALKIE TALKIES. if they walk off while i am in another room, how can i stop them? if they are selling drugs in their room, am i to blame? if the visitor brings them drugs and they are doing them in the bathroom am i too blame?

[anotherone, BSN, RN]

How do you keep them from stopping? do you just make them all sign out AMA? i dont think the doctors where i work would do this. the most we can do is call security and we all know security is powerless. and will only deter those who aren't smart enough to realize this. I can't imprision the patients..... or restrain them to prevent them from walking off the unit to go smoke. nor should that be my job at all.

[kids]

oh yes..we have all of that. He just got to the unit..has not been here 10 minutes. I understand that it is a highly powerful addiction. I was basically venting about the fact that he is here for COPD and his stay is paid for by medicaid and he is adamant about smoking.

I just don't care about it. Medicaid pays pennies on the dollar on hospitialization, the fraction of a penny of my tax dollars, that is going to his care, is so miniscule that it would take hundreds if not thousands of medicaid recipients to add up to a whole penny.

I care far more about the habits of the people who are sharing the pool of the private health insurance I pay hundreds of dollars for.