culture-shocked...i want to understand why

Xbox Live Addict · Oct 18, 2008

I was the incoming nurse, and after reporting this one lady resident on wheelchair comes up to me and asks me for her cigarette. I know this is like stupid but I was really shocked...I have never in my life hand down a cigarette to a patient, and knowing that a cigarette is detrimental to her health..i was hesitant. I mean, I am supposed to be guarding this old woman's health, right? I really hate cigarettes and smoking and have seen/taken care of lots of COPD patients and lung cancer patients as a student in the Philippines, but it's not like I'm back there where I can say "hey, stop smoking dude!" I mean, here in America, it's like a burger king 'have it your way' commercial everyday...and this old lady, if i tell her that smoking is bad for her, she'll tell my face 'I have the right to get lung cancer'...I feel sad..and I know this is not supposed to be a big deal, but by handing out a smoke to her, I feel like I am not being an advocate for health. So it's really upsetting me..

I saw this all the time in LTC. While an increasing number of acute-care and psych hospitals do not allow smoking anywhere on the facility's property, smoking is still alive and well among LTC residents.

And while you may feel like you're not advocating for health and are conflicted, consider this too: There are a lot of smokers in LTC. They are in their 70's, 80's, and even 90's, with COPD or CHF. Their prognosis is very poor - they have a few years to live, at most, under the best possible circumstances. Smoking is an activity they've enjoyed all their lives. It's a diversion from the long, sluggish routine typical of most NHs. It's an excuse to go outside for people who are otherwise confined indoors nearly every moment of their life. Some are even receiving hospice care, which usually (though not always) means their prognosis is six months or less. At this stage in life, after thousands upon thousands of cigarettes, a few more aren't going to make things one bit worse. Withholding them will not delay the inevitable, and will only serve to deepen their despair at having one more thing they enjoyed lost, and resentment and anger at having a personal choice taken from them, when declining health, declining self-care ability and often decimated finances have taken nearly everything else away.

The rationale here is: Let them have the few pleasures left to them to make the last months or years of their life as enjoyable as possible.

While it is important to advocate for your residents' physiological health, you may be able to do an even greater service for some residents by advocating for their emotional well-being as well.

Pepper The Cat, BSN, RN · Oct 18, 2008

Question: What if she came up and asked you to open her chocolate bar. Would you do that?

What if her family brought her in KFC as a treat - would you stop them at the door?

As Xbox said, this lady has been probably been smoking for years. Any damage has been done years ago. Do you really want to put her through nicatine withdrawal?

We had a COPD pt on Oxygen who would walk out with her O2 tank, have her smoke while off the O2 (we hoped) and then come back. This was her choice. All we could do was educate her about the risks, and pray that she didn't blow us all up! :saint:

TeresaB930, BSN, RN · Oct 18, 2008

I'm not going along with the flow of responses here. If your administrator saw you giving her a cigarette, what do you think the response would be?

It isn't your responsibility to provide cigarettes to her....period. So lose the guilt. If she wants to smoke bad enough, she will ask family or friends to bring them in for her. Once you've set your foot down firmly, she will stop asking you.....and hopefully she doesn't take the O2 tank out with her!!

Jules A, MSN · Oct 18, 2008

I say the same thing with regard to alcohol and dietary restrictions. Where do we think these people are going from here? Its not like we trying to rehabilitate them so they can go home and live a long, independent life. It is rather cruel imo to all the sudden expect Grandmom not to have her cake for desert if that is what she is used to and enjoys, imo. Heck I'd light the stogie for her if smoking is allowed at the facility. :)

queenjean · Oct 18, 2008

In the acute care settings I've worked in, we do not allow this. No one helps someone smoke, etc.

In the LTC facilities I've seen, though, it's another story. The idea is that it is the resident's home. The LTC facility I worked in had an outdoor area for residents to smoke, and we kept their cigarette packs and lighters under lock and key (it was the dementia unit). We were responsible for making sure that if they were going to smoke, it was done in a safe manner (no O2 in the area, for example). We also had a liquor cabinet. Several residents would have a beer or glass of wine with supper. Doctor's orders!

Pepper The Cat, BSN, RN · Oct 18, 2008

I assumed that the cigarettes were locked up and she had to ask for one, not she was asking to be given a cigarette.

Hausfrau · Oct 18, 2008

I'm not going along with the flow of responses here. If your administrator saw you giving her a cigarette, what do you think the response would be?
It isn't your responsibility to provide cigarettes to her....period. So lose the guilt. If she wants to smoke bad enough, she will ask family or friends to bring them in for her. Once you've set your foot down firmly, she will stop asking you.....and hopefully she doesn't take the O2 tank out with her!!

Anywhere I have worked as a CNA it was our job to take the residents out for cigarette or cigar breaks. If we denied them the right to do that then we'd be in trouble with the administrator.

To add though that that it is where they lived, it wasn't in a hospital..

I don't see a problem with it as long as they don't ask to go out every hour or something. Once or twice a shift is reasonable.

SuesquatchRN, BSN, RN · Oct 18, 2008

Let the woman have her smoke, for goodness' sake.

I had one LOL on pureed NAS. Every day she'd say, "Needs salt." And every day I'd wish I could salt her mush for her.

TeresaB930, BSN, RN · Oct 18, 2008

Anywhere I have worked as a CNA it was our job to take the residents out for cigarette or cigar breaks. If we denied them the right to do that then we'd be in trouble with the administrator.
To add though that that it is where they lived, it wasn't in a hospital..
I don't see a problem with it as long as they don't ask to go out every hour or something. Once or twice a shift is reasonable.

Wow, not where I work! In our SNF. If our residents choose to go out to smoke, they sign an informed consent, and no way do our employees take them out.

Xbox Live Addict · Oct 18, 2008

I'm not going along with the flow of responses here. If your administrator saw you giving her a cigarette, what do you think the response would be?
It isn't your responsibility to provide cigarettes to her....period. So lose the guilt. If she wants to smoke bad enough, she will ask family or friends to bring them in for her. Once you've set your foot down firmly, she will stop asking you.....and hopefully she doesn't take the O2 tank out with her!!

I should clarify, that Staff members should not be obligated to spend money on resident's cigarettes... that actually could be considered a minor boundary crossing, and it would be unethical of any administration to expect staff members to sacrifice from their own families' needs for their residents. The O.P. clearly stated s/he is not a smoker, which is fine. No harm, no foul if s/e doesn't want to. There is usually a staff member who smokes who will willingly take a resident out to smoke, if only so the staff member can have an extra smoke break. :smokin: I myself am not a smoker, but on times when my work was caught up and a resident needed a little out, I'd get them a cigarette from their personal supply and take them for a little outing.

Many of these residents do have families or interested relatives that will buy them cigarettes for their own use. And almost all of these residents at least receive a small stipend from Social Security for personal use, and Social Services or even the Administrator, at the resident's request, can use the resident's money to buy them cigarettes for the use of THAT RESIDENT only.

Also, smoking is not, and should not, be allowed to interfere with the staff's duty to care for EVERY resident.

Xbox Live Addict · Oct 18, 2008

Let the woman have her smoke, for goodness' sake.
I had one LOL on pureed NAS. Every day she'd say, "Needs salt." And every day I'd wish I could salt her mush for her.

At most facilities I worked at, if a resident had a poor prognosis and didn't want their puree/NAS/thickened liquids, the responsible party would sign a witnessed AMA dietary waiver, the physician would write the order for the requested diet, and the resident would be able to enjoy foods just the way they wanted them. One physician even interceded on the resident's behalf and overrode Speech's dietary recommendation of puree - again, his rationale was, "What's the point of denying her what she likes? She's 85 y/o and never going to get better." Plus, if the family took the resident for an outing, they assumed all responsibility for the resident's condition and could feed them any darned thing they wanted.:chuckle

I have tasted both puree and thickened liquids, and what little flavor they do have is unpleasant.