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

[chuchie, ADN, BSN, MSN, LPN, APRN, NP]

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.

[SuesquatchRN, BSN, RN]

The approval is probably for liability reasons so the family doesn't sue if the pt falls or something.

I think it's a violation of the pt's rights, yes.

As a student nurse PLEASE don't make the mistake of questioning anyone associated with your clinicals about this. No good can come of it.

[Blee O'Myacin, BSN, RN]

Never a good idea to escort a patient off grounds, for any reason. Even if you don't agree, it isn't worth the liability of "kidnapping" a LTC resident.

Personally, I don't have the time to take patients out to smoke. They get their line pulled and an AMA sheet. I'm not forcing them to stay.

LTC is completely different - and there's a lot at play. I'm wondering if the resident was taking advantage of a new and sympathetic person to take him out for a smoke. What would you do if he fell? Probably get booted from the program. Even if he wants a smoke, he can't per facility policy.

Please follow the rules of your clinical facility - you are their guest.

Blee

[morte, LPN, LVN]

good question for your instructor, though.....as a learning thing, not confrontational. Having worked a lot of long term care, i think perhaps the nurse is not used to having competent patients...and assumes they all need family/poa consent for everything.....

[nitroprussideNlight]

I once had a patients family specifically come up to me and ask me if he could just smoke one cigg...the pt was dying of bone mets we had to be very careful positioning him , he was satting 100% on 2LNC so I removed his canula, opened his window, moved the bed towards the window, propped him over on his right side, made him a little ashtray out of one of them kidney shaped emensis basins, told him to have it. I guarded the door at the end of the hallway for him, and checked on him periodically. The look of relief on that guys face was amazing...he died the next evening, he was actually a full code and aspirated, he coded twice more before finally getting a celestial discharge. I hope I helped him. I know off topic, but it reminded me of the story. Continue discussion please...lol

[JBudd, MSN]

I hate cigarrette smoke with a passion. Don't even like the smell on people's clothes. I like no smoking zones, because I don't want other people's decisions to inflict harm on me.

But I have this really strong notion that people should make their own decisions, Big Brother needs to keep his nose out of my life and personal decisions.

I used to get the dollar off coupons, or one free pack, and take them to the social worker at the LTC I worked at for the old vets who wanted to smoke, but didn't have much cash.

[Ms.RN]

when patient is first admitted and if they smoke, they must be evaluated by social worker or nurse to make sure they have dextricity to be able to smoke alone, and if they are not, then staff must accompany patient at all times. i had patients who burned their hand or leg from smoking alone and that is a liability to the facilitiy. if patient is a heavy smoker, they usually have scheduled times to go out and smoke with staff. patients who are alert and oriented can make decision to smoke or not but there are lot of patients in nursing home setting with dementia and family usually make decisions for the resident, and family must bring cigaretts for the residents because staff wont buy them for the resident to smoke.

[THAT Nurse., MSN, RN, APRN]

I am with Jbudd.

My view, as someone who works acute care, is if you are well enough to go smoke, you are probably well enough to d/c. That said, the whole anti-smoking craze has gone overboard. I rarely take patients to smoke, not because I think they ought to be d/c (in reality, they might be staying for a procedure or something, obviously they could be well enough to go), but because I do not like the stench.

As far as family desires, unless they are calling the shots for my patient, I tend to ignore them. Family desires are a very distant second to patient desires.

[txspadequeenRN, BSN, RN]

this sums up everything i was about to write....to the op ... you should never and i mean never take a patient out of the facility. first you will probably need permission fro the family next then you will be responsible for this person and all of their diagnosis's /behaviors while they are out...scary thought huh

when patient is first admitted and if they smoke, they must be evaluated by social worker or nurse to make sure they have dextricity to be able to smoke alone, and if they are not, then staff must accompany patient at all times. i had patients who burned their hand or leg from smoking alone and that is a liability to the facilitiy. if patient is a heavy smoker, they usually have scheduled times to go out and smoke with staff. patients who are alert and oriented can make decision to smoke or not but there are lot of patients in nursing home setting with dementia and family usually make decisions for the resident, and family must bring cigaretts for the residents because staff wont buy them for the resident to smoke.

[GrumpyRN63, ADN, RN]

Geez, I would hope if I'm in an LTC one day I wouldn't need my children's permission for a smoke--(they would finally know and I[ve been in the closet forever!!!!

[Tait, MSN, RN]

Some of the posts in this thread seem pretty confrontative on the OP, but maybe its just because smoking is a touchy subject and I just woke up to my maintenance guys in the apartment. Meh anyway.

Objectively:

1. Check with LTC policy.

a. Can patients leave the facility. What is the policy?

b. Don't be afraid to ask your instructors/the staff, in a polite nature, how they handle the situation.

2. Is the patient under a HPOA, some families might have POA and be concerned for their family members future health. Being in a nursing home doesn't always mean you are on the brink of death, and being a cardiac nurse I can vouch that it's never too early to quit, or to have your family care enough to try and help you.

3. Is the person on oxygen? If so then I wouldn't take her out at all, because her head might start on fire!

Tait

[Flare, ASN, BSN]

If the patient is competent and the facility allows it then sure - why not. A patient has every right in the world to smoke. Although I do agree with the notion that if a petient is well enough to smoke, they are well enough to go home (barring LTC residency, of course).

I can remember when my own grandmother was dying of lung ca with mets. My aunt got very angry with me (a nursing student at the time) for allowing her to have a cigarette. I explained to my aunt that I had shut her oxygen off, I sat right next to her and that she only took 3 or 4 drags off of it before telling me that she was finished with it. I mean the woman had been smoking for 66 years at that point, was on hospice with a DNR. One final cigarette could hardly her her at that point.