Feasibility of non-smoking policy in psychiatric hospitals?

[psych nurse]

The hospital is a crisis stabilization facility for non-insured psychiatric patients. Length of stay is generally less than a week. Staff do not want to "supervise" patient smoking because of exposure to second-hand smoke. A non-smoking policy is being considered but many staff do not support the idea because they believe patient aggression will increase and because patients are here for psychiatric treatment...not smoking withdrawal. Would like to hear from colleagues who have faced the same issues.

[WickedRedRN, BSN, RN]

I worked for a state psych hospital when it went non smoking, pts included. Aggression did increase in the first couple of weeks that it was enacted, however for the most part it went smoothly. There was a huge non smoking campaign prior to the official date, and the hospital did provide patches, and other non smoking aids.

At the hospital I am currently at (non-psych) all smokers are offered patches for the duration of their stay. Most take them and are cooperative, but there are those few that are difficult.

I wish you the best, I know from experience it can be rough, but once you get past the initial shock, it will get better.

[TheCommuter, BSN, RN]

I'm an LVN medication nurse at a local psychiatric hospital. A non-smoking policy would greatly lack feasibility because the majority of the patients have no desire to kick the habit. They look forward to their cigarette breaks and become hostile anytime there's not enough staff to administer the breaks in a timely manner.

Exposure to secondhand smoke is not a problem for most of our mental health technicians since the majority are smokers and, therefore, not bothered by the smell of smoke.

[CharlieRN]

We are have a no smoking policy inside the buildings but permit patients to smoke on fenced in porches. Since they are unable to leave the smoking area, they don't need close supervision. They are not permitted on the smoking porches during the 11p to 7a shift.

We did not think this would work but it did and now I'm pretty sure we could deal with a no smoking at all policy.

[kristen38]

The hospital that I am at has a no smoking policy for the whole property. Before my psych. unit applied this policy they had signs up and informed the pt. of it months ahead of time. When it came time to have the building no smoking pt. (with our assessment and privileges from the psychiatrist) are able to go off the unit, once every hour on the hour and have one cigarette, they need to sign out and we keep their lighter as well. No one is allowed to go if a group is going on. Of course those who are certified or at risk are not allowed to go but they are provided with patches and gum. There were very little problems and it seems to work well.

Kristen

[NurseCard, ADN]

I am sitting here praying that that never happens at my facility. From my experience working in med-surge, I KNOW how agitated that post-op patient could and would get when told that they couldn't smoke. To be able to go somewhere where almost all of the patients are allowed to smoke, and they have that patio RIGHT THERE where they can go smoke (granted, only at certain times of the day)... it's a relief. :)

[Thanet]

This is due to happen in our hospital in November. The patients are not allowed to smoke any where in the hospital or grounds...

But 50% of my patients are section 37/41 (Only allowed to be discharged by the home office) or some other section which restricts their movement off the ward or grounds.

I think it will be interesting... to say the least...how a 6 foot, 300lb sectioned patient who smokes and is not allowed off the ward is going to take being told he cannot smoke ... anywhere!

[elkpark]

Part of the trick to making a policy like this work is that you don't just tell the clients that they can't smoke -- you institute an aggressive program of treating their nicotine addiction like any other comorbid medical problem. You have to get the docs to "buy into" the program and routinely order nicotine patches and gum for smoking clients, and all staff need to approach this as a routine safety and medical issue, not a power struggle or punitive issue.

Remember that most of the clients will take their cues from the staff -- if the staff act like changing the smoking policy is a big deal and a bad thing, that's how most of the clients will react, as well. The more positive, relaxed, and matter-of-fact you can be about it, the better.

[LydiaNN]

In California, all public buildings are non-smoking by law. Too bad, so sad.

[nightnurse47]

Our facility went non smoking about 8 years ago for the psych unit and entirely, even on the grounds last year. We had the same concerns that many of you have expressed about the patients, but we were surprised to find that they handled it quite well. We offer a nicotine patch or gum and they all know coming in they can't smoke. Of course not everyone is tickled pink, but we had no increased aggression or any other negative outcomes. SO, those that are anticipating this change, load up on the nicotine replacements and take heart, it will probably not be as difficult as you think!

[HotmaleSPN]

I had to teach quit smoking group at the Psych hospital in NJ during my clinical rotation as a student there. I did not go over very well as most patients showed little or no interest. The smoking ban followed the next week and the violence and agression escalated. The ban lasted about 2 weeks and they dropped the ban, now they can all smoke again out on the porch. Mostly the staff that smokes accompanies the patients on the porch for regulated smoke breaks.