free cigs for psych patients

[eak16]

question for you psych nurses-

Does your unit give free cigarettes to patients who dont have any (and are allowed supervised smoking breaks)?

I was on a psych unit today and was rather surprised that they have a "designated patient carton".

I asked them if, as nurses, it bothered them to give patients free cigarettes (i obviously didn't have to tell them the health dangers, etc.), and they seemed surprised by my question, saying that patients were less anxious if they knew they had access to cigarettes.

I can understand how in a high acuity psych ward it would be good to keep the patients less anxious about their nicotine cravings so they an focus on solving more pressing issues,but I feel there is a better way of doing it (patch maybe?)..hmmm...what do you think?

[Hellllllo Nurse, BSN, RN]

I think you might find this article very interesting-

http://www.daily.umn.edu/daily/1997/01/21/news/ap21nd.ap/

Scientists find link between nicotine, schizophrenia

WASHINGTON (AP) -- Scientists have located a gene that may increase the risk of inheriting schizophrenia -- a finding that, in an unusual twist, could also explain why many schizophrenics chain smoke.

Essentially, nicotine appears to briefly override a brain defect characteristic of the devastating mental illness, providing frenzied patients a few minutes of calm, researchers reported in today's edition of Proceedings of the National Academy of Sciences.

"Schizophrenics are the most heavy smokers of any psychotic patients," said Dr. Robert Freedman of the Denver Veterans Affairs Medical Center. "They had discovered this (effect) before we had, and it had been overlooked as a clue to the biology of schizophrenia."

At issue is the inability of many schizophrenics to filter out unnecessary sights, sounds and other stimuli -- that tapping tree branch or the refrigerator hum that healthy people can ignore -- so they essentially suffer information overload.

Freedman and colleagues at the University of Colorado discovered that this trait is inherited. And they linked a gene that appears responsible for that to a brain receptor that helps filter information, a receptor that can be stimulated by nicotine.

That means schizophrenics who smoke get enough nicotine to switch on this receptor for brief relief, Freedman explained. "All the patients report they feel great after a cigarette," he said.

The study is "an excellent piece of work," said Dr. Elliott Gershon, neurogenetics chief at the National Institutes of Health.

But Gershon cautioned that while Freedman has strong evidence linking this schizophrenia trait to the nicotine receptor gene, he doesn't yet have proof -- especially because Freedman has not found the gene mutation that would cause it.

Still, "it's an important step forward" that points to a potential new target for drug therapy, Gershon said.

Indeed, while Freedman is searching for the mutation, he has begun working with drug companies to find treatments that target this receptor.

"We certainly don't recommend people take up smoking to try to combat their schizophrenia because the effect literally lasts just a few minutes" and smoking causes killer diseases like lung cancer, he stressed. But the findings are "reassuring to family members who wonder why their (schizophrenic) children can't stop smoking."

Some 4 million Americans suffer schizophrenia, a mental illness characterized by hallucinations, delusions, bizarre behavior and the inability to feel pleasure.

[dragonfly954]

Worked on a dual diagnosis and regular psych floor.The AA and NA people would always bring in donations of cigs as"patient cigs" or ones leaving would donate.Amazing!

[gwenith, BSN, RN]

Thanks Hellllo Nurse I have been looking for a link to that article for some time. Although I work in Coronary Care we allow a lot more latitude with any schizophrenic patients that we have about going out for cigs etc because of this finding.

[Agnus]

There are safer ways of delivering nicotine as already mentioned. What medically sound excuse is there for not using them?

[Town & Country]

When I worked one particular LTC facility, it was "part of our job" to retrieve patients' cigarettes from the med room and dole them out for their "designated smoking breaks."

Like we didn't have enough to do already......

[Nurse Ratched, RN]

If patients leave cigs when they're discharged they go into the kitty for any patient. Our policy is: we don't purchase cigs. *IF* we happen to have unit cigs, they will be doled out one per hour for pt's who don't have them, but no more than ten cigs during the admission. Pt needs to have someone bring them in if they want them.

There are new city and county ordinances prohibiting smoking that include the hospital (we having smoking rooms on our adult psych units), and I have questioned this as high as possible in-house, and we apparently intent to continue to violate the law. I've been debating whether to report this to the appropriate enforcement folks. I appreciate the thing with schiz pt's benefitting from nic, but as far as our folks with addictions, the mere fact that we have smoking causes WAY more trouble than it's worth.

[USA987, MSN, RN, NP]

I worked in a LT Psych facility. The facility purchased enough cigs for each pt. who smoked to have 6 cigs/day. That money was taken out of their disability or whatever it is that they got. If they wanted to smoke more than that, they had to get it from an outside source, but still they could only smoke at those 6 designated times....

[CoffeeRTC, BSN, RN]

In our LTC facility our psych pts do seem less anxious if allowed to smoke. The thing that bothers me is that we have to keep them locked up in med room (along with lighters) and have to give them out to res one at a time. Yah, like I have the time to fetch cigs:( while passing meds and assessing 26 other folks. Yah and I really love it when I just had to give one woman her prn nebulizer treatment "now" then when she finishes....out side to smoke. Ugggh!

As far as where they come from... they have to purchase their own smokes... any left behind are given out to the others when they run out. Sometimes staff will buy some for the res. just to keep some of them less agitated and easier to deal with. This I don't like either..

[marcieg]

I managed group homes for severely mentally ill pts. (mostly schizophrenics) and it was rare to have a pt. of any diagnosis that didn't smoke. We usually kept some on hand, much easier to keep a carton than deal with a violent outburst. (Sometimes behavior plans aren't the most practical solution) I can't remember how they reimbursed us, they probably didn't. They also could only smoke one an hour between 6a to 11p. Sometimes this was the only way to get them up for meds. (Oh, btw, I am not a nurse yet, but these guys convinced me that I would like to try to be a psych RN)

[olol765]

At my facility as well we gave our patients 6 cigarettes a day. If pts were "good" some of the other staff would reward them with extra cigs. I did not approve of this and would explain to them why this was not good for our pts as well. I also refused to hand out cigs... it just didn't feel right!!!

[HJPenn]

At the facility I work at the whole campus is smoke-free. The pts. are given the choice of the patch or gum to control cravings.

Heather