Going smoke-free on psych units

[Nurse Ratched]

I'm posting this in general nursing as I am interested in hearing from anyone who has knowledge of their facility's psych unit smoking policies.

Our city has recently passed a smoking ordinance that will prohibit smoking in public buildings after a certain date. We have smoking rooms on all three of our adult psych units and I presume we will need to shut our down after that date altho mgt has thus far been mum on it. I am interested in hearing about other facilities that have had their psych units go smoke-free for any reason.

I expect that this will cause a decline in the numbers of addictions admissions as many people would not even sign the voluntary admission form without knowing they could smoke. Those that do I expect wil have shorter lengths of stay and more requests for discharge signed.

We do not have access to a courtyard area for patients to smoke in, and none of the nurses are willing to take responsibility for walking a pt off the unit to smoke given the high probability of elopement.

[purplemania, BSN, RN]

From the news I gather that the reason tobacco co. are paying fines is due to the addictive power of their product. Can you treat a smoker as an addict???

[mattsmom81]

LOL...I remember an eery old Twilight Zone episode with James Woods...where he signed into a psych ward- type place to quit smoking...

Even in my acute care facility, patients still go into fits and leave AMA without their cigs (even with patches, gum, Xanax, etc) so I can see it may be a worse problem for psych. 'Course one of the reasons I stayed away from psych is cuz I have mild asthma...couldn't handle the smoke filled rooms.

I always wondered how the antismoking laws would effect this area of healthcare.

I know smoking rights is a big issue in LTC and staff MUST assist residents to smoke...it's considered their informed right to choose to smoke. There are even special devices for disabilities now I hear to hold and maneuver the cigarettes.

[Wolfpax]

Well... Ex-Pres Clinton singed the bill that prohibitted smoking in all government buildings... so we've been relatively smoke free for some time at the VA hospital...everyone of them has their own rules but on the acute admission unit I work on there is absolutely not smoking priviledges, in or out, they are offered nicotine patches while they are here but it has gotten to the point that our recidivists try to sneak in cigs, in their socks, under their armpits, in their underwear, under their hat...wherever they can and sell them to other vets for a buck a cig...(my personal opinion is that if you are desperate enough to smoke a cigarette that has bee sitting in someone's sweaty jock strap, by all means knock yourself out), but it is generally a struggle... you search for contraband in all the usual places but you feel like a prison guard when you know they've had them in all the wrong places... I'm not willing to go there...you do health and safety checks routinely, we have VA police on campus so sometimes they shake them down if it's getting rough, the acting out behavior gets unreal over a cigarette at times, matches and lighters wind up all over too... but for the most part... you don't smell smoke coming out of the rooms and most get over it after a few tantrums and try not to sneak.

[sanakruz, ADN]

There is actually a diagnosis in the DSM for several nicotine related disorders-292.0 is Nicotine Withdawal "...abrupt cessation of nicotine use....followed within 24 hours by four or more of the following signs:

dysphoric or depressed mood

insomnia

irritability frustration or anger

anxiety

difficulty concentrating

restlessness

decreased heart rate

increased appetite or weight gain

Our contracted facilities have MDs prescribe patches for adult pts. No it doesnt stop the craving alotogether.Yes contraband is a problem.The last impatient facility I worked at accomodated smokers with an outdoor patio. Most were not voluntary guests. Many eloped over the eight foot fence because the staff was unwilling to stand out in the midst of a 8x8 box filled with smoke.(mea culpa)

I feel its absurd to try to control what OTHER PEOPLE do and legislate behavioral norms. As a member of the minority on such issues I am able to appreciate that this is still a democracy in which we live, encourage the use of patches and be sympatetic to the clients while they wrestle with symptoms that are certainly co-occuring with whatever they are hospitalized for in the first place!!