Mental Health Acute Wards

[wnoise]

Dear colleagues!

I would like to contact nurses working in Mental Health Acute Wards (all over the world) where smoking is forbidden.

In Spain, smoking in Mental Health Acute Units is allowed by law. I am working in an article about Ethics and smoking.

Thanks a lot for your help in advance,:)

Note: I apologise for my English.

Wnoise

[goettin98]

Our hospital is entirely smoke-free. If the patient wants a nicotine patch, the doctor has to write an order. If the staff thinks the patient has tobacco or a lighter on them (and they usually do), but refuses to give it up and we can't find it during room check, we have security come up and shake them down. In my state, all public places are smoke-free, and that also includes inside jails/prisons.

[StuPer]

i work in an acute mental health hospital and we allow patients to smoke.

one of the reasons is because if you give meds to psych patients and they are not smoking while on the unit and the med is successful one gets the impression that the dose of med is effective. in all reality most patients start smoking as soon as they are discharged [often lighting up while walking out the door]. nicotine effects drug metabolism and the dose that was effective while in the hosp is no longer effective on the outside because the pt is smoking. often times the pt then discontinues the med because it's not working like it did in the hosp which in actuality is due to the false impression from the non-smoking policy.

i have worked in both smoking and non-smoking facilities and find that there is less relapse due to noncompliance with ineffective meds when the pts are allowed to smoke.

just my two cents worth.

this is an absolutely brilliant point, i had forgotten to mention in my response, without diggin up the research i think i'm accurate in saying both lithium and clozapine metabolism is affected by nicotine levels. if we initiate a therapy based on unrealistic levels of nicotine in a patients system, we are potientially exposing them to toxic or sub-theraputic levels once they return home... something that may open up an avenue for litigation should an adverse event occur.

stuper

[elkpark]

This is an absolutely brilliant point, I had forgotten to mention in my response, without diggin up the research I think I'm accurate in saying both Lithium and Clozapine metabolism is affected by nicotine levels. If we initiate a therapy based on unrealistic levels of nicotine in a patients system, we are potientially exposing them to toxic or sub-theraputic levels once they return home... something that may open up an avenue for litigation should an adverse event occur.

StuPer

Again, I don't think anyone here is talking about suddenly cutting people off from all nicotine. In every unit I've seen that has gone this route, all "smoker" clients get a daily nicotine patch pretty much automatically. So, they're still getting daily nicotine -- it may not be exactly the same amount of nicotine they would have in their systems if they were at home at free to smoke at will, but the same was true when smoking was permitted and there were a set number of "smoke breaks" during the day, and I don't recall (yes, I lived through the transition from just letting people smoke freely on the unit all day to limited numbers of smoke breaks, too :)) anyone making the argument at that time that it would be a bad idea because of concerns about medication metabolism ...

I don't see that as a valid reason to continue to allow people to smoke in psych settings.