I am a nursing student in the last semester of my nursing program and I am currently in my psychiatric rotation at a (locked) long-term inpatient facility with 210 beds. Most patients have schizophrenia, major depression, bipolar disorder, or a combination of a few disorders. Since this is my only experience with this type of environment, I wanted to ask if the following two practices this facility allows are commonplace in most long-term inpatient psych facilities:
1. They can have sex with each other at the facility
The sex concerns me because what happens in the event that a female becomes pregnant. The women here are not capable of taking care of themselves, so, who would take care of the baby?
Another issue with the sex is how can it be assured that people aren't getting taken advantage of. Since these individuals are not thinking clearly at times, can they really consent to sex?
2. They are provided cigarettes by the staff and can smoke INSIDE the building during frequent smoke breaks throughout the day (in the common areas)
The smoking inside is a hazard to everyone in the facility, why would a health care facility agree with this? My instructor keeps saying, "it is their right to smoke." I keep thinking, isn't it the right of the non-smoking residents (doesn't seem to be many of these) and staff (doesn't seem to be many of these either) to have a smoke free environment?
Most of the residents are on Medicaid, why would Medicaid pay for these individuals to smoke? I would understand if they provided them with patches or gum, but cigarettes?
*I should mention I live in a state that does not allow smoking in restaurants or bars. So, it seems really strange to me that a health care facility would be exempt from this law.
My son suffered a traumatic brain injury. Even when he was oriented x0 he wanted a cigarette and badgered the nurses and everyone else constantly for a smoke.
I am sorry to hear about your son's injury.
That is interesting that he still requested cigarettes in his condition. Nicotine is powerful stuff.
Short story: My mom is a nurse. Back in the '70s, she and another nurse helped a patient smoke a cigarette. He was unable to hold it himself, so, my mom held it for him. I think this was a one time occurrence but I bet a lot of patients would have liked her as their nurse.
I realize I shouldn't have just assumed the cigarettes were all coming from Medicaid. I'm not exactly sure how they pay for them but I will find out next week. Thanks for your input! :)
What I am saying is that it is erroneous to assume that just because Medicaid is paying for health services, that a patient has no other source of income. Consider the low-wage earner, who works possibly even full-time, but is still eligible for Medicaid.
Many of your patients will likely be getting social security or other disability benefit payments. These are separate from Medicaid, and are the patient's income. The funds are theirs to do whatever they wish.
What I am saying is that it is erroneous to assume that just because Medicaid is paying for health services, that a patient has no other source of income. Consider the low-wage earner, who works possibly even full-time, but is still eligible for Medicaid.
Many of your patients will likely be getting social security or other disability benefit payments. These are separate from Medicaid, and are the patient's income. The funds are theirs to do whatever they wish.
I understand and agree with what you are saying.
I updated my post:
"I realize I shouldn't have just assumed the cigarettes were all coming from Medicaid. I'm not exactly sure how they pay for them and most likely never will."
The site where I did my psych rotation encouraged residents to contact the local smoking cessation service on their own. I could see how that encouraged independence and respected autonomy.
Smoking in a psych facility ...along with endless cups of tea used to be standard for patients and staff! Seriously, whilst I appreciate the detrimental health impact of smoking, many chronically psychiatric patients have little else to enjoy... nicotine patches do not curb the ritual of lighting, smoking and even sharing a cigarette, whether it be inside or out doors.
I often wonder about the behavioral health unit attached to the hospital where I work, which prohibits smoking everywhere on the premises... a lot of nicotine patches must be prescribed!
In terms of sexual relations, if this this a long term care facility and residents are engaged in intimacy, I think it is entirely appropriate to discuss birth control with the patients and MDs.
Hmmm...I've had clinical rounds at a few psych facilities and I've never seen nor heard of sexual relations between patients being permitted...not saying it NEVER happened, but it wasn't permitted.
Now, the smoking issue on the other hand, I've seen both sides of this coin recently. One of the facilites we rotate through still has a smoking room for the patients and has designated smoking times. The entire hospital campus is smoke free except this one tiny little room on the psych unit. The issue has been raised by the management many times, and, believe it or not, the nursing staff and social workers are the ones who adamantly oppose getting rid of the room! The other faciltiy I've rotated through does not allow smoking at all...even outside. They provide patients with patches if they wish to have them.
That being said, in my opinion, I believe that the unit that ALLOWS smoking has the most unrest amongst the patients...they are constantly worrying and fretting about that smoke break. The patients on the unit that doesn't allow smoking know they can't have a cigarette, so it kind of seems to be off their minds for the most part. Plus, they have the patch to help with the nicotene cravings.
I don't really see how any health care facility can condone smoking within the facility walls. We are there to promote HEALTH. I understand that it may be home to some, but there are a lot of comforts of home that can't be "enjoyed" in a health care facility...consuming alcohol, coming and going as you please, etc...because they are unsafe. Smoking is unsafe as well.
Specializes in Medsurg, Homecare, Infusion, Psych/Detox.
I think a facility that allow the mentally ill to have sex, do so at its own legal peril. Some pts are very manipulative, its what they know and have done all their life. some of the mentally ill are really not mentally ill, but are malingers who were successful at fooling a psychiatrist into diagnosing them, so they can collect for life. Some may have a disease and knowingly spread it. Some pts are very naive and may have mild MR. Some pts are very promiscuos and are always on the prowl...and on and on
In 2010 do we even need to still fight for the right to a smoke free work place! When employees are subjected and exposed to harmful chemicals in the work place, like secondhand smoke, then cigarettes and all its known carcinogens should be listed in the MSDS at that facility.
Getting people to quit is near impossible. Cigarettes are a vice to them. Some of them have absolutely no interest in quitting. There is also an inherent risk of fire when pts are allowed to smoke.
Should patients be forced to quit smoking? Maybe not. But, should staff and residents who are nonsmokers have to be exposed to harmful carcinogens? NO! Smoke outside.
As for sex between residents.. How would staff determine whether relationships are consensual or not? And the OP brings up a very valid point about the risk of pregnancy. I wonder what the protocol for that would even be?
Specializes in Med/Surge, Psych, LTC, Home Health.
Wow! Never seen either of those policies at any facility that I have ever worked! At both psych facilities that I have worked, patients have been able to smoke outside in a courtyard area. My current facility is not "smoke free" and I do hope it never becomes such. I honestly don't feel like it is beneficial to make many psych patients stop smoking while they are hospitalized... well, adult patients anyway.
And as far as the sex... that blows my mind. Who thinks this is a good idea???
noyesno, MSN, APRN, NP
834 Posts
I am sorry to hear about your son's injury.
That is interesting that he still requested cigarettes in his condition. Nicotine is powerful stuff.
Short story: My mom is a nurse. Back in the '70s, she and another nurse helped a patient smoke a cigarette. He was unable to hold it himself, so, my mom held it for him. I think this was a one time occurrence but I bet a lot of patients would have liked her as their nurse.