Obviously we have the smoking ban in place but are finding it hard to cope with on the ward. Patients have e-cigarettes a their disposal and use these well. There is no issue with patients that have unescorted leave as they are able to go for a cigarette whenever they want. However, patients with escorted leave need staff to take them out for a cigarette. As a team we are aware that we should no longer be escorting out for cigarettes but due to the majority of incidents revolving around patient inability to smoke, we do escort out and have put in place set times when we will do this that the patients are aware of. The issue with this is that we are often short staffed and are unable to escort out at the set times which increases incidents. This also brings up the issue of leave for sectioned vs informal patients. Obviously it is easier to not escort a sectioned patient for a cigarette then an informal patient.
I'm trying to find an easier way to deal with this that suits both staff and patients (as much as possible), so anything that can be offered in terms of experience or research would be very helpful.
Thanks in advance.
There is great value in holistic wellness and approach to treatment. There is an inpatient addiction treatment program in Idaho called The Walker Center that has some success with implementing a no-smoking policy. They provide smoking cessation medications, patches, and lozenges. They do not allow gum, you may reach out to them for specifics.
A for me important person ended her smoking habit but what do I see on the inpatient ward? Yes, staff sitting in the sauna smoking together with the patients and leading the one who had stopped into new temptations. I felt so hurt.
Am J Psychiatry. 2006 Nov;163(11):1934-42.
A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder.
Baker A1, Richmond R, Haile M, Lewin TJ, Carr VJ, Taylor RL, Jansons S, Wilhelm K.
CONCLUSIONS:
These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions.
A piece of research was conducted at Rampton High Secure hospital several years ago (see https://pdfs.semanticscholar.org/4388/7b22c5fec9d3a04b081af3bb66d9b8d83d5f.pdf) which may be of some use. There has also been other research in non forensic settings (eg
https://search.proquest.com/openview/a94ad3fa330e02395f1509deff81272c/1?pq-origsite=gscholar&cbl=35532; Article Smoking Bans in Psychiatric Inpatient Settings? A Review of ...
;Article Smoke-free policy in acute mental health wards: Avoiding the pitfalls
; https://www.bmj.com/content/357/bmj.j2952) and into the impact of unit / unit manager on implementation (egArticle Type of unit and population served matters when implementing...
).Hopefully there will be something of use in there . . . planning and careful implementation seem to be key features. Some units also manage / restrict access to caffeine because of eg interactions with medications; possible substance misuse paralleling behaviour. Similarly - planning and clear policy / practice seems to be key to success.
Here is the results of the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. I think it is helpful.
Reference: Lawn s et.al. Smoking Bans in Psychiatric Inpatient Settings? A Review of the Research
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