Factors Associated With Success of Smoke-Free Initiatives in Australian Psychiatric Inpatient Units (original) (raw)
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Mental Health and Addiction Research
Objective: to describe psychiatrists' views regarding implementation of smoke free policies in inpatient units, the acceptability and perceived helpfulness of a clinical pathway, and the frequency of provision and acceptability of various interventions. Method: Sequential mixed-methods combining a questionnaire based survey with interviews with 43 psychiatrists working in two services in Queensland, Australia. Data were analysed descriptively and thematically. Results: Psychiatrists agree that they have responsibility to assess smoking, encourage quitting and optimise management of nicotine withdrawal during admissions. Uncertainty remains about the rationale for 'smoke free', however. Psychiatrists express concern about 'rights' of patients and others, paternalistic restriction of choice and their roles as agents of government, rather than health professionals. Most psychiatrists assess smoking informally, with intervention titrated to perceived motivation to quit. The manner in which conversations are approached and interventions are offered is critical to engagement of patients. Conclusions: Psychiatrists are overcoming longstanding ambivalence and therapeutic nihilism that have hindered integration of management of smoking in clinical care. Sustained improvement will depend on frank engagement with lingering concerns, careful management of the 'unintended' consequences of smoke-free policies and ensuring that clinicians are resources appropriately.
The International journal of social psychiatry, 2014
The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types. Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care. Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as ...
Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research
International Journal of Environmental Research and Public Health, 2013
The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders' continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to
Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy
BMC Psychiatry, 2014
Background: People with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental health facilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental health facilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental health facility with a smoke-free policy.
Background: The Smoke-free Policy represents a challenge in mental health services. Aim: To compare the stages of a smoke-free policy in a psychiatric hospital, according to the prevalence of smokers, hospital admission acceptance by hospitalized people, psychiatric complications, and the prescription of psychotropic drugs. Methods: Cross-sectional study was conducted with a comparison before and after implementing the Smoke-free Policy in a psychiatric hospital. Secondary data were obtained in 2020 from the medical records of 573 discharged people from psychiatric hospitalizations between September 2017 and August 2018. Fisher's exact test and the Kruskal-Wallis test were applied. Results: In the transition stage, there were more hospitalizations by court order, discharge motivated by the patient's disruptiveness behavior, administration of psychotropic drugs before the schedule time, physical aggression, physical/chemical restraints, length of stay, and dosage of psychotropic drugs. After the ban, there was a reduction in discharges motivated by the patient's disruptiveness behavior and an increase in discharge due to improvement in psychiatric symptoms, less occurrence of anticipation or modification in the use of psychotropic drugs, and fewer attempts to escape, aggressiveness, and physical restraint. Conclusion: The implementation of the Smoke-free Policy has a positive impact on psychiatric hospitalizations, with an increase in discharge due to improvement in psychiatric symptoms and a reduction in discharges due to other reasons. However, the transition stage requires greater attention from the nursing team, as the moment of adaptation to new rules and routines is followed by a momentary worsened behavior of those hospitalized.
The International Journal of Qualitative Methods, 2013
The reasons for the persistently high prevalence rate of smoking among people living with severe and persistent mental illness (SPMI) are complex and multifaceted, and tobacco control policies can be integral to influencing tobacco use among this population. In addition, secondhand smoke is responsible for serious illness, including heart disease and lung cancer, in otherwise healthy nonsmokers, and tobacco control policies are key to reducing these exposures (Ontario Tobacco Research Unit, 2001; U.S. Department of Health and Human Services, 2006). Smoke-free buildings can eliminate harmful exposure to secondhand smoke (U.S. Department of Health and Human Services, 2006). Health authorities in Canada extended smoke-free building policies to include surrounding grounds and introduced stringent tobacco-free grounds policies to further reduce these exposures (Kunyk, Els, Predy, & Haase, 2007; Parle, Parker, & Steeves, 2005). Implementing these policies can be particularly challenging in contexts in which health care is provided to people living with SPMI because of the complex social environment. The aim of this study was to describe how the implementation of a smoke-free grounds policy (SFGP) was affected by institutional cultures. Institutional cultures pertain "to the multiple aspects of what is shared among people within the same organization: for example, beliefs, values, norms of behavior, routines, traditions, sensemaking" (Parmelli et al., 2011, p. 2). In this article, we present the perspectives of health care professionals (HCPs), describing their underlying beliefs, norms, and the contexts that influence policy implementation. We also suggest some recommendations for applying the study findings to future policy implementation. Smoking and SPMI To understand better the study and our aims, some background on the relationships between smoking and SPMI is necessary. Smoking has been described as a cultural norm in psychiatric settings, and some authorities attribute the high rates of smoking among people with SPMI as influenced primarily by cultural factors (Crockford,