Implementation of Smoke free policies in psychiatric inpatient care: A mixed methods study of practices and views and of psychiatrists’ in an Australian mental health service (original) (raw)
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Factors Associated With Success of Smoke-Free Initiatives in Australian Psychiatric Inpatient Units
Psychiatric Services, 2010
Smoking is the largest cause of preventable illness in the United States, the United Kingdom, Canada, Australia, and many other countries. Smokers with mental illness smoke significantly more than those without mental illness and therefore experience even greater smoke-related harm. Internationally, there is increasing pressure on psychiatric inpatient settings to adopt smoke-free policies. This study examined smoke-free policies across psychiatric inpatient settings in Australia and thereby identified factors that may contribute to the success or failure of smoke-free initiatives in order to better inform best practice in this important area. Methods: Semistructured in-depth telephone interviews were conducted with 60 senior administrators and clinical staff with direct day-to-day experience with smoking activities in 99 adult psychiatric inpatient settings across Australia. Quantitative data were analyzed using descriptive statistical analysis and Pearson's chi square correlations measure of association. Results: Factors associated with greater success of smoke-free initiatives were clear, consistent, and visible leadership; cohesive teamwork; extensive training opportunities for clinical staff; fewer staff smokers; adequate planning time; effective use of nicotine replacement therapies; and consistent enforcement of a smoke-free policy. Conclusions: A smoke-free policy is possible within psychiatric inpatient settings, but a number of core interlinking features are important for success and ongoing sustainability. (Psychiatric Services 61:300-305, 2010)
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 ...
BMC Public Health, 2010
Background The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit. Methods Cross-sectional survey of both clinical and non-clinical staff in a large inpatient psychiatric hospital immediately prior to the implementation of a total smoking ban. Results Of the 300 staff, 183 (61%) responded. Seventy-three (41%) of total respondents were clinical staff, and 110 (92%) were non-clinical staff. More than two-thirds of staff agreed that a smoking ban would improve their work environment and conditions, help staff to stop smoking and improve patients' physical health. The most prevalent clinician perceived barriers to a successful total smoking ban related to fear of patient aggression (89%) and patient non-compliance (72%). Two thirds (67%) of all staff indicated support for a total smoking ban in mental health facilities generally, and a majority (54%) of clinical staff expressed support for a ban within their unit. Clinical staff who believed a smoking ban would help patients to stop smoking were more likely to support a smoking ban in their unit. Conclusions There is a clear need to more effectively communicate to staff the evidence that consistently applied smoking bans do not increase patient aggression. There is also a need to communicate the benefits of smoking bans in aiding the delivery of smoking cessation care, and the benefits of both smoking bans and such care in aiding patients to stop smoking.
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
Journal of Psychiatric and Mental Health Nursing, 2010
Accessible summary• The rates of smoking in mental health inpatient settings remains high. This study aims to describe the views of nurse managers in mental health inpatient settings regarding providing smoking-related care to patients, and whether these views are associated with the types of nicotine dependence treatment that is provided.• A survey was mailed to all public mental health inpatient units in New South Wales, Australia, to be completed by nurse managers.• Factors that impact on patients were considered to have a high level of influence on the type of nicotine dependence treatment provided. Many nurse managers said they provided smoking care if the patient requested assistance to quit (58%), and if the patient's health improved with quitting (45%).• Nurse managers who thought that nicotine dependence treatment was as important as other roles were more likely to provide smoking care compared with units whose manager did not hold this view.• While the results indicate strong support for providing nicotine dependence treatment, this support depends on patient readiness to quit, suggesting care is provided selectively rather than routinely. Encouraging a view of smoking as an addiction requiring treatment may increase the likelihood of nicotine dependence treatment being provided in mental health inpatient settings.• The rates of smoking in mental health inpatient settings remains high. This study aims to describe the views of nurse managers in mental health inpatient settings regarding providing smoking-related care to patients, and whether these views are associated with the types of nicotine dependence treatment that is provided.• A survey was mailed to all public mental health inpatient units in New South Wales, Australia, to be completed by nurse managers.• Factors that impact on patients were considered to have a high level of influence on the type of nicotine dependence treatment provided. Many nurse managers said they provided smoking care if the patient requested assistance to quit (58%), and if the patient's health improved with quitting (45%).• Nurse managers who thought that nicotine dependence treatment was as important as other roles were more likely to provide smoking care compared with units whose manager did not hold this view.• While the results indicate strong support for providing nicotine dependence treatment, this support depends on patient readiness to quit, suggesting care is provided selectively rather than routinely. Encouraging a view of smoking as an addiction requiring treatment may increase the likelihood of nicotine dependence treatment being provided in mental health inpatient settings.The rates of smoking in mental health inpatient settings remains high. This study aims to describe the views of nurse managers in mental health inpatient settings regarding providing smoking-related care to patients, and whether these views are associated with the types of nicotine dependence treatment that is provided.A survey was mailed to all public mental health inpatient units in New South Wales, Australia, to be completed by nurse managers.Factors that impact on patients were considered to have a high level of influence on the type of nicotine dependence treatment provided. Many nurse managers said they provided smoking care if the patient requested assistance to quit (58%), and if the patient's health improved with quitting (45%).Nurse managers who thought that nicotine dependence treatment was as important as other roles were more likely to provide smoking care compared with units whose manager did not hold this view.While the results indicate strong support for providing nicotine dependence treatment, this support depends on patient readiness to quit, suggesting care is provided selectively rather than routinely. Encouraging a view of smoking as an addiction requiring treatment may increase the likelihood of nicotine dependence treatment being provided in mental health inpatient settings.AbstractThe prevalence of smoking in psychiatric settings remains high. This study aims to describe the views of nurse managers in psychiatric inpatient settings regarding the provision of nicotine dependence treatment, and whether there were associations between such views and the provision of nicotine dependence treatment. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales, Australia, for completion by nurse managers. Of the identified 131 service units, 123 completed questionnaires were returned (94%). Patient-related factors were considered to have a high level of influence on the provision of nicotine dependence treatment: patients requesting assistance to quit (58%), patients being receptive to interventions (52%), and patient health improving with quitting (45%). Units where the respondent reported that nicotine dependence treatment was as important as other roles were more likely to provide nicotine dependence treatment compared to units whose respondents did not hold this view (OR = 0.257, d.f. = 1, P < 0.01). While the results indicate strong support for the provision of nicotine dependence treatment, this support appears qualified by perceived patient readiness to quit, suggesting care is provided selectively rather than systematically. Positioning smoking as an addiction requiring treatment within a traditional curative approach may lead to a health service more conducive to the routine provision of nicotine dependence treatment.The prevalence of smoking in psychiatric settings remains high. This study aims to describe the views of nurse managers in psychiatric inpatient settings regarding the provision of nicotine dependence treatment, and whether there were associations between such views and the provision of nicotine dependence treatment. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales, Australia, for completion by nurse managers. Of the identified 131 service units, 123 completed questionnaires were returned (94%). Patient-related factors were considered to have a high level of influence on the provision of nicotine dependence treatment: patients requesting assistance to quit (58%), patients being receptive to interventions (52%), and patient health improving with quitting (45%). Units where the respondent reported that nicotine dependence treatment was as important as other roles were more likely to provide nicotine dependence treatment compared to units whose respondents did not hold this view (OR = 0.257, d.f. = 1, P < 0.01). While the results indicate strong support for the provision of nicotine dependence treatment, this support appears qualified by perceived patient readiness to quit, suggesting care is provided selectively rather than systematically. Positioning smoking as an addiction requiring treatment within a traditional curative approach may lead to a health service more conducive to the routine provision of nicotine dependence treatment.