Addressing the arguments against implementation of smoke‐free policies in psychiatric facilities

Thomas, Mathew; Richmond, Robyn

doi:10.1111/jpm.12383

Cited by 8 publications

(10 citation statements)

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“…Further work is needed to understand if these results are likely to be the same for other Trusts implementing this important policy change that is needed to improve the mental and physical health of people using mental health services. Smoke-free policies challenge the culture in mental health units, [20][21][22][23] but the financial pressure involved should not derail the ambition to be smoke free because it is consistent with national policy and is of significant benefit to people with a mental health disorder. 18…”

Section: Discussionmentioning

confidence: 99%

Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users

et al. 2018

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Aims and methodThe increased rates of smoking in people with mental illness is well documented, and establishing smoke-free mental health environments has been emphasised over recent years. This article examines the financial costs of implementing smoke free guidance and assesses the cost associated with patients who were prescribed clozapine and who committed to stopping smoking cigarettes for the duration of the study period.ResultsPatients (38) who were prescribed clozapine were included in the study. A moderate reduction in dose was noted with a moderate reduction in prescribing costs. The total increase in cost for the whole group, however, was £17 624, largely due to the use of nicotine replacement therapy and an increase in the number of clozapine assay tests.Clinical implicationsFurther studies on implementing this important policy change are needed. The positive effects must be balanced with increased financial pressure on Mental Health Trusts.Declarations of interestNone.

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Section: Discussionmentioning

confidence: 99%

Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users

et al. 2018

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“…There is however evidence for mixed support for smoke-free policies in some NHS settings (e.g. psychiatric services) [ 12 ]. Internationally, countries report mixed results after implementing smokefree policies within hospital settings.…”

Section: Introductionmentioning

confidence: 99%

The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study

Crosby

Bell

Savva³

et al. 2018

BMC Public Health

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BackgroundSmoking is a cause of avoidable morbidity and mortality. In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. There is a perception it has led to smokers congregating around hospital entrances (Selbie D. 2016, It’s time for a truly smokefree NHS. Public Health Matters Blog. Public Health England). Efforts to shift social norms and create positive smokefree environments might be strengthened by delivering social norms messages. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances.MethodRepeated cross sectional study design. Staff, patients, and hospital visitors at Pinderfields National Health Service (NHS) Hospital (Wakefield, United Kingdom (UK)) completed a survey before and after implementation of a public health social norms campaign (n = 481 surveyed before; n = 459 surveyed after). The main outcome measure was difference between perceived and reported levels of support for smokefree hospital entrances.ResultsThere were high levels of support for smokefree hospital entrances. The majority of participants agreed that patients (n = 849, 90% agreed), staff (n = 863, 92% agreed), and visitors (n = 850, 90% agreed) should not smoke in the hospital entrance.Participants underestimated the proportion of others who self-reported keeping the entrance smokefree. Over 90% of respondents reported not smoking in the hospital entrance, but the perception was that between 50 to 75% of hospital staff, patients, and visitors did not smoke in the hospital entrance.The mean percentage of hospital staff, patients, and visitors who respondents thought did not smoke in entrances was higher for respondents responding after, compared to those responding before, the campaign. There was an overall significant effect of time on attitudes towards smoking in the entrances; in all instances the mean percentage of hospital staff, patients, and visitors the participants believed agreed that hospital entrances should be smokefree was higher for those responding after, compared with before, the campaign.ConclusionsPeople hold misperceptions of the proportion of people who choose to smoke in the hospital entrance. The social norms approach campaign was associated with a strengthening of positive social norms. Such campaigns should be considered by Trusts as one evidence-based based tactic to denormalise smoking, increase support for smokefree policies.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6231-x) contains supplementary material, which is available to authorized users.

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“…Unfortunately, recent research demonstrated that levels of NRT received by patients on psychiatric units are often suboptimal; additionally, psychiatric RNs reported that they did not have enough training to provide these medications in an effective manner (Thomas & Richmond, ). Thomas and Richmond () called for the implementation of staff training for managing tobacco dependence among psychiatric inpatients. The clinical guideline published by the United States Department of Health and Human Services (USDHHS, ) offers one of the most recent sets of recommendations for NRT use.…”

Section: Introductionmentioning

confidence: 99%

“…Ideally, nurses educate patients about tobacco withdrawal and options available to treat it, while patients exercise these options in ways that are most effective for them. Unfortunately, recent research demonstrated that levels of NRT received by patients on psychiatric units are often suboptimal; additionally, psychiatric RNs reported that they did not have enough training to provide these medications in an effective manner (Thomas & Richmond, 2017). Thomas and Richmond (2017) Evidence has demonstrated that higher-dose nicotine patches, gum and lozenges are the most efficacious for highly dependent patients; a combination of NRT products may be particularly helpful for this population (USDHHS, 2008).…”

Section: Introductionmentioning

confidence: 99%

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study

Muladore

Brown

Haefner

et al. 2018

Psychiatric Ment Health Nurs

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Introduction Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre-intervention and post-intervention patient groups were conducted to explore the outcomes of the intervention. Results Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre-intervention and post-intervention patient groups were found. Discussion Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long-term practice changes. Implications for practice This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted.

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Addressing the arguments against implementation of smoke‐free policies in psychiatric facilities

Cited by 8 publications

References 89 publications

Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users

Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users

The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study

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