Smoking and mental health nurses: a survey of clinical staff in a psychiatric hospital

There is a lack of evidence on the prevalence of smoking among mental health nurses, and the beliefs and attitudes they hold about smoking at work. This paper describes results from a cross-sectional survey of clinical staff working in a UK specialist charitable-status psychiatric hospital and focuses on the responses of registered mental health nurses. Questionnaires specifically developed for this study were sent to all 1371 clinical employees. Completed questionnaires were returned by 167 of 429 (38.9%) registered nurses (RNs), 300 of 842 (35.6%) nursing assistants (NAs), and 123 of 200 (61.5%) other health professionals (OHPs). Twenty-nine (17.4%) RNs, 93 (31%) NAs and eight (6.5%) OHPs reported themselves as current smokers. Differences in response to attitudinal questions between groups could not be attributed to age. RN smokers were significantly more likely than RN non-smokers to state that staff should be allowed to smoke with patients, and to report therapeutic value for patients in this activity. RN smokers were less likely than RN non-smokers to report that patients should be encouraged to stop smoking. RNs were significantly more likely than OHPs to report therapeutic value for patients in smoking with staff, even after controlling for the possible confounding effect of smoking status. Implications of the survey are discussed in the context of the international literature, including the disproportionately high smoking prevalence among patients living in psychiatric institutions and current guidelines to move towards no 'smoking allowed' areas for staff working in them.     

Admission to a psychiatric unit and changes in tobacco smoking

Smoking and withdrawal from smoking complicates the assessment and treatment of mental illness. We aimed to establish whether psychiatric inpatients smoke different amounts after admission than beforehand and, if so, to find out why. Forty-three inpatients on a working age adult psychiatry ward completed self-report questionnaires about smoking habits. Those who smoked a different amount after admission had a follow-up interview to find out why they thought this had occurred. The interview incorporated qualitative and quantitative aspects which were analysed accordingly.Fifty-six percent of participants were smokers before admission, rising to 70% afterwards. Of the smokers, 17% smoked less after admission, and 63% smoked more. The average number of cigarettes smoked per person per day increased from five to thirteen. The main reasons for smoking more were boredom, stress and the wish to socialise.     

1286例住院患者医院控烟认知现状调查

目的了解广东省第二人民医院住院患者及对本院控烟认知情况,为本院制定科学合理的控烟策略提供依据。方法 2012年12月,采用自行设计的《住院患者吸烟及对医院控烟情况调查表》,对本院1 286例住院患者进行问卷调查。结果本院住院患者总吸烟率为40.70%,男、女性吸烟率分别为65.04%和5.87%;60.00%以上患者对烟草的危害认识错误;60.00%以上调查对象认为医院内应该设置吸烟区、对在非吸烟区吸烟者进行罚款是合理的、医院禁烟标志及宣传不够充分;38.58%的不吸烟者在院内曾暴露于二手烟;33.90%患者曾在医院内见过医务人员吸烟,16.56%的患者见过医务人员当着患者的面吸烟;67.32%患者见过医务人员劝阻他人在非吸烟区吸烟;17.81%的患者见过医务人员向患者宣传吸烟危害;88.02%的患者认为医务人员应该是拒绝吸烟的榜样。结论本院住院患者吸烟情况较为严重且对吸烟相关知识掌握较差;本院控烟效果有待提高,控烟措施有待加强;加强对本院医务人员进行控烟教育培训,降低医务人员吸烟率,发挥医务人员表率及示范作用。     

Satisfaction guaranteed? Forensic consumer satisfaction survey

Despite many people being forensically hospitalized worldwide, there is limited research reporting on their views of the care they receive. To describe consumer satisfaction and areas for improvement, we utilized our forensic psychiatric hospital's consumer survey. Eleven years of surveys, including a total of 541 surveys, were analysed both quantitatively and qualitatively. The majority of the forensic inpatients believed that their views were valued in their care and treatment. Most felt physically and emotionally safe at the hospital and believed that staff knew how to support them in times of distress. The majority felt that their culture and spirituality were respected. However, some areas for improvement were also noted, such as regarding staff attitudes. This consumer survey demonstrated a reasonably high level of satisfaction with forensic inpatient care, over the course of eleven years, despite this population of people being subject to lengthy hospitalisations. Satisfaction surveys of people in forensic inpatient units can be a regular part of forensic care and can help guide improvements in their care.     

Inpatient views and experiences before and after implementing a totally smoke‐free policy in the acute psychiatry hospital setting

In the present study, we examined the views and experiences of patients admitted to an acute psychiatry unit before and after the implementation of a totally smoke‐free policy. Forty‐six inpatients completed a questionnaire assessing their views before the smoking ban. Another 52 inpatients completed a questionnaire assessing their views and experiences after the smoking ban. Before the totally smoke‐free policy, 69.6% smoked, with 67.7% smoking more when admitted to the psychiatry ward. Before the smoking ban, 54.4% reported that the totally smoke‐free policy would be ‘negative’ or ‘very negative,’ and 30.5% said it would be ‘positive’ or ‘very positive.’ After the totally smoke‐free policy, 57.7% smoked heavily before hospital (mean cigarettes/day = 24.9), with consumption dramatically reducing following admission to a totally smoke‐free psychiatric unit (mean cigarettes/day = 8.3). After the totally smoke‐free policy, 36.5% reported that it was ‘negative’ or ‘very negative,’ and 50% reported that it was ‘positive’ or ‘very positive.’ Overall, inpatients reported improved acceptance of the policy following implementation. Inpatients stated that the most difficult thing about the smoking ban was experiencing increased negative emotions, while the most positive aspect was the improved physical environment of the ward. Inpatients who smoke must be appropriately supported using a range of strategies, and in the present study, we suggest relevant clinical implications.     

Staff representations and tobacco‐related practices in a psychiatric hospital with an indoor smoking ban

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well‐being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco‐related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke‐related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non‐smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.     

Smoking: rates and attitudes among nursing staff in central Sydney

The objectives of this study were to determine the prevalence and predictors of smoking and attitudes to smoking-related issues among nurses employed by the Central Sydney Area Health Service in Sydney, Australia. A self-administered questionnaire, was distributed via the internal mail system of the Central Sydney Area Health Service in November 1997 to 610 randomly selected nursing staff. Twenty-one per cent (n = 127) of respondents smoked. Smokers were significantly younger than non-smokers and were more likely to speak mainly English at home. There were clear differences between smokers and non-smokers in response to all attitude statements. Interventions specifically directed at nurses who smoke to assist them to stop and maintain cessation are indicated. Future health service workplace tobacco control programmes should address deficits in knowledge about the health effects of passive smoking, should raise awareness among nurses who smoke about their potential to affect the behaviours of others through modelling, and should provide all nurses with the skills required to be smoking educators and advocates for tobacco control.     

Ward atmosphere - the Scarlet Pimpernel of psychiatric settings?

Patients and staff in a forensic psychiatric setting were requested to name three distinguishing characteristics of the ward atmosphere. The manifest content analysis of the responses revealed the following categories: interpersonal relations and pre-conditions for interpersonal relations; organization; staff; treatment; daily activities; physical environment; and feeling good and secure. The patients appeared to have a peripheral role as contributors to the ward atmosphere in the views of the respondents. The easily administered single question format provided valuable information about an intangible element of psychiatric settings - the ward atmosphere.     

Unpacking disclosure: Interrupting unquestioned practices

Patients and staff in a forensic psychiatric setting were requested to name three distinguishing characteristics of the ward atmosphere. The manifest content analysis of the responses revealed the following categories: interpersonal relations and pre-conditions for interpersonal relations; organization; staff; treatment; daily activities; physical environment; and feeling good and secure. The patients appeared to have a peripheral role as contributors to the ward atmosphere in the views of the respondents. The easily administered single question format provided valuable information about an intangible element of psychiatric settings—the ward atmosphere.     

Implementation of a smoke‐free policy in an inpatient psychiatric facility: Patient‐reported adherence,support, and receipt of nicotine‐dependence treatment

The implementation of smoke‐free policies in inpatient psychiatric facilities, including patient adherence, mental health nursing staff support, and provision of nicotine‐dependence treatment to patients, has been reported to be poor. The extent to which the quality of smoke‐free policy implementation is associated with patient views of a policy is unknown. We conducted a cross‐sectional survey of 181 patients (53.6%, n = 97 smokers; and 46.4%, n = 84 non‐smokers) in an Australian inpatient psychiatric facility with a total smoke‐free policy. Smokers' adherence to the policy was poor (83.5% smoked). Only half (53.6%) perceived staff to be supportive of the policy. Most smokers used nicotine‐replacement therapy (75.3%); although few received optimal nicotine‐dependence treatment (19.6%). Overall, 45.9% of patients viewed the smoke‐free policy in the unit as positive (29.9% smokers; 64.3% non‐smokers). For smokers, adhering to the ban, perceiving staff to be supportive, and reporting that the nicotine‐replacement therapy reduced cravings to smoke were associated with a more positive view towards the smoke‐free policy. These findings support the importance of patient adherence, mental health nursing staff support, and adequate provision of nicotine‐dependence treatment in strengthening smoke‐free policy implementation in inpatient psychiatric settings.     

The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.     

Effect of an inpatient nurse-directed smoking cessation program

The purpose of this study was to evaluate the effect of a nurse-directed smoking cessation intervention for adults hospitalized in a small community hospital using a quasiexperimental, prospective, longitudinal design with biochemical validation of self-reported tobacco abstinence. Sixty-eight inpatients were assigned to either a control (n = 30) or an intervention group (n = 38). The control group received smoking cessation literature. The intervention group received smoking cessation literature and a nursing intervention. Each member of the intervention group was randomly assigned to a one or four telephone call subgroup for post discharge nurse follow-up at 3 months. Fifty-five participants completed the study. Smokers receiving the nurse-directed intervention were significantly more likely to be tobacco abstinent at 3 months (n = 17, 55%) than smokers in the control group (n = 5, 21%). Within the intervention group, tobacco abstinence at 3 months was not significantly different between the one and four telephone call groups. For the total sample, smoking relapse was significantly higher for participants who lived with another smoker.     

The Importance of Being Acceptable – Psychiatric Staffs’ Talk about Women Patients in Forensic Care

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff’s talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.     

吸烟和不吸烟急性心肌梗死患者住院期间焦虑、抑郁水平的比较

目的探讨吸烟和不吸烟的急性心肌梗死（AMI）患者在入住心脏监护室（CCU）期间压力水平的差异。方法选择在CCU住院的AMI患者74例,根据患者是否吸烟分为吸烟组（n=33）和不吸烟组（n=41）,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）调查患者的焦虑、抑郁状况。结果74例患者中有焦虑症状的占75．68％,有抑郁症状的占63．51％;吸烟组患者的SAS、SDS评分分别为（64．39±15．39）,（65．80±15．39）分,不吸烟组的SAS、SDS评分分别为（52．50±6．55）,（53．96±5．32）分;吸烟组焦虑、抑郁程度高于不吸烟组,差异均有统计学意义（t=4．15,4．87;P〈0．01）;且吸烟组重度焦虑、抑郁发生率较高。结论吸烟的AMI患者在人住CCU期间表现出更高的焦虑、抑郁水平,护理人员应给予重视,进行有针对性的干预。     

Age-related brain atrophy enhanced by smoking: a quantitative study with computed tomography

We examined the chronic effect of smoking on brain atrophy quantitatively with computed tomography (CT). Study was performed on 159 smokers and 194 non-smokers from 40 to 69 years old with neither neurological nor focal abnormality in brain CT. Brain atrophy index (BAI) which was a quantitative marker of brain atrophy reported previously, was calculated from each pixel of brain CT. There was a significant age dependent increase of BAI in both non-smokers and smokers. Smokers showed a significant increase in BAI (atrophic) compared to non-smokers in three age groups, 50-54, 55-59 (p less than 0.01, both) and 65-69 (p less than 0.05). In the male, the mean BAI became high when the smoking index increased (p less than 0.01). The systolic blood pressure and serum triglycerides of smokers were significantly higher than the non-smokers (p less than 0.05 and p less than 0.01). It was suggested that age-related brain atrophy was increased by chronic smoking through advanced atherosclerosis.     

Are Patients' Views on Seclusion Associated With Lack of Privacy in the Ward?

The lack of single-bed rooms in psychiatric wards may reduce the possibility of patients getting sufficient rest and privacy and may increase their risk of being overstimulated. This study explored whether residing in single- versus multiple-bed rooms in a psychiatric ward was associated with psychiatric patients' opinions about seclusion. More specifically, it was studied whether patients who had shared a room with other patients prior to seclusion rated seclusion more favorably. It was thought that they would rate seclusion more favorably due to the lack of rest they previously experienced in their regular room. For this, the Patient View-of-Seclusion Questionnaire of Hammill, McEvoy, Koral, and Schneider [Hammill, K., McEvoy, J., Koral, H., & Schneider, N. (1989). Hospitalized schizophrenic patient views about seclusion. Journal of Clinical Psychiatry, 50, 174-177] was completed by 54 secluded adult patients hospitalized in a locked ward of a Dutch psychiatric hospital. A significant association was found between residing in multiple-bed rooms prior to seclusion and a less negative view on seclusion. This finding suggests that the ward environment may have a rather large impact on how seclusion is perceived. The results underline the need for single-bed rooms in the treatment of psychiatric inpatients.     

Quantification of recent smoking behaviour using proton transfer reaction-mass spectrometry (PTR-MS)

Smoking is the most important single risk factor in current public health. Surveillance of exposure to tobacco smoke may be accomplished using environmental monitoring or in-vivo tests for smoking biomarkers. Acetonitrile exhaled in human breath has been described as a potential marker mirroring recent smoking behavior. The aim of this study was to determine exhaled acetonitrile levels in a sample of 268 volunteers (48 smokers, 220 non-smokers) attending a local health fair. Breath specimens were collected into inert sample bags, with parallel collection of ambient air. Subsequently, all samples were analysed using proton transfer reaction-mass spectrometry (PTR-MS). Smokers had elevated levels of exhaled acetonitrile compared with non-smokers (p<0.001). Analysis using the receiver-operating-characteristic curve demonstrated that smoking can be predicted with a sensitivity of 79% and a specificity of 91%, using a cut-off concentration of 20.31 parts per billion of acetonitrile. This first field survey of exhaled acetonitrile in a large group of test persons demonstrates the feasibility of a rapid and non-invasive test for recent exposure to tobacco. We conclude that analysis of exhaled-breath acetonitrile may serve as a method of determining recent active smoking behaviour.     

Smoking accelerates impairment of pulmonary function at high altitudes

This work aimed at studying annual impairment of pulmonary function in smokers and in subjects leaving off smoking under conditions of intermittent hypoxia at high altitudes. The prospective 4-year study included 449 smokers aged 38.1 +/- 8.0 yr (97.8% men) and 234 non-smokers aged 38.5 +/- 9.3 yr (65.8% men) employed by a gold-mining company. Subjects of group 1 underwent a decrease of lung vital capacity (LVC) and forced LVC at a rate of 49.5 and 70.7 ml/yr respectively. The forced expiratory volume in the first second decreased by 80 ml/yr. Smokers who left off smoking showed an increase of LVC by 79.8 ml compared with its decrease by 31.6 ml in those who continued to smoke (p < 0.01). It is concluded that smoking under conditions of intermittent hypoxia leads to progressive impairment of pulmonary function; the impairment slows down after leaving off smoking that should be encouraged in every possible way.     

Health risk behaviors in smoking and non-smoking young women

PURPOSE: To compare the health, health risk behaviors and stress levels of college female smokers and non-smokers. DATA SOURCES: Forty-one college women, ages 18-21 years, participated in an interview and completed a health survey and the Derogatis Stress Profile. CONCLUSIONS: The smokers perceived themselves to be more overweight (Chi square, p = < .001). Smokers used more marijuana (Chi square, p = < .003) and had higher scores on depression [t (39) = 2.29, p = .028], hostility [t (39) = 2.562, p = .014] and perceived quality of health [t (39) = 2.72, p = .01]. In the interview, smokers identified social situations involving alcohol as the time they would most likely smoke. Smokers did not smoke when ill and all were interested in quitting. The non-smoking women support smoking cessation for their peers. IMPLICATIONS FOR PRACTICE: College alcohol and substance use prevention and treatment programs should address tobacco cessation. The majority of college women are not smokers and could be resources to encourage smoking cessation among their peers. Smoking cessation at this age has dramatic implications for future health.