A qualitative investigation of smoke-free policies on hospital property

Abstract

Background: Many hospitals have adopted smoke-free policies on their property. We examined the consequences of such polices at two Canadian tertiary acute-care hospitals. Methods:We conducted a qualitative study using ethnographic techniques over a sixmonth period. Participants (n = 186) shared their perspectives on and experiences with tobacco dependence and managing the use of tobacco, as well as their impressions of the smoke-free policy. We interviewed inpatients individually from eight wards (n = 82), key policy-makers (n = 9) and support staff (n = 14) and held 16 focus groups with health care providers and ward staff (n = 81). We also reviewed ward documents relating to tobacco dependence and looked at smoking-related activities on hospital property. Results:Noncompliance with the policy and exposure to secondhand smoke were ongoing concerns. Peoples' impressions of the use of tobacco varied, including divergent opinions as to whether such use was a bad habit or an addiction. Treatment for tobacco dependence and the management of symptoms of withdrawal were offered inconsistently. Participants voiced concerns over patient safety and leaving the ward to smoke.Interpretation: Policies mandating smoke-free hospital property have important consequences beyond noncompliance, including concerns over patient safety and disruptions to care. Without adequately available and accessible support for withdrawal from tobacco, patients will continue to face personal risk when they leave hospital property to smoke. AbstractSee related commentary by Lawn at www.cmaj.ca/lookup

Are Canadian hospitals leading by example to promote smoke-free hospital properties? Rationale, challenges and opportunities

“…Yet reassuringly, many concerns prior to smokefree policy implementation have not come to fruition after implementation. [16,17,22,25] Compliance by staff, patients and visitors is one of the biggest challenges identified with a smoke-free property policy; [17,20] however, concerns of such policies go beyond compliance issues to include leadership (or lack thereof), fears of negative public and staff perceptions, safety concerns and issues related to patient care, [23] which will all be discussed here.…”

“…[19,23,24] There are many proposed explanations for this, including inadequate tobacco dependence treatment for patients and staff, inconsistent enforcement, lack of clear guidance for staff and DSA's that send mixed messages to stakeholders. [19,23] In order to truly understand the issue of compliance, hospitals that have smoke-free property policies and those that have "comprehensive" smoke-free property policies first need to be differentiated. Many hospitals report they do have policies in place, but are lacking the critical infrastructure and systems needed for compliance.…”

“…[20] 3.4 Safety concerns From a safety perspective, patients leaving the unit and property to smoke garners concerns by administrators and staff, as well as the patients themselves. [16,17,19,23,28] While smokefree property policies do protect individuals from exposure to ETS, they do not provide safety for those that choose to leave the unit or property to smoke, often alone. [28] Limited mobility and/or being connected to medical equipment, also contribute to these concerns.…”

“…[28] Limited mobility and/or being connected to medical equipment, also contribute to these concerns. [19,23] Some patients who feel the obstacles for leaving are too challenging then smoke in unauthorized areas within and outside of the hospital, which also raises additional safety concerns. [19,23] In colder climates, such as in Canada, additional worries emerge around patients not being properly dressed for the cold and the potential performance issues of medical equipment, such as IV lines and pumps.…”

“…[19,23] Some patients who feel the obstacles for leaving are too challenging then smoke in unauthorized areas within and outside of the hospital, which also raises additional safety concerns. [19,23] In colder climates, such as in Canada, additional worries emerge around patients not being properly dressed for the cold and the potential performance issues of medical equipment, such as IV lines and pumps. [19,23] Leaving against medical advice waivers have been used by many hospitals to address the issue of safety; however, in a study conducted by Schultz et al, [23] a qualitative investigation of smoke-free policies on hospital property, found these were used inconsistently.…”