Psychiatric nurses’ ethical stance on cigarette smoking by patients: Determinants and dilemmas in their role in supporting cessation

Abstract

It has been argued that psychiatric nurses are ideally placed to provide smoking cessation interventions to patients with mental illness. This assumes that psychiatric nurses actively support smoking cessation. The current paper articulates some of the reasons why this has not occurred, in particular, some of the ethical beliefs held by nurses that may prevent such activity. Such an assumption also discounts the evidence that confirms psychiatric nurses to have among the highest smoking rates in nursing and in the health professions in general. The role and impact of the institution are also considered. In-depth interviews with seven community and inpatient psychiatric nurses were thematically analysed. Extensive individual and group discussions were also held with inpatient nurses from open and locked psychiatric settings during participant observation of the settings. The findings suggest that psychiatric nurses can be more effective in the primary care role of supporting patients' smoking cessation if they receive adequate institutional support to do so.

Cigarette Smoking, Nicotine Dependence, and Motivation for Smoking Cessation in Psychiatric Inpatients

“…Historically, many psychiatric facilities may have unintentionally promoted smoking, using cigarettes to manage conflicts and modify behaviour through an implicit or explicit token economy, with some staff reportedly viewing smoking restriction as undermining patients' autonomy. 65,66 It has been hypothesized that psychiatric institutionalization may teach patients to self-medicate with smoking, and can even encourage smoking in nonsmokers. 65,67 Keeping this in mind, the frequency of smoking cessation advice reported in our study may reflect improvement and a shift in attitudes.…”

Mental health professionals’ perspectives on the implementation of smoke-free policies in psychiatric units across England

“…However, smoking cessation was generally not perceived by staff as a treatment priority and some staff still perceived smoking as an acceptable cultural norm for patients (Dickens, et al, 2004;Lawn, & Condon, 2006;Green, & Hawranik, 2007). Therefore, how mental health professionals deliver their own beliefs, values and knowledge to patients is important.…”

Psychiatric nurses’ knowledge and practices towards patients’ tobacco-related habits in Mental Health Hospitals in Greece in the face of the upcoming psychiatric care reform

“…The majority of nurses felt capable to organize a seminar on tobacco cessation and to help their patient quit smoking despite their own smoking habits 12 . This is very important knowing that psychiatric patients are among those with the greater risk of suffering from diseases and of premature death as a consequence of their smoking behavior [20][21] . Nurses expressed various concerns related to smoke-free policy implementation in mental health settings especially with regard to psychiatric patients, a finding also evident in other studies 22 .…”

“…Nurses' comments revealed that they believe smoking to be the right of the patient. The patient should decide by himself about smoking cessation and nurses' responsibility should be limited in providing information to the patient on what a cessation plan means as well as providing assistance to make a quit attempt 21 . Only 24.2% of nurses reported the existence of a smoking room inside their hospital, mainly a nurses' room or patient's lounge.…”