Paper
Saturday, July 14, 2007
The Banning of Tobacco Use on Inpatient Psychiatric Units: Patient and Staff Outcomes
Christine A. Wynd, RN, PhD, CNAA, College of Nursing, The University of Akron, Akron, OH, USA
| Learning Objective #1: 1. Discuss implications of establishing a tobacco-free policy on an inpatient psychiatric unit. |
| Learning Objective #2: 2. Evaluate the use of the Transtheoretical Model for smoking behavioral change with inpatient psychiatric patients. |
This descriptive study was designed to examine outcomes of a tobacco-free policy recently instituted on an inpatient psychiatric hospital unit in the U.S. Data were collected before and after policy implementation and the Transtheoretical Model of Change (TTM) served as an organizing framework. Twenty-seven staff members participated in six focus groups examining staff perceptions and predictions about patient behaviors before and after policy implementation. Focus group data were qualitatively analyzed using content analysis with identification of patterns and themes from the transcribed audiotaped data. Pre-policy themes reflected staff beliefs about possible outcomes from the policy such as increased patient agitation and greater needs for PRN medications, as well as concerns for safety issues. Post-policy focus groups discussed actual outcomes resulting from the policy including fewer power struggles and conflicts between patients and staff, less patient agitation, but an increase in smuggling of cigarettes and smoking paraphernalia. Seventy patients participated in data collection regarding tobacco dependence, anger, anxiety, depression, and the TTM variables including stages of change, pros and cons of smoking, self-efficacy/temptation to smoke, and processes of change. Sixty-seven percent of the patients were in the precontemplation stage for changing smoking behavior and positive beliefs about smoking outweighed negative beliefs; however, the greatest process of change for these patients focused on knowledge of smoking as socially unacceptable; therefore the tobacco ban policy represented an influential factor encouraging potential smoking reduction. Differences in study variables before and after implementation of the tobacco-free policy were analyzed using t-tests, and relationships among study variables were analyzed through Pearson Product Moment correlations. Study findings will be used to encourage smoking bans in other hospitals, and research is currently being designed to evaluate smoking cessation interventions with psychiatric patients based on the TTM.