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de Oliveira RM, Santos JLF, Furegato ARF. Stages of the Smoke-Free Policy Implementation in a Psychiatric Hospital: Evolution, Effects, and Complications. Issues Ment Health Nurs 2022; 43:1136-1144. [PMID: 36227892 DOI: 10.1080/01612840.2022.2132328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The Smoke-free Policy represents a challenge in mental health services. Aim: To compare the stages of a smoke-free policy in a psychiatric hospital, according to the prevalence of smokers, hospital admission acceptance by hospitalized people, psychiatric complications, and the prescription of psychotropic drugs. Methods: Cross-sectional study was conducted with a comparison before and after implementing the Smoke-free Policy in a psychiatric hospital. Secondary data were obtained in 2020 from the medical records of 573 discharged people from psychiatric hospitalizations between September 2017 and August 2018. Fisher's exact test and the Kruskal-Wallis test were applied. Results: In the transition stage, there were more hospitalizations by court order, discharge motivated by the patient's disruptiveness behavior, administration of psychotropic drugs before the schedule time, physical aggression, physical/chemical restraints, length of stay, and dosage of psychotropic drugs. After the ban, there was a reduction in discharges motivated by the patient's disruptiveness behavior and an increase in discharge due to improvement in psychiatric symptoms, less occurrence of anticipation or modification in the use of psychotropic drugs, and fewer attempts to escape, aggressiveness, and physical restraint. Conclusion: The implementation of the Smoke-free Policy has a positive impact on psychiatric hospitalizations, with an increase in discharge due to improvement in psychiatric symptoms and a reduction in discharges due to other reasons. However, the transition stage requires greater attention from the nursing team, as the moment of adaptation to new rules and routines is followed by a momentary worsened behavior of those hospitalized.
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Oliveira RMD, Santos JLF, Furegato ARF. Indicadores hospitalarios y comportamiento de pacientes internados en hospital psiquiátrico que adoptó la prohibición de fumar. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5666.3610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: comparar indicadores de internación, alta, costo con medicamentos y comportamientos de los pacientes antes y después de la prohibición del tabaquismo en un hospital psiquiátrico. Método: estudio ecológico, longitudinal y retrospectivo realizado en un hospital psiquiátrico. Fueron obtenidos datos secundarios, a partir de consulta a las fichas médicas, referentes a 2.142 internaciones. Fue aplicado el test de medianas para comparación de las variables antes y después de la prohibición. Resultados: con la implementación de la prohibición el porcentaje de ocupación de las camas fue reducido en las unidades masculinas de trastornos mentales (88,8% para 48,4%) y de dependencia química (94,4% para 42,8%). La media de días de internación fue reducida en la unidad masculina de dependencia química (13,5 para 12,6) en comparación con la unidad femenina (14,7 para 19,5). Los costos con psicofármacos y expectorantes, las agresiones verbales/físicas y las contenciones físicas/químicas fueron reducidas. Conclusión: la prohibición de fumar alteró los indicadores hospitalarios, redujo costos y mejoró el comportamiento de los pacientes, contrariando el mito de que esta resulta en hostilidad. Se espera que este estudio contribuya para que los enfermeros revisen sus creencias relacionadas con la prohibición del tabaquismo, considerando los resultados positivos para las relaciones interpersonales y para la administración de los servicios de salud mental, que fueron obtenidos.
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Oliveira RMD, Santos JLF, Furegato ARF. Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban. Rev Lat Am Enfermagem 2022. [PMID: 35920539 PMCID: PMC9342906 DOI: 10.1590/1518-8345.5666.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. Method: ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. Results: after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. Conclusion: the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.
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de Oliveira RM, Santos JLF, Furegato ARF. Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban. Rev Lat Am Enfermagem 2022; 30:e3611. [PMID: 35920539 PMCID: PMC9342906 DOI: 10.1590/1518-8345.5666.3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. METHOD ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. RESULTS after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. CONCLUSION the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.
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Affiliation(s)
| | | | - Antônia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Russell L, Whiffen R, Chapman L, Just J, Dean E, Ugalde A, White S. Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study. BMJ Open 2021; 11:e044489. [PMID: 34011592 PMCID: PMC8137196 DOI: 10.1136/bmjopen-2020-044489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the perspectives of hospital staff regarding the provision of smoking cessation care. STUDY DESIGN A qualitative description study using focus group discussions. STUDY SETTING Data were collected across metropolitan regional and rural hospitals in Victoria, Australia, between November and December 2019. PARTICIPANTS Clinical and non-clinical hospital staff. RESULTS Five focus groups were conducted across four hospitals. Staff (n=38) across metropolitan regional and rural hospitals shared similar views with regards to barriers and facilitators of smoking cessation care. Four themes were present: (1) Clinical Setting wherein views about opportunity and capacity to embed smoking cessation care, relevant policies and procedures and guidelines were discussed; (2) Knowledge consisted of the need for training on the provision of pharmacotherapy and behavioural interventions, and awareness of resources; (3) Consistency represented the need for a consistently applied approach to smoking cessation care by all staff and included issues of staff smoking; and (4) Appropriateness consisted of questions around how smoking cessation care can be safely delivered in the context of challenging patient groups and different settings. CONCLUSIONS Staff across metropolitan regional and rural hospitals experience similar views and identified shared barriers in implementing smoking cessation care. Responding to staff concerns and providing support to address smoking with patients will help to foster a consistent approach to cessation care. Clear practice guidelines for multidisciplinary clinical roles need to underpin staff training in communication skills, include priorities around smoking cessation care, and provide the authorising environment in which clinical staff actively provide smoking cessation care.
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Affiliation(s)
- Lahiru Russell
- Deakin University, School of Nursing and Midwifery, Burwood, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Rachel Whiffen
- Quit Victoria, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Lorena Chapman
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Jasmine Just
- Quit Victoria, Cancer Council Victoria, Melbourne, Victoria, Australia
- Heart Foundation Melbourne, Docklands, Victoria, Australia
| | - Emma Dean
- Population Health, Alfred Health, Melbourne, Victoria, Australia
- QUIT Victoria, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Anna Ugalde
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Sarah White
- QUIT Victoria, Cancer Council Victoria, Melbourne, Victoria, Australia
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Williams J, Craig TJ, Robson D. Barriers and facilitators of clinician and researcher collaborations: a qualitative study. BMC Health Serv Res 2020; 20:1126. [PMID: 33278896 PMCID: PMC7718701 DOI: 10.1186/s12913-020-05978-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The poor translation of research findings into routine clinical practice is common in all areas of healthcare. Having a better understanding of how researchers and clinicians experience engagement in and with research, their working relationships and expectations of each other, may be one way to help to facilitate collaborative partnerships and therefore increase successful translation of research into clinical practice. AIMS To explore the views of clinical and research staff about their experiences of working together during research projects and identify the facilitators and barriers. METHODS We conducted four focus groups with 18 participants - clinicians, researchers and those with a dual clinical-research role, recruited from one mental health Trust and one university. Data was analysed using thematic analysis. RESULTS Eight themes were identified under the headings of two research questions 1) Barriers and facilitators of either engaging in or with research from the perspective of clinical staff, with themes of understanding the benefits of the research; perceived knowledge and personal qualities of researchers; lack of time and organisational support to be involved in and implement research; and lack of feedback about progress and outcome of research. 2) Barriers and facilitators for engaging with clinicians when conducting research, from the perspective of researchers, with themes of understanding what clinicians need to know and how they need to feel to engage with research; demonstrating an understanding of the clinician's world; navigating through the clinical world; and demands of the researcher role. CONCLUSION There was agreement between clinicians and researchers about the barriers and facilitators for engaging clinicians in research. Both groups identified that it was the researcher's responsibility to form and maintain good working relationships. Better support for researchers in their role calls for training in communication skills and bespoke training to understand the local context in which research is taking place.
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Affiliation(s)
- Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Tom J Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Robson D, Spaducci G, McNeill A, Yates M, Wood M, Richardson S. Fire Incidents in a Mental Health Setting: Effects of Implementing Smokefree Polices and Permitting the Use of Different Types of E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8951. [PMID: 33271985 PMCID: PMC7730299 DOI: 10.3390/ijerph17238951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022]
Abstract
Comprehensive smokefree policies in health care settings can have a positive impact on patients' smoking behaviour, but implementation is impeded by concern that surreptitious smoking may increase fire incidents. We investigated the incidence of routinely reported fire and false alarm incidents in a large mental health organisation in England over an 81-month period when different elements of a smokefree policy were implemented. We used negative binomial regression models to test associations between rates of fire and false alarm incidents and three hospital smokefree policy periods with mutual adjustment for occupied bed days: (1) an indoor policy which allowed disposable e-cigarettes; (2) a comprehensive policy which allowed disposable e-cigarettes; and (3) a comprehensive policy with all e-cigarette types allowed. We identified 90 fires and 200 false alarms. Fires decreased (incidence rate ratio (IRR): 0.35, 95% CI: 0.17-0.72, p = 0.004) and false alarms increased (IRR: 1.67, 95% CI: 1.02-2.76, p = 0.043), each by approximately two-thirds, when all e-cigarette types were allowed, after adjusting for bed occupancy and the comprehensive smokefree policy. Implementation of smokefree policies in mental health care settings that support use of all types of e-cigarettes may reduce fire risks, though measures to minimise effects of e-cigarette vapour on smoke detector systems may be needed to reduce false alarm incidents.
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Affiliation(s)
- Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (G.S.); (A.M.); (S.R.)
| | - Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (G.S.); (A.M.); (S.R.)
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (G.S.); (A.M.); (S.R.)
| | - Mary Yates
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK; (M.Y.); (M.W.)
| | - Melissa Wood
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK; (M.Y.); (M.W.)
| | - Sol Richardson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (G.S.); (A.M.); (S.R.)
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