Challenging the smoking culture within a mental health service supportively

Systematic review of tobacco smoking prevalence among young people in treatment for first-episode psychosis

To determine whether smoking prevalence in first-episode psychosis (FEP) is different than in people with established psychosis in long-term treatment. A systematic review of cross-sectional, case-control and cohort studies identified from searches of PubMed, Embase, CINAHL and PsycINFO up to 12 August 2023. 20 studies out of 2773 screened titles were included. There was no clear pattern of smoking by diagnosis as smoking rates in people with FEP ranged from 43% to 78%, while in those with established psychosis, it ranged from 19% to 76%. The wide range of smoking levels in both populations precluded conclusions as to whether smoking rates are different between people with FEP and established psychosis suggesting that factors other than the time course of the illness influence smoking levels.

Moving Beyond the Behavior-Change Framework for Smoking Cessation: Lessons for a Critical Ontology From the Case of Inpatient Psychiatric Units

BACKGROUND: Leading scholars have called on nursing schools to pay more attention to smoking cessation in the education of nursing students. AIM: This article argues that attention to this subject should include a rethinking of the behavior-change framework that forms the methodological basis of this field. METHOD: Drawing on classic and contemporary work in sociology, anthropology, and critical public health, this article explores the specific example of smoking in long-term inpatient units to illustrate the limitations of a behavior-based ontology and suggest an alternative conceptual vocabulary. RESULTS: An alternative approach posits smoking as a social practice. It sheds light on situational factors that incentivize smoking and might be contributing to patient resistance to cessation. CONCLUSIONS: A different conceptual framing of smoking can point to interventions beyond the level of individuals, focusing instead on the broader interface between people and situations, where decisions and desires meet institutional and organizational dynamics and structures of opportunity and access.

Self-efficacy in providing smoking-cessation services among psychiatric nurses in central and southern Taiwan: an exploratory study

Smoking by psychiatric patients remains prevalent. The purpose of this cross-sectional study was to understand the influence of self-efficacy and its correlates among psychiatric nurses when providing smoking-cessation services (SCS). A convenience sample of 193 nurses from psychiatric institutions was obtained. Surveys were conducted using self-report measures regarding SCS provided by psychiatric nurses. The survey questions focused on self-efficacy, attitude, practical experience, and smoke-free policies, and their implementation in the workplace. The participants reported low self-efficacy for providing SCS in their self-assessment, as demonstrated by their scores of 55.3 ± 20.4, on a scale of 0 (low confidence) to 100 (high confidence). Using multiple linear regressions, statistically-significant, relevant factors included perceived provider-related barriers in providing SCS, environmental tobacco smoke exposure, the nurse's attitude towards a patient smoking, and the nurse's frequency and practical experience in providing SCS. The correlates of this self-efficacy can serve as a reference for in-service curriculum planning of SCS by psychiatric nurses. In addition, policies to limit exposure to second-hand tobacco smoke should be explored.

Health care professionals implementing a smoke-free policy at inpatient psychiatric units

Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success.

Investigating change in non-government mental health service organisations’ ‘smoke-free’ attitudes and practice in New Zealand

Smoking prevalence amongst service users from the mental health and addictions sectors is higher than the general population. Cross-sectional web- or paper-based surveys comprising open and closed response options were used to examine changes in prevailing attitudes and practices amongst non-government mental health service staff and users. Thematic analysis was used to interpret and present open response answers. Multi-variate logistic models were used to investigate which factors are associated with smoke-free attitudes and practices. Staff who smoke were found to be less likely to provide cessation support to clients (AOR 0.51, 95% CI 0.31–0.82) and gave significantly lower estimates of the percentage of clients who wish to stop smoking (30% vs 44%, p < 0.0001). Those who had completed cessation training also had more positive views about the importance of providing cessation support and service user desire to stop smoking. Staff who had not completed cessation training had significantly lower odds of reporting they carried out quit smoking support often and routinely (AOR 0.33, 95% CI 0.23–0.47) The results suggest that continuing improvement will be enabled by increasing rates of cessation training amongst staff of mental health and addictions non-government organisations. In addition, there is a need for increased incentive and support for staff who smoke to quit.

Climate for innovation, 12-step orientation, and tobacco cessation treatment

This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness.

Qualitative exploration of family perspectives of smoke-free mental health and addiction services

The significant health disparities experienced by people with mental illness indicate the need for mental health service improvement. This qualitative study explored family and whānau (Māori family group) perspectives of smoke-free mental health services. Thematic analysis found that family and whānau identified a number of barriers to the implementation of successful smoke-free policy, including lack of coordination and consistency, and limited, if any, family and whānau inclusion. Family and whānau discussed smoking as a strategy for coping with anxiety and boredom; therefore, the need for other activities and strategies to replace smoking was identified as necessary in effective service delivery. The attitude that mental health service policy should be different from general health policy, due to the experience of mental distress, was also identified. In this paper, we argue that the development and implementation of quality mental health services would be strengthened by involving family and whānau in smoke-free initiatives. Furthermore, the provision of relevant information to family, whānau, and service users would help dispel myths and stigma associated with tobacco and mental health.

Mental health nurses' beliefs about smoking by mental health facility inpatients

This study examined beliefs of mental health nurses about smoking by clients, nurses, and visitors in inpatient facilities and identified the influence of years of experience, smoke-free status, and workplace on these beliefs. Data were collected by a survey, distributed via a nursing newsletter with approximately 600 members. Descriptive statistics and cross-tabulations explored the data. A total of 104 responses were received. Smoke-free status made significant differences to nurses' beliefs relating to prohibition of smoking for clients, staff, and visitors; concern about the effects of passive smoking; the role of smoking in the development of therapeutic relationships; smoking as a source of patient pleasure; and the role of smoking in symptom management. That half of the nurses who responded believe that smoking is helpful in the creation of therapeutic relationships is of concern. The nurse plays an important role model in promoting smoke-free lifestyles amongst clients, and the effects of positive role modelling could be lost if nurses continue to smoke with clients. The negative impacts of smoking on the physical health of mental health inpatients is considerable and well documented, and the creation of smoke-free inpatient mental health services can help to address these.

Understanding jordanian psychiatric nurses' smoking behaviors: a grounded theory study

Purpose. Smoking is prevalent in psychiatric facilities among staff and patients. However, there have been few studies of how contextual factors in specific cultures influence rates of smoking and the health promotion role of psychiatric nurses. This paper reports the findings of a classical grounded theory study conducted to understand how contextual factors in the workplace influences the smoking behaviors of Jordanian psychiatric nurses (JPNs). Method. Semi-structured individual interviews were conducted with a sample of eight male JPNs smokers at a psychiatric facility in Amman, Jordan. Findings. Constant comparative analysis identified becoming a heavy smoker as a psychosocial process characterized by four sub-categories: normalization of smoking; living in ambiguity; experiencing workplace conflict; and, facing up to workplace stressors. Conclusion. Specific contextual workplace factors require targeted smoking cessation interventions if JPNs are to receive the help they need to reduce health risks associated with heavy smoking.

A qualitative examination of the positive and negative consequences associated with going tobacco-free in substance abuse treatment: the NY State experience

INTRODUCTION

In 2008, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS) required all state-funded or state-certified addiction treatment programs to be 100% tobacco-free. The regulation prohibits the use or possession of all tobacco products by patients, employees, volunteers, and visitors. This includes exterior grounds and vehicles owned, leased, or operated by the facility. Addiction treatment centers are also required to screen patients for tobacco use and incorporate tobacco cessation into treatment programming. This study examined the perceived effectiveness of this regulation from the perspective of counselors and clinical supervisors.

METHODS

Qualitative data were collected from 261 counselors and 80 clinical supervisors working in 50 free-standing substance abuse treatment programs throughout NYS. Questions asked about the perceived positive and negative consequences of the OASAS regulation approximately 1 year after its implementation.

RESULTS

The findings indicate mixed reactions to the regulation. A wide range of positive and negative consequences were identified, which were generally consistent across counselor and clinical supervisor reports. The most commonly reported positive outcomes were positive behavior change (e.g., less smoking, increased intentions to quit) and increased awareness about smoking (e.g., dangers, available assistance to quit). The most commonly reported negative consequences were reinforcing addict behaviors among patients (e.g., lying, "dealing" cigarettes) and enforcement problems (e.g., difficulty enforcing, policing for compliance).

CONCLUSION

Findings have implications for the implementation of tobacco-free regulations in substance abuse treatment programs.

Going tobacco-free: predictors of clinician reactions and outcomes of the NY State Office of Alcoholism and Substance Abuse Services tobacco-free regulation

In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation nor clinician outcomes. Practical implications are discussed.

Total smoking bans in psychiatric inpatient services: a survey of perceived benefits, barriers and support among staff

BACKGROUND

The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit.

METHODS

Cross-sectional survey of both clinical and non-clinical staff in a large inpatient psychiatric hospital immediately prior to the implementation of a total smoking ban.

RESULTS

Of the 300 staff, 183 (61%) responded. Seventy-three (41%) of total respondents were clinical staff, and 110 (92%) were non-clinical staff. More than two-thirds of staff agreed that a smoking ban would improve their work environment and conditions, help staff to stop smoking and improve patients' physical health. The most prevalent clinician perceived barriers to a successful total smoking ban related to fear of patient aggression (89%) and patient non-compliance (72%). Two thirds (67%) of all staff indicated support for a total smoking ban in mental health facilities generally, and a majority (54%) of clinical staff expressed support for a ban within their unit. Clinical staff who believed a smoking ban would help patients to stop smoking were more likely to support a smoking ban in their unit.

CONCLUSIONS

There is a clear need to more effectively communicate to staff the evidence that consistently applied smoking bans do not increase patient aggression. There is also a need to communicate the benefits of smoking bans in aiding the delivery of smoking cessation care, and the benefits of both smoking bans and such care in aiding patients to stop smoking.

Comparison of mental health nurses' attitudes towards smoking and smoking behaviour

Smoking is widely recognized as an important public health issue for the general population and in the mental health field where the rates are particularly high. Mental health nurses are well positioned to take an active role in encouraging and supporting people diagnosed with mental illness to cease smoking. Information about smoking behaviour and the attitudes of mental health nurses is necessary to develop strategies to prepare nurses for this important role. A cross-sectional study was conducted to examine the smoking behaviour and attitudes of mental health nurses in Queensland, Australia, through a random selection of mental health nurses (n = 289). Smoking rates (16%) in this study were lower than those for the Australian population. Smokers were significantly (P < 0.001) less likely to agree that health-care facilities should promote a healthy environment. All participants, but predominantly those who smoked (P < 0.001), supported the individual's right to smoke. Participants believed they possessed appropriate skills to deliver the antismoking message effectively, although stronger beliefs were characteristic of non-smokers. Participants who smoked perceived that their smoking status assisted in facilitating interactions with consumers (P < 0.001). The findings have implications for the health promotion activities of mental health nurses.

Community mental healthcare providers' attitudes and practices related to smoking cessation interventions for people living with severe mental illness

OBJECTIVE

This study aimed to describe mental healthcare providers' attitudes about tobacco use, their personal smoking status, their confidence in offering smoking cessation support to clients living with severe mental illness, and the extent to which they incorporated smoking cessation interventions into their practice. The study also aimed to determine whether the providers' attitudes, smoking status, and confidence were associated with offering smoking cessation support to clients.

METHODS

Self-administered questionnaires were distributed within community-based mental health agencies to those who provide care and support to adults living with severe mental illness. Outcomes measured included respondents' smoking status, attitudes related to the provision of smoking cessation support, confidence in providing smoking cessation intervention, and smoking cessation practices. We conducted multivariate analyses using logistic regression analyses to examine the factors associated with the providers' tobacco-related practices.

RESULTS

In total 282 of 871 care providers responded to the survey, 22% of whom were current smokers. The providers who held sympathetic attitudes about their role and their clients' role in smoking cessation, who were never or former smokers, who were healthcare professionals rather than paraprofessionals, who had relatively more confidence, and who had more experience working in the mental health field were more likely to engage their clients in tobacco-related interventions.

CONCLUSIONS

In this study the healthcare providers working in community-based mental health have a smoking prevalence rate that exceeds that of the region's general population and did not provide optimal smoking cessation support to their clients.

PRACTICE IMPLICATIONS

Interventions that bolster the confidence of providers to engage is smoking cessation activities and that support a shift in attitudes about the role of tobacco use in mental health are required.

Staff's attitudes toward the delivery of tobacco cessation services in a primarily psychiatric Veterans Affairs hospital

To prepare for improving the delivery of cessation services in a primarily psychiatric Veterans Affairs (VA) hospital, the investigators surveyed (n = 150) and interviewed (n = 8) clinical and nonclinical staff to determine staff's characteristics associated with attitudes about providing cessation services and to seek suggestions about what would be important to include in a tobacco cessation program. Almost one third reported that they currently use tobacco products. Almost three quarters said that they felt that the VA should be doing more to assist patients to quit smoking, yet only approximately one quarter said that they personally provide cessation services. Over half felt moderately, very, or extremely confident in providing cessation services. Multivariate analyses showed that higher education and, surprisingly, not being a nurse were associated with feeling that it was important to provide cessation services.

Windows of opportunity for culture change around tobacco use in mental health settings

BACKGROUND

Smoking rates among individuals with mental illnesses are significantly higher than in the general population and contribute to increased rates of morbidity and mortality.

OBJECTIVE

The purpose of this study was to generate a theory of the process by which to lower the prevalence of smoking in this population.

STUDY DESIGN

Grounded theory methods, including constant comparison and theoretical sampling, were used to uncover the emerging process of addressing tobacco use in mental health settings from the perspective of national leaders.

RESULTS

Participants suggested that the culture in mental health settings around tobacco use significantly contributes to the high rates of smoking and described barriers to and opportunities for culture change.

CONCLUSIONS

The findings highlight several windows of opportunity that have begun to be explored. Leaders described current signs of change within mental health settings and expressed optimism about the possibility to lower future rates of smoking among mental health consumers and staff members.