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Hospital smoking bans need to consider safety
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The Canadian Press-
Smoking bans on hospital properties have important safety consequences for patients who venture out to smoke, researchers say.
Hospitals across Canada have smoke-free policies for their buildings and grounds to reduce exposure to second-hand smoke for employees, patients and visitors near entrances and on parking lots.
The policies make sense for clean air but the tobacco withdrawal symptoms that hospitalized patients face also need to be addressed, Dr. Annette Schultz, an assistant professor at the University of Manitoba's Faculty of Nursing and her co-authors said.
"As an emerging standard for Canadian hospitals, smoke-free property is intended to reduce exposure to second-hand smoke, communicate de-normalization messages about smoking and enhance tobacco cessation," the study's authors concluded in Monday’s issue of the Canadian Medical Association Journal.
"However, noncompliance and inadequate treatment for tobacco dependence appear to be the practice norm."
In the study, investigators interviewed 186 patients and health-care professionals at Winnipeg Health Sciences Centre and the University of Alberta Hospital in Edmonton between December 2008 to May 2009, which included a cold winter. Both sites introduced smoke-free policies three years before the study began.
Managing nicotine withdrawal
Patients and staff identified safety issues related to leaving hospital wards to smoke, such as:
Staff being unaware of a patient's whereabouts.
Patients feeling unsafe going out to smoke alone.
Weather issues that cause equipment to malfunction.
For example, one patient said: "Patients being locked out at entrances not open 24 hours a day. I got locked out there …I was in a wheelchair, and I went outside, but I didn’t see the sign on the door that was up at eye level, but in a wheel chair, I didn't see it."
The comments from health-care professionals expressed a range of perspectives on smoking, from, "It’s only nicotine; they say most of its psychological," to "We need to address these people, because it is a stressful time to give up your bad habit."
Schultz suggested that hospital staff need to be more proactive about offering a variety of nicotine-replacement therapy products such as the patch and gum.
"With the advent of these policies, abstinence support with effective management of withdrawal symptoms for patients in hospital is imperative," the authors said.
In a journal commentary accompanying the study, Sharon Lawn of the department of psychiatry at Flinders University in Bedford Park, Australia, said the findings reflect how smoke-free policies in hospitals need to acknowledge nicotine dependence as an addiction instead of considering it a social habit.
"The comments made by staff, although sometimes alarming, capture the tension between their opinions as public citizens, shaped by the policies and social norms of their society, and their knowledge as clinicians demanding a response (or not) to the clear evidence of the harms of smoking to the health of their patients," Lawn wrote.
Staff should not only set a positive example by abstaining from smoking but they should acknowledge that smoking is an addiction and have the knowledge and skills to support patients with smoking cessation and tobacco practice, she added.
The study's authors acknowledged that the study only looked at two hospitals and that the findings may not apply elsewhere, and that they were unable to look at how smoke-free policies affected patients over time.
The study was funded by the Strategic Initiative Advancing the Science to Reduce Tobacco Abuse and Nicotine Addiction in a partnership with the Canadian Institutes of Health Research, Canadian Cancer Society, National Cancer Institute of Canada, Health Canada, Heart and Stroke Foundation, and Canadian Lung Association in partnership with l’Association pulmonaire du Québec, and was coordinated by the Canadian Tobacco Control Research Initiative.
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