Effect of Tobacco Restriction on Length of Hospital Stay of Psychiatric Patients
DOI:
https://doi.org/10.12970/2310-8231.2015.03.02.2Keywords:
Tobacco control, psychiatry, psychiatric department hospital, psychiatric nursing.Abstract
Purpose: The objective of the study was to compare the length of hospital stay of smokers, former smokers, and nonsmokers admitted to the psychiatric unit before and after an increase in the severity of smoking restriction.
Design and Methods: A cross-sectional study was conducted with 270 patients (smokers, former smokers, and nonsmokers) hospitalized in a psychiatric ward of a general hospital. They were divided into two groups: (1) 101 patients allowed one cigarette per hour (from 8:00 a.m. to 10:00 p.m.) and (2) 169 patients whose restriction was changed to eight cigarettes/day.
Findings: The smokers hospitalized after the change in the patients’ access to cigarettes presented shorter length of hospitalization (13.8 days) than with smokers hospitalized and allowed one cigarette per hour (17.1 days). Regardless of the restriction in place, the smokers’ average length of hospital stay (14.9 days) is shorter than the average for former smokers (17.7 days) and for nonsmokers (17.6 days).
Practice Implications: The restriction on smoking may be an important tool of care in psychiatric services; however, the way it is implanted, the support resources available, and the training of nurses to enable them to deal with patients during the course of implementation must be revised.
References
Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). 2011 Pesquisa Especial de Tabagismo – PETab: relatório Brasil. http://bvsms.saude.gov.br/bvs/publicacoes/ pesquisa_especial_tabagismo_petab.pdf. (Accessed March 16, 2015).
Green MA, Hawranik PG. Smoke free policies in the psychiatric population on the ward and beyond: a discussion paper. Int J Nurs Stud 2008; 45: 1543-9. http://dx.doi.org/10.1016/j.ijnurstu.2007.12.004
Prochaska JJ, Hall SM, Bero LA. Tobacco use among individuals with schizophrenia: what role has the tobacco industry played? Schizophr Bull 2008; 34: 555-67. http://dx.doi.org/10.1093/schbul/sbm117
Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). 2011 A situação do tabagismo no Brasil: dados dos inquéritos do Sistema Internacional de Vigilância, da Organização Mundial da Saúde, realizados no Brasil, entre 2002 e 2009. http://www1.inca.gov.br/inca/Arquivos/ situacao_tabagismo.pdf (Accessed March 16, 2015)
Johns M, Coady MH, Chan CA, et al. Evaluating New York City’s Smoke Free Parks and Beaches Law: a critical multiplist approach to assessing behavioral impact. Am J Community Psychol 2013; 51: 254-63. http://dx.doi.org/10.1007/s10464-012-9519-5
Lei n 12.546, de 14 de dezembro de 2011. (2011, 14 de dezembro). Altera a Lei no. 9.294 de 15 de julho de 1996. Diário Oficial de União.
Lei n 9.294, de 15 de julho de 1996. (1996, 15 de julho). Dispõe sobre as restrições ao uso e à propaganda de produtos fumígeros, bebidas alcoólicas, medicamentos, terapias e defensivos agrícolas. Diário Oficial da União.
Szklo AS, Almeida LM, Figueiredo VC, et al. A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008. Prev Med 2012; 54: 162-7. http://dx.doi.org/10.1016/j.ypmed.2011.12.005
Aubin HJ, Rollema H, Svensson TH, et al. Smoking, quitting, and psychiatry disease: a review. Neurosci Biobehav Rev 2012; 36: 271-84. http://dx.doi.org/10.1016/j.neubiorev.2011.06.007
Chaves L, Shirakawa I. Nicotine use in patients with schizophrenia evaluated by the Fagerstrom Tolerance Questionnaire: a descriptive analysis from a Brazilian sample. Rev Bras Psiquiatr 2008; 30: 350-52. http://dx.doi.org/10.1590/S1516-44462008005000014
De Leon J, Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 2005; 76: 135-57. http://dx.doi.org/10.1016/j.schres.2005.02.010
Lasser K, Boyd JW, Woolhandler S, et al. Smoking and mental illness: a population based prevalence study. JAMA 2000; 284: 2606-10. http://dx.doi.org/10.1001/jama.284.20.2606
Crockford D, Kerfoot K, Currie S. The impact of opening a smoking room on psychiatric inpatient behavior following implementation of a hospital –wide smoking ban. J Am Psychiatr Nurses Assoc 2009; 15: 393-400. http://dx.doi.org/10.1177/1078390309353347
Etter M, Khan AN, Etter JF. Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital. Prev Med 2008; 46: 572-8. http://dx.doi.org/10.1016/j.ypmed.2008.01.004
Gelkopf M, Noam S, Rudinski D, et al. Nonmedication smoking reduction program for inpatients with chronic schizophrenia: a randomized control design study. J Nerv Ment Dis 2012; 200: 142-6. http://dx.doi.org/10.1097/NMD.0b013e3182438e92
Keizer I, Descloux V, Eytan A. Variations in smoke after admission to psychiatric inpatients units and impact of a partial smoking ban on smoking and on smoking related perceptions. Int J Soc Psychiatry 2009; 55: 109-23. http://dx.doi.org/10.1177/0020764008092357
Smith CM, Pristach CA, Cartagena M. Obligatory cessation of smoking by psychiatric inpatients. Psychiatr Serv 1999; 50: 91-4. http://dx.doi.org/10.1176/ps.50.1.91
Patten CA, Bruce BK, Hurt RD, et al. Effects of a smoke-free policy on an inpatient psychiatric nursing. Tob Control 1995; 4: 372-9. http://dx.doi.org/10.1136/tc.4.4.372
Prochaska JJ, Gill P, Hall SM. Treatment of tobacco use in an inpatient psychiatric setting. Psychiatr Serv 2004; 55: 1265-70. http://dx.doi.org/10.1176/appi.ps.55.11.1265
Shmueli D, Fletcher L, Hall SE, et al. Changes in psychiatric patients` thoughts about quitting smoking during a smoke-free hospitalization. Nicotine Tob Res 2008; 10: 875-81. http://dx.doi.org/10.1080/14622200802027198
Oliveira RM. Smoking in schizophrenics, its relation to clinical indicators, and its importance to the user (master’s thesis). 2012 http://www.teses.usp.br/teses/disponiveis/22/22131/ tde-05112012-205108/pt-br.php
Desai HD, Seabolt J, Jann MW. Smoking in patients receiving psychotropic medications: a pharmacokinetics perspective. CNS Drugs 2001; 15: 469-94. http://dx.doi.org/10.2165/00023210-200115060-00005
Winterer G. Why do patients with schizophrenia smoke? Curr Opin Psychiatry 2010; 23: 112-9. http://dx.doi.org/10.1097/YCO.0b013e3283366643
Wu TH, Chiu CC, Shen WW, et al. Pharmacokinetics of olanzapine in Chinese male schizophrenic patients with various smoking behaviors. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 1889-93. http://dx.doi.org/10.1016/j.pnpbp.2008.08.022
Zevin S, Benowitz NL. Drug interactions with tobacco smoking: an update. Clin Pharmacokinet 1999; 36: 425-38. http://dx.doi.org/10.2165/00003088-199936060-00004
Etter M, Etter JF. Acceptability and impact of a partial smoking ban in a psychiatric hospital. Prev Med 2007; 44: 64-9. http://dx.doi.org/10.1016/j.ypmed.2006.08.011