Stages of the Smoke-Free Policy Implementation in a Psychiatric Hospital: Evolution, Effects, and Complications.

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.

Nurses' beliefs, attitudes, and opinions regarding a smoking ban in a psychiatric hospital.

PURPOSE: This study aims to identify the beliefs, attitudes, and opinions of nursing professionals associated with tobacco smoking and its prohibition in a psychiatric hospital in Brazil. METHODS: Using a cross-sectional epidemiologic study, a total of 73 nursing professionals in a smoke-free psychiatric hospital were interviewed. The Varimax Rotation and the Fisher's exact test at a 5% significance level were used to analyze the responses. FINDINGS: Most nursing professionals reported observations of patients becoming calmer after smoking (n = 59, 80.8%) and tobacco withdrawal worsening patients' mental health symptoms, suggesting agreement among professionals that some psychiatric patients need to smoke tobacco. Most respondents stated that patients with mental health disorders have more difficulty with smoking cessation (79.4%) and are less interested in quitting smoking than those without disorders (95.9%). While one-third mentioned having used cigarettes as a reward or bribe, the majority (83.6%) was in favor of continuing the smoking ban, with more support observed from those working on a night shift and those who worked in the public psychiatric wards. Over 71% noted improvements in their health after the smoking ban. CONCLUSION: The nursing professionals were surprised by the effectiveness of the smoking ban and highlighted the improvement in the hospital environment after its implementation. CLINICAL RELEVANCE: As trusted healthcare professionals, nurses are essential in the fight against smoking and can contribute to awareness promotion, supporting patients during nicotine withdrawal, and decision-making processes for health policies.

Prevalence and Epidemiological Profile of Smokers in the Psychiatric Population and General Population: Smokers in Psychiatric Population.

This study aims to estimate the prevalence of smokers living in Brazil who use outpatient and hospital psychiatric services and outpatient services in primary health care services. It also aims to identify the sociodemographic and clinical factors associated with current smoking in these samples. This is a cross-sectional study with 378 participants from a Brazilian city: P1, persons from the mental health outpatient service; and P2, persons from the psychiatric hospital; P3, general population from the primary healthcare center. A Poisson multiple regression model for current smoking was adjusted. The prevalence of smokers was greater in the psychiatric population than those in the primary health care population (mental health outpatient service = 27%, psychiatric hospital = 60.3%, primary healthcare center = 19%). Current smoking is associated with younger groups (15-29 years old: PRadjusted = 3.35; 30-39 years old: PRadjusted = 2.28), Roman Catholicism (PRadjusted = 1.60), not having a religion (PRadjusted = 2.45), severe psychiatric illness (PRadjusted = 3.04), anxiety disorders/other disorders (PRadjusted = 3.96), and the previous and current use of alcohol (PRadjusted = 2.27 and 2.25, respectively) and illicit substances (PRadjusted = 1.81 and 2.00, respectively). In conclusion, the independent factors associated with current smoking are age, religion, psychiatric diagnosis, and use of alcohol/illicit substances.

Opinions of Hospitalized Patients with Mental Disorders and Patients in Basic Health Units in Brazil Regarding Tobacco Smoking.

This study aims to investigate the opinions of psychiatric patients and the general population on the smoking ban in health service facilities. A cross-sectional study was carried out in a mental health outpatient care unit (MHOC; n = 126), a psychiatric hospital (PH; n = 126), and a basic health unit (BHU; n = 126). The participants in the hospital were less in favor of the smoking ban compared with those attending out-of-hospital units (MHOC, 84%; PH, 69%; and BHU, 100%). Subjects with four or more psychiatric admissions (odds ratio (OR), 3.24) and smokers (OR, 3.18) were most likely to agree that patients have the right to smoke in health service facilities. The psychiatric population was less tolerant of the smoking ban, reflecting the culture of smoking in mental health service facilities.

The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?

UNLABELLED: The smoking ban during psychiatric hospitalization provokes personal and institutional changes. OBJECTIVE: To identify the mental disorders carriers' perception, the smokers ones, about the decreasing number of cigarettes during psychiatric hospitalization. METHOD: Exploratory study with 96 hospitalized carriers of mental disorders who are smokers: G1 (34 subjects hospitalized when was allowed one cigarette by hour) and G2 (62 subjects hospitalized when it was reduced to eight cigarette by day). Semi-structured questionnaire. Thematic content analysis. RESULTS: The G1 admitted satisfaction with the restriction--smoking during hospitalization as entitlement. The G2 resists the restriction change occurred without dialogue or support. In spite of the difficulties, some attitude changes about the cigarette were noticed such as increase of the responsibility, discovery of the ability to reduce smoking and the meaning of its role. CONCLUSION: Some subjects understand the smoking health policy change as punishment, while others as opportunity to think about the role of cigarette in their life.

Nicotine dependence in the mental disorders, relationship with clinical indicators, and the meaning for the user.

OBJECTIVE: to identify the degree of nicotine dependence among patients with schizophrenia and other mental disorders hospitalized in a general hospital, correlating these indices with clinical indicators and the meaning for the user. METHOD: the study was performed in the psychiatric unit of a general hospital, interviewing 270 patients with mental disorders using a questionnaire and the application of the Fagerstrom test. A descriptive statistical analysis of the data and thematic analysis of the content were performed. RESULTS: among the 270 patients with mental disorders, 35.6% were smokers; of whom, 53.2% presented high or very high nicotine dependence. Of the 96 smokers, 32 (33.3%) were schizophrenic, among whom, 59.4% presented high or very high dependence. Higher levels of dependence were also found among the 59 elderly people (61.5%) and 60 subjects with somatic comorbidities (62.5%). Meanings of smoking for the subjects: helps to forget problems and face daily conflicts; alleviates side effects of the medications; self-control; distraction; part of life. CONCLUSION: more intense tobacco dependence among schizophrenic patients is justified due to it helping them to cope with the difficulties of the disease. Nurses occupy a strategic position in the care.

[Sociodemographic profile of smokers admitted to the psychiatric ward of a general hospital]. / Perfil sociodemográfico de tabagistas internados em enfermaria psiquiátrica de hospital geral.

From the interest of health professionals in tobacco control, stood out its high frequency in psychiatric population. This paper aimed to identify the socio-demographic profile of psychiatric patients who are also smokers, comparing with former smokers and non smokers. Exploratory survey, conducted from August 2010 to February 2012, involving psychiatric patients hospitalized in a general hospital, through interviews using a structured questionnaire. Out of the 433 persons hospitalized, 270 took part of this study; 83.7% are carriers of severe mental disorders; 35.6% are smokers, 14.1% former smokers and 50.4% non smokers. Higher proportion of smokers was found among male, 30-49 years old, junior high schooling, rural area, separated/divorced, without occupation, income and religion practice. This profile is similar to smokers of other groups of population. There was difference in the profile of psychiatric patients according to smoking. This knowledge may help nurse to plan interventions, according the needs and possibilities of the subjects.

[An elderly couple and their long life raising four schizophrenic children]. / Um casal de idosos e sua longa convivência com quatro filhos esquizofrênicos.

The objective was to identify, among parents of schizophrenics, elements of their daily life in coping with the disorder and the care offered and received through the health system. This is a field research, using thematic oral history. The parents of four patients with schizophrenia took part in this study. Interviews were conducted, recorded and transcribed, based on three instruments (two specific questionnaires and a field diary). Three categories were identified that reflect difficulties experienced in daily life: limitations in knowledge about schizophrenia; fatigue and burden with impairment of quality of life; and uncertainly about the future and resilience strengthened by faith in God. The concept of care was associated with technical procedures, revealing general satisfaction with the care received. The suffering related to living with schizophrenic relatives is intense, and professionals must be prepared to deal with these experiences of pain and suffering from patients with mental disorder and their relatives.