Policies banning smoking on hospital property are leading to unintended safety consequences for patients, new Canadian research shows.
To wit: IV lines and electronic pumps malfunctioning in extreme cold; patients in wheelchairs accidentally being locked out of entrances during a winter night; immobilized patients smoking in their beds when they can’t get help leaving the ward; nurses not knowing where their patients are when they leave the unit for a smoke.
“We report the lived experiences of the people directly affected by these policies,” researchers from the University of Manitoba, University of Alberta and the Winnipeg Regional Health Authority said in a study published in this week’s issue of the Canadian Medical Association Journal.
At the two hospitals studied – the University of Alberta Hospital in Edmonton and Winnipeg’s Health Sciences Centre – the team found “ample” evidence that patients as well as staff continue to smoke on hospital property despite polices banning smoking inside all buildings, entrances and on all hospital grounds.
People were seen smoking directly under signs forbidding smoking. Smokers were usually spotted near entrances or in places allowing them to hide while they smoked, researchers wrote.
“Staff who had reportedly been seen smoking on hospital property included security guards, ambulance drivers, nurses and doctors.”
Enforcement efforts, they said, were reportedly minimal.
Cleaners described picking up five to 10 pounds of discarded cigarette butts some days.
The researchers stressed that hospital smoke-free policies make sense. Tobacco is the leading cause of disease and premature death. What’s more, patients who smoke have more post-operative complications and a worsening of their health conditions while in hospital than non-smokers, they say.
But smoking needs to be framed as an addiction and not a habit, said lead author Annette Schultz, an assistant professor at the University of Manitoba’s faculty of nursing.
Smokers – already feeling vulnerable and stressed because of being in hospital – need to be offered help coping with withdrawal, such as nicotine patches and gum. However nicotine-replacement therapy wasn’t consistently offered, the researchers said, and even those smokers who requested it had difficulty obtaining it.
“Although some patients abstained from smoking while in hospital, many received minimal or no support in doing so,” the team wrote in the Canadian Medical Association Journal.
And they faced “a variety of safety concerns as a result.”
In interviews, patients said they felt unsafe going outside alone to smoke. A few worried “about getting suddenly sick while smoking outside.” Some risked frostbite. Security guards described patients “pushing this IV pole all the day down the sidewalk in the snow” after being told not to smoke on hospital grounds.
Comments from health-care workers included, “I have zero understanding on the drive to make a person get out of there, have that cigarette when they’re obviously having pain.”
Other expressed compassion for smokers. “We need to address these people, because it is a stressful time to give up your bad habit.”
In an accompanying commentary, Dr. Sharon Lawn, of Flinders University, South Australia, said the study illustrates “how the notion of responsibility can become distorted when smoking is viewed as a morally interpreted behaviour – a lifestyle choice – rather than an addiction that requires clinical support.”
She said it was “immediately striking” how little staff felt “that enforcing the smoke-free policy was their responsibility.”