Lawn Sharon, Pols Rene
Division of Mental Health/Finders Medical Centre, South Australia.
Aust N Z J Psychiatry. 2005 Oct;39(10):866-85. doi: 10.1080/j.1440-1614.2005.01697.x.
This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings.
After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included.
Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term.
The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.
本文回顾了26项国际研究的结果，这些研究报告了住院精神科环境中吸烟禁令的有效性。主要目的是确定哪些过程有助于吸烟禁令的成功实施，哪些过程在这些环境中给实施带来问题。
在对文献进行电子检索后，对各项研究的所用方法、涉及对象、环境类型、禁令类型、所采用的措施和过程以及总体结果进行了比较。全面禁令与部分禁令有所区分。纳入了从1988年至今所有已知的关于精神科住院病房吸烟禁令的研究。
工作人员普遍预期的与吸烟相关的问题比实际出现的更多。禁令实施后，攻击行为、隔离使用、违反医嘱出院或按需用药的增加均未出现。禁令的一致性、协调性以及全面的行政支持被视为成功的关键，若不具备这些条件则会出现问题。尼古丁替代疗法被患者广泛用作应对禁令的一部分。然而，许多患者在入院后仍继续吸烟，这表明禁令不一定能长期有效地帮助人们戒烟。
在精神科住院环境中实施吸烟禁令是可行的，但需要是一个涉及受禁令影响的所有各方的清晰且精心规划的过程。在住院环境中实施禁令仅被视为克服精神卫生人群高吸烟率所需的更广泛战略的一部分。
