Using E-cigarette in a meeting

[StrawberryShortbread2001]

I'm a support worker and work on a ward. E-cigs are allowed in the communal rooms (lounge, dining room) and the bedrooms. The only time they're not allowed is in ward round.

We were having a community meeting which we have every week. E-cigarettes are allowed to be used during the meeting. This was a special meeting about a certain issue so as well as the usual service users, nurses, support workers, occupational therapists and social worker - the consultant, head social worker, psychologist and hospital manager were there. One of the service users was engaging and putting a point across with a bit of back and forth. She was using her e-cig when not talking. Suddenly the hospital manager looked at her a bit horrified and said 'are you smoking?' She said 'No! I'm using a e-cigarette' The consultant then jumped in to say she shouldn't be using it. She was embarrassed and confused at being called out on it and stopped engaging in the meeting. At the end she spoke to the consultant to tell him they always used e-cigarettes in the merting and he told her she should have known not to use it and she needs to be more flexible in her thinking.

Am I right to think 1. If e-cigs weren't to be used it should have been announced at the beginning of the meeting and 2. She shouldn't have been called out in public like that

It caused the service user a lot of upset and has really wound me up!

Of course you are op. You can stop @ing me thanks, I'm happy for you to have the last word.

Haha - sorry for having a discussion with you on a forum for discussing things (I won't use your name if you don't want me to!)

Well I've read all of this contentious thread and would like to add my thoughts...I have schizophrenia, diagnosed 25 years ago and have spent time on mental health units many times. I don't smoke, never have done, never will, and I hate being around both smokers and vapers. I find it a bit ironic that the OP and her colleagues didn't feel able to speak up during the meeting, while being convinced that sectioned patients on a secure unit would have no problems with speaking up against the culture of the ward

One other point that will probably come across as nit-picking to many ...I absolutely hate the term " service user" used about sectioned patients. They're not service users, they will almost all ( if not all ) hate being in hospital. Apparently it is supposed to show the patient more respect, but I think it has more to do with the uncomfortable feelings of staff about the fact that actually, what they are doing is detaining people who have usually committed no crime

And one final one OP..the patients on your ward are really not telling you everything

@user147 - I actually acknowledged it could be a problem. However I don't have experience of that situation. And just to be clear not all our patients are sectioned.

I don't like service user as I said although we are told to use it. It does not come from front line staff. However it is used for all patients not just those sectioned.

And yes - I'm aware they are not telling me everything! However a long term unit such as ours has a very different culture to an acute or short-term ward.

It sounds like you hated being in hospital (this isn't the case for everyone!) so I really hope you never have to go back.

@user147 - sorry I think I misundetstood your point. I realise you were saying you hate 'service user' especially for sectioned patients as of course they have not chosen to use the service. I quite agree!

Service user is always a contentious one. In my current workplace client is used as we are a service (well set of services) offering open rehab residential care - so shorter interventions (2 years ish) and not long term care which would be "resident". Our clients have a choice to be at the service or not and chose to use it.

Like you say service user isn't really appropriate for sectioned folk and there is part of me that feels If you are in hospital patient is perfectly acceptable given you are there for medical reasons just like a phys health patient would be in a gen hospital.

Is using different terminology just widening the parity of esteem rather than closing it!?

When we asked the guys I worked with on a low secure they preferred patient to client but service user over patient. We went with service user.

Can you tell I've pondered this a lot over the years? lol

@user147 I can see what you're saying about being around smoke. I think the biggest thing I notice when I go on wards now is that they smell a lot better, less stale smoke wafting around. I've not smoked in 20 years and so used to really notice it. That's got to be a bonus for all at least. It's always going to be a balance in such a restrictive environment I suppose. Helping those who do smoke to have their liberties and those who don't to have space from them.

@StrawberryShortbread2001 depending on the type of service you're in removing wardrobe doors COULD be considered overly restrictive practice without very robust reasoning and consultation. The cqc have very clear guidelines that you may want to google on blanket bans.

In regards to social media use, I've a good knowledge of services across England and couldn't identify where the OP is. Sounds very standard practice being described in regards to ward environment / meeting set up. There is a social media code of practice which is aimed at nurses but often the standard for all staff and nothing about this thread has breached it.

@StrawberryShortbread2001

I agree actually and I think people prefer being called 'patients'. But we are constantly told to say 'service user'!

And I think this is where a lot of the confusion has come from on this post. Your OP sounded like a formal work meeting and, if you’re not in the know, a ‘service user’ doesn’t sound like a ‘patient in a secure psychiatric unit’ - so it didn’t alert people that this was something different! Similar with the e-cig/vape confusion.

Not a criticism by the way - just an observation as I find the use of language interesting - particularly how jargon (particularly euphemistic jargon such as ‘service user’) can cause confusion.

I’m also quite interested in the logic that people should be allowed to use e-cigarettes in the ward because ‘it is their home’. I’m sure there are lots and lots of behaviours that people would be allowed to undertake in their own home that wouldn’t be appropriate in a ward - many of which would make the person feel more comfortable. Given that people who live in a secure ward automatically have many of their freedoms restricted, policy-making must be an absolute minefield, and I’m very, very surprised that a hospital manager wasn’t much more clued up on what is and isn’t allowed.

@doublebarrellednurse - thanks. I do feel the wardrobe doors and other things are not least restrictive practice. The trouble with banning so many things without good reason is patients/SU start ignoring restrictions full stop and 'sneaking' things in. Not that they could do that with a wardrobe door of course!

@ItsGoingTibiaK - informative post, thanks. The thing about it being their home is linked with least restrictive practice and institutionalisation. So as it is their home they should be able to use it as their home as far as possible and it should be respected as their home. Things shouldn't be banned just because it makes it easier on staff. Patients/SU should be assumed to have capacity unless proven otherwise. I'm trying to think of examples - but getting tired! They shouldn't all be forced to have showers in the morning as it suits staff - they should be able to have showers whenever they want.

That's why blanket bans were kinda banned @StrawberryShortbread2001 😉

You mentioned the word physchiatric on about page 12 of the thread

By which time every other poster on this thread knew it was a psychiatric ward. It was pretty obvious.

It wont be down to staff It will be down to the people who run the place, and they probably have a policy that they cant. Sounds to me that the support workers allow it on the sly.

How can you possibly get this from what OP has posted, @TabbyMumz? She's made it perfectly clear that this is official policy. Look, for instance, at the fact that the consultant condones it except during ward rounds. You really can't just make up the facts to suit your viewpoint.

But I am right in that Social workers work for local government

No, you're wrong. Social workers can be employed by all sorts of bodies, including private companies, and can indeed be self-employed.

Now it may happen in a physchiatric ward (now I know that it is one), but the hospital trust will be taking a calculated risk in allowing it I think.

It's not a hospital trust, and there's no such thing as a physchiatric word. You've been told often enough that it's a psychiatric ward.

The wardrobe door thing is to do with ligature risk surely? Another thing cqc seem keen on these days. Having worked on a ward where someone commit suicide by hanging they came down heavy on us for the fact we hadn't managed our ligature risks as much as possible.

I'm suprised you have informal patients in low secure. Our commissioners were chomping at the bit when we had someone informal for 3 days after he won his tribunal but his flat wasnt ready.

@FormerlyFrikadela01 - yes re:wardrobe doors. But not all our patients ligature and had had wardrobe doors for a long time with no issue. The most ridiculous thing CQC said was the bedroom doors looked messy - each patient personalises their door - and they look lovely in my opinion.

Yes, quite a few informal. Most are still mid treatment when they become informal so they still stay with us for a long time.

Wow - no that was a horrible thing for the manager and consultant to do!

@user1471422568 - I agree that service user is horrible - have always prefered patient. However I don't think it's anything to do about any uncomfortable feelings from the staff (it's not as if they like patients being on section) - it is just what they are told to call us. I also disagree that they all hate being there - that is really not true (although I'm sure depends on the ward). While I agree on an acute ward patients are less likely to confide in staff - but I agree with the OP that long-term units have a different culture.

I also have to say smoking is life for pretty much all the women on my ward. There are 2 of us that don't smoke. E-cigs are allowed here but I don't notice any smoke and only a smell if sitting next to someone. I think the fruit smells are nice, though. All those getting in a flap about the poor non-ecigger having to sit in smoke and not be able to speak up about it. It is honestly a real non-issue.

Forgot to say - we are allowed to use e-cigs during ward round! But we have a therapy group where we have agreed to not use them during teaching.

All those getting in a flap about the poor non-ecigger having to sit in smoke and not be able to speak up about it. It is honestly a real non-issue

Seems rather dismissive of those 'service users' on the thread who have clearly and eloquently expressed how much of an issue it was for them

@bluegregreen - I may have missed that but I haven't read anyone having an issue with others using e-cigarettes.

Sorry @bluegreygreen - I have seen some hypothetical thoughts but none of service users directly experiencing it.

Sorry, I worded that badly.

One (possibly 2, sorry I haven't time to go back and check) people have described clearly how they felt unable to challenge the status quo regarding smoking while they were service users / inpatients, and have explained their reasons and why those reasons are also likely to apply wrt e-cigarettes.

It appeared to me that their point was regarding their experience and concerns being ignored, and hence to describe such concerns as 'a real non-issue' seemed at least unhelpful.

@bluegreygreen - I may be wrong but I saw one person saying the staff thought they smoked when they didn't. Which to be honest I find hard to believe. If the staff take you out on your leave - they can clearly see if you smoke or not. But maybe this was someone with unescorted leave so the staff didn't see them on their leave - in which case they'd have no need to be around smokers.

When I said 'real non-issue' - I wasn't refering to the hypothetical situation of someone not being able to get their needs met. More just about actually having experienced the situation and it not being a problem for me or others and I find it hard to believe how it could be a problem. Fair enough it depends where you are etc - but the main people getting a little hysterical about it were not service users/patients just people imagining scenarios in their heads!

All those getting in a flap about the poor non-ecigger having to sit in smoke and not be able to speak up about it. It is honestly a real non-issue

I use e cigs which irritates my DH who has never smoked. He freely admits there is no smell, no obvious vapour and causes him no discomfort whatever. He just hates that it 'looks' like I'm smoking.

It's a leftover reaction to when I actually did smoke.

@YummyChipCurryDip - that's funny! But yeah as you say no smell or vapour so I can't imagine a patient being concerned at others using them on a ward.

@bluegreygreen - while patients/SU having their concerns listened to and dealt with is paramount - those concerns could be about all sorts of things and will have to be dealt with as they arise.

But noone had any negative experience of being on a ward with e-cigarettes and yet the ward was expected to have all these contingencies (patients not allowed their e-cigarettes in the lounge, for example) for an issue that may never arise. @underthecedartree who has experienced it in real life refers to it as a 'non-issue' and I think I'd rather listen to that than all sorts of hypothetical ideas.