精神科住院病患之戒菸護理

Helping Patients Cease Smoking in Psychiatric Setting

嚴重精神病患比一般人有較高吸菸率，過去精神科病房因限制病人進出病房，在院內設置吸菸室，因此容易讓護理人員忽略精神科病人吸菸的問題。行政院衛生署基於保障人民健康已開始施行菸害防治法，因此精神科病房內已全面實施禁菸規定，護理人員面對沒有戒菸意願而必須住院治療的精神病患，要處理其問題是複雜的。因為病人不僅正遭受急性精神症狀干擾的痛苦，還要面對原本吸菸習慣被迫改變，部分個案更可能因暫時無法吸菸，出現尼古丁戒斷症狀，而造成情緒焦慮、激動與暴力行為。本文旨在提供精神科護理人員瞭解相關尼古丁對精神疾病與藥物的影響、戒斷症狀、替代療法和護理衛教相關知識，期可提供工作人員對住院病患戒菸的評估與服務，以提供病患更好的住院醫療環境及生活品質。

Severe psychiatric patients have higher rates of smoking than the general population. Due to the patient control in passing in and out, a smoking room was generally set up in the therapy ward. Thus, psychiatric nurses may tend to ignore the smoking issue. Nowadays Tobacco Hazards Prevention Act has been enforced in Taiwan on the basis of health promotion. Smoking cessation has become a major clinical concern for psychiatric nurses. However, the patients in smoking cessation may encounter painfully acute psychiatric symptoms and withdrawal symptoms of nicotine, and become anxious, agitation and aggressive in the actual ward. Managing these patients in the process of smoking cessation is complex. This paper was to review and discuss the role of nicotinic receptors in smoking, nicotine and psychiatry drug, nicotine dependence, nicotine replacement therapy, clinical management and nursing care of smoking cessation in the psychiatric setting. The holistic views of smoking cessation may be used as a clinical reference to provide high quality smoking cessation services for psychiatric patients and help them cope with nicotine withdrawal in the future.