Abstract
Psychiatric hospitals, like all public healthcare facilities, are mandated to uphold
national standards of clinical practice and ensure that environments promote health
and safety. However, the exceptionally high prevalence of smoking among psychiatric
patients continues to pose substantial challenges for effective policy implementation.
Managing large numbers of patients who smoke places considerable strain on
psychiatric staff, particularly nurses who are directly responsible for supervising
smoking behaviour and enforcing policy guidelines. This study sought to explore and
describe the challenges nurses face in implementing a smoking policy among mental
healthcare users in a selected tertiary psychiatric hospital and formulate specific
recommendations to improve smoking policies’ implementation in tertiary psychiatric
hospitals.
Guided by the theory of planned behaviour (TPB), a qualitative, exploratory,
descriptive and contextual research design was used to gain an understanding of
nurses’ experiences in enforcing the smoking policy using two phases. Phase one
explored and described the challenges nurses face in implementing a smoking policy
among mental healthcare users in a selected tertiary psychiatric hospital. Phase two
formulated specific recommendations to improve smoking policies’ implementation in
tertiary psychiatric hospitals. Twelve nurses who routinely supervise patients who
smoke participated in semi-structured interviews, supplemented by field notes and
observations. Data were analysed using thematic analysis, and an independent coder
verified the emerging findings. The researcher ensured the quality of the research
findings by following the principles of credibility, transferability, dependability and
confirmability. The following ethical considerations were also adhered to in this study:
autonomy, respect, confidentiality, anonymity, privacy, risks and benefits, justice and
compliance with the Protection of Personal Information Act (POPIA). Five themes were
generated, reflecting the multifaceted realities of policy implementation within the
psychiatric context and highlighting interconnected challenges at individual,
organisational, and systemic levels...