You are a health worker on a medium dependency surgical ward.
Tom is a 56yr old patient with terminal lung cancer and boney metastases. Tom currently lives alone. Although Tom is normally independent and mobile, he appears profoundly fatigued, fragile and thin on appearance. Tom is on continuous oxygen therapy, via nasal cannulae, and has been admitted to the ward, and in to a side room, for post-operative care and rehabilitation.
Tom fell at home recently, and as a result, suffered a pathological fracture to his right shaft of femur. Tom has received an open reduction and internal fixation during surgery, the previous day.
Tom is expected to be discharged from the ward in about 3-4 days, following physiotherapy, occupational health and social care assessments and evaluations. He is expected to stay with his brother following discharge, Tom has reluctantly agreed to this. Toms brother will care for him until he regains most of his previous optimum mobility, at which point Tom says he will return home alone.
Despite the fact that Tom lives alone, his brother and sister, who visit frequently, have offered to care for Tom in their own residences, in the long-term. They feel this necessary, especially as he has become more fragile of late and his disease course has progressed . Tom has openly and firmly resisted this and is protective of the autonomy he currently still has, wanting to stay in his own home.
Tom has remained a 40 a day heavy smoker since he was diagnosed with lung cancer, 18 months ago. Despite pressure from his doctors and family Tom has been reluctant to give up smoking, and says that he enjoys it too much, being one of the only things he continues to find quality in, in his life now. Tom's siblings describe Tom as 'stubborn and someone who doesn't take orders from others.' They also suggest that as soon as Tom is able to mobilise, he will find a way to go outside, or in a toilet in order to smoke a cigarette.
You are assigned to care for Tom on the late shit. During the evening, Toms' siblings visit and enter Tom's private room and you witness them clearly hand over an electronic vapour cigarette to Tom. You are surprised by this and you are also concerned as since recent EU directives have come into force, the hospital has both a smoking and E-cigarette ban, operational within its buildings and grounds. You offer to ask the doctor to prescribe nicotine replacement patches for Tom but Tom says he finds these ineffective and prefers an e-cigarette, as it feels more like a cigarette. You offer other alternatives such as gum but Tom at this point becomes anxious, agitated and cross, which visibly increases his respiratory effort somewhat.
What would you do in this situation?
It is proposed that you take Tom's E-cigarette away from him.