Lying about a med to a psych patient

Meriwhen, ASN, BSN, MSN, RN · Apr 11, 2012

I haven't lied to my patients about what their medications are, and I'm not about to start now. Depending on the state of the patient, I may say something like, "this is to help calm you down/quiet the voices/organize your thoughts/help you sleep" and not initially give the name...but if asked, I'll tell them exactly what they are getting.

If they refuse and/or need to receive it against their will, that's a whole other basket of eggs...but I'm still not going to lie to them.

This is not me being holier-than-thou, but this is something I learned from years of experience with psych patients: the majority handle it better when you are honest with them, and nothing kills a therapeutic relationship faster than lying about meds.

elkpark · Apr 11, 2012

How, exactly would it be considered "lying" to a patient that is psychotic?
They cannot be held accountable for their actions, or understand the ramifications of their medical regime.
Hello, Mr. Schizophrenic.. I know you cant comprehend what I am saying.. but I am going to give you Haldol now ..
Please don't kick me while I am administering this med.
PULEEZE!!

Where do people get the idea that people with schizophrenia can't understand "the ramifications of their medical regime" or what is being said to them and lying to them doesn't count as lying, or that a "true schizophrenic," per RN-Cardiac, is going to feel "better" after the meds and won't remember later what happened or who said what to them at the time? That has not been my experience in nearly 30 years of psychiatric nursing (including my fair share of wrestling people down and medicating them against their will). Maybe y'all have some different variety of schizophrenia where you live ...

mindlor · Apr 11, 2012

Let me give you the legal answer if I may.

Nurse is open to being charged with battery and malpractice.

Patients maintain the right to call the shots until they are deemed incompetent. At that time someone will be assgigned as their guardian. .......

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 11, 2012

Where do people get the idea that people with schizophrenia can't understand "the ramifications of their medical regime" or what is being said to them and lying to them doesn't count as lying, or that a "true schizophrenic," per RN-Cardiac, is going to feel "better" after the meds and won't remember later what happened or who said what to them at the time? That has not been my experience in nearly 30 years of psychiatric nursing (including my fair share of wrestling people down and medicating them against their will). Maybe y'all have some different variety of schizophrenia where you live ...

I will admit that as an ER nurse my experience with true psychiatric pt's is limited compared to a psych nurse. I made my statements based on my experiences.

We have two patients that immediately come to mind when reading this post. One is a younger woman who was diagnosed with schizophrenia at age 22. She is a brilliant artist with a college degree, her father is a retired physician. The first time I met this young woman she was wearing a large pink tutu, a tank top that was three sizes too small (this was three days before Christmas and there was snow on the ground), no shoes and had black mascara and bright red lipstick smeared all over her face. She was brought in by local PD after she assaulted a woman in line at the bank. She explained to police that she was a federal officer, and that the woman at the bank was part of a group of people they were investigating as being responsible for planing the 911 attack. She was dead serious, very frustrated that she wasn't getting assistance from local PD and fought with them. By the time I got her, she had abrasions on both knees, huge bruises and open areas on her arms and a large hematoma on her head from beating it against the window of the police car. When trying to speak with her she didn't recognize any of the staff that she has often called by name and sent gifts to. She didn't believe she had any disease or needed any meds. This lady is ill. She isn't high on meth or drunk, she is ill and has stopped taking her meds. Recently I visited with her while she was visiting her Mother who was in the hospital. She was well dressed, well spoken and completely normal. I will admit that often when she goes off her meds, lying to her isn't even an option, as she doesn't feel she needs any medication at all, so yes we physically restrain her to give her meds. If I can lie to her, tell her she needs a tetorifice shot and giver her the meds she needs I will.

hiddencatRN, BSN, RN · Apr 12, 2012

If the patient's not going to take the haldol calmly without becoming a danger to him/herself and others, why am I going to trust them to accept another injection without having some backup on hand to restrain while giving the med? In that situation, I'm not sure lying about the med would make me that much safer to justify a breach in ethics and a potential legal issue.

"It's something to calm you down" and then restrain and inject as necessary.

brillohead, ADN, RN · Apr 12, 2012

i'm coming to learn that in the er patients give implied consent for many things that would not be acceptable on the floor (for example, tox screen w/o consent). but it comes down to maslow: safety and security before self-esteem. we had a similar incident in the er last week and with 7 people holding someone down, a chemical restraint was the kindest thing to do. the patient had been awake for 3 days, already deemed a danger to self and was screaming "you're not helping me!" when the incident started, but then with some meds on board was able to relax and sleep.

patient was a nursing student, eh?

Meriwhen, ASN, BSN, MSN, RN · Apr 12, 2012

I'm not sure lying about the med would make me that much safer to justify a breach in ethics and a potential legal issue.

Especially when the patient finds out she lied. Good luck trying to give them medications after that.

chevyv, BSN, RN · Apr 12, 2012

Nope, here in WI it is illegal to lie to a pt regarding a medication. The doc would have to give the order to administer over the pts objection. I call several times a week for that reason. Everyone has the right to refuse medication unless the pt is on court ordered med compliance. This normally means that if they refuse po meds, the rn must give other meds IM. It's very specific.

Other times when a pt is out of control, we get a verbal or telephone order to give the IM with the objection noted. Sounds like the pt was not only a danger to themselves, but to others as well. Certainly would have gotten haldol (or Zyprexa), ativan, and benadryl where I work.

TomGuy · Jun 28, 2012

No, it is not okay to lie to the patient.
I don't know the whole story, but if the Ativan worked and the patient was no longer acting out or posing any immediate threat to himself or others, then he could refuse the Haldol.
If, however, he was continuing to behave in a dangerous way, then you can physically restrain him if necessary and give him the Haldol against his will.
Either way, there is no need to lie, and further, in my opinion, it would be unethical to do so.

I also agree 100% with Stargazer.

I'm a fairly new nurse, I work in an inpatient psych facility where we are known for taking a lot of violent patients that other facilities in our area will not take. Here is what I do when a patient is acting out or violent, try to talk them down if that doesn't work, try to get them to take medication PO. If they continue to act out despite offering these things, firm limit setting is not working, they refuse to take medication, and they continue to be a threat to themselves or to others around them, THEN you restrain them and give give IM medication.

No where in those steps would it be necessary to lie.

lovedijah · Jun 28, 2012

You people are better than me. I worked in a group home for people with severe mental disabilities. We had no restraints. The only thing we could do is call the police to take them to a hospital or clinic. And that was often a 20 minute wait. A lot can go down in 20 minutes. If I had a dollar for everytime I said.. "take your vitmains". We had a resident manager leave with 12 stitches once.

BluegrassRN · Jun 28, 2012

I don't get why anyone has to lie. If we call a code gray and the doc says to give them haldol, I'm not asking permission at this point. I'm telling him/her "We're giving you haldol because you are a threat to yourself and others. These large men will be holding you down for me to give it." At that point, we've gone way beyond asking permission; we've already been there. Typically on my floor, before someone gets violent they get agitated. At that point we're giving whatever we can, again informing the pt what we're doing and why, as well as informing of them of our expectations and the consequences of their actions.

Honestly, I've had pretty good success with asking agitated psych pts what works for them. "I can see you're getting restless/upset/angry. I'm here to help you. Is there something I can do or some med I can get you that will help you out?" Heck, half of them will ask for ativan or valium by name.

The only time I've been struck hard enough to have any residual side effects was when an old, demented, physically as healthy as a horse psych nurse kicked me right in the face. She knew exactly what we were giving her. "Oh great, you ******* little ******* . Now you're going to hold me down and give me some ***** haldol, aren't you." Why yes, yes we are.

allnurses Guide · Jun 28, 2012

Tough one. The patient should have just been given the med

that the doctor was willing to prescribe, WITHOUT being lied

to. Which would have meant coding the patient, restraining,

lots of paperwork... phone calls... all of which the doctor and

nurse were trying to avoid. Restraining the patient, while

very unpleasant, would have actually been more ethical, IMO,

than lying to him.

Controversial probably, but that's my vote.

Okay, after reading previous posts, let me clarify.. of COURSE

you are going to do what it takes to get someone like this

calmed down, for the safety of everyone involved. However,

it sounds like this person was actually in control enough to

stop and say "Oh, you're giving me Ativan? Goodie!", and

that's what produced my opinion.

In a dangerous situation, you don't even need to tell someone

what you are giving them, you just hold them down and

you give it!