Lying about a med to a psych patient - page 4
by cel58 7,098 Views | 39 Comments
I'm interning in the emergency department right now. We recently had a schizophrenic patient come in and then had a major breakdown, becoming very violent and throwing tables at staff members. He eventually agreed to take IM... Read More
- 4Apr 11, '12 by Meriwhen Senior ModeratorQuote from hiddencatRNEspecially when the patient finds out she lied. Good luck trying to give them medications after that.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.
- 2Apr 11, '12 by chevyvNope, 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.
- 0Jun 28, '12 by TomGuyQuote from ~*Stargazer*~I also agree 100% with Stargazer.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'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.
- 0Jun 28, '12 by lovedijahYou 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.
- 2Jun 28, '12 by BluegrassRNI 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.Last edit by Esme12 on Jul 6, '12 : Reason: TOS/profanity
- 0Jun 28, '12 by NurseCardTough 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!Last edit by NurseCard on Jun 28, '12
- 1Jun 28, '12 by VictoriaGayleQuote from elkparkI don't think you could even argue that the patient was dangerous, since they had apparently calmed them down already (though to what extent we can't be sure) and since they were able to get consent when they thought they were going to give patient X, I don't see why you would have to lie when you got Y instead, unless the patient was agitate again or demanding X and refusing Y.You can medicate someone against her/his will, without her/his consent, over her/his objections, in an emergency situation where the individual is acutely dangerous to self or others. However, in nearly 30 years in psych, I've never lied to a client about a medication I was giving, and can't imagine doing so.
I've been to a psych ward as a patient. It's sad how some of the nurses look at you like you aren't even human, just a problem they don't want to deal with. Don't get me wrong, there are some amazing psych nurses out there! But in any specialty, theres always a few bad apples. I'm not saying you should never use restraints, or give meds with out consent, just don't think that just because someone is in a psych ward that its ok to treat them poorly.
My big question for OP is : what was the reason for the lie? Was patient becoming agitated/dangerous again? Was there reason to believe he would only take ativan? Or did the person administering the medicine just not feel like explaining what they were going to give them and getting consent again?
- 7Jun 28, '12 by marydcI've been a psychiatric nurse for 24 years and have been involved in many crisis situations requiring emergency medications. I also speak as the voice of one who was assaulted and seriously injured by a psychotic patient. We state the facts and do what is necessary for the safety of the patient and others. Those burdened with a mental illness deserve honesty and respect just like any other patient. I don't see how there can ever be any moral justification for lying to a patient.Last edit by marydc on Jun 28, '12
- 1Jun 28, '12 by sauconyrunnerPart of the problem here may be that the patient was becoming more and more agitated and was not medicated until he began throwing things.
The patient possibly could have been medicated with ativan long before the table throwing started. Case in point. I came in one day and was working in the Psych holding. There was a woman who was standing at the door, staring in a menacing way. The night shift RN told me, oh yeah, she has been standing now and pacing and staring for about 2 hours... About 30 minutes later, she assaulted the CNA who was trying to bring her breakfast. When did that woman need medication? oh about 30 minutes after she started pacing. It was not recognied...and thus she escalated and a very dangerous situation occurred.
The other option which does not always work with psych pts because they are usually well informed on meds...is to ask them: Can I give you a medicine to help you calm down some? Never name the medication....thus you aren't lying. But of course...that does not always work...
- 0Jul 6, '12 by MalanyaQuote from Esme12As long as the way the chronic psych patient is wanting to avoid "feeling" is the extreme pain of EPSE, your first reaction would be legit IMHO. While I've never been combative in an ER, a situation did arise where I was given Haldol, and developed severe EPSE. I have never been in that much muscular pain in my life, and it wasn't confined to just one muscle group.Many chronic psych patients KNOW their drugs and will refuse psych meds because they don't like the way they make them "feel". In the interest of everyone, even though you aren't "supposed to", a little white lie doesn't hurt when someone is psychotic in an Emergency Room. MunoRN is essentially right but I have always considered it part of implied consent.
Really, given that less potent neuroleptics are less likely to cause EPSE and NMS, I don't understand why haloperidol and droperidol are still so commonly used. It might be a bigger shot to use Thorazine, but if your combative is screaming "No Haldol", there might be a reason that's more than just that they don't like how it "feels"....and if you aren't sure why they're rejecting one particular one, go for one that has a slightly less intense side effect profile JIC.