[Nitengale326]

Originally Posted by stevierae

Thank you. Exactly----a deep IM injection of sterile water is a well-known placebo, and it's been around a long, LOOONNG time. And, no, I was not making this up--we did this often (for malingerers and narc seekers) when I was a military corpsman, (age 21) working in the emergency room. Of course, it was ordered by a physician--we didn't just do it arbitrarily.

It burns like crazy, (but does absolutely no harm----unlike IV Phenergan, which I absolutely will NOT administer, under any circumstances--that type of burning means it is damaging a vein) which makes the malingerer or narc seeker think he is getting something really good, and he or she goes away happy as a clam---but next time remembers how much it burned, and thinks twice about coming to the ER faking various symptoms of various maladies, thinking he has cleverly fooled us all when he gets his "drug." He even fools himself into thinking that he is high.

Placebos are a wonderful thing, and will always have their place in medicine. In fact, they are downright therapeutic.

It was not administered to be cruel. Would you have preferred that we simply gave them their narc of choice, (p.o., so that it wouldn't hurt, of course) no questions asked, and sent them on their merry way--until next time they showed up, demanding more narcotics, in ever increasing dosages, for non-existent problems--only to repeat the scenario?

That is the problem at my hosp... all these druggies know which docs admit and which ones don't and know who they can get the narcs from... I am so sick of giving Dilaudid Q1H for "abdominal pain"... its an automatic admit with workup and meds at this looney bin!!!
Now for the original ER chick... honey, glad it was you and not me, I'd told hubby and preacher man to stand aside... out of site, and do that sternal rub or pinch an earlobe or something... I guess you can be thankful for one thing... at least she didn't have pea soup for dinner before presenting to you guys

[MAGIK GIRL]

Originally Posted by estrogen

....Ummm, no I'm just a little ole LPN in a little ole med surg unit. And I didn't take it seriously, I just didn't think it was that funny. Sorry.

So, since you are comming back to this, let me elaborate...
I wasn't around thirty years ago (as a matter of fact I was just born around that time) and on top of that in a different country, so I don't know if the ethics of nursing were somehow different then, but to be honest I thought that you are making this up.... So it is more shocking to me, if this is infact true, as it seems from your second post.... Not the fact that it is in fact cruel (you yourself were vividly describing how painfull it is to get such an h2o injection), very judgemental and presumptive, but more so the fact that in this day and age a NURSE would think this kind of practice is agreeable...

And it is still illegal and still not therapeutic...nor is it moral or ethical.... And not funny either.... Sorry once again.

oh, that explains it, med surg. if you have not walked in our path, you have no place calling us cruel, judgemental or presumptive.

we give our pts what they need. in fact, giving the patient nothing, including placebo, would have been cruel. because perception is 9/10's of reality. if you can get rid of someones pain with out loading them with junk, why not. or should we just creat some more addicts?

be less judgemental and more open minded and you may find your life a little easier.

:hatparty: :hatparty:

[SARAH CONNOR]

Originally Posted by stevierae

Like you too, Magik Girl.

I have always intrigued by Magik, Wicca and references to The Goddess, but am not really knowledgable about any of it. Everybody I have ever met who WAS knowledgeable about these things was one of the most thoughtful, kind and creative people I have ever had the good fortune to cross paths with. Theynever take life too seriously, and have a great time LIVING it. I am certain, also, that crossing paths with them was predestined--part of some higher plan--and that each encounter had a profound influence on the way I look at things.

Bet you are among them, and hope I will meet you one day. Maybe I have already, in some previous life!

I wonder why estrogen didn't jump all over the post about rapid sequence intubation?! I mean, surely doing cricoid pressure and attempting to intubate someone like the "possessed" woman in the ER--that is, crashing her-- (and without benefit of Succs--not to induce general anesthesia; but because cricoid pressure alone--even without an attempt at intubation--would then surely make her open her eyes, start gagging and attempt to talk--presumably in English, too; not in ancient biblical tongues-- and ask them to STOP---presto; demons BEGONE!! problem SOLVED!! another ER SAVE!!!) would raise some management eyebrows as being "inappropriate" and "non-therapeutic--" but, hey, some ER patients are "inappropriate" and need "unconventional" and "non-therapeutic" interventions----otherwise they end up as "frequent fliers" at that ER, or others where their "unconventional" behavior is tolerated or even encouraged (and attention, time, money and resources diverted from other patients who actually NEED emergency care) in the name of "patient satisfaction." What a colossal and outrageous waste.

(Remember what "GOMER" stands for, estrogen? GET OUT OF MY EMERGENCY ROOM!!!) Ah, I miss those days!!

Personally, if anyone was going to suggest crash induction in front of this patient, I would have made sure to LOUDLY say, "And grab some rectal Brevital, too!" to whoever was assembling the laryngoscope, ET tube, etc. in preparation for intubation. LOL, that would have made the "possessed" woman sit right up, worthy of Lazarus---AN ER MIRACLE!!!

Anyway, I don't think the person who posted about crash induction was serious about actually DOING it--and I, too, am well aware that deep IM injections of sterile H2O would not meet management approval in this day and age.....

But maybe they SHOULD .......

i have seen some miracles too. i have even measured for airways and ngt's. works like a charm?

[Angie O'Plasty, RN]

I have issues with placebos, even in jest. I was around 30 years ago and it brings back very painful memories of patients being given no effective therapy for pain.

I realize that this is off-topic. But just in case some people think it's still OK to use placebos, I offer this:

http://www.edc.org/PainLink/placebo.html

Clinicians may administer a placebo, not out of maleficience, but rather in good faith, based on erroneous beliefs that use of the placebo will provide valuable information or help patients by relieving pain without harmful side effects. [Or]... clinicians may use placebos in a punitive sense for patients who have exhibited manipulative or demanding behaviors or for patients in whom diagnosis of the cause of the pain or methods to relieve pain have failed.

Central ethical tenets of the American Nurses Association Code for Nurses (1995) include truth telling, fidelity, trust, and respectful care. The use of placebos necessarily involves deception, which automatically raises serious ethical concerns. Use of placebos threatens the inherent ethical values and norms of healthcare professionals. Informed consent, which is most often absent in the use of placebos, is a necessary requirement for promoting the autonomy and well-being of patients. The use of placebos may ultimately compromise the therapeutic relationship between patients and healthcare providers by eroding the necessary environment of trust.


Again, I want to emphasize that the placebo idea was only a suggestion of one poster, I understand it was not used in the OP's scenario, and I am not trying to do anything here but clarify to newcomers that giving placebos is NOT accepted nursing practice today.

[estrogen]

Originally Posted by mommatrauma

It's called placebo...and that's not illegal...down with the fakers!!! :hatparty:

...well, last I checked, using placebo was illegal. Unless you're conducting scientific research...

[estrogen]

Originally Posted by stevierae

Thank you. Exactly----a deep IM injection of sterile water is a well-known placebo, and it's been around a long, LOOONNG time. And, no, I was not making this up--we did this often (for malingerers and narc seekers) when I was a military corpsman, (age 21) working in the emergency room. Of course, it was ordered by a physician--we didn't just do it arbitrarily.

It burns like crazy, (but does absolutely no harm----unlike IV Phenergan, which I absolutely will NOT administer, under any circumstances--that type of burning means it is damaging a vein) which makes the malingerer or narc seeker think he is getting something really good, and he or she goes away happy as a clam---but next time remembers how much it burned, and thinks twice about coming to the ER faking various symptoms of various maladies, thinking he has cleverly fooled us all when he gets his "drug." He even fools himself into thinking that he is high.

Placebos are a wonderful thing, and will always have their place in medicine. In fact, they are downright therapeutic.

It was not administered to be cruel. Would you have preferred that we simply gave them their narc of choice, (p.o., so that it wouldn't hurt, of course) no questions asked, and sent them on their merry way--until next time they showed up, demanding more narcotics, in ever increasing dosages, for non-existent problems--only to repeat the scenario?

Okay,
A) yes, you're right, maybe thirty years ago placebo was legal, acceptable and used... Today it's not...thank God.

B) You wouldn't give IV Phenergan???? For what, instead of a narcotic??? I have no Idea what you are talking about. IV Phenergan is not a narcotic, but it has calming effects and it makes one sleepy etc... As a matter of fact, there are people that are SEEKING Phenergan. So why would you even think of that?

C) Most drug seekers WANT their drugs IV, not PO.

D) If it burns while you're administering IV Penergan, it most likely means that it's damaging the vein because you're pushing it too fast...


Excuse me, where do you work again?

[estrogen]

Originally Posted by MAGIK GIRL

oh, that explains it, med surg. if you have not walked in our path, you have no place calling us cruel, judgemental or presumptive.

we give our pts what they need. in fact, giving the patient nothing, including placebo, would have been cruel. because perception is 9/10's of reality. if you can get rid of someones pain with out loading them with junk, why not. or should we just creat some more addicts?

be less judgemental and more open minded and you may find your life a little easier.

:hatparty: :hatparty:

...for this I have no words ...

How the heck does med surg explain anything? ....and thank you, my life is wonderfull

[estrogen]

Originally Posted by Angie O'Plasty, RN

I have issues with placebos, even in jest. I was around 30 years ago and it brings back very painful memories of patients being given no effective therapy for pain.

I realize that this is off-topic. But just in case some people think it's still OK to use placebos, I offer this:

http://www.edc.org/PainLink/placebo.html

Clinicians may administer a placebo, not out of maleficience, but rather in good faith, based on erroneous beliefs that use of the placebo will provide valuable information or help patients by relieving pain without harmful side effects. [Or]... clinicians may use placebos in a punitive sense for patients who have exhibited manipulative or demanding behaviors or for patients in whom diagnosis of the cause of the pain or methods to relieve pain have failed.

Central ethical tenets of the American Nurses Association Code for Nurses (1995) include truth telling, fidelity, trust, and respectful care. The use of placebos necessarily involves deception, which automatically raises serious ethical concerns. Use of placebos threatens the inherent ethical values and norms of healthcare professionals. Informed consent, which is most often absent in the use of placebos, is a necessary requirement for promoting the autonomy and well-being of patients. The use of placebos may ultimately compromise the therapeutic relationship between patients and healthcare providers by eroding the necessary environment of trust.


Again, I want to emphasize that the placebo idea was only a suggestion of one poster, I understand it was not used in the OP's scenario, and I am not trying to do anything here but clarify to newcomers that giving placebos is NOT accepted nursing practice today.

Thank you

[renerian]

I am with you, very interesting.

renerian

[stevierae]

Originally Posted by estrogen

Okay,
A) yes, you're right, maybe thirty years ago placebo was legal, acceptable and used... Today it's not...thank God.

B) You wouldn't give IV Phenergan???? For what, instead of a narcotic??? I have no Idea what you are talking about. IV Phenergan is not a narcotic, but it has calming effects and it makes one sleepy etc... As a matter of fact, there are people that are SEEKING Phenergan. So why would you even think of that?

C) Most drug seekers WANT their drugs IV, not PO.

D) If it burns while you're administering IV Penergan, it most likely means that it's damaging the vein because you're pushing it too fast...


Excuse me, where do you work again?

estrogen, I was merely trying to clarify that I am not some mean, vindictive, cruel nurse, as I think is your perception of me. I very clearly stated in my original post that it was while I was in the Navy--30 years ago--that we used that technique in our ER. As I said, it was a very different world then----there was no JCAHO; people were not litigious (in fact, at that time, military and their dependents could not sue military health care providers) and the terms "standard of care" and "policy and procedure" had not yet made it into the general health care system vocabulary. In fact, those terms did not even become popular until the '90s--I never heard them in nursing school (I graduated in '81.)

I used to teach IV nursing, and I am an operating room nurse, as well. If you do a search of the archives here by typing in Phenergan, you will find multiple discussions about whether it can/should be given IV. The Intravenous Nurses' Society has a list of drugs that are vessicants, and should never be given IV. Phenergan is one, and it is also one that is the subject of many IV lawsuits, and has actually caused tissue necrosis leading to sloughing and even the loss of fingers and even arms.

The problem with Phenergan is, no matter in what volume it's diluted, or how slowly it's pushed, ITS pH REMAINS THE SAME. It remains a vessicant, and can cause serious damage to the intima of the vein--hence the burning--and if it extravasates, tissue necrosis etc. Yet, it continues to be given in ERs all over the country by nurses who think that they are not held to INS standards of care. The truth is, once you choose to give IV meds, of any sort, you are held to the same standards of care that nurses certified by INS are held to.

The burning with IM sterile water, however, was not causing any damage. It had a placebo affect, which was accepted medicine and nursing care in that era.

Drug seekers would "prefer" that they get their meds IV? So what? Are we just supposed to accomodate them, in the name of patient satisfaction? As Mick Jagger said, "You can't always get what you want."

Actually, I think that the legions of drug seekers who go from ER to ER to ER with vague complaints of "low back pain" or "abdominal pain" (with "symptoms" that aren't supported by lab work or radiological studies) for which they are seeking a script for Percocet or Vicodin disprove your theory that "MOST" drug seekers want their narcotics IV. Again, what SHOULD we do with these drug seekers? They aren't interested in what's therapeutic---they want a steady supply of narcotics, often to sell on the street. Do we simply accomodate them, no questions asked, to avoid risking offending them or being "judgemental?"

Angie O'Plasty, thanks for that info from ANA. I haven't given an injection of sterile H2O as a placebo since I was in the Navy. It makes sense that patients should give informed consent for any drug they are administered (wonder why they aren't told anything about possible risks and complications--other than "this may burn a little--"--when they are given IV Phenergan?!) and that as nurse advocates we are part of that informed consent and teaching process.

I am still betting, however, that the use of various placebos is alive and well---right or wrong--we just don't hear about it anymore.