Quote from ksusn
The pt has had a history of being very aggressive
I am a student nurse and I was pulled to work in the ED the other night to be a sitter for a psych pt. The pt has had a history of being very aggressive and claims to have seizures (which were determined to be fake by RN and MD). The pt was very agitated/anxious at the time with security on stand by. The nurse had drawn up olanzapine (antipsychotic) to give IM. The pt asked for anti-seizure med and insisted the RN tell him the name of the drug and the drug class in which he was about to receive. The RN told him the correct name of the drug, but told him it was an anti-seizure medication. I understand that if the pt had been violent, he may not have had a choice in whether he received the drug or not. However, I feel like it was wrong for the nurse to lie about the medication. Any thoughts on this or how the situation should have been handled? Thanks!
The pt was very agitated/anxious
I feel like it was wrong for the nurse to lie about the medication.
The RN told him the correct name of the drug, but told him it was an anti-seizure medication.
A- "This is Olanzapine, it is an anti-seizure medication."
B- "This is Olanzapine, it will help stop your seizures."
Which did the nurse say? Either one helps the patient get the medication he needs to keep him safe. B is also 100% accurate, and meets any definition of "ethical". But, in the heat of the moment, would you really draw an ethical line between these two statements? Is the nurse who was heads up enough to parse his/her words in a potentially dangerous situation really any more ethical than the nurse who is just trying to keep the patient safe?
Lets look at option C:
"This is Olanzapine. It is not an anti seizure medication, it is an antipsychotic. Oddly enough, it actually lowers seizure threshold. But, you my friend, are not having seizures. You are having a psychotic episode."
This is the most truthful answer, and the most likely to cause harm to the patient. Would an ethical nurse choose this?
- Beneficence - to do good.
- Non-maleficence - to do no harm.
- Respect for Autonomy.
Sometimes these principles can conflict with one another.
Even if, in your situation, the nurse chose statement A above, he or she was still maintaining the first 2 principles, despite a sub-optimal choice of semantics.
Also- remember that there are different theories of ethics.
It looks like you are focused on Deontology
. "This theory judges the morality of an action based on the action's adherence to rules."
But, there are other ways to look at this.
- "The theory states that before decisions are made, the context of the decision must be examined."
- " The value of the act is determined by its usefulness, with the main emphasis on the outcome or consequences. "
- "Feminist theory requires examination of context of the situation in order to come to a moral conclusion."
Once, while working in the ICU at 0300, I got a call from a nurse on the floor, asking me to come upstairs and pretend to be a doctor. (I am a middle aged man) She said that she had a little old lady with dementia who really needed to take a medication. The nurse had told the patient "The doctor really thinks you should take this medication". The patient said she wanted to hear that straight from the doctor.
I went up stairs, walked into the room, and said "Mrs Smith, you need to take this medication".
Regardless of the fact that I did not lie, I deliberately mislead the patient. Did I do the wrong thing?
I recently had a patient with pseudoseizures as a result of conversion disorder. The doctor was able to stop these seizures by pushing 3 ml of normal saline. This allowed us to accurately diagnose and treat the patient. On a moral scale of 1-10, where do we stand on this?
Those are my thoughts on this. Now, I am going to ask you the question you asked:
What do you think would have been the right thing to do with this agitated anxious patient with a history of aggression?