patient right to information

delirium · Feb 26, 2002

While its great that your plan worked and your patient's pain was relieved, I have to say that seems rather unethical to me.

I wouldn't have done it.

I've been involved in a lot of situations in acute care (as a student, I'm not a real nurse yet ) where it was really difficult for me *not* to tell the patient the truth. A recent example: I was caring for a woman who was s/p splenectomy, and the doc had broken off the better part of a needle into her abdominal cavity while suturing her and wasn't able to find it. They had to do an x-ray to try and locate the needle. She kept asking me why they needed an xray, the doctor hadn't told her anything about it, etc. Its a very difficult situation... of course, as a student, its not my role to do anything about that. As a nurse, I suppose it would be more appropriate to speak to the physician about the way he is handling the situation rather than blurt it out to the patient. I do feel like patients have a right to know about their medical treatment.

That was a long-winded way to say I don't know if there is a LAW forbidding you to do that, your ethical/moral code notwithstanding.

Are you a student? I ask because you posted this in the student nursing section. What does your instructor have to say about this situation?

I'm interested in hearing the responses you get to this one.

:roll

nursy_ann · Feb 26, 2002

I did what my teacher told me to do but I feel it isn't ethical to do that. Even if that patient is well known by the docs and nurses as a morphin asker. I give him what the doc prescribe him.

but.....I'm still having difficulty to deal with that.

It is unethical to give a patient a placebo and tell him he'll be better in a few minutes.

Tiggur · Feb 27, 2002

oh wow those both sound like some real uncomforitable situations .....do tell how the outcome came of both ....

tapper · Feb 27, 2002

Legally I have no idea, but as long as you didn't tell the pt that you had given him a pain med, sounds good to me.

My question is, how would you handle it if say, the nurse on the next shift has a similar experience with the pt and the pt says "Just give me the same thing the last nurse did. That seemed to help. By the way, what was that?" Now you have set up a situation where either the next nurse is expected to lie for you, or you are going to lose your credibility when the nurse tells the truth and says it was just NS.

nursy_ann · Feb 27, 2002

well...the nurse will do the same as me caus e it is the prescription..... aquapure 2mg PRN if thoracic pain (The pain isn't a cardiac one....it is a fake)

meownsmile, BSN, RN · Feb 27, 2002

If the patient didnt ask, i wouldnt worry about telling him. Most of the time they write plecebo orders the Dr. handles it in 24 hours anyway. They write them to determine dependancy and they will usually discharge the patient and refer them to counseling. If the patient gets to abrupt and demanding about what he is given, you can always call the super and have them go in to deal with the patient.

I have seen doctors refuse to treat a patient further when they are seekers like this one sounds like he was. The patient will find another doctor to take advantage of and will go through the same senerio again and again.

As far as the needle incident MsPurp spoke about, i wouldnt touch that with the patient. As staff nurse you are putting yourself into a real situation if you share that information with the patient without the Dr. having addressed it with them first. Any questions the patient had i would just tell them you havent been trained to read the x-rays and anything concerning the surgery would have to be discussed with the doctor. If you werent in the OR when the needle dropped, you know nothing about it. Keep yourself covered that way.

mattcastens · Feb 27, 2002

You're dealing with a very concise ethical issue: giving a patient a placebo and telling him that it was a painkiller. The only time this would be ethical is if you're doing research (i.e. clinical drug trial), but even then ethics requires the patient to know that they may be getting a placebo.

One of the basic tennents of compassionate nursing care is that pain is what the patient says that it is. Period. Yes, there are those that abuse the system. There are also ethical ways to deal with the situation, for example telling the patient up front that only a limited amount of medication will be given in a certain period of time and sticking within that parameter.

Keep in mind, too, that drug-seakers are frequently drug addicts. Drug addicts by their very nature need more pain medication to deal with pain because of high tolerance (alcoholics are included in this group). He might have been tweaking the system because he actually had pain, and that was his way of getting the higher doses he needed.

All experienced nurses have dealt with drug-seakers. It's not easy -- pretty maddening, actually. No matter how frustrated you get, though, it's not an excuse to break a nurse's code of ethics.

As a general point, it's frequently hard for student nurses (myself included, when I was one), to learn assertiveness in being a patient advocate. Sure, you have great intentions, but they can be hard to pursue when faced with an instructor or physician aggressively or angrily demanding that you give this med or perform this treatment. Especially with your lack of experience, you simply might not know if what they are asking is the right thing to do.

When in doubt, simply say, "I don't feel comfortable doing that in this situation, if you want to do it, that's fine."

This serves three purposes. 1) You're license isn't in jepardy for what they do. 2) It might make them re-think the medication or treatment when they realize that their ass is on the line. 3) If what they're asking is reasonable, they will do it themselves and you get to learn about it.

Good luck in your future endeavors!

**canoehead, BSN, RN** · Feb 27, 2002

It is absolutely unethical to lie to a patient whether directly or by just letting them assume the opposite of what is true.

Since 90% of a drug addiction is the psychological, not physical need, whether you gave the MSO4 or water you are reinforcing that behavior. The litmus test is how you would feel if someone did the same to you. If you wouldn't like it, likely they wouldn't either. And remember that patients needs to consent to all treatments. If we tell them one thing and do another without their knowledge they lose their right to make their own decisions.

As for the needle in the abdomen I would say to the patient that they REALLY need to talk with the doc, that I know he needs to speak to them about the Xray, and he would be the best person to explain it, then call te doc and say the patient is insisting on knowing, and if he doesn't come over and speak with them....well something's going to happen and it's not going to be good. Refuse to lie for the doc- if he wants that done he can come over and do it himself. And call your supervisor.

I've dealt with a similar situation by saying that there was a conflict between what the chart said and what I heard in report, and that I didn't quite understand what the "real" story was, and they would probably get the best, most reliable information from the doc, let me give him a call. And then forward the call to the room so they can speak directly. :)

crnasomeday · Feb 28, 2002

I agree with Mattcastens and canoehead. I really don't think it's ethical in any circumstance to mislead or directly lie to a patient. It robs them of their rights. There's just something about that situation that really gives me the creeps, and I personally wouldn't be able to comply with a doctor's orders to do something like that.

delirium · Feb 28, 2002

Just an update on my clinical situation:

I didn't discuss it with the patient at all. I couldn't. I'm a student.

When she asked me why they needed an x-ray, I just said something like, "Oh, its just to make sure everything's alright with your belly before you go home. Make sure you talk to the doctor about it when he comes up to see you."

I left the floor before the doctor came up, so I have no idea if he told her the truth or not.

Makes me never want to have surgery again.

:eek: