Legal?

MrChicagoRN, RN · Oct 19, 2014

Did the patient achieve relief? If so, that means the patient was helped with out the potential side effects of the "

It's legal, and ethical, as long as it isn't misrepresented as something else. "here is something that will help you with the pan...nausea...whatever" is acceptable. And, it has to be ordered of course.

read up on the placebo effect, which is real; and does not mean the patient is faking or that the symptoms aren't genuine.

http://www.webmd.com/pain-management/what-is-the-placebo-effect

Junebug14, ASN, RN · Oct 19, 2014

Unfortunately, I didn't get to see whether he was relieved or not. I was just frustrated by her saying to me, "he just thinks he has nausea. " It was just a saline flush she used but she said here is something to help with your nausea. I've read about the placebo effect, just was confused

elkpark · Oct 19, 2014

It is completely unethical unless the person has agreed, through a standard "informed consent" process, to the potential administration of the placebo (ie., understands and has agreed to possibly receiving NS for nausea). "Here is something to help you with nausea" being said by a particular nurse is not acceptable. I'm surprised your instructor didn't respond to your question(s) with a clearer answer.

Please note that the WebMD link posted by MrChicagoRN only references placebos being used in research (as controls) and makes no mention of any appropriate clinical applications ...

imintrouble, BSN, RN · Oct 19, 2014

I gave placebo injections for pain, in a NH as a new nurse. I've never seen placebos ordered since that time.

It's not legal. It probably wasn't legal 20 years ago. For sure it wasn't ethical. But it worked.

I wouldn't give that injection now for any reason.

Times change.

Or at least I thought they did.

MrChicagoRN, RN · Oct 19, 2014

Yes, it can be both legal and ethical:

The ethics of the placebo in clinical practice -- Lichtenberg et al. 30 (6): 551 -- Journal of Medical Ethics

Abstract

While discussions of the ethics of the placebo have usually dealt with their use in a research context, the authors address here the question of the placebo in clinical practice. It is argued, firstly, that the placebo can be an effective treatment. Secondly, it is demonstrated that its use does not always entail deception. Finally guidelines are presented according to which the placebo may be used for clinical purposes. It is suggested that in select cases, use of the placebo may even be morally imperative. The argument is illustrated by three case vignettes.

icuRNmaggie, BSN, RN · Oct 19, 2014

We had a confused elderly man who wanted a neb tx constantly. He was on routine nebs and perfectly stable. A coworker tried put 5cc of sterile water in the nebulizer and it kept him from becoming agitated. We did this just three times in two days. Is this bad management? I don't think so.

klone, MSN, RN · Oct 19, 2014

Yes, giving placebo in a clinical setting, without the person's knowledge (outside of a research setting when the person knowingly agrees that they may get placebo instead of active medication) is incredibly unethical. In and of itself, it may not be illegal, but if they are BILLING for the medication that the person was supposed to get, then that would be illegal/insurance fraud. Deception of a patient as to be "in their best interest" is paternalistic and inappropriate.

elkpark · Oct 19, 2014

Yes, it can be ethically and appropriately used in clinical practice, but only, as I said, in the context of informed consent being given by the individual to be administered placebos.

Here is the AMA position statement on the question:

"... Physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use..."

Opinion 8.083 - Placebo Use in Clinical Practice

Susie2310 · Oct 19, 2014

Yes, it can be both legal and ethical:
The ethics of the placebo in clinical practice -- Lichtenberg et al. 30 (6): 551 -- Journal of Medical Ethics
Abstract
While discussions of the ethics of the placebo have usually dealt with their use in a research context, the authors address here the question of the placebo in clinical practice. It is argued, firstly, that the placebo can be an effective treatment. Secondly, it is demonstrated that its use does not always entail deception. Finally guidelines are presented according to which the placebo may be used for clinical purposes. It is suggested that in select cases, use of the placebo may even be morally imperative. The argument is illustrated by three case vignettes.

The nurse-patient relationship is based on trust. The Nurse's Code of Ethics does not appear to support the use of placebos.

jadelpn, LPN, EMT-B · Oct 20, 2014

Unfortunately, I didn't get to see whether he was relieved or not. I was just frustrated by her saying to me, "he just thinks he has nausea. " It was just a saline flush she used but she said here is something to help with your nausea. I've read about the placebo effect, just was confused

Ya, and he just "thinks" he has nausea until such time as he vomits, and aspirates. If the patient is ordered Zofran, I am not sure why it would not be given.

This kind of nursing is not only just plain mean, but unethical. Especially if there are anti-nausea meds available to this patient.

It is a really slippery slope when nurses start assuming they know what a patient thinks. Interestingly, a saline flush has on more than one patient given a metallic taste in the mouth. And has made patients more nauseous.

Overall, poor practice. If the patient's nausea is something that needs to be addressed, you need to address it. Not lie and say that a saline flush will do one thing for the patient's nausea. Because it will not. Nausea can come from any number of things that cause a sensation. And never, ever assume that a paralyzed patient can not have a sensation such as nausea.

Sorry that you were shown an unethical way of practicing. Know going forward that this is the case. Should you be asked to do this in the future, have conversation with the powers that be as to why you will not participate, and ask for their assistance.

subee, MSN, CRNA · Oct 21, 2014

We had a confused elderly man who wanted a neb tx constantly. He was on routine nebs and perfectly stable. A coworker tried put 5cc of sterile water in the nebulizer and it kept him from becoming agitated. We did this just three times in two days. Is this bad management? I don't think so.

How is one supposed to explain the complexities of possible placebo administration to a confused man

who was probably feeling like he couldn't breathe? It would be cruel NOT to give him the saline and dangerous to overload him with beta agonists. I would have done the same thing with no guilty conscience. However, in a sentient patient in NAD, that would be different.