Ethical Question about NGs and medication administration

cardiacRN2006, ADN, RN · Feb 10, 2009

Beachy,

You are doing the right thing.

If a MD just told me to crush the meds znd give them ayway then I'de give them a not so pleasent lecture on pt rights and then I'd notify them that I chart all conversations with Drs.

I might say something like this,

"Just so I can clarify for documentation purposed, You want me to crush the medications and give them to the pt against her wishes?"

Or I might say, "Sure, no problem. Please write an order in the chart that says 'please crush meds and give to pt even if she refuses"

I'm willing to bet no ethical Dr would still continue to tell you to do this after that.

Fact is, unless that pt is petetioned or court ordered, she has the RIGHT to refuse medications.

Continue to chart that the pt refused and that the Dr was notified. If the Dr tells you to give the meds anyway then tell him it will go in the charting.

mamason · Feb 10, 2009

As long as the pt is of sound mind and doesn't suffer from dementia, schizo, etc, it is her right to refuse. At least it is in my state. If she refuses, notify the doc. Let the doc take it from there. If he insists on you administering the meds via NG tube and you don't feel comfortable doing so, then go to your charge nurse, supervisor, manager, etc. THen, let them take it from there. I am a firm believer in protecting my license. I worked too hard to get it and I'm not willing to lose it over something I find uncomfortable doing. Just my:twocents:

woknblues · Feb 10, 2009

I agree with the above sentiments. However, I would be hesitant to call his bluff, he is likely to say "ok, document it and do it".. then you are agreeing to go through with it. As you have stated, your client is oriented and alert. This person has the right to refuse. You are doing your job as advocate. Well done.

mamason · Feb 10, 2009

I've known a few nurses who have gone as far as handing the medication over to the doc and politely stating that they couldn't do it, but, by all means, if you feel comfortable in doing so...........I'd rather take the chance of getting fired for something like this than losing my license. At least I would still have my license to find another job. Medical ethical dilemmas are tough. As was stated, sometimes we are the only advocates that some of these pts have. :anpom:

highlandlass1592, BSN, RN · Feb 10, 2009

Other posters have stated she has a right to refuse her meds, which she certainly does. However, just because you say "she's alert and orientated" doesn't mean she's competent to refuse. I"d highly recommend a psych consult to she if she's competent to make such a decision to refuse meds. If she's suicidial, which she may be from the behavior you're describing, she actually may not be declared competent to refuse care. I'm betting there's an awful lot going on here we're not aware of. So if I were you, I'd push for a psych consult after conferring with your supervisor and the MD about how uncomfortable you are about the whole situation.

BeachyRNn08 · Feb 10, 2009

Other posters have stated she has a right to refuse her meds, which she certainly does. However, just because you say "she's alert and orientated" doesn't mean she's competent to refuse. I"d highly recommend a psych consult to she if she's competent to make such a decision to refuse meds. If she's suicidial, which she may be from the behavior you're describing, she actually may not be declared competent to refuse care. I'm betting there's an awful lot going on here we're not aware of. So if I were you, I'd push for a psych consult after conferring with your supervisor and the MD about how uncomfortable you are about the whole situation.

I absolutely agree with you!

talaxandra · Feb 10, 2009

It sounds as though she may be profoundly depressed - not eating, not participating in self-care, becoming incontinent... If she has an NG in for feeds because she's refuced/decided not to eat, I think giving meds through the NG isn't necessarily unreasonable or unethical. She hasn't removed the NG, which I would take as an indication that she's prepared to be passively fed, and may similarly be prepared to passively accept medications.

I agree with those who urge a psych assessment, and would give the meds NG if she were my patient.

BradleyRN · Feb 10, 2009

If a pt is A&Ox3, then they have the right to refuse care, period! I had diabetics in the past refuse their meds, and though it seems that no one in their right mind would do so when presented with the consequences, that is from our perspective and not theirs. We cannot force people to take medicine against their will, no more than we can force a Jehovah's Witness to have a blood transfusion. Certainly we know the benefits, and thus one day we will be able to choose for ourselves, i hope!

highlandlass1592, BSN, RN · Feb 10, 2009

If a pt is A&Ox3, then they have the right to refuse care, period! I had diabetics in the past refuse their meds, and though it seems that no one in their right mind would do so when presented with the consequences, that is from our perspective and not theirs. We cannot force people to take medicine against their will, no more than we can force a Jehovah's Witness to have a blood transfusion. Certainly we know the benefits, and thus one day we will be able to choose for ourselves, i hope!

Again, competence needs to be considered in certain situations and in the scenario the OP is describing, I'd say it really must be assessed. Just because someone is A&O x 3 per your assessment, other issues must be considered. Yes, people have the right to make bad decisions...but we must make sure there are not other factors in play..that is part of making a thorough patient assessment: trying to look beyond the initial refusal for treatment and seeing if a valid reason exists. Your scenario regarding diabetics refusing meds really can be different than what the OP is describing..are there any other indicators that could shed light on their behavior? Are they making a poor decision due to lack of education or is something else going on? If someone is truly exhibiting behavior that could indicate depression or even possibly suicidial ideations, then by not administering care they should have we are in fact assisting them in a suicide attempt...which opens a whole new can of worms. My whole point being that when someone refuses care, as nurses, we have a responsibility beyond just notifying the MD...we have an obligation to seek out, if we can, the reason for their behavior. If they need help in the form of counseling or psychiatric assitance, we should see that the proper referrals are made. It's all a part of wholistic assessment which is really the perview of nursing.

suzanne4, RN · Feb 10, 2009

Acute care facility and the patient has been there for months?

Is she the one that is signing consents for whatever that needs to be done and requires a consent? This would be my first question.

What has your supervisor or manager said about this?

Has ethics committee been involved with this patient? They most certainly need to be.

If the patient is competent to sign their own consents, then they are competent to decide what they want and do not want. The physician cannot require you to sneak meds into the patient without them knowing in this case. It can be considered patient abuse. If the physician wishes to give the meds, then they may do so; they cannot require that you do it.

Patients do have the right to refuse any treatment that they desire.

tihne_13 · Feb 10, 2009

Just check for the drug or medicine u are administering because some meds needs not to be crushed coz it will eliminate their potency..