Holding prn meds for attention seeking behavior

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I need help in making this decision. I have been a nurse for 27 years. recently I had a patient who was obviously attention seeking. she asked for a prn pain medicine but it was not given to her With her morning meds. She thought the pain medicine was in her cup of morning meds. After taking her morning meds five minutes later she stated the pain medicine was effective. After giving her one on one attention feeding her a few spoonfuls of breakfast telling her she looked nice for the day she was soothed. So was I wrong for not giving her the requested PRN pain medication or should've I just given her the PRN med and called it a day. The patient travels to a program after breakfast, at the program there are several nurses there, if the patient were truly in pain she could've asked for the medicine again and never did. What say you?

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If the medicine is ordered prn then the prescriber is giving the patient the option of whether to take the medicine or not. I believe the only time the nurse can make the decision is if the patient is over sedated. You did the right thing as far as refocusing the patient and trying alternate methods of pain relief but you should never ever mislead the patient about what medications they have been given.

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Specializes in Med/Surg, Ortho, ASC.

Something's missing from this story. What was your rationale for withholding a requested prn med in the first place?

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Specializes in Oncology; medical specialty website.

I agree with roser13, but want to add that it is unethical to deceive a patient.

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Specializes in Complex pedi to LTC/SA & now a manager.
I agree with roser13, but want to add that it is unethical to deceive a patient.

Placebos are deemed unethical in the absence of a signed informed consent and a provider order/prescription , such as in a double blind placebo controlled clinical trial

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Specializes in ER.

I may be out of step, but I personally think that placebos have their place in situations like this. From your brief description, this patient isn't 100% competent?

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Specializes in Peri-op/Sub-Acute ANP.

If you believed that this patient was asking for her ordered meds in order to seek attention, rather than receive pain relief, you should have requested a psych evaluation.

Sorry, but not your place to play psychiatrist on this patient even if it did work out OK and the placebo effect appears to have worked in this instance. You are her nurse, not her researcher.

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Specializes in Oncology; medical specialty website.
Placebos are deemed unethical in the absence of a signed informed consent and a provider order/prescription , such as in a double blind placebo controlled clinical trial

I don't understand why you're quoting me. Isn't giving a patient a placebo without his/her consent being deceitful?

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Specializes in Complex pedi to LTC/SA & now a manager.
I don't understand why you're quoting me. Isn't giving a patient a placebo without his/her consent being deceitful?

My intent was to agree with you. Sometimes my not so smart phone drops off words and sentences. It should have said "agreed". It IS deceitful and generally not within a nurse's scope of practice to independently make such a therapeutic decision or substitute a placebo for a provider ordered PRN medication. In this case it may have worked but it does not make it right.

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Specializes in Oncology; medical specialty website.
My intent was to agree with you. Sometimes my not so smart phone drops off words and sentences. It should have said "agreed". It IS deceitful and generally not within a nurse's scope of practice to independently make such a therapeutic decision or substitute a placebo for a provider ordered PRN medication. In this case it may have worked but it does not make it right.

Thanks. I am easily confused. ;)

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I understand what you did. It makes sense logically. However it was wrong.

I would suggest you either shrug your shoulders, roll your eyes, and just give the med......or set up some kind of MD, nurse, facility, individual medication review plan for this patient.

Unless it is a drug rehab program you might just need to do the shoulder shrug and eye rolling thing.

I have found what helps me when getting a headache from eye rolling is to take a deep breath and think...."lower your expectations of this person or situation."

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Specializes in OB.

New acct, 1 post: I think we just did someone's homework for them again.

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