Lying about a med to a psych patient

[cel58]

I'm interning in the emergency department right now. We recently had a schizophrenic patient come in and then had a major breakdown, becoming very violent and throwing tables at staff members. He eventually agreed to take IM ativan to help him calm down but the doctor ordered haldol and the nurse then lied and gave it to the patient saying it was ativan. I was just wondering is this illegal? While it was medically necessary for both the patient and the staff I was unsure whether or not it was ok to do.

[sandyfeet]

Many chronic psyche patients KNOW their drugs and will refuse psych meds because they don't like the way they make them "feel". In the interest of everyone, even though you aren't "supposed to", a little white lie doesn't hurt when someone is psychotic in an Emergency Room. MunoRN is essentially right but I have always considered it part of implied consent. This is one of those time that the "school way" is completely different from the "real way". Heck years ago we gave placebos to our seekers ALL the time. We kept carpujets of NACl in the fridge to make it cold so it would sting and call it "Norasol" you know Demerol, Norasol......, and it worked!

I'm coming to learn that in the ER patients give implied consent for many things that would not be acceptable on the floor (for example, tox screen w/o consent). But it comes down to Maslow: safety and security before self-esteem. We had a similar incident in the ER last week and with 7 people holding someone down, a chemical restraint was the kindest thing to do. The patient had been awake for 3 days, already deemed a danger to self and was screaming "You're not helping me!" when the incident started, but then with some meds on board was able to relax and sleep.

[sapphire18]

No, you cannot lie to a patient like that. What's even the point? You're going to give the med whether he "consents" or not. In some states lying about a med you're giving is in direct violation of the nursing practice act.

[Esme12, ASN, BSN, RN]

No, you cannot lie to a patient like that. What's even the point? You're going to give the med whether he "consents" or not. In some states lying about a med you're giving is in direct violation of the nursing practice act.

Just like you can't keep a patient against their will......but we do. Nursing in general is full of contradictions. Psych and emergency medicine even more so. Therein lies the greater liability of these areas. If you are going to physically restrain someone you had better chemically restrain them as well.....it the only humane thing to do. Many psych patients are frequent visitors to the ED (due to so much cutting in reimbursement and benefits from medicare and medicaid) and are well known to staff and they know what works.

Many psych patients in the ED are on psych hold so they cannot leave. They have been deemed temporarily unable to make decisions and consent for safety. I suppose I could tell the patient what the med is, get reinforcements, restrain them, give the med anyway. Or.....give them the med with as little drama as possible. I frequently will use an alternative med name from another country meaning Haldol.......but I have also mutely agreed when they ask....is that Ativan? I have nodded yes when I know that their piece of mind and the safety of others is at stake.

[OCNRN63, RN]

I have to disagree with most posters. I worked in psych for several years straight out of school, and was certified in psych nursing. While we told patients they were getting something to calm them down, we never lied and said a med was something else. I'm sorry, but I think that's unethical, and I'm pretty sure you could get in trouble legally.

You should pose this question to the nurses in the psych forum.

[imintrouble, BSN, RN]

Standing stiffly on a line because it legally can't be crossed, all the while being pummelled by a pt, makes no sense.

[sapphire18]

Standing stiffly on a line because it legally can't be crossed, all the while being pummelled by a pt, makes no sense.

Lying to them also makes no sense. Restrain and inject. If you're going to say anything at all, say the truth.

[elkpark]

You can medicate someone against her/his will, without her/his consent, over her/his objections, in an emergency situation where the individual is acutely dangerous to self or others. However, in nearly 30 years in psych, I've never lied to a client about a medication I was giving, and can't imagine doing so.

[leslie :-D]

how are we considered as one of the most trusted professions, when some seem to devalue those who depend on us for truth and veracity?

maybe it sounds drippy, but if a pt trusts me (just by virtue of being a nurse), i am not going to deceive him/her in anyway shape or form.

even if they don't trust me, i will always be truthful.

it's the right thing to do.

leslie

[Been there,done that, ASN, RN]

How, exactly would it be considered "lying" to a patient that is psychotic?

They cannot be held accountable for their actions, or understand the ramifications of their medical regime.

Hello, Mr. Schizophrenic.. I know you cant comprehend what I am saying.. but I am going to give you Haldol now ..

Please don't kick me while I am administering this med.

PULEEZE!!

[BrnEyedGirl, BSN, MSN, RN, APRN]

I would almost always agree that you shouldn't lie to a patient,..this however might be the exception. In my ER, in my state, if this psych pt was out of control, a threat to himself or others, we are legally allowed to force him/her to take meds. Chemical restraint is legal (in my ER et state) and is often preferred for those really out of control pts, especially the schizophrenic who is off his/her meds. I look at it this way,...if the pt is that out of control,...is it better to get security, physically control the pt, then give the med,..or lie to the pt, skip security et physical restraints and give the meds. I think it is better for the pt to limit physical altercations. The true schizophrenic is going to feel better after the meds and won't remember the altercation or the lie anyway.

[Anna Flaxis, BSN, RN]

No, it is not okay to lie to the patient.

I don't know the whole story, but if the Ativan worked and the patient was no longer acting out or posing any immediate threat to himself or others, then he could refuse the Haldol.

If, however, he was continuing to behave in a dangerous way, then you can physically restrain him if necessary and give him the Haldol against his will.

Either way, there is no need to lie, and further, in my opinion, it would be unethical to do so.

[wish_me_luck, BSN, RN]

I agree 100% stargazer. To me, it sounded like he was calmed down a bit and not throwing anything. He should have been told what he was receiving, not lied to; also, since he was not at that time a threat to himself or others, he could have refused. In addition, I agree with the other poster that said something about not trusting the nurse anymore after she told him he received Ativan instead of Haldol. I think some nurses take advantage (for lack of better words) of mentally ill patients and treat them as sub-human when they are incredibly vulnerable. Just my opinion.