Placebo's & Trust

[DJ-Adia]

A new grad RN started on our med/surg unit approx 4 months ago. Her goal for the unit, as she stated @ at our last unit meeting, is to change the unit by reorganizing supplies as "SHE" feels would best promote efficiency on the unit. I think that that would be great...but her ideas aren't practicle. Our nurse manager thinks she is the "ideal" role model for the unit. I have come to live by the belief "I trust everyone 100% until they give me a reason not to". After being an RN for 15 years, you just get the intuition that "something just is right"

She (Allison) informed us at the last meeting, that she recently had a patient, who was on a cardiac diet, where her family brought her in a Cheeseburger from McDonalds. Allison did not hesitate to throw the meal the meal in the garbage and told the family that she would reimburse them for the cost of the meal, but as long as she was ordered to be on cardiac diet, the patient will comply with orders whether she liked it or not.

Secondly, I was informed by allison that one of her patients were c/o pain & nausea, however Allison did not feel that the patient's was having as much discomfort as she wanted staff to believe. She told the pat. that she was giving her zofran IV to help treat the nausea, but instead only gave her an injection of normal saline. 15 minutes later the nausea was gone . Are placebos legal especially when a patient is aware that they are receiving it?

[Jonathank]

I don't know about the legality (it may vary by state). But giving a placebo without consent is at least unethical. It's a violation of trust to say you're giving something that you don't actually give.

[ErinS, BSN, RN]

No, never, no way! Shame on this nurse for doing something like this. Beyond that, since when can you look at someone and know that they are nauseated? And why withhold zofran anyways- this is not a medication that people come in seeking? This nurse sounds like she is on a power trip and it is time for her to get a new career.

[MunoRN, RN]

Placebo use is usually only considered ethically acceptable as part of a trial where the patient is informed that a placebo may be used. At the same time, there are "treatments" such as therapeutic touch, where much of the beneficial effect is likely due to placebo effect. It's an interesting issue when it comes to non-pharmaceutical treatments; if the goal is to make the patient feel better, it would seem that the placebo effect would be preferable if it achieves the goal given the lack of adverse effects of a medication. In terms of medications though, saying you are giving a medication and then not giving it is not accepted practice by my state's BON and is usually considered universally bad ethics.

As for the cheeseburger, a cardiac diet is a treatment, and as such the patient can refuse it. That doesn't mean the hospital has to provide the patient with cheeseburgers, but the family can provide them as long as there are not universal restrictions against bringing in food. The Cleveland Clinic recently started a rule that cardiac patients (mainly post PCI) have to submit to dietary restrictions while in the hospital, which includes having all visitors being searched for 'contraband' foods, although they are only able to apply this to patients who agreed to this stipulation beforehand as as part of an elective procedure. We put all of our post-OHS patients on a cardiac/ADA diet, but we usually go out of our way to get the patient whatever they want while their appetite is still recovering. Poor nutritional intake is usually far more of a concern immediately post-op than a high-fat diet is; the primary goal is usually to keep their albumin at least above critically low levels, we've had surgeons stop at drive-thru's for shakes, fries, whatever as long as the patient is eating.

[elkpark]

What you describe is both illegal and unethical. I hope you pointed this out to her. And I would be inclined to make the NM aware of the situation, also. What she did could have legal repercussions for the entire facility.

And did she chart that she administered NS instead of the ordered medication? If not, she's also falsifying medical records. Wow! She's certainly off to a great start with her career ...

As for throwing away the client's McDonald's meal, clients have the right to refuse a special diet order, just as they have the right to refuse any other treatment. While I would never go out, myself, and get a client something like fast food that was contrary to the ordered diet, if someone else brings it in to her/him and s/he chooses to eat it, we can't legally stop them. Your colleague was way out of line in that situation, also. You say that she talked about this at a "meeting" -- did anyone point this out to her in the meeting?

[BrookeeLou_RN]

Allison is trouble with a capital A!! She is unethical, practicing illegal things and going to mess up your entire until in record time.. NM, I am sure likes her off the bat as she is taking charge.. charge the NM should be asserting herself. I suggest you speak with NM and report these things and also ask for another meeting with Allison. She can easily get all the hospital brought up on charges.

[hopefulwhoop]

Pretty sure that's illegal. Definitely unethical, too.

[LegzRN]

I agree that it was unethical, but I also feel that throwing her name around a public forum is unethical, as well.

[xluescluesx]

I think she means well but it sure sounds like she's going a little overboard.

[traumaRUs, MSN, APRN]

I think Allison will be looking for a new job soon. And next step might be defending her license at the BON.

[thinkertdm]

Wow- the only nurse in the world with the name of Allison?

[OldNurseEducator]

I think Allison will be looking for a new job soon. And next step might be defending her license at the BON.

WOW!!! Totally agree with above. Her poor patients...unethical AND illegal as h***!