"I don't need that medication... I've been healed"

[SweetLemon]

Recently I came across the sweetest older women who became one of my patient's in an acute care psych hospital. She is a paranoid schizophrenic who insists that she is healed mentally and physically. I have run into this many times with patient who are prescribed only psychiatric medications. While I always encourage medication compliance I never try to argue their beliefs or bully them into taking meds (Until they are court committed with IMBUs it is their choice to take meds or not). So my lil lady with paranoid schizophrenia also came in with a UTI and was prescribed antibiotics.... each time she came to the window she insisted that she had no UTI she had been healed by God.... and even though we wanted her to take meds she told us she loved us anyways.:heartbeat a total sweetie! I again highly encouraged medication compliance and kept the medical doc informed of the situation but still was not able to get her to take meds. Anyone run into this problem? I would be really curious of what one does if the medication was medically necessary??? I am specifically interested in ways to encourage compliance before appropriate measures have to be implemented to "force" compliance (deeming the patient mentally incompetent to make their health care decisions and putting them in restraints to allow medication administration).

Within my own hospital I have heard stories of nurses telling the patient that "God has told them (the nurse) that the patient should take their medicine" :eek::eek:. I have also heard of sneaking meds into coffee without the patient being aware (without guardian consent). Both practices I find incredibly unethical and something I would be unwilling to participate in.

Any other ideas?????

[anonymurse]

Pt refused, MD aware.

[mustlovepoodles, RN]

I had a friend in HS who experienced a "miraculous healing" of type 1 diabetes. Yeah, that lasted about 3 days before she was admitted to the ICU

[JustEnuff2BDangerous, BSN, RN]

Pt has the right to refuse any and all treatment prescribed for them, period. Forcing them to take a medication (and putting it in their coffee is, in fact, forcing them) violates their rights as a patient. The only way to encourage compliance is to encourage compliance, without stepping over the boundaries of their rights as individuals. Your duty as the nurse is to provide the medication and to advocate for the pt regarding medication administration. Putting it in their coffee or something similar means you are not being an advocate for the pt.

[treysdaddy08]

You could ask them, "Do you think its possible that God is healing you by assisting us in helping you?" Or some variation of that.

[dietsprite]

First of all, I would like to congratulate you for being a true professional.

Placing medication in coffee or stating that God has told the nurse that the patient should take the medicine are clearly unethical actions because they violate the patient´s right to self determination (refusal of treatment), informed consent to treatment, and involve a breach in trust and honesty necessary to developing and maintating a therapeutic relationship.

I suggest that you spend some time speaking to your patient and inquire whether she is a member of a particular faith communiy or adheres to a particular belief system (Christianity, Islam, Judaism, Budhism, etc). If this is the case, it may be beneficial to ask the patient whether she would be willing to speak to a person of authority in her faith commuity (priest, rabi, etc) for counsel as to what her religion says God´s wishes would be in a particular situation such as this. I would make sure that you make clear that the purpose is not to convince her to accept medication, but to assist her in spiritual counsel and whether or not her beliefs allow the use of medication in this particular case. Emphasize that she will be making the decision, not her religous leader. Also, provide the option of the faith leader for purposes of spiritual guidance/prayer/healing aside from discussion of medication.

If your patient has a self-constructed belief system, perhaps spend some time asking to reflect on whether God would have allowed the discovery of this medicine to occur if it were contrary to His wishes that it could be used when necessary. Ask her to reflect/pray or guidance from her higher power in terms of what His wishes are for her during this hospitalization. As kmcnelly said, have her reflect on the pssibility that God is using you (nurses, doctors) as intermediaries in His desire to heal her by allowing her access to health care and medicine, etc.

The hope is always that she will consent to treatment before her health is in enough risk to qualify for a court order, but we must alway respect the wishes of our patients and act according to the ethical principles that guide nursing care.

[1uvakindmom]

First of all, I would like to congratulate you for being a true professional.

Placing medication in coffee or stating that God has told the nurse that the patient should take the medicine are clearly unethical actions because they violate the patient´s right to self determination (refusal of treatment), informed consent to treatment, and involve a breach in trust and honesty necessary to developing and maintating a therapeutic relationship.

I suggest that you spend some time speaking to your patient and inquire whether she is a member of a particular faith communiy or adheres to a particular belief system (Christianity, Islam, Judaism, Budhism, etc). If this is the case, it may be beneficial to ask the patient whether she would be willing to speak to a person of authority in her faith commuity (priest, rabi, etc) for counsel as to what her religion says God´s wishes would be in a particular situation such as this. I would make sure that you make clear that the purpose is not to convince her to accept medication, but to assist her in spiritual counsel and whether or not her beliefs allow the use of medication in this particular case. Emphasize that she will be making the decision, not her religous leader. Also, provide the option of the faith leader for purposes of spiritual guidance/prayer/healing aside from discussion of medication.

If your patient has a self-constructed belief system, perhaps spend some time asking to reflect on whether God would have allowed the discovery of this medicine to occur if it were contrary to His wishes that it could be used when necessary. Ask her to reflect/pray or guidance from her higher power in terms of what His wishes are for her during this hospitalization. As kmcnelly said, have her reflect on the pssibility that God is using you (nurses, doctors) as intermediaries in His desire to heal her by allowing her access to health care and medicine, etc.

The hope is always that she will consent to treatment before her health is in enough risk to qualify for a court order, but we must alway respect the wishes of our patients and act according to the ethical principles that guide nursing care.

That is really good advice. I think that I would use that if I ever run across that situation.

[TwilightRNurse]

I would chart it and be done with it. She's happy in her world, I'd leave it be.

[Meraki]

Given that she has paranoid schizophrenia it is likely that her belief that she has been healed and her disdain of medication is more related to her delusional thought process, likely religious delusions. In people with chronic schizophrenia who have not only have decades of delusional thinking but also decades of dealing with health care, these beliefs and attitudes are quite common. They are rarely in keeping with the person's actual spiritual beliefs that they have when well. So while dietsprite's approach would be appropriate for other patients it probably wouldn't be overly useful for someone with paranoid schizophrenia.

I would not just chart and walk away - this is part of the illness and part of treating mental illness. It is often not an informed, rational decision the patient is making to refuse meds. I have over the years done any number of things to get meds into psychotic patients because meds are the only thing that is going to get them better to the point they can make informed decisions. Do I hide meds - very, very rarely and only if that is for some reason part of a team decision. Tricking them by hiding meds from someone who is suspicious, paranoid and delusional is a recipe for disaster. I have however entered portals to other world, sent meds telepathically, done special prayers and chants, and used the delusional thoughts to my advantage to get the meds in. Sometimes it takes many tries, different people, different approaches, creative thinking but usually I can eventually get the meds in. It is all part of nursing care for mental illness - just a different approach needed than in treating physical illness.

[SweetLemon]

Thanks everyone for all the good advice and ideas.... wherehastimegone... I can't help but crack up at sending meds telepathically:yeah: but in the best interest of your patient I could totally see how that would work. You sound very creative in your approach and I think I am going to need to focus on becoming more so. Working with the patient rather then against them, thanks much!

~Sweetlemon

[madwife2002, BSN, RN]

Yesterday I was medicating a pt on dialysis we were talking about the med and the pt said I dont need that med my kidneys are working.

I stood there unable to convince him that after 3 years on hemodialysis his kidneys were definatly not working. when he left he told me I had burst his bubble! I got the nephrologist and his NP to talk with him because he had been refusing to go on the transplant list because he honestly believe his kidneys would kick back in!!