Sharing unorthodox treatments - Where to draw the line?

Nurses General Nursing

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Dear Fellow Nurses,

All during school we are taught to "think outside of the box". We are taught to use alternative approaches such as meditation or imagery for pain management. It is also engrained in us to respect, embrace, and enable our patient's religious, family, health, and ceremonial practices as much as possible. My question to you then is what is the liability involved in sharing and/or supporting these practices, and where do we draw the line?

As an example, I used to work with a physician who prescribed her patient's douche with anti-septic mouthwash to prevent and treat UTI's. Many patient's swore by this method, and I feel that it may have had some validity, but I would never share an idea like this with my patient's for fear of liability or retribution. Another example is the patient that wants my professional opinion on the mega doses of vitamin D-3 & K-2 that they are taking. I mean obviously I pull out the old R.D.A's. to cover my hide, and also refer them to their practitioner, but sometimes I would like to say more, but find I do not, because I do not want to offend my patient, upset my fellow staff, or risk liability or safety issues.

Readers, I ask that you please share some unorthodox treatments that you may have come across in your nursing career, and tell me how you chose to handle that situation, and what was your outcome?

Your input is greatly appreciated.

GrnTea, I agree with your comments. Very thoughtful. I forgot to read before commenting.

I thank you for the idea, as I feel naturopathy would be a good fit for me. Currently, however, I live in a small traditional town, which I very much value, yet many residents here think organic means you bought your spinach from the produce isle this week instead of the canned foods isle. :) Sad to say, but we are lacking in our selection of alternative health options locally.

I'm sure this info is readily available elsewhere, and as well off the beaten path of my original post, but does anyone know if alternative medicine/naturopathy where available offers RN employment opportunities, or do they tend to gear more towards certified non-licensed personnel?

Specializes in Mental Health, Gerontology, Palliative.
Educating patients regarding meds is different than recommending meds/supplements without dr's orders or discouraging against dr's orders. Legally I wouldn't take that chance and my employer would fire me.

Same with wound care, I would lose my job if I implemented wound care such honey treatment without dr's orders or whatever today's PC terminology. I often make wound care recommendations to dr's who appreciate and authorize my recommendations but I don't implement without authorization.

Wow......

We have the scope to use what ever wound product we feel is appropriate to use with a particular wound. If we want something specialist eg negative pressure, compression, it needs to go through the appropriate team however much of it is still very much nurse driven

We will continue to liase with the patients doctor and take direction from them as they see fit however most doctors realise that they dont know alot about wound care and are more than happy to take guidance from the RN

Specializes in psychiatric.

The question raised about recommending an otc product without a physician prescription has my interest. I was under the impression (and direct instruction in the facilities) I have worked at that even an otc should not be recommended by a nurse. I have seen situations that gave me reason to agree with this, for instance a nurse telling a pt to take Tylenol for headaches, when said pt had hepatic and renal issues and should not have gone anywhere near it.

I also understand that wound care nurses are specialists in their field so of course their ideas on how to treat would be the best course to follow.

So if Grntea or anyone else can add some insight or education here regarding this type of situation and where do you draw the line, I would appreciate it.

Specializes in Mental Health, Gerontology, Palliative.
The question raised about recommending an otc product without a physician prescription has my interest. I was under the impression (and direct instruction in the facilities) I have worked at that even an otc should not be recommended by a nurse. I have seen situations that gave me reason to agree with this, for instance a nurse telling a pt to take Tylenol for headaches, when said pt had hepatic and renal issues and should not have gone anywhere near it.

I also understand that wound care nurses are specialists in their field so of course their ideas on how to treat would be the best course to follow.

So if Grntea or anyone else can add some insight or education here regarding this type of situation and where do you draw the line, I would appreciate it.

We cant prescribe meds/OTCs. However honey dressings were a standard part of our tool box, along with silver, seaweed, iodine, silicone.

Wow......

We have the scope to use what ever wound product we feel is appropriate to use with a particular wound. If we want something specialist eg negative pressure, compression, it needs to go through the appropriate team however much of it is still very much nurse driven

We will continue to liase with the patients doctor and take direction from them as they see fit however most doctors realise that they dont know alot about wound care and are more than happy to take guidance from the RN

Why the wow? Do you work independently of physician orders?

i thought it was implied but perhaps not, but I don't sit around waiting to be told what to do, I assess and make recommendations, often I am sent out to assess and start an appropriate wound therapy because as you stated, dr's rely on us for guidance but a dr has to sign nonetheless. I make sure that'll happen before I initiate a therapy.

If I were to go out there and just do my thing without confirmation that a dr will authorize, I would be fired and possibly worse. Not so for you?

Specializes in Transitional Nursing.

I just had a professor who swears that colloidal silver is the answer to Cancer and infections. I've tried to do some research on it, but haven't gotten very far.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

I don't think it's a matter of nurse autonomy when one works for or with a medical doctor (or an alternative practitioner) treating a patient but more a matter of being able to accurately observe the efficacy of the original treatment plan, such as in the example of wound care.

I once worked with a doctor who promoted the idea that mega-doses of Vitamin C were essential to human health. I thought his theory was BS, but I didn't say anything to the patients. If I worked with the person who I heard tell a patient with stage 4 ovarian cancer that drinking a solution made from 35% food grade hydrogen peroxide would cure her, I would likely shoot my mouth off and depart the premises before they could fire me!

Great topic! :up:

Specializes in SICU, trauma, neuro.
The question raised about recommending an otc product without a physician prescription has my interest. I was under the impression (and direct instruction in the facilities) I have worked at that even an otc should not be recommended by a nurse.

I was taught that recommending drugs was outside the scope of an RN. Not that we can't do anything independently of the provider, but we couldn't recommend drugs.

Specializes in Mental Health, Gerontology, Palliative.
Why the wow? Do you work independently of physician orders?

Nope. However our doctors accept that they dont really know much about wound care and usually will happily defer to nurses. We will keep them in a loop as at the end of the day they have the overall care for this person however we have the authority to be able to change dressings when its clinically indicated.

i thought it was implied but perhaps not, but I don't sit around waiting to be told what to do, I assess and make recommendations, often I am sent out to assess and start an appropriate wound therapy because as you stated, dr's rely on us for guidance but a dr has to sign nonetheless. I make sure that'll happen before I initiate a therapy.
Again, if after assessment I feel that a different dressing would be more benefical on a particular type of wound. I will run it by the patient eg to check allergies and whether they have had that particular dressing before, did it work, did it have any side effects.

It floors me that you have to have authorisation from a doctor before you can try a particular type of dressing.

If I were to go out there and just do my thing without confirmation that a dr will authorize, I would be fired and possibly worse. Not so for you?

Nope. Thats not to say that I could go out and stick a VAC/renasys dressing on to any old wound. Those sorts of specialist dressings are still needed to be implemented by tertiary services. Much of still which implimented by nurses in that area.

I was taught right from graduation to be continually assessing wounds. If a wound remains static look for possible causes and address those by changing to a different dressing. Apart form being a huge waste of my time, it would drive me up the wall if I had to ring a doctor each time we needed to change a dressing.

Also, re honey dressings. Just incase it wasnt clear, we only use manuka honey on wounds. Its well documented for its antimicrobial properties. And it comes in a specially prepared dressing, we dont just slap it on out of the jar.

Manuka honey vs. hydrogel--a prospective, open label, multicentre, ... - PubMed - NCBI

I believe we are saying the same thing.

The question raised about recommending an otc product without a physician prescription has my interest. I was under the impression (and direct instruction in the facilities) I have worked at that even an otc should not be recommended by a nurse. I have seen situations that gave me reason to agree with this for instance a nurse telling a pt to take Tylenol for headaches, when said pt had hepatic and renal issues and should not have gone anywhere near it. [/b']

I also understand that wound care nurses are specialists in their field so of course their ideas on how to treat would be the best course to follow.

So if Grntea or anyone else can add some insight or education here regarding this type of situation and where do you draw the line, I would appreciate it.

I think the answer the question implied by the bolded line above is not to prevent every nurse from doing a better job in patient teaching within scope of practice as mandated by our nurse practice acts and the ANA Scope and Standards of Nursing Practice. The line is already drawn. Any nurse who recommends acetaminophen to someone with hepatic issues is doing a wrong (and potentially harmful) thing out of ignorance, which is not compatible with existing nursing standards of practice and would likely be so judged (I am not an attorney, but not meeting standards of practice is often the basis of a successful lawsuit).

Re your example above, it is perfectly appropriate for a nurse with experience in orthopedic injury, for example, to tell a patient that acetaminophen is very effective for ortho pain after the acute postinjury/postop period, and to caution the patient that acetaminophen should not be used in excess of the dose specified on the bottle, and not be used by people with liver or alcohol use issues. That information is widely available in the literature and had better be part of responsible patient teaching.

Likewise, an experienced pediatrics nurse would not be out of line telling a parent about current research on aspirin vs acetaminophen for fevers (ASA is associated with an increased risk of Reye's syndrome).

I hope this clarifies somewhat.

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