Are You Ever Justified in Deceiving a Patient?

A patient’s irrational refusal to take medication can be frustrating for the nurse. Crushing the pill into applesauce or ice cream saves time and effort, and spares the patient the aggravation of quarreling. But while hiding medication is sometimes ethically justified, often it is not.

That’s the start of the “Putting the Meds in the Applesauce,” an article (free for March) by nurse ethicist Douglas Olsen in the current issue of AJN. Olsen notes that studies suggest hiding medications in food may be a relatively common practice, considers the ethical principles at play in such a decision, and offers advice for those who may be considering it. (Added: The column chiefly concerns the nursing care of cognitively impaired patients—not those who simply don’t want medications or those with with psychiatric illnesses who may be endangering themselves or others by refusing medication.)

Says Olsen, “[t]wo factors must be considered in determining whether hiding medication is justified or not: the nurse–patient relationship and the patient’s rights.” He adds that such a decision “requires the nurse and surrogate decision maker to imagine how the patient might have reasoned: would the earlier, cognitively intact patient have agreed that, given the present impairment, the providers shouldn’t be morally bound to accept the patient’s decision to decline medication?”

Another question he suggests asking oneself is this: “could the deception survive public scrutiny, including that of professional peers?”

What’s your take? What’s your experience?—JM, senior editor

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2016-11-21T13:10:34-05:00March 1st, 2012|Ethics, Nursing, patient engagement|3 Comments
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A Role to Live Up To

By Kinsey Morgan, RN. Kinsey is a nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her previous posts on working as a new nurse can be found here.

Now in my sixth month as a new nurse, I find every day that there is something new to learn, figure out, or adjust to. The constant stimulation and challenge is part of what makes me love being an ICU nurse.

Recently I was exposed to the simple yet powerful fact that being a “unit nurse” carries more weight than I’d thought. During a code blue on the medical–surgical floor a few weeks ago, I was performing CPR when it became necessary to initiate a dopamine drip to support a failing blood pressure.

One of the medical–surgical nurses spiked the bag and connected the tubing and proceeded to tap me on the shoulder and ask me if he had correctly entered the dosage of dopamine into the IV pump. Time stood still for a split-second while I contemplated the weight of this question. Though my mind and body quickly returned to the task at hand, the implications of that question haven’t left me yet.

The nurse who asked has been an RN for several years and has a lot more experience than I have. In reflection, I am honored and humbled by his trust. Not having encountered vasoactive drugs very often in his practice, this nurse […]

2016-11-21T13:10:35-05:00February 28th, 2012|career, nursing perspective|1 Comment
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Military Medicine Has a Head Nurse – Notes from Our Interview

By Maureen ‘Shawn’ Kennedy, MA, RN, AJN editor-in-chief

“Hi, this is General Patty Horoho,” and so began a phone interview with army nurse Lieutenant General Patricia Horoho, who was sworn in as the 43rd Army Surgeon General in December.

Horoho made history, becoming the first woman and the first nonphysician to assume command of the U.S. Army Medical Command, a $13 billion global health system. She had also been the first nurse to command Walter Reed Army Medical Center, taking over after a report  in the Washington Post revealed a host of deficiencies in care, housing, and processes at that facility, leading to the firing of the commanding officer, Maj. General George Weightman.

She was recommended for her new position by the prior Army Surgeon General, Eric Schoomaker, and it then went up the chain to the secretary of the army and the secretary of the defense, who then recommended her appointment to President Barack Obama.

We (there were representatives from four nursing publications on the call) spent over an hour peppering General Horoho with questions about her experience, objectives, strategic plans, and major challenges. Here’s a few of the highlights:

2016-11-21T13:10:36-05:00February 24th, 2012|nursing perspective|3 Comments
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Examining Our Biases About Mental Illness

“There’s nothing really wrong with him, it’s just anxiety.” How many times have you heard someone say this—or said it yourself? Mental health problems are among the most marginalized health conditions in the United States. They’re viewed as less “real” than physical illnesses; there’s no tumor to be palpated, no abnormality to be spotted on an X-ray. Emotional and psychological problems are often thought to be under a person’s control in a way that, say, multiple sclerosis or cancer is not. And because mental health problems can be construed as signs of weakness, sufferers may hide their symptoms. People who suffer from a mental illness need to feel comfortable seeking care and to trust that they’ll be treated with skill, compassion, and respect. This is vital: studies consistently find that mental illnesses, particularly depression, take a terrible toll on health. Such illnesses have been associated with an increased risk of stroke, coronary artery disease, and dementia, as well as increased mortality in people with cancer, diabetes, or chronic kidney disease and following a myocardial infarction or coronary artery bypass surgery.

That’s from “Examining our Biases About Mental Illness,” the Editorial in the February issue of AJN by clinical managing editor Karen Roush, MS, RN, FNP-C. What biases and assumptions about the mentally ill, the depressed, the anxious have you seen in your practice? Do you ever find yourself slipping into such biases yourself as a kind of default setting?

2016-11-21T13:10:37-05:00February 24th, 2012|nursing perspective|4 Comments
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States Easing Up, Pediatricians Buckling Down on Childhood Immunizations

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Two newspaper reports last week showed the dichotomy that exists in attitudes about mandating vaccines for children.

On February 15, the Wall Street Journal reported that more pediatricians are turning away families who refuse to have their children receive immunizations.

The next day, USA Today reported that several states are considering changing laws that currently allow parents to opt out of mandatory vaccines only for religious reasons, and extending the opt-out to include “philosophical reasons.” These reasons invariably come back to parental fears that vaccines put their children at high risk for autism. (See the our November 2011 report on what fueled this controversy.)

Highly publicized resurgences of measles and pertussis seem to have done little to change some parents’ mindsets about the need for immunizations. Has the success of the vaccines campaigns lulled some into a false sense of security—that the “risks” of vaccines, though unproven, are more dangerous than the diseases or their complications?

I shared in an editorial a story of a childhood friend who was left paralyzed in his lower extremities from contracting polio in childhood. And a cousin has a child, now almost 40 years old, who was left blind and speechless from encephalitis following measles contracted when she was five years old.

Cases like these are rarely seen anymore, but will they become more commonplace with more parents refusing to let their children receive vaccines? […]

2016-11-21T13:10:41-05:00February 21st, 2012|Nursing|9 Comments
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