Ethical issues in med administration/psych dementia

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This topic contains 5 replies, has 4 voices, and was last updated by Profile photo of Veronica Cheney, BSN, RN Veronica Cheney, BSN, RN 3 years, 2 months ago.

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  • #16258
    Profile photo of Venusandtoby
    Venusandtoby
    Member

    I am a new RN in LTC w 30 pts. One refuses meds and tries to hit me and I was told to put meds in her food-then told No-not so; if State comes-bad news (cna’s cannot feed her her meds). If this pt does not get her meds it is a very difficult night. Several pts are like this. Another insists he gets x# of x kind of pills hs (which he does not) they are narcotics but the status quo seems to be to tell him this is so. Except me-because I was new and not in “the loop” last week (my first) and now this pt is suspicious/fearful every time I enter the room. Is it ever ok to violate veracity? Can I give 1700, 1900, 2100 meds together in pudding before sun-downing if I am lucky enough for pt compliance? I have over 10 yrs of experience in field (CNA/CMA) so am not new. Am getting different info depending upon who I talk to and training ends soon.

    #16309
    Profile photo of MonMac
    MonMac
    Member

    never give a med in a way that is not ordered. never chart that you did something that you did not. if this is going on at your facility, run fast. I let my agency talk me into ONE shift at a nursing home/rehab. I was one nurse to 40 patients. I simply could not finish it all. They pressured me to chart things as done when they were not. I refused and charged “not done” I left that place and told my agency never to call me again for that type of job. a month later I was glad I had chatted appropriately. that place was all over the news. they were shut down and several nurses lost their licenses for charting thing falsely. protect yourself. find a new job. eventual the state will catch up with that facility and you don’t want your name associated with a facility that does that.

    #16310
    Profile photo of scrubdoogie
    scrubdoogie
    Member

    My background is a Surgical Tech (scrub) for 19 years when I received my nursing degree, RN, 5+ years ago. I have been employed part time as a weekend charge nurse at a local LTC facility. I do have a couple of residents that refuse to take their medicine every once in a while. When I give them their medicine, “I always tell them it’s their medicine”. If they refuse at first I do try to get them to take it, explaining to them it’s for their BP or heart, but if they still refuse, I will save the meds for a little while and make a second attempt. If still refusing then I dispose the meds and chart “chooses not to take am meds”. I personally believe in not lying to my residents. These residents usually end up taking their meds at some point. I believe in autonomy, they have the right to refuse. These residents are geriatric, some dementia. Now on the other hand, we do have a couple residents that are court ordered to take their meds, i.e.; psych meds. These residents want to live here at the LTC facility and they become out of control mentally if they choose not to take their meds. Why they are court ordered is that they are capable of normal functioning with their meds. If they choose not to take their meds they are referred to go to the psych ward vs. staying here at the LTC facility. These residents are in need of assistance mentally vs. physically.
    Another little story, we had an “elderly lady” that at the age of 100 she requested no more meds! She stated she has taken her meds for 100 years and she is done. The only med order she had was Tylenol PRN. She lived to be 104 years old! I believe every situation is subjective and unique. You must ask yourself why are they refusing? Find out how they feel about taking their meds, it could be as little as the taste or the timing when they want to take them.
    The best advice I can give is never force meds on anyone, if they continue to refuse the MD needs to be notified along with always document refusals. There are possibly other options or modifications in their meds that can be done. Good luck, sorry about the “book” I just wrote! 🙂

    #16370
    Profile photo of Venusandtoby
    Venusandtoby
    Member

    I am happy to report that after several more days on the unit, my residents have come to trust me!!!!! I have been able to give meds to Jane Doe whole with her consent; she even wheels herself to my med cart when she sees me coming:) I walked her the other day for the first time in God knows how long and reported to the physician to get her PT. The others are beginning to converse and interact with me as well. I think they needed a compassionate soul of a nurse to bring them trust and love. My guy who questioned his # of pills has been set straight and now knows correct dose and is content. I can make it better. I treat my residents as human beings and notice this is rubbing off on other nurses. There is change at the facility for the better and I am in on it.

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