The licensed practical/vocational nurse is caring for a client frequently admitted for constant stabbing pain in her lower back, rated 8 out of 10 on a pain scale. Diagnostic testing reveals no treatable back issues
The physician prescribes a placebo (a substance that has no therapeutic effect to comfort the client). The physician wants the nurse to administer normal saline in a syringe that will look like the narcotic because he does not believe the client's pain is real. The nurse believes this is an ethical dilemma because is it right or wrong to administer a placebo and lie to the client that it is the narcotic the client requested for her pain. The nurse believes that pain is what the client says it is. Which is the best action for the nurse to take?
A) Administer the placebo, but don't say what it is, and if the client remains in pain within 15 minutes, and then administer the narcotic analgesic as ordered and report the findings to the physician
B) Ignore the physician's order and continue to administer the narcotic analgesic as ordered previously
C) Inform the physician that he has an issue with administering the placebo because he feels it is unethical and ask if it would be best served to refer the client to a chronic pain management clinic
D) Inform the nursing supervisor of the physician's unethical behavior, and ask what to do in the situation
Ans: C
Feedback:
When presented with an ethical dilemma, there is no right or wrong way to approach the matter, and since the nurse is uncomfortable about administering the placebo and lying to his client, he should inform the physician and ask the physician about referring the client to a chronic pain management clinic. Just because the client's diagnostic tests reveal no treatable cause for her back pain does not mean that her back pain is not real. Since she is frequently visiting the hospital for pain management solidifies that the pain management is ineffective, she needs expert help that the pain clinic may offer to provide the client with the fullest potential for a pain free or manageable level of pain. Administering the placebo goes against the nurse's belief that an ethical dilemma exists and that he feels it is wrong to lie to a client and withhold treatment because he believes pain is what the client says it is. Ignoring the order is an incorrect action to take because the newest order supersedes the previous order for narcotic administration. Informing the nursing supervisor that the physician is acting unethically is also incorrect because the nurse recognizes the situation as an ethical dilemma. The nursing supervisor should advise the nurse to call the physician back and discuss the issue and ask about a referral to a chronic pain management clinic.
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