Imagine for a moment you’ve had a really shit day at work. Not that hard? Even in the best of jobs we’ve all had days when dealing with the stupidity of others can stretch even the most patient amongst us. Whether or not the cause is real or imaginary, for you, feeling the emotion that the day has generated is unique. The emotion you feel may be anger, bitterness, perhaps frustration and it may be that the need arises to express these feelings verbally. How would you feel then, would it be OK, for someone to give you a magic potion or pill to take away those feelings or to limit your capacity to express? Would you be happy for a 3rd party to arbitrarily decide what is right, correct and proper behaviour for you?
It’s these sort of questions the nurse must ask themselves when deciding the appropriateness of dispensing prescribed PRN (as required) medications to the elderly and or dying. Many has been the time in my nursing career when I’ve had to make a clinical decision on whether or not to give a medication which was effectively altering my patients emotional state.
At what point is dispensing mood altering medication appropriate? Definitely if there is a foreseeable risk to another party being physically injured. In my time as a nurse, fortunately, I have only needed to be involved in the “taking down” of a patient twice. One of these was a ninety year old man who had a history of assault and was in the process of moving to strike an elderly lady when he was tackled by myself and three other nurses and administered with a strong sedative.
But what about when it’s just noise. Does the patient with dementia need to be chemically quietened if they have been screaming at the top of there lungs for hours? Or the old person who makes inappropriate sexual or racists comments; should they be given medication to quieten them down. How about the palliative patient who is angry, frightened or just wants to blow off steam. Should their ability to express their emotions as they see fit be minimised?
There is no simple one size fits all answer to these questions and thank goodness for that as each and every situation described along with countless others must be viewed, interpreted and acted upon as the situation demands.
What is common to every situation is that the reaction of the nurse will depend on the nurse themselves. Education and experience play a great part here but the single most important aspect is the nurses on value system. When this is in conflict with the behaviour of the patient the risk can be that the nurse acts on what they perceive to be in the patients best interest. This is not always a bad thing and at times is unavoidable but over the years in order to minimise my own prejudices and value judgement being foisted onto the patient I have whenever possible consulted with family or colleagues.
This isn’t to say I’m always right but at least when I consult with others something as fundamentally important as taking away the ability of another person to feel and express themselves is not being made unilaterally.
So, is it ok for old people and palliative patients to have emotions ? Absolutely it is and more importantly they don’t always need to be tampered down with drugs or therapies.
I’d love your thoughts …