Psychiatric-Mental Health Nursing: From Suffering to Hope

CRITICAL THINKING Jason – Relapse Phase You are assigned to a clinical rotation in an urban Emergency Department. Your first patient, Jason, is a 23-year-old Caucasian male with a history of paranoid schizophrenia and self-mutilating behaviors. He is not compliant with his medication regimen and consistently refuses voluntary psychiatric hospitalization. According to the chart, the local police brought Jason to the hospital after he resisted arrest for disturbing the peace. Jason was yelling obscenities at passersby on a busy street corner while wielding a broken bottle. Upon admission to the Emergency Department, Jason resisted medical evaluation and repeatedly attempted to kick and bite staff. He was restrained and received 10mg of haloperidol (Haldol). Now much calmer, Jason asks that you remove his wrist restraints. “They’re hurting me.” He does not appear dangerous at this time. You ask a veteran nurse about the restraints, and she instructs you to leave the restraints in place. “We’re short staffed tonight—and don’t be fooled, Jason will swing at you in a minute.” You inform him that you are unable to remove the restraints. He responds: “If you don’t take these things off of me, I’m suing you and everybody in this place.” The tenor in his voice frightens you. A seasoned nurse hears the commotion and with the help of security administers another 5mg of haloperidol as Jason kicks and screams, “No! No! No!” As you exit the room to look for your preceptor, Jason’s parents enter the emergency department demanding to know their son’s condition and insist that he be committed. Application What potential legal and ethical concerns do you identify in Jason’s case? What other concerns do you have at this time? Answers There are several potential legal and ethical concerns in this case, including administering a medication against a patient’s wishes; the use of physical and chemical restraint; Jason’s threat to sue if he continues to be restrained; the veteran nurse implying that staffing concerns are part of the reason for keeping Jason in restraint. Answers will vary.