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‘Medication is a last resort’

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I was a bright-eyed nursing student, placed on a busy surgical ward with pressures high and theatre checklists flying round.

However, the behaviour of one patient brought the ward to a halt.

The patient, new to the ward for post-operative care, became very agitated and restless and began demanding to leave the ward.

The situation escalated and within minutes became an emergency.

The strategy should have been to defuse the situation and attempt to calm the patient as soon as possible without causing further distress.

In order to achieve this effectively, the ward staff appeared to have two options: either de-escalate the scenario or medicate the patient.

In the event, the medics wrote the script and the ward staff read the lines – they medicated.

I have reflected upon this experience and struggled with the ethical issues that have arisen from it. In my experience, this hasn’t been the first time I’ve felt that the keys to the medication cupboard have been used far more swiftly than we may like to consider.

In cases where the escalating distress of a patient and their possible subsequent actions may put their health and safety and that of others in danger, surely medication should be considered as an ultimate ‘treatment’ once all other options have been exhausted?

That is a dilemma all of its own. However, to my shock, I have witnessed medication being administered as a prophylactic method of addressing patient agitation. It seems that we play with Pandora’s box when it comes to administering medications, as they may have an almost immediate desired effect but may ultimately cause an array of more serious mental and,
indeed, physical health problems.

Which raises the question: is it in the patient’s best interest or our own? It’s time we began thinking outside this cosy medicine box.

Don’t get me wrong – it’s not all bad news. As a nursing student, I have learnt to consider the holistic approach and have had the privilege to work with colleagues who have demonstrated communication and de-escalation techniques, which have really made a difference to patient care.

I have learnt that nurses and other healthcare professionals should always practise communication, de-escalation and listening techniques, and use them before reaching for the haloperidol.

James Squires is a nursing student at King’s College London

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