Administration of <i>pro re nata</i> medications by the nurse to incapacitated patients: An ethical perspective

Vaismoradi, Mojtaba; Moe, Cathrine Fredriksen; Vizcaya-Moreno, María Flores; Paal, Piret

doi:10.1177/14777509211034146

Cited by 3 publications

(3 citation statements)

References 75 publications

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“…It also enhances their compliance to the medication regimen ( Fernandez et al, 2006 ; Mardani et al, 2020 ). Therefore, the opportunity for asking about PRN medications and giving consent when PRN medications are offered should be given to patients ( Hipp et al, 2018 ; Vaismoradi et al, 2021b ).…”

Section: Discussionmentioning

confidence: 99%

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

et al. 2022

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Background and objectives: Highly widespread use of pro re nata (PRN) medicines in various healthcare settings is a potential area for improper medication prescription and administration leading to patient harm. This study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for safe prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings.Methods: An integrative systematic review on international databases were performed. Electronic databases including Web of Knowledge, Scopus, PubMed (including MEDLINE), and Cinahl were searched to retrieve articles published until end of May 2021. Original qualitative, quantitative, and mixed methods studies written in English were included with a focus on PRN medicines management in healthcare settings. Research synthesis using the narrative method was performed to summarise the results of included studies.Results: Thirty-one studies on PRN medicines in healthcare settings by different healthcare providers were included after the screening of the databases based on eligibility criteria. They were published from 1987 to 2021. The majority of studies were from Australia, the United States, Canada, and the United Kingdom and were conducted in psychiatric settings. Given variations in their purposes, methods, and outcomes, the research synthesis was conducted narratively based on diversities and similarities in findings. Eight categories were developed by the authors as follows: “PRN indications and precautionary measures,” “requirements of PRN prescription,” “interventions for PRN administration,” “monitoring and follow up interventions,” “deprescription strategies,” “healthcare professionals’ role,” “participation of patients and families,” and “multidisciplinary collaboration.” Each category consists of several items and describes what factors should be considered by healthcare professionals for PRN medicines management.Conclusion: The review findings provide insights on the practical considerations of PRN medicines management in clinical practice. The suggested list of considerations in our review can be used by healthcare professionals for optimal PRN medicines management and safeguarding patient care.

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Section: Discussionmentioning

confidence: 99%

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

et al. 2022

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“…This conversation is further complicated by whether actors’ motivations align or conflict ( 32 ). An oversimplified example might manifest as clinicians pursuing therapeutic goals (eg, symptom management), families concern with safety goals, direct care staff aiming towards resident-centered goals, and administrative staff prioritizing compliance goals ( 50 , 53 ).…”

Section: Discussionmentioning

confidence: 99%

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

Dys

Carder

2022

Innovation in Aging

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Background and Objectives As-needed (PRN) antipsychotic medication use (APU) among assisted living/residential care (AL/RC) residents is a controversial health policy issue. AL/RC care staff, families, clinicians, researchers, and policymakers disagree about PRN APU to manage behavioral expressions associated with residents’ dementia or cognitive impairment. Research Design and Methods Semi-structured interviews among eleven direct care staff (n=3), licensed nurses (n=2), administrators/executive directors (n=4), and consultant pharmacists (n=2) currently working in Oregon AL/RC. Using situational analysis, we identify, describe, and visualize positions and ideologies by job role to theorize PRN APU decision-making. Results Three broad processes underlie APU to manage residents’ behavioral expressions: justifying PRN APU, moralizing APU, and balancing local practices (e.g., managing behavioral expressions, respecting individuals) with nonlocal practices (e.g., professional authority). People involved in the situation of APU in AL/RC describe positive and negative justifications, and personal moral positions that frame PRN antipsychotics or nonpharmaceutical interventions as “right” or “wrong,” driving various approaches to behavior management. Participants described a converse orientation between perceived level of agency within and proximity to the situation of APU. Those most closely involved, or local, to the situation of passing medications (e.g., direct care staff and nurses) expressed less agency compared to nonlocal physicians and policymakers, who are not involved in the day-to-day practices within AL/RC. Discussion and Implications This study raises practice and policy implications regarding APU in AL/RC settings. Care staff roles, ethical considerations, and perceived agency inform decision-making on whether to use antipsychotic medications. Participants described costs and benefits associated with both PRN APU and nonpharmaceutical interventions when responding to AL/RC residents’ behavioral expressions. Participants’ experiences emphasize the interactions across multiple levels of care. Balancing regulatory goals with resident-centered practices underscores the need for a systems-level perspective, extending beyond direct care staff passing antipsychotic medications to residents.

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“…Sometimes PRN medications including sedatives are prescribed to the patient who refuses care and may harm himself/herself, but the medication can improve the patient’s collaboration with care [ 61 ]. The cases of the involuntary PRN medication administration of psychotropics, hypnotics or sedatives for older people with cognitive diseases or patients with mental disabilities [ 62 , 63 ] requires the interpretation of their symptoms and behaviours by the nurse, but it can cause concerns, moral uncertainty and distress, especially when the nurse takes the paternalistic role and coerces the patient who resists receiving medications [ 51 , 64 ]. In such cases, open discussions with informal caregivers and families of the patient about dangers posed by non-adherence to PRN medications [ 65 , 66 ] without invalidating the user response to the medication suggestion is an ethical intervention and leads to active involvement in medication self-management [ 67 , 68 ].…”

Section: Ethics and Prn Medicines Managementmentioning

confidence: 99%

Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

et al. 2021

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Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: ‘benefiting the patient’, ‘making well-informed decision’, and ‘follow up assessment’ as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.

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Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective

Cited by 3 publications

References 75 publications

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

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