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In January 1986, the Ohio Department of Mental Health began implementing a pilot program to establish procedures for obtaining a client's informed consent for medication and treatment. An essential component of the policy is the client's right to refuse medications (Ohio Department of Mental Health, 1987).
Although there is a consensus that psychotropic medications are effective in treating the mentally ill, it is also well known that these medications have side effects ranging from mild discomfort to serious and long-term symptoms such as tardive dyskinesia (feather, 1985; Kemna, 1985). The issue, then, involves the extent to which institutionalized clients can be forced to take the medication when they choose not to. The legal community supports the opinion that mentally ill clients have the right to refuse medication if this refusal does not threaten the client or others (Kemna, 1985).
The client's right to refuse medication is a crucial problem facing psychiatric nursing today (Vickerman, 1984). Pharmacotherapy is considered essential for most hospitalized patients, particularly those suffering from psychosis (Sadoff, 1983). Kemna (1985) and ftather (1985) report that refusal to take medication does not necessarily increase harm to patients by leading to further deterioration. However, if restoration of functional behavior rather than prevention of further deterioration is the goal of hospitalization, then pharmacotherapy especially for psychotic patients may be essential.
When clients refuse medications, the symptoms of their illness remain or may be exacerbated. Because the client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurses' responses to patient refusal of medication.
When a patient refuses medication, the nurse may experience the emotional response of powerlessness. Peplau (1953) emphasizes the importance of examining those factors that disempower nurses and that may initiate feelings of anxiety, inadequacy, insecurity, and ineffectiveness. Medication refusal by patients may be a disempowering factor for nurses. When nurses are aware of their feelings in response to patients who refuse medication, they are more likely to cope effectively with such responses and to develop alternative interventions.
This study examines the extent to which nurses state they feel powerless when a client refuses medication and describes other perceived feelings surrounding an event of medication refusal.