The Controversy Surrounding Sedative Medication Use in Healthcare

This essay delves into the controversial use of sedative medications, particularly psychotropic drugs, in managing behaviors and symptoms of mental illnesses. It highlights the ethical issues surrounding the use of these drugs, including the lack of complete understanding of pathophysiological mechanisms and the potential for misuse, abuse, and addiction. The essay discusses the role and challenges faced by registered nurses in administering these medications, emphasizing the importance of patient assessment, medication management, and recognizing potential risks. It also explores the challenges nurses face in addressing patient behaviors, including verbal, non-verbal, and physical behaviors, while ensuring patient safety and promoting recovery-oriented practices. Furthermore, the essay covers the importance of holistic care, including psychosocial management alongside pharmacological therapy, and the need for long-term plans to address repeated patterns of disturbed behavior. The conclusion emphasizes the need for nurses to take precautionary steps, accurately diagnose the main disease, and optimize treatment plans while considering the potential benefits and risks of sedative medications.

Running Head: CONTROVERSY USE OF SEDATIVE MEDICATION 1
CONTROVERSY USE OF
SEDATIVE MEDICATION
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CONTROVERSY USE OF SEDATIVE MEDICATION 2
Introduction
Mental and behavioral disorders account for approximately 12% of the global burden of
diseases and only a minority person receives basic treatment. Mental and behavioral disorders
include affective disorders, schizophrenia, depressive disorders, dementia, post-traumatic
stress disorder, epilepsy, obsessive and compulsive disorder, primary insomnia, and panic
disorder. The World Health Organization (WHO) post review of the evidence for treating
mental disorders states that a combination of pharmacological and psychosocial approaches is
expected to deliver the best results (World Health Organization, 2016). However, the use of
psychotropic medication has been used to control behaviors and manage symptoms in people
experiencing mental illness has been controversial. These drugs have the potentiality of being
misused and abuse is high. Moreover, their drugs are highly coercive in nature with
significant effects on a person. The current scope of the essay discusses the controversial use
of psychotropic medication to control behaviors in patients experiencing mental illnesses and
managing their symptoms.
The controversy of psychotropic medication
The pharmaceutical industry has provided a host of new psychotropic drugs to clinicians
who provide treatment to people with mental disorders (Douglas‐ Hall, & Whicher, 2015).
Though the use of psychotropic drugs has an increasing role in treating mental disorders,
there has been significant controversy facing the use of such medication to control behaviors
and manage symptoms amongst people with mental illnesses. The advent of pharmacological
treatment has been used in psychiatry started in the late 1950s, with chlorpromazine being
introduced (Muir-cochrane and Grace, 2017). There are ethical issues concerning the
pathophysiological understanding of diagnostic validity regarding when a patient needs to be
administered such drugs. The lack of knowledge in understanding pathophysiological

CONTROVERSY USE OF SEDATIVE MEDICATION 3
mechanisms in understanding the exactly pathophysiological mechanisms in psychiatric
disorders or medicinal treatments in relieving symptoms in curing the disease is a major
limitation (Calver et al, 2015). There are significant limitations and a great deal of complexity
as well as uncertainty in treatment and outcomes related to psychotropic drugs.
The use of psychotropic drugs is often used for the purpose of controlling behaviors in
patients. These drugs are used for a wide range of mental conditions. However, patients in the
mental health setting can present with violence and a wide range of behaviors. Such
challenging behaviors can be verbal, non-verbal or physical that might make it difficult in the
delivery of quality care in a safe manner. The behavioral outcome of the patient can be biting,
grabbing, self-injury or punching (Lucas, & Bowblis, 2017). The most crucial aspect of such
behavior remains that the patient might be totally ignorant of such behaviors and it might
become necessary in restraining such behaviors. The use of psychotropic drugs can ease
patient condition however might be associated with a range of side effects that the patient
might face. While sedative drugs can be helpful in treating sleep problems and anxiety but
there can be high dependence or addiction towards the drug. Psychotropic drugs are a drug
that can slow brain activity. They are often referred to as tranquilizers or sedatives,
depressants having a calming effect and possess the capability to induce sleep. The effects of
psychotropic medication are similar to those of alcohol (Weaver, 2015). Hence along with the
effects of calming, such drugs can also cause dizziness, drowsiness, and confusion. The
patient might experience problems with movement and memory, the slow pace of heartbeat
that might worsen in case combined with alcohol. Its ethical challenges include risks from
injury and falls. In its worst cases, it might worsen anxiety symptoms and depression with
impaired judgment and attention (Hayes et al, 2015). It can lead to inappropriate behaviors
and mood swings, risks of addiction and dependence. In high or inappropriate dosage, it can
lead to death, either intentional or in an unintentional manner (Asadi-Noghabi et al, 2015).

CONTROVERSY USE OF SEDATIVE MEDICATION 4
Therefore, the effects of these drugs can be highly coercive with the above-discussed effects
on a person.
Sedative medications have been used for treating a wide range of mental disorders with
the potentiality of being misused and also abused by patients. There have been seen many
problematic patient behaviors with the use of prescribed sedatives and clinicians as well as
nursing practitioners have to deal effectively with sedative abuse along with its
consequences. It becomes essential to address the patient's problematic behaviors regarding
controlled substance medications while using sedatives for ensuring patient safety, in cases of
patient morbidity and mortality from overdosage. There are involved ethical issues as well as
appropriately treating addiction and prevention of drug diversion. Sedative drugs are
commonly prescribed for insomnia, sleep problems and other types of anxiety attacks and
benzodiazepines are the most common type of sedative used. These sedatives are similar to
alcohol and in addition to the reduction in anxiety and inducing sleep, they have been seen to
cause euphoria hence are subject to abuse and often considered recreational drugs.
The use of psychotropic drugs in treating patients with mental illness includes
pharmacological with psychosocial management. However, psychosocial management
remains almost non-existent and pharmacological therapy has been adopted as the most
common treatment procedure across facilities. There needs to be present psychosocial with
biological treatment for the effective management of mental illnesses (McDaid, & Smyth,
2015). The use of psychotropic medication is important for the purpose of holistic care for
patients suffering from mental illnesses. An RN who is duly educated and qualified might
receive, accept and transcribe orders from authorized prescribers of medicines such that
minimum to moderate sedation can be created. The RN might administer such medications
intended for sedation when only duly authorized by the prescriber. Professional standards
recognize nurse’s responsibility and abilities so as to perform an activity in a safe, competent

CONTROVERSY USE OF SEDATIVE MEDICATION 5
and effective manner. Medication management is useful when the behavior is specifically
related to psychiatric origin or where the behavior is putting either the patient or others at
significant immediate risk. Medicines can be used when the risk of not undertaking such
management is greater than the inherent risks of introducing medicine in an already stressful
situation.
Challenges aspects for registered nurses
A registered nurse administering a mental health patient might face a considerable
challenge in psychotropic medication. Nurses need to evaluate the patient's in an appropriate
manner to evaluate if the patient posses’ significant risks from harm to self or to others in the
recovery-oriented practice (Alessi et al, 2016). Mental health patients might exhibit a wide
range of behaviors which include verbal, non-verbal or physical behaviors, which might deter
the nurses' intervention to deliver safe care in an effective manner. With the use of
psychotropic drugs, a patient's behavior can be controlled, but there might be challenges
associated with the risk of harm to self and others in recovery-oriented practice. Repeated
patterns of disturbed behavior might emerge to be problematic and in patients with chronic
scenarios, the focus should be on preventing a repetition of such events.
Responsibility of registered nurses includes management and administration of mild,
moderate or deep sedation (Gustafsson et al, 2016). However, RN's might face a range of
challenges when administering sedation within the work settings. Nurses need to take into
consideration, the competence of the prescriber, the hospital/ healthcare settings policy,
effects of the medication ordered competence of the nurse experienced in airway
management and advanced life support skills for monitoring the patient during and after the
administration of such drugs. It is nearly impossible to predict the potential for profound or
rapid changes in the sedative or the anesthetic depth during the process of sedation. Most

CONTROVERSY USE OF SEDATIVE MEDICATION 6
importantly, nurses need to determine the competency of care and availability of practitioners
for the patient (Calver et al, 2015). Patients who experience significant risks from self-harm
and harm to others, need to be screened by nurses for patient screening and selection.
Nurses need to undertake an appropriate selection of pharmacology as per their properties,
mechanisms and physiological responses. Then nurses need to administer safe and competent
medication administration only by specific routes and provide constant and continuous
support to the patient. Nurses need to develop the ability for recognizing patient conditions so
as to be able to appropriately react in case of emergency situations. It is the sole
responsibility of nurses to manage the patient's airways such that the dosage can be
administered by the trained clinician in anesthesia or by an expert in airway management
(Lim, Wynaden, & Heslop, 2019). Nurses need to continuously monitor signs of patient
consciousness and detect early signs of adverse sedation provided to individuals. The
healthcare organization needs to have appropriate infrastructure for ensuring the safety for
patients, as per defined policy, nursing competency and practice. Before putting an effective
plan in place for the management of challenging behavior, it is essential that RN's understand
the underlying behavior as to why the patient is disturbed. Patients in unfamiliar settings
might not feel well and their behavior might be a direct consequence of being frightened
(Bourdenet et al, 2015). RN need to monitor physical signs such as pain, delirium, any other
medications which are ineffective or are actively causing challenges, any situation of epilepsy
before and after seizures. RN needs to overview the cognitive condition of patient
communication difficulties, autism, learning disabilities or dementia. The patient needs to be
also evaluated for substance misuses such as in illicit substance or alcohol misuse, such as
withdrawal symptoms and intoxication. RN needs to monitor signs of psychological or
emotional distress such as the presence of fear, stress, and anxiety in the patient.

CONTROVERSY USE OF SEDATIVE MEDICATION 7
RNs need to maintain good communication as a part of their overarching strategy to de-
escalate the situation, reduce anxiety and distress and calm down the patient. In case the
patient is violent or aggressive behavior, then short-term intervention includes de-escalation
technique to defuse the situation, physical restraint and moving the patient to an alternative
setting. The patient needs to monitor early signs of irritation, agitation, anger, and aggression.
RN needs to understand the likely signs of aggression or violence. RNs need to adopt
techniques for distraction and calming and encourage relaxation (El Alaoui et al, 2015). The
RN needs to recognize the importance of personal space of patients and respond to a patient's
anger in a measured, appropriate and reasonable manner to avoid provocation. Along with
mediations, intervention from a psychiatric liaison team or the police might be necessary for
these options. Oral medication should be offered and used wherever possible. Parenteral
options need to be considered only in cases where oral administration is not feasible. RN
needs to make an informed decision regarding the care that they offer. The use of
psychotropic drugs needs to be used only to reduce the risk of harm or minimization of
agitation and violence inpatient.
RNs needs to consider long-term management where repeated patterns of disturbed
behaviour is seen as problematic in chronic situations such as in dementia or in patients with
learning disabilities or autism (Lucca et al, 2015). Inpatient cases where repeated incidents of
violent or disturbing behavior occur then RN needs to take decisive action in evaluating the
number of chronic scenarios. Post evaluation of the overall scenario, its review of target
symptoms, causes or contributory factors needs to be identified and addressed to prevent the
occurrence of further events. A long-term plan should be put in place for addressing the
medium-term goals, with or without the use of medicines. RNs need to view the presentation
and diagnose related behaviors and then optimize the use of any prescribed medications

CONTROVERSY USE OF SEDATIVE MEDICATION 8
(Bohnenkamp, Stephan, & Bobo, 2015). This can enable RNs to review the situation and
medicine used to control behaviors and understanding if they cause more harm than good.
Conclusion
In conclusion, nurses need to take precautionary steps while administering psychotropic
drugs. RNs primary role is to diagnose the main disease and planning its treatment in an
accurate manner in an optimized manner. Such as a patient of dementia needs to receive
treatment for dementia itself and needs to be optimized prior to the addition of regular or
required oral antipsychotics for behavioral symptom management. Patients should be
reviewed frequently along with their disturbing behaviors with routine patterns and
arrangements around regular behaviors. Psychotropic drugs need to be used only for
controlling or subdue any disturbed or violent behaviors when other therapeutic options have
failed. Thus, RNs need to evaluate the ethical challenges and other aspects of the patient prior
to undertaking medication management or suggesting any treatment for patients.

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