Your patient refuses exams from you and their physician?
I cared for a patient who was septic due to shooting drugs into her femoral vein. She was in the stepdown unit for 9 days and was transferred to my floor (medical overflow). I heard in report that the patient had a "blister in her lady parts." per patient statement. I also was told that the patient was refusing for anyone to look at it or do a back assessment (Braden). I was also told that her MD's were baffled that she continued to be febrile despite the mess of antibiotics she was on.
During my morning assessment I asked the patient about the "blister." She said that it was "better," and refused an assessment of the area and her back. I also asked if she wanted to walk and she refused. I told her about the risks associated with not ambulating and she said "I know, that is why I do leg exercises in bed." At the time I let it go and asked the CNA to not assist her getting up without me being there so I can do my assessment.
Later in the day she needed the bedpan (she has refused to walk for over 10 days and insisted on the bedpan). The sheet accidentaly fell and as I was handing it up to her I saw this "blister."
The labia was so big that it was hanging between her legs like testicles! No wonder why the poor girl didn't want to walk! I also was able to get her to turn to her side when removing the bedpan. I saw stage II's on her coccyx and buttocks. I was horrified.
I called the MD and she said "I heard about this blister, but she never let anyone examine it." Not even the MD's saw this "blister," but knew about it?! I could not believe that just because a patient tells us not to assess something, we listen! This "blister," could the be the reason as to why she wasn't getting any better- and if you all had seen this thing you would agree! I wonder if anyone even assessed the femoral area for abcesses?
I went back to the nursing documentation and half of the assessments note that she refused the assessment and the other half documented her skin to be intact (it may have been at that time, but how would anyone know if she refuses the assessments?). Physician assessments also document refusal of assessments.
What is your practice if a patient refuses care? Do you just document the refusal? Do you get creative in ways of assessing patients? Do you feel it is okay to not assess patients because they refuse?
To add more, this patient refused CT scans, X-rays and other diagnostic care. One would think that if she refused these other diagnostic tools, a physical assessment by an MD would be imperative.
