Patients who refuse to cooperate with medical/nursing treatment.... - page 3

I have just about had it with patients who think the hospital is a joke. I took care of a patient recently who basically refused to cooperate with the medical/nursing treatment and plan....This... Read More

  1. by   canadiannurse21
    Its so true sometimes---just a couple days ago, a lady lost her temper with me when I did one of my q1h checks on night shift. earlier I had given her an Ativan to try to help her sleep (the Dr hadn't ordered her anything else despite multiple requests from me) and she told me she hopes I dont hand it out too often because its sh**. She then slapped my flashlight out of my hand and told me to get lost. Although I understand some patients are either in pain or irritable from being in the hospital, its not fun when all your efforts go unseen.
    And still, I love my job
  2. by   wolfie
    Kimberle, that's a little bit different then what we have said here. You chose the more conservative way to deal with your childs illness. When you go into the ED the Dr. is required to go all out because should he or she choose the conservative route and it not be right he'll probably be sued. The pt's we're talking about are the ones that come into the ED or hospital and refuse everything, lab work xray's meds etc. For an abuse pt I use the phrase my friend told me this is not the Hilton, I'm not your servant and please and thank-you go a long way.
  3. by   hoolahan
    I agree kimberle, you made an educated decision, you do NOT fall under the category of TSTL!!

    Two weeks ago I had a fever for two days and just some gen'l body aches,mostly in low back/flank area. Did I have a UTI? I didn't know. I caled my doc who wanted me to go to the ER. He was concerned I had another kidney stone (trust me, I know that pain, and it was NOT a kidney stone) and he was concerned it was a pyelonephritis. I said look, let me com into ythe office, he said the labs take too long to get back. I said this is NOT an emergency, and I am NOT going to wait three hours in a freezing cold ER w doors opening and closing while I am shivering w a 102 fever!! He went on and on, I cut him off finally and said look, if you are saying you will not see me in the office tomorrow, fine. I also understand that you are advising me to go to the ER and I am making a decision to NOT follow that advise, just write "pt verbalizes understanding of instructions and refuses to follow treatment plan." He was pissed, but said, OK, I'm calling in some levaquin for you, but I want you to understand this is NOT the appropriate way to treat you. (Aaaahhh Bite me!! Tee hee!)

    Well, to my surprise I survided w/o an ER visit or a CT scan of my kidneys. It took thre more days for fever to subside, so I figured it was viral instead of bacterial or AB would've probably worked sooner. But geesh, he was going overboard and not listening to what I was saying. I am a freaking nurse, I think I know when I need to go to the ER or the office!! I don't consider my decision made based on stupidity, but rather I evalauated my symptoms and my options and chose a more conservative route.
  4. by   frannybee
    Got a lady in at the moment having I-131 (radioactive iodine) for thyroid Ca...keeps trying to come out of the isolation room with her various bits (plates, teacups etc) even though it has been explained to her that we can't remove them. She smashed a whole load of them on the floor toda trying to get someone to take them away - now she has a sharps bin in there as well which can't come out! Her attitude is that because she's in a cubicle (this is an NHS hospital, no private rooms) her room should be cleaned top to bottom every day, fresh sheets etc every 24hrs. Wants her friends in all day, and gets threatening with us when we tell them they have to leave after 1hr. She's flatly non-compliant with the 'clean' diet for 131 Rx, tried this AM to walk out, had her bags packed etc but refused to talk to the nursing staff....docs have told her if she doesn't toe the line and pull her head in, she'll end up dead at home after DAMA with obstructed airway due to swelling and a glow-in-the-dark thyroid.
  5. by   montroyal
    Document,document,document. Pts have the right to refuse treatment, but that comes with accepting responsibilty. Most insurance companies including medicare/medicaid, will refuse to pay the bills of a patient who has refused to follow medical advise. I can't tell you how many patients have come back to complain about their bills because the insurance company read non compliance or AMA on their chart and therefor refuses to cover the bill. With choice comes responsibility.
  6. by   AmAnRN
    I work on an O.B. floor and we often have pt' s who come in w/preterm labor supposed to be on BR who go downstairs to smoke, etc. and DM pt's who ask us for ice cream all night long!
  7. by   debyan
    Okay I understand the rationale for patient rights, and I know it is the right thing to do and all,but there are times when charting to cover your a** just don't seem to be enough. The times when you just want to be your daddy and say" do it because I said so" (of course my dad added or I will smack your a**)as irrational as that is. Me, I work with a lot of stobborn geriatric persons whose families seem to think that we can make them act right. The ones who don't want their medicine today, I have one woman who will tell me God has told her she don't need it. Then there are the ones who are unsteady on their feet but still want to do what they want without asking for help getting there. Well we have those restraint free alarms so we will know when they try to get up out of their wheel chair after they remove their own seatbelt. They will take off the alarms and hide them which is to me a refusal, but it also is a Drs. order to have ti on. It makes no sense to me if they can remove the alarm they know what they want, can we make them wear them? One lady came strolling up the hall alarm in her hand I guess it was attached to her in a way. Then there is the guy who is on fluid restriction who goes down to the snack machine and gets his own drinkks or to the water fountain. The one who wants his PRN drugs when he wants them along with all his other drugs and if you tell him not a smart idea he calls 911 to tell them you are causing him to be in pain, or the guy who goes out for a cigarrette then comes in and wants his O2 hooked up. Its Cwazy, I really have respect for those of you in the ER your stories are enlightening as where my trouble started As tiny Tim said"May God Bless us, everyone" deb
  8. by   emily_mom
    Originally posted by AmAnRN
    I work on an O.B. floor and we often have pt' s who come in w/preterm labor supposed to be on BR who go downstairs to smoke, etc. and DM pt's who ask us for ice cream all night long!
    GEE, wonder why she's in pre-term labor...

    Had a young lady in the other day (21...preggers with 4th kid)...was dehydrated and needed fluids. Asked for an ultrasound b/c if she couldn't see the heart/legs/arms she wanted an abortion. Doc consented to US (even though we are a Catholic hospital....forgot to mention she was only 7 weeks along). Discharged her next a.m. as she had an appt. at the clinic that performs abortions.

    Just made me so damn mad. Why the hell did she even come in if she didn't plan to keep it? GRRR
  9. by   mattsmom81
    Originally posted by montroyal
    Document,document,document. Pts have the right to refuse treatment, but that comes with accepting responsibilty. Most insurance companies including medicare/medicaid, will refuse to pay the bills of a patient who has refused to follow medical advise. I can't tell you how many patients have come back to complain about their bills because the insurance company read non compliance or AMA on their chart and therefor refuses to cover the bill. With choice comes responsibility.
    This is so true... when dealing with this type...some will cooperate out of fear of getting socked with a bill himself. So I tell them the above in hopes it will motivate them to think.

    Sadly too many just don't care and wouldn't pay their bill anywho.
  10. by   deespoohbear
    Had a meeting yesterdy at the hospital. Went to my unit to check the schedule....the guy is still there.....I am about ready to hurl just thinking of the possibility of having him this weekend.....
  11. by   Nurse Ratched
    Originally posted by frannybee
    Got a lady in at the moment having I-131 (radioactive iodine) for thyroid Ca...keeps trying to come out of the isolation room with her various bits...
    OK - see, that's the sort of situation that ought to have this lady on a temporary hold in a med-psych ward in a LOCKED seclusion room while she completes her therapy. You can't send her home still radiating, and if she's clearly endagering the health of staff, other patients, and visitors by attempting to leave her room, then what other option do you have? (I'm guessing that there isn't such a ward available, or she'd be there.) I can accept people doing stupid stuff that harms their own health, but don't endanger others, too.

    Man, I feel for you all. Fortunately, we each get at least one moron patient so no one is too overburdened with having them all .
  12. by   frannybee
    You guessed right, Ratched - her team were discussing it but as she was allegedly competent, they were reluctant to transfer her out anyway. All is well, she went home today and because the room is hot now, we have one less patient to worry about
  13. by   neneRN
    Just today, had a pt come in with c/c chest pain. Pain went down from 6 to 3 after first NTG SL, came time for second dose and pt flat out refused any more NTG. Reason? NTG giving her a headache... okay, so explain to her we can easily fix the H/A- doc essentially offers her any pain med she wants for H/A and explains the whole rationale for giving NTG. Nope, still refuses NTG. Okay, hello...let's see risk damage to your heart or deal with a H/A (that we are trying to fix, offered Morphine, Vicodin, Tylox, plain old tylenol...) This pt was willing to go ahead and deal with the chest pain and risks involved rather than following the doc's prescribed treatment. SO WHY ARE YOU COMING TO THE ER SO WE CAN FIX YOUR CHEST PAIN YOU MORON? I don't know people get by in this world with absolutely NO common sense!

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