Pt refusals

ChristinP · Mar 21, 2012

I've educated, instructed, shown video, given brochures drawn pictures and even printed webMD handouts from patients (they prefer webMD to CDC or othe reputable sources) I've reasoned. begged and yes I've bribed (it was homecare & my patient was homebound and was dying for a kit kat bar- it worked she got up and walked for me and lol I gave her candy bar).

When I worked med/surg rehab too many refusals from patient = a nice talk with the DON so I always did my best to get a patient to cooperate.

The only thing to do if a patient continues to refuse is document refusal and how you educated the patient.

Merlyn · Mar 21, 2012

We had a Trisomy 21 kid going into CHF, the mom refused to give a dose of lasix until she researched, then once she was done she comes and refuses to give the lasix until we got a Magnesium level. Apparently lasix can lead to low Magnesium in a Downs kid. I wanted to tell her that's nice, but CHF will KILL your child before that Magnesium level gets back if you don't let me give the beaver dam lasix!! (And ironically, she didn't care anything about the potassium level.)

Oh, Well. One less

SHURN · Mar 21, 2012

Oh, Well. One less

Excuse me?

BostonTerrierLover, BSN, RN · Mar 22, 2012

Excuse me?

SHURN, Am I reading what he said correctly,. . .?

wanderlust99 · Mar 22, 2012

I took care of a jerk patient a few weeks ago. He was refusing everything (IVF, meds, etc..). They started him on Coumadin. The pharmacist spent 45 minutes in his room giving him Coumadin education. 45 minutes! Then an hour later I go in and tell him it's time to take the Coumadin and he starts arguing with me saying he's not going to take it, etc.. What is this medication, why am I on it? Etc... I explained to him why he was taking it and he continued to argue with me. I then grabbed the medication back and told him you have the right to refuse the medication. Then he got all angry and said "well give me another nurse". Blah blah blah. He was such an *******!

All I do now if a patient refuses something is tell them why we are giving it and then I say you have the right to refuse. I'm not going to debate jerk patients anymore.

Vespertinas · Mar 22, 2012

The medical team should have anticipated this if they were aware of his previous refusals. Of course, they did their job by attempting to educate but they should have already had a back-up plan in place. If you have a known non-complaint patient, better to send him home with nothing and document that the patient stated he would not plan on coming in for follow-up and therefore could not be safely discharged with coumadin Rx. God speed.

pinkstethoscope · Mar 23, 2012

I helped care for a pt post liver tx. He did absolutely NOTHING to help himself. Refused to get up, try to walk, and fought to keep his foley in, etc. I know this is incredibly mean, but everytime I went in there all I could think was "what a waste of a liver!"

BelgianRN · Mar 23, 2012

I helped care for a pt post liver tx. He did absolutely NOTHING to help himself. Refused to get up, try to walk, and fought to keep his foley in, etc. I know this is incredibly mean, but everytime I went in there all I could think was "what a waste of a liver!"

It's not mean and it is a waste of a liver. That liver could have gone to someone that would do something useful with their life after receiving it. Let's hope he has a change of heart and something good can still come out of it.

MN-Nurse, ASN, RN · Mar 23, 2012

How much do you want to bet that the pt will go home complication free and say "I told them so!"

Considering the odds of getting complications with the behaviors you describe, I'll take that bet over and over again.

You might win one once in a while, but eventually, I will have all your money. :-)

Vespertinas · Mar 23, 2012

I helped care for a pt post liver tx. He did absolutely NOTHING to help himself. Refused to get up, try to walk, and fought to keep his foley in, etc. I know this is incredibly mean, but everytime I went in there all I could think was "what a waste of a liver!"

Why do I get the sense that you're not a transplant RN?

These folks don't hop out of bed and many of them are people with past history of poor self-care. They turn around. Saying "it's a waste of a liver" makes it sound like there are plenty of innocent ill-stricken people out there being robbed of a liver. For the most part, that's not the case. You're happy if it is a recovered alcoholic who has even taken the necessary steps to stay sober. They're the cases who end up making the MOST of their livers (survival time) versus the other common diagnoses!

And we didn't allow our transplant patients the option to not walk. If they didn't want to move, we moved for them. On the slide board and straight onto a recliner chair. When transplant team rounds at 0800 and sees their patient in the bed, they think "what a waste of a nurse."

Merlyn · Mar 23, 2012

I helped care for a pt post liver tx. He did absolutely NOTHING to help himself. Refused to get up, try to walk, and fought to keep his foley in, etc. I know this is incredibly mean, but everytime I went in there all I could think was "what a waste of a liver!"

It's not mean, It's true full. When I first became a nurse after being a cop in the Air Force, I used to sigh out loud for a non cooperative patient could hear me, "Oh! for my old

side arm (.45 hand gun) and a ounce of lead." I was warned that I was upsetting the patients. But the patients I did have were cooperative.

Vespertinas · Mar 23, 2012

You... insinuated to your patients that you'd like to murder them? Am I losing my mind?