I am writing for some advice about how others reconcile their "duty of Care" with patients refusing correct treatment. I am currently a third year Nursing Student doing my advance clinical placement on an orthopeadic ward.
In the past week I have had two patients, both with fractured NOF's trying to get out of bed. The first one made it out of bed and fell in a screaming heap, damaging his femur further. This has led to a delay in surgery and other complications. This patient was very confused at the time and eventually settled.
The second patient, is another story, he is not confused, he understands exactly what is wrong with him and continues to try getting out of bed. We have caught him several times undoing his traction and trying to get out of bed. He then gets aggressive when we stop him. He is on moderate to high Diazapam dosage to keep him in bed but due to his drug history it may as well be paracetamol.
I am finding it hard to not let him get out of bed to "teach him" that it is a bad idea, I know that I have a proffessional attitude but am finding it very hard to reconcile my professionalism with this patient. Does anyone have any ideas on strategies to make this dilemma any easier?
Apr 15, '07
Right on, Tazzi.
Make sure his doc knows about this behavior -- this patient is going to be noncompliant post-surgery and post-discharge too. AND he'll be the first one to sue for malpractice when his leg never heals, so document everything and CYB.
Apr 15, '07
Document, document, document. Non compliant patients are difficult. If they didn't want fixed why come to the hospital? Some of the many reasons for this concerning behavior include dementia and psychosis along with withdrawal from something they take daily but they failed to share that information with anyone. Rule out every option and then you can assume that they are properly informed, educated and remain non-compliant.
Apr 16, '07
Document all education attemtps et his reaction to them. He will be the first to yell, "No one told me!" when his leg never heals. Make sure that you cover yourself. And update doc when he attempts to get up so doc knows what is going on! It is hard to help people when they are non-compliant. But it is not our job to make them do what we say, only to educate them the best we can on their situation. What they do with that info is up to them (if they are A&Ox3). I do understand yoru frustration though.
Apr 24, '07
Thankyou for your advice everyone!
Sorry to delay getting back, between my placement, Uni assignments and work there hasn't been much time for the 'net.
Update; the patient had his surgery and is recovering well, it came out that he was undergoing through ETOH and Marijuana withdrawal and has now "come around", he constantly apologises to the staff and is almost a model patient. His recent history did not come out until after my first post and we were not aware of his addiction, (we thought there was a psycological problem that was undiagnosed).
I very nearly gave up on the idea of nursing in the public health system because of this patient as well as a few others who made life hell for everyone. What changed my mind was the appreciation shown by other patients in the days that followed. I guess there will always be bad days but the good will (hopefully) shine brighter.
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