refusal of treatment

[tiger]

if a patient has rights to refuse treatment of any kind, do you think they should be able to refuse a special diet. maybe salt free, dys 1, 1600 cal reducing, or diabetic diets. whatever. tell me your opinion.

[nursedawn67, LPN]

Yes...but document document document!!!!

[jevans]

have to agree with Greer128

our job is to ensure that patients make an informed choice. All we can do is provide the information and rationale for treatment.

BUT document every interaction

j

[MetaRN]

From my experience with the patient popultion in the specialty clinic I help to manage, daily compliance with any type of restricted diet is, at best, difficult. While we as health care providers may see the medical necessity for the patient to comply -- and indeed, the long term consequences of noncompliance may end in negative results -- we can not always assume that our patients will agree with our point of view. Often their are many other factors impacting the overall success of a patient staying on diet, including the type of support structure he/she has, financial concerns, life style (work schedules, responsibilities to other family members, etc), cultural differences, as well as ther issues of feeling different from others, or of feeling "left out" during special occasions, such as Holidays and at parties, when others are scarfing down whatever is on the table and the patient must deny him/herself the goodies. However difficult and frustrating, those of us who are the health care providers, might find it, when dealing with patents who seem to be "noncompliant" -- I think it is best that we try to avoid creating a shaming or adveseral environment and rather try to maintain a partnership approach. And, in the case of our adult patients, we must come to realize that they have the right to refuse treatment -- no matter the final outcome. It might drive us all crazy and add another grey hair to our heads, but such is the fact of life.

[ageless]

very well said, MetaRN!

[Cowgirl]

:)

[Becka]

When I am reeeeeeaaallllly old (next month), living in a LTC facility, and someone who doesn't really know me, but THINKS they know what's best for me ... tries to put me on a NAS diet, I will gladly sign any form you want me to stating that I understand the risks so I can still enjoy the privilage of saying, "please pass the salt" at meal time.

Trust me .. NOBODY had better take away my sodium, or you can count on having to restrain me for threatening the staff with my plastic "spo-rk" (spoon-fork combo a' la 7-11 stores).

Becka

cheerfuldoer wrote:

>Patients most certainly do have a right to refuse whatever treatment they aren't willing to acknowledge being necessary or desired for their well being, HOWEVER, that's when the patient needs to be asked to sign a documentation that they were educated on the facts of what could happen to them by their refusing to be compliant with any given treatment plan

[bandaidexpert, BSN, RN]

We have instituted a "waiver' that gives the resident (client)the right to choose. For those of us in LTC, this is a biggie. Resident's rights are where it's at. If ST recommends thickened liquids, the resident just doesn't like it at all, the family, resident, HC sur has the option of signing this form. If you think about it, this has a big impact on weight loss, depression etc. Okay, my 2 cents(sense).

[Nurse Ratched, RN]

Refuse anything - cool with me and certainly a patient's right. But as others said, if the thing they are refusing to comply with is part of the tx plan to get them well and out of the hospital, they need to sign out (AMA if necessary) and skedaddle. Not being unkind, but if the patient is not interested in regaining/preserving his own well-being, I can't drag him there.

LTC residents - that's a bit hairier. It's home for them, and we don't interfere with people's right to make decisions about their own bodies. Educational notes, copious documentation and waivers from families who bring in "contraband" food and the like would hopefully be enough to protect you if someone has an untoward outcome from ignoring medical advice.

Reminds me of a quote, "Exercise, eat healthy, die anyway." I wouldn't want to stand in the way of a 95 year old diabetic and her candy bar either lol.

[Flo1216]

You know, I would never force anything on a patient that they didn't want, but it really pisses me off sometimes when some patients refuse everything. I mean, they ARE in the hospital. Like today this man wouldn't let me check his blood sugar and he tends to run low. Like really low. And he knows it but he wouldn't let anyone check it and I am sure he bottomed out later since he didn't eat lunch and had insulin earlier. If something were to happen to him , we would get in trouble. That's why as a student and future RN I document document document. I know it is the patients right but I still want to cover my own a#*.

[MetaRN]

It is always very frustrating when your patient refuses to comply. In the case of the man who wouldn't have his blood glucose drawn -- you were concerned about what could have been a very serious hypoglycemic event. In a situation like that, some of the questions one might ask are: what else was going on with the patient during the time of his refusal? What was his emotional state? Was he weary of being in the hospital -- perhaps feeling like a pin cushion from all the lab draws in addition to blood glucose draws? What type of sleep did he have? Patients in the hospital for any length of time simply become exhausted from lack of good, solid sleep -- the night time noise, the routines of the nursing staff -- all serve to disrupt a patients rest. (I know from recent experience!). Also, what was going on with his family issues? Was he having family problems that might have impacted his mood and compliance on that day? Was he missing work? Were their monetary issues weighing heavily on his mind? Is he an older man -- with other complications that have him scared and depressed and maybe giving up?

Sometimes we become angry with our patients -- lets face it, we're human too. We know the reality of what can happen to them. And maybe, in this man's case, he understood too the risk he was taking -- but at that particular moment in time his feelings over-rode logic.

So often there are many other issues impacting how a patient responds to what we ask of them. Let me share what was an eye opening experience for me recently -- where I "missed the mark" with a young, new mother-- (and hey, I've been in nusring since 1976!)

In the state of California, we are currently in the process of the trial phase of the Expanded Newborn screening program, which will test for a large number of Metabolic disorders. As the nurse for our Regional Metabolic Clinic - the presumptive positive cases are called to our office and I contact the parents of the infants to arrange the necessary repeat testing.

In once case, I called a mother who had triplets - the infant girl required retesting. When I placed the original call to "mommy" - she seemed almost disinterested and hostile. She insisted on speaking with the doctor - not a "nurse". Her right -- no problem by me. I connected her with my Physician who discussed the issue with her, then told me to call her again and set up the lab draw.

So I called her a second time-- and again was met with resistence and seeming hostility. She refused to go into the lab for another 3 days...."the doctor said I didn't have to go over the weekend." So I set the lab draw up for the next Monday -- then called her.

On the third call --I am told, "We can't go until maybe Friday."

Well by now, I am somewhat steamed. And I am thinking-- what's with this lady???? Her newborn might have a serious medical problem and she keeps refusing to go in for testing? Sheesh!

Thoughts of - great, do I have to call Department of Children's Service's in on this one?

But then -- she made a statement that caught my ear: She said "WE'll all go to the lab on Friday when my husband has off."

I paused and said: "ALL? You mean you're going to take all 3 of the babies to the lab with you?

"Yes." She answered.

"But, can't you have somebody else stay with the boys while you and your husband take your baby girl to the lab?" I asked.

"We have nobody else who can do that," she told me.

I was floored! It was then I realized -- WAIT A SECOND! RED ALERT!

I then questioned what was going on -- and learned that this poor sweet mama had 3 tiny babies, with NO HELP! Her husband had to return to work -- her family was from out of the country and didn't have their visas approved yet -- the couple was new to their community and had no friends to turn to -- and somehow, in the day to day world of medicine, their needs were missed by the Discharge planner and by their Physician and the nurses in the clinics on follow-up visits.

The poor woman was frazzled -- no sleep -- trying to feed and take care of 3 babies at once - alone. Just trying to survive!

No wonder she was overwhelmed when I come along and call and demanded her to grab up one of the babies and high tail it over to the lab.

Well -- I put the brakes on -- and realized we needed to get this mama some day to day help with her babies, as well as getting her little infant girl in for testing.

I contacted their Pediatrician, as well as our High Risk follow-up clinic. I also got our team Social Worker involved. I stopped and really listend to this mama -- and ya know what, the anger and hostility went away. And the baby was tested. And the results were normal, thankfully.

But I learned -- or relearned -- a valuable lesson once again. That I need to listen to my patients -- and also listen between the words. And ask questions. And not get so focused on the single GOAL that I HAVE -- that I forgot that maybe the patient has other needs more pressing to them at that moment in time.

And we all need to remember that Nursing isn't just task oriented. The greatest thing that Nurses bring to the world of medicine is our ability to get into the Patient's total SCOPE of needs....to become their advocates on many levels. Sometimes they will gladly accept our help and follow the advice, the plan of care. Other times, they might want the help, but for whatever reasons fail to follow through. And we are disappointed or worried or even angry.

The population I work with are "live long" patients -- with complex needs. And there are times when I am driven to grey hairs by them! And there are times when I wanna give some of of them "what for!" -- but when I reach that point-- I know it is time for a breather -- and to call upon another member of my team to step in and talk with the patient/family. Or work with them for a time. I am NOT tossing the family aside for good -- if I did - then I also should toss my nursing license into the shredder -- I am giving myself a human break.

And maybe --- especially with the day to day stresses of floor nursing, which I did for many, many years -- there might be times when a patient doesn't click to one nurse's approach -- won't have the blood glucose drawn -- that it might be worth asking another nurse or even the social worker to step in and see if they might be able to achieve a different outcome. Or maybe, the next time you encounter what seems to be a noncompliant patient bent on harming himself -- try to listen between his words and see if there isn't something else there that is happening -- some other need the patient has that is crashing in on common sense and the choices he makes.

I am very excited -- and want to welcome you, Junior member, to the world of nursing! We and the patients out there -- new "new blood" and your knowledge and engery and spirit! :-) I think you will find, as I did, that the real learning of nursing happens once you leave the class room and are working one the floors. And there will be lots of ups and downs. Lots of good times and days of total frustrations. But always hang in there and know-- that while you might never get rich in this noble profession of ours (at least I haven't as yet! LOL!).... you are impacting human lives and giving of yourself in a special way.

Best of luck in all you do!

[teeituptom, BSN, RN]

Howdy Yall

From deep in the heart of texas

Got to respect their wishes. If they choose to refuse any kind of treatment or diet or whatever, THEY HAVE THAT RIGHT, THANK GOD