What can we deny our patients?

[Crux1024]

Question here, Inpatient hospital setting.

What can we deny pts? Like with a diabetic patient insisting on regular soda and not diet, or asking for 5 apple juices with each meal and a BS of 300 already? Pt on fluid restriction sticking his face under the faucet (to drink)?

Where do we draw the line? I once had a pt insist on something that he shouldnt have had and a preceptor gave it to them, saying we cant deny them what they want, even if it interferes in medical care.

Another example: I had a dialysis pt ordered to be NPO by a surgeon for an I&D to take place AFTER dialysis. Pt heard this and had a fit, was refusing the surgery and dialysis unless he had something to eat before hand. He really needed dialysis, and after discussing it with some other nurses (including the dialysis nurse I called report to), I gave him some cereal so his dialysis wasnt delayed. I then called the surgeon to inform him and he had a fit, telling me had to be NPO and how dare I feed him, even after I explained. I was very conflicted with this one. I feel that I shouldnt have fed him in anticipation of surgery, but if I didnt, he wasnt going to comply with ANY care that day. IDK.

Where is the line?

Any opinions are appreciated!!

[E.R. Rookie]

I got to agree with Angel Fire. I don't do well with tantrums and probably would have told him to man up but hey thats just the ER nurse in me. I love to baby my patients but not when they are acting like spoiled brats. Were talking about an adult here!

Try not to loose the respect and trust of the Drs. The ones I work with I can ask anything and they are always willing to listen to my input as well. I would never go against an order without consulting first and getting input from the MD.

[canoehead, BSN, RN]

I inform them of the reasons behind the care plan, and then they make the choice to follow the plan or not. So I wouldn't bring them the juice, but I wouldn't take it away if they went and got it themselves. I generally say that I will not help them get sicker if they ask why the discrepancy.

I understand you were in a catch 22 with the dialysis patient, and you did the best you could. In my opinion, sometimes we have to call the bluff. some people are very manipulative, and will try to make their noncompliance your fault. I would have said no to feeding him/her, and the rest is their decision (whether to go to dialysis). Remember that if they don't go to dialysis they are going to feel much worse for much longer- that choice will come back to haunt them. It DOES mean more work on your part but if you stick to the plan consistently they will know you cannot be manipulated. Less work in the long run.

[llg, PhD, RN]

I would have called the physician BEFORE I gave the cereal to the dialysis patient rather than after. The outcome for the patient would have been the same, but my butt would be a little more covered and I would be a little less chewed out.

I wouldn't actively break a written order without notifying the person who wrote it first and giving them a chance to intervene.

[Pepper The Cat, BSN, RN]

I tell my patients that I can provide them with the knowledge they need to make their choices. If they chose to ignore that, that is fine but I am not going to help them.

We have a pt on thickened fluids. He hates it. I've told him and his family the reason for the thickened fluids and the risk involved with drinking thin fluids. The wife keeps telling us that he won't drink the thickened fluid and to bring regular. I've told her I am not about to do that. If he choses to drink the thin fluids, knowing that it could result in aspiration pneumonia and possible death, that is up to him, but I am not going to help him with it. He gets thickened fluids from me or nothing.

Same goes for diabetic pt or weight loss pts who want something that is not on their diet. I can tell them why they shouldn't do it, but if they still chose to ignore that, fine. But don't expect me to help you with it.

As for the NPO pt - it would be NPO or no surgery. Again, their choice.

[Ayvah, RN]

Agree with the posts above. If you have a patient in the future that is giving you a very hard time, call the doc before doing anything, and let the doc talk to the patient. Many docs have no problem laying it on the line for the patient very bluntly, or, sometimes they decide it is ok to have their orders modified a bit. Sometimes the patient just needs to hear it from the doc one more time before it sinks in. And, as said above, you will be covered.