when what client says conflicts with med chart

smartnurse1982 · Apr 21, 2009

Oops should have been dad bagged for 5 min. Oh and agency knew all of this and did not say anything to me.

smartnurse1982 · Apr 21, 2009

We ambubag we depend on it is a typo. Ignore it. The blackberry won't allow me to edit post.

november17, ASN, RN · Apr 21, 2009

Obviously those parents are doing a fantastic job. So good in fact, that maybe they should take little Ty or Caylee or whatever their name is back home instead of leaving it to the professionals.

NYCRN6 · Apr 21, 2009

If you document everything THOROUGHLY I don't think you would be held legally for this. I don't work with children but if my patient is throwing a fit and is A+Ox3 and states I do not want this do not give it to me. I review the consequences with them of not having this medication (we'll say for example purposes), I would notify the doctor immediately and have them come down to back me up. I also would ask the charge nurse to be involved too. This way when you document you can say you notified the appropriate people had them come and evaluate/teach also, and they still refused. However in your case... the kid can't advocate for him/herself. Now that i am a paragraph into this.. I'm not sure how it works! When in doubt DOCUMENT EVERYTHING down to the TEE. In the end you are covering yourself.

Katnip, RN · Apr 21, 2009

They are refusing care that was ordered by the physician on behalf of their child. Document each and every word, and let the physician know.

buttercup99 · Apr 21, 2009

I am not in the workplace yet, I'm a 3rd year student. But I would've thought that the parents are the legal "consenters" so as long as you explain the reason why they need this treatment (not just because they'll get sicker) and the possible consequences of refusing this medication/treatment, and document not only the refusal but the education you gave, then you have covered yourself.

Look at the opposing side, if they refuse consent for a treatment, and you give it anyway, you could get in trouble for that.

I know it feels like you are doing the wrong thing by not giving the appropriate care, but as long as you follow your workplace's policies, you have done the "right" thing. When it comes down to it, you have to go by the views of your workplace and the law if you want to avoid trouble and these can differ between places, so best to check that out.

There are undoubtedly other ways to approach the situation but this is the "cover your ass" method.

**canoehead, BSN, RN** · Apr 21, 2009

I would document that parents refused treatment despite teaching, and I'd teach til I was blue, but respect their decision. I'd talk about lack of rest and stress on the body if the child needed to work that hard to breathe and get physio and cough every 30 minutes. I'd also talk about air trapping in the lungs and the need to actually open the airways as opposed to just forcing air down a closed tube. I'd also ask them to provide me with links to what they were reading, and pass on a few links myself.

To get anywhere you'll have to meticulously respect their choices as far as care for the child, be very respectful, and always approach it from what is ultimately best for the child. Don't debate as the situation is happening, you'll just end up yelling at each other. If you feel the child's life or health is in danger ask them to take over responsibility until you can both sit down and talk. (bagging for hours with low sats- if they want to do it thats fine, but I don't want to go against protocol without a good reason.)

Let your aganecy and the physician know what is going on at home. They may change their protocols in this case, or back you up and change the parents' minds. They need to know what's happening. Ask the parents to put their wishes in writing (CYA) so you are very clear about what they want and don't want done.

It's a touchy situation. If you can't keep the lines of communication open with the parents it's time to leave. It's OK to disagree if you can both talk about it, but you want them to be making decisions knowing how you feel about it. They might actually have some good points once you read the literature, or they might be right but taking things too far. Tell them what you think, and encourage them to keep researching a variety of opinions. That covers you and increases their knowledge about their child's condition.

morte, LPN, LVN · Apr 21, 2009

disclaimer: i am not a pedi nurse.....that said.....

the first case i would be calling doc and considering CPS

Purple_Scrubs, BSN, RN · Apr 21, 2009

I agree that the MD should be consulted, and you should insist that he/she speaks to the parents. Some sort of resolution should be made between those two parties and it should be clearly documented in the chart in the form of new orders or clarification of the original orders. It really bugs me that nurses get put in the middle of this. We do not make the orders, but we are the ones who get yelled at when the family does not like the MD's decisions. It screams of a lack of communication on the MD's part.

jpRN84, BSN, RN · Apr 21, 2009

Document, Document, Document everything that was said and done and what happened. Always keep the MD and your charge nurse abreast of what is going on and you should be fine. Good luck with your situation.

Batman24 · Apr 21, 2009

Document thrououghly.You can't document enough in situations like this one. You then need to get on the phone with the doctor PRONTO. The yneed to get involved and see if they can explain why what is needed or come to some resolution in this situation. Sometimes people trust the Internet more than doctors/nurses and that can be a very bad thing as those giving medical advice often aren't medical professionals. I'd follow up with CPS if the convo with the doctor didn't work. The children are suffering. And if you feel it is an emergency call 911 and get an ambulance. Don't let them bully you.