Alert,oriented LTC patients who refuse routine nightly insulin? - page 3

by Blackcat99 | 5,813 Views | 45 Comments

What is your LTC policy for alert oriented patients who refuse to take their routine ordered nightly insulin? She just says she doesn't want it and doesn't need it. What would you do?... Read More


  1. 2
    I know I'm going to get blasted for this, but I have a similar pt who has an order for 15 units of novolog with meals. He is alert and oriented, too. Every night he tells me to give him less than the 15. He always says "give me 7 units tonight" or something like that. I say "okay" and give him the 15 units anyway. What he doesn't know won't hurt him. And the doctor knows I do this and finds it amusing.
    joanna73 and Blackcat99 like this.
  2. 2
    I think an alert and oriented person who is trapped in a freaking nursing home should be allowed to make their own choices as long as they understand the implications.

    God save me from well intended people making those decisions for me. I would rather be dead any day.
    catlvr and Blackcat99 like this.
  3. 1
    Quote from CrunchRN
    I think an alert and oriented person who is trapped in a freaking nursing home should be allowed to make their own choices as long as they understand the implications. God save me from well intended people making those decisions forme. I would rather be dead any day.
    If you won't follow the doctors treatments, what's the point of even being IN a nursing home. If these people were capable of making these kind of decisions they wouldn't be here in the first place. By definition of their being here they can't take care of themselves....
    Blackcat99 likes this.
  4. 0
    Well. I wouldn't be there by my own choice, but we all know that many people become disabled eventually due to age and infirmities and you will be "put" in a nursing home whether you want to or not if unable to care for your self and no family available.
  5. 0
    I get your point, but I still don't think that not allowing residents to dictate their medication regimen is a violation of their rights or something. I mean, society has legally decided you are incompetent to live on your own, but it's okay for you to decide which meds to take and which not to? That never made sense to me.
  6. 1
    Quote from Blackcat99
    What is your LTC policy for alert oriented patients who refuse to take their routine ordered nightly insulin? She just says she doesn't want it and doesn't need it. What would you do?
    If she's AO4 and legally competent, then there is nothing you can do to force her to take it. Document every refusal, let the MD and management know, and keep trying to educate her.
    Blackcat99 likes this.
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    Quote from BrandonLPN
    I get your point, but I still don't think that not allowing residents to dictate their medication regimen is a violation of their rights or something. I mean, society has legally decided you are incompetent to live on your own, but it's okay for you to decide which meds to take and which not to? That never made sense to me.
    Except in this case and many more Brandon they are only physically unable to care for themselves. They should not have their rights to make their own decisions taken away because they are unable to physically care for themselves.

    Say you were in a car accident today (god forbid) and ended up paralyzed and in a nursing home but were completely mentally competent. Shouldn't the decisions about your health be your own?
    MoopleRN and Blackcat99 like this.
  8. 1
    Quote from tamadrummer
    Shoot let them end up in DKA and on endotool or some other algorhythm And the amount of sticks for blood sugar and the pain in the butt it becomes for them will teach them. Blindness and losing appendeges is way further than a good stent of DKA.
    Aaaand again, there is a lot in between "let them suffer the consequences of refusing this!" and forcing someone into a treatment they don't want. Active listening, clarifying concerns, providing education as appropriate, a depression screen, all things that nurses wish we had more time to do, but so important for respecting our clients' autonomy.
    Blackcat99 likes this.
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    Quote from hey_suz
    Aaaand again, there is a lot in between "let them suffer the consequences of refusing this!" and forcing someone into a treatment they don't want. Active listening, clarifying concerns, providing education as appropriate, a depression screen, all things that nurses wish we had more time to do, but so important for respecting our clients' autonomy.
    I more than understand education and trying to prevent unnecessary suffrage but if it is not possible to prevent it, the consequences are many many many more fingerpricks and lots of insulin in the critical care area. Just take the darn treatment and live comfortably.

    Sent from my iPhone using allnurses.com
    Blackcat99 likes this.
  10. 0
    Quote from BrandonLPN
    I get your point, but I still don't think that not allowing residents to dictate their medication regimen is a violation of their rights or something. I mean, society has legally decided you are incompetent to live on your own, but it's okay for you to decide which meds to take and which not to? That never made sense to me.
    What society has legally decided you are incompetent? Residents are admitted thru doctors' order/families/DPOAs... they aren't committed like some psych patients! Many residents I take care of are skilled patients and they are absolutely A&O x 3 and are there for a short time while they get PT/OT or further eval. Even a demented resident has the right to refuse a med even though they can't benefit from education. If a demented resident refuses to open their mouth to take something PO, what are you going to do? Force them because they're not competent? No, you're going to attempt to give (more than once) and if they won't, they won't. Then you document "patient refused" and inform staff/the PCP/family etc...

    Whether a patient/resident is competent or not, you are NEVER to force them to accept a med/tx/procedure (psych patients who are a danger to self or others aside). You attempt and if they don't allow, you document that. They might allow next time. Just because a resident/patient isn't "competent", that doesn't mean they still don't have rights.


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