Two incidents I would like to share with you guys to get some advice, both relate to our duty of care and that thin line between giving prescribed care and abuse.
1) Man with eye infection, prescribed eye drops, man will not open his eyes to allow me to put them in, he squeezes his eyes shut and fights with his fists. I record it in his drug kardex as refused. Nurse A says he needs them and she gets a carer to hold his eyes open whilst she inserts them. I think this is abuse, I would not like someone prising my eyes open whilst I lie in a state of terror even if it was for my own good. NB Eyes continuously slightly infected due to eyelashes turning inwards but this does not appear to bother him.
2) Medication controlled diabetic lady who we know eats biscuits and chocolate in her room, asks for a cake with her tea. I give her it, Nurse B says I shouldn't as she is diabetic. I feel she has made her choice by eating sweets etc in her room, she also asked me to give her a basic human need -food. The whole room of people were also getting this. Nurse B refused to give her a cake the other day and there was mayhem! She shouted and got herself worked up, refused to eat any food. What would you do?
I always feel we are there to help those who want to help themselves. In an age where we promote patient choice, how much choice do we give???
Jan 28, '07
1. Is the patient competent? If so he has the right to refuse. If not, then it is appropriate to give the eye drops.
2. The woman may have made a choice, but you do not have to comply with it. Giving her cake is doing a grave disservice to her by promoting noncompliance. You know she is diabetic. You know she's not supposed to have these things. Let her get worked up. It's not your place to promote her disease. Cake is not a basic need. It's junk food. Now if her BS is fine with a cake or so now and then, then it would be ok once in a while.
It's time to talk with docs and family about a possible change of care. But any infection can spread and manage to turn itself into sepsis. And a diabetic can suffer terrible complications if uncontrolled.
Last edit by Katnip on Jan 28, '07