Pt refusing basic nursing care - page 2
i'm a newish rn work in neuro med/surg. i got a 30-something year old patient who has a highly unstable spinal fracture from a fall---bone fragments everywhere...80% spinal canal is compromised... Read More
Jun 7, '04these are the kind of patients that make me second guess my reasoning for going into nursing!!!!!!!!
Quote from kellyann0198i'm a newish rn work in neuro med/surg. i got a 30-something year old patient who has a highly unstable spinal fracture from a fall---bone fragments everywhere...80% spinal canal is compromised around the l3 level....our neurosurgeon started cancelling surgeries to fit in her necessary spinal fusion (7 hrs). he ordered strict flat bedrest, pneumos, logrolls, foley until her brace is made and/or surgery is done.
she will not comply with any of this business. she wanted seven other opinions and until she got her seven opinions she did not want to comply with anything including the basics: foley and/or bedpan, pneumos/teds, and staying in bed. nurses and mds talked to her and she says "it's my right to refuse care" and i have a right to other opinions (after 1 hour of discussion, she finally agreed to 2 other opinions), etc... this morning (5 am) i noticed her cruising around the room in the teds she put on herself sometime overnight with no non-skid stockings (might as well be ice skating in there). she is well aware of paralysis/neuro damage consequences since she's received several hours of counseling from the staff.
i tried the calm, caring approach, and i tried the vivid explanation of consequences approach ("one of these times you get up, you may move wrong and send a bone fragment right through your spinal cord that's why we're encouraging bedrest at this time..."). she'll comply for a bit and then sneak around and do her own thing.
what the heck should we be doing with her? any suggestions? i've never had a patient refuse things like having the siderails up and bedpan use. there's no previously diagnosed psych problems or anything obvious. should i just say "fine do what you want" or keep encouraging compliance like a broken record. any tips? similar problems? we're all stumped.
Jun 8, '04These type of patients are so hard to deal with. They take no accountability or responsibility for their own health. It's like they have this attitude of "It's your job to fix me- so do it." Without any contribution of their own to the healing process.
I believe it's an attitude problem. Seems like a sign of the times. Many patients and family members expect there to be some magic pill or procedure that will make them well. And they are so angry when this does not happen. How many times have we as caregivers been blamed for not fixing people? I hear the complaints all the time. "Granny wasn't confused until she came to the hospital" "He never had such problems with his blood pressure until he came here". "Why is my sugar so high?" "Why do I need to go home on oxygen, I never needed it before? (from the 2 pack a day smoker)"
If a person is noncomplient and has an attitude of entitlement- not my problem. It took years for them to develop this attitude and I have learned that they do not take kindly to nurses who remind them of their responsibility in getting well. Usually they are spoiling for a fight or a reason to complain. So I request their cooperation- inform the doctor when they refuse and document, document, document. Best I can do.
Jun 8, '04we have a form for patients to sign stating they have been advised of need for treatment and have refused to be treated. This form makes the patient acknowledge they understand the risks of non-compliance. I know you are concerned about your patient, but sometimes people just have to do it their own way. She is sacrificing her physical health for her mental health. You sound like a good patient advocate.
Jun 8, '04I think she forgot to read the RESPONSIBILITIES section of that patient rights booklet!
Remember the movie Michael where Jean Stapleton's character asks Andie McDowell's if she is "impaired in some way I am not aware of?" Sounds like your pt.
You did fine, you just can't fix stupid, unfortunately.
Jun 8, '04Quote from mjlrn97Yup. CYA. And then thank your lucky stars when you're not around when the inevitable happens.I second what memphispanda said---document your @$$ off, this patient sounds like the kind who'll sue the pants off you and everyone else when she injures herself beyond help and wants somebody---ANYBODY---to pay for it. :angryfire
Jun 8, '04Quote from mjlrn97:angryfire At the LTC where I use to work a patient refused to let anyone touch her period. After she died, the family sued. To avoid going to court the LTC gave the family a huge settlement. The family sued the LTC because the woman had lost weight. Staff had charted that she refused to eat and refused to accept any assistance.I second what memphispanda said---document your @$$ off, this patient sounds like the kind who'll sue the pants off you and everyone else when she injures herself beyond help and wants somebody---ANYBODY---to pay for it. :angryfire
Jun 9, '04The whole situation surrounding this patient and her refusal of care is SAD. I hope the staff members involved in this case get some emotional support and stress counseling. I am sure each and every staff member attempted to do the best job they could do under extremely difficult circumstances.