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 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.
---kelly