Ethical Dilemma - page 2
I had an incident come up recently, but I wanted to see what you all thought. I don't remember all the specifics, but I'll give you the scenario as best I can. I had a patient who had surgery a few... Read More
Mar 6, '13Quote from RoseyposeyI agree. The same way we are to use our nursing judgement to know when to hold a medication. Or when the change in a pt's condition might warrant not following an "order."Who are the doctor's orders written for???? The name on the label is not Brandon LPN, it is Patient Doe, John. This is what doctors and nurses alike tend to forget. The doctors are absolutely NOT giving ME an order!!!!! I do not take orders from anybody. I, as a nurse, FOLLOW orders. The order is FOR the patient. I carry out the orders. We are doing for the patient what they cannot do for themselves. If they were at home they would either take their Lisinopril or they would not....the order is for their care. In my world, we do not call them "doctor's orders," we call them "suggestion sheets." A patient can choose to selectively follow THEIR orders. We document which orders are carried out and which are not.
....sorry guys, hot-button issue.
Mar 7, '13The patient has the right to refuse to be NPO just like the surgeon and anaesthesiologist have the right to refuse to perform a procedure on someone who can't be compliant. Don't lose sleep over it, dude sounds entitled and ready for discharge AMA.
Mar 7, '13Your manager is ridiculous to even have addressed this with you. Was it you who approached your manager about this situation first?
Some ice chips are the least detrimental thing your patient could possibly have consumed before surgery. And if he can't physically get up and get food himself yet he demands it, you are at that point basically keeping him prisoner by denying him basic rights (food, water).
The resident I can't blame too much bc he probably was scared of ruining his attending's surgery schedule by taking a patient off the list simply bc he can't be "controlled". If you think you're fretting over your manager's reaction, you don't want to be in the resident's shoes when he gets chewed out for that one.
Mar 7, '13Like others I see no ethical dilemma here. Or really even a confusing situation. I would have explained to the patient why he was NOP and educated him about the possibiliety of another surgery. If the patient makes an educated decision to not be NPO then that is his decision. I would have no problem letting him eat anything he wants. Of course a call to the physician is in order as they may want to come over and try to reason with the patient themselves but other than that there is nothing to be done from a staff RN point of view.
I see two problem here The first is with the ortho residents refusal to come to bedside. The second in the lack of knowlage about patient rights on the part of the staff nurse and the nurse manager.
Mar 7, '13I don't see how it's okay to provide the pt with food. At least not until after you call the doctor.
Mar 7, '13It's not an ethical dilemma. Your patient has the right to refuse...both being NPO and further surgery. The residents should have spoken to the patient about the matter after you asked them to (document that the residents were informed and that you asked them to talk to the patient and that they didn't). Then you should have notified the attending surgeon of all of the above (and document that too). The surgeon can speak with the patient via telephone if needed and can try to change the patient's mind or not. Either way, you've done all you can to mediate the patient's wishes versus the surgeons.
Mar 7, '13Quote from Daisy_08I would love a link to that thread, that sounds very interesting!I feel like a read somewhere on here about a nurse being charged with something for not giving an NPO pt food when asked? I don't think it stuck though.
Mar 7, '13I agree with other posters...not an ethical delimna, but an uncomfortable one for you, for sure.
Your hospital likely has patient rights and responsibilities posted somewhere...they outline the patient's right to choice in treatment options.
Mar 7, '13I encountered a similar situation in clinicals recently (I am a nursing student). I explained to the patient the purpose of NPO before surgery including the potential risks involved, notified his nurse of the situation, and wrote a very detailed nursing note explaining his resistance to the NPO order. He also had open drinks in his room and a piece of ice he'd been chewing on. I took everything out, told his nurse, and documented everything I observed.
He really didn't seem to grasp the importance of remaining NPO before his procedure even after I explained it to him, but eventually backed down.
As a nursing student, I think I covered all my bases. I'm glad he didn't push the issue any further, though!