Noncomplience and uninvolved management

Nurses Professionalism

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I currently work in home care for quadriplegics who require trach and vent care.

I have a client who I love dearly, but is extremely noncompliant. He refuses ROM, ADLs, he has refused to get in his wheelchair for the last two years, ect ect

Most recently he refused his Miralax (the only bowel medication he is on) for 2 weeks and ended up with a fecal impaction which he refused to go to the hospital for treatment.

My manager is completely uninvolved. She is intimated by him and doesn't want to emphasize things he doesn't want to hear.

What at is my responsibility here? I know he has the right to refuse, but it seems extremely unethical to allow someone so much say over their care when they aren't in the medical profession and don't understand how serious the situations are.

Please help, I'm worried I'll have to come off this case that I love. Simply because I can't stand around and watch him die.

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Specializes in Dialysis.

Document, document, document. As you educate and reinforce, document it like crazy. As long as he is cognitively intact, you cannot force any treatment on him, regardless of what your feelings are. Just continue to attempt, document attempts and responses. If he has a POA or significant other involved, see if they can assist with persuading him

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Thank you very much! Will keep that in mind as I chart!

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Specializes in ICU.

Can you notify the MD for guidance and a home visit?

Is palliative care or treatment for depression indicated?

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Specializes in Psych, Addictions, SOL (Student of Life).
Document, document, document. As you educate and reinforce, document it like crazy. As long as he is cognitively intact, you cannot force any treatment on him, regardless of what your feelings are. Just continue to attempt, document attempts and responses. If he has a POA or significant other involved, see if they can assist with persuading him

Document ................"Explained benefits of treatments as well as risks up to and including death. Patient alert and oriented and verbalized understanding. Will continue to monitor.......Bla Bla Bla"

In short CYA

Hppy

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Specializes in NICU, ICU, PICU, Academia.
I currently work in home care for quadriplegics who require trach and vent care.

I have a client who I love dearly, but is extremely noncompliant. He refuses ROM, ADLs, he has refused to get in his wheelchair for the last two years, ect ect

Most recently he refused his Miralax (the only bowel medication he is on) for 2 weeks and ended up with a fecal impaction which he refused to go to the hospital for treatment.

My manager is completely uninvolved. She is intimated by him and doesn't want to emphasize things he doesn't want to hear.

What at is my responsibility here? I know he has the right to refuse, but it seems extremely unethical to allow someone so much say over their care when they aren't in the medical profession and don't understand how serious the situations are.

Please help, I'm worried I'll have to come off this case that I love. Simply because I can't stand around and watch him die.

I think you do not respect your patient's autonomy. Just because his body doesn't work and hs is not a medical professional does not mean he is incapable of making his own decisions. People ALL THE TIME make decisions that negatively impact their life and health. In a free society, this is a basic human right. trust me- he understands full well what he is doing/ not doing. It is his decision to make- and hardly 'unethical' to 'allow' him to make this decision. Please refer to the ANA Code of Ethics for Nurses.

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Specializes in SICU, trauma, neuro.
What at is my responsibility here? I know he has the right to refuse, but it seems extremely unethical to allow someone so much say over their care when they aren't in the medical profession and don't understand how serious the situations are.

This is called "paternalism," and it has no place in contemporary nursing/medicine. This idea is why so many elders question nothing, but rather "follow the dr's orders," because it used to be the common practice.

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Your patient can decide or not decide to do whatever it is they would like to. Your job at this point is to meet him where he is, and use your resources. His practitioner needs to know what is going on. You can suggest to the practitioner that other disciplines become involved: palliative/hospice care, a counselor to help work through this stuff, that kind of thing.

What happened that he ended up like he is? An accident? Military service? Sometimes various support groups have people who will come and spend some time.

And as noted above DOCUMENT everything. Leave no stone unturned in your attempt to get other disciplines involved in a goal of peace and calm. Do NOT argue about his choices. Do not plead, carry on, or otherwise. There's no need to work this patient up into a frenzy over his control of his own body.

And remember, sometimes patient's wishes are different than our own. And that's ok.

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Is he attention-seeking? Does he WANT to die? Sometimes that is the only control he has, refusing medications/treatment. There as to be a motivation to refuse care, find the motivation (if you can,) then you can move forward. And yes, document, document......

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First off, do NOT the the term noncompliant.” That term is very derogatory to patients, it objectifies them. The correct term is nonadherant.” (I personally prefer the term self directed…"

...What at is my responsibility here? I know he has the right to refuse, but it seems extremely unethical to allow someone so much say over their care when they aren't in the medical profession and don't understand how serious the situations are.

Please help, I'm worried I'll have to come off this case that I love. Simply because I can't stand around and watch him die.

Tie him to the bed and and force him to accept what YOU think is BEST for him. After all, isn't that what his healthcare is all about. If he has reasons, such as the gender of his providers, just ignore them. After all, you apparently have NO issues with any such concerns. Be aware, that he may be depressed and does not want (or care) about life any more. Ignore his feelings and wishes and do what you think is the best for him. (Admittedly, that is the orders from his physician.)

You are also so correct that he has NO MEDICAL knowledge either. I find it amazing how so many people without any medical training are allowed to make decisions for themselves, their children, or their family. We really need government to step in and let the healthcare system tell people how to live their lives.

Thank you for your concerns comrade nurse.

Yes, this is sarcasm, but do you see my point?

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Perfect advice. Document. As a hospice nurse, I see patients who make choices I would not make for myself all of the time. Some separation from your patient might actually be a good idea for you. Perhaps work on another case for a while? Regardless, good luck to you and thanks for the post.

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Specializes in LTC,Hospice/palliative care,acute care.

[quote=AbigailJo;885815

I have a client who I love dearly

This is the problem.You have lost your objectivity,you need to seek help from your team regarding appropriate boundaries.......

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