Dealing with an uncooperative patient?

Equinox_93 · Feb 16, 2009

Hi everyone!
I was wondering if I could get some input from you all about how you feel about uncooperative patients. Do you feel like a loss of control in care is the biggest reason patients are difficult or unwilling to cooperate? Do you think effective communication skills such as how to be assertive, what body language to use, and actively listening to patients would help in getting them to be more cooperative?
Any ideas and input would be really great.
Thanks!

Getting a patient to cooperate is entirely dependant upon what they find objectionable. Some object to what might come across as non-medically-necessary procedures/etc.- the key to getting them to cooperate is to get them to understand the necessity... You just have to figure out WHY they are objecting- and work to resolve that. MHO

mcknis · Feb 17, 2009

Getting a patient to cooperate is entirely dependant upon what they find objectionable. Some object to what might come across as non-medically-necessary procedures/etc.- the key to getting them to cooperate is to get them to understand the necessity... You just have to figure out WHY they are objecting- and work to resolve that. MHO

Exactly! And if that doesn't work...Vitamin H (Haldol) or Vitamin T (Taser)!!!

diane227, LPN, RN · Feb 25, 2009

1. Are they confused or disoriented? 2. Do they understand what you are asking them to do? If the answer to both those questions is yes then you have a situation where the patient has the right to refuse and to be uncooperative. I try to explain the situation to them,why they are getting that particular med, treatment or test but if they refuse, I just document that they have refused. If it is something like a test, procedure, etc, I write a note to the MD in the progress note. If they will not be compliant with their diabetic diet, I just let the doc know (but not in the middle of the night). If it is an emergency situation I just call the doc. After 31 years of this kind of stuff, I have stopped trying to get people to do what is good for them. I DO MAKE SURE that I have fully documented their refusal. This is KEY in case they have a bad outcome. If they want to sign out AMA, just sign this form and you can go. They are adults and they have the right to be stupid.

flygirl43 · Feb 27, 2009

Pts have the right to refuse care and we must respect that. All we can do is provide adequate health teaching and let them make their own decisions. I hate the term "non comliant". I think they have their own way of thinking about their destiny (as long as they are lucid) Who are we to impose or judge. I prefer the term "informed consumer" . if they are health taught appropriately and enough, I think this is fair, informed and most importantly.....respectful

diane227, LPN, RN · Feb 28, 2009

I agree. All you can do is educate and let them make their own decisions.

OldnurseRN · Nov 5, 2009

While I agree that patients have every right to refuse treatment I question (to myself) WHY are they here seeking treatment? I usually inform them them that this IS the treatment for their problem but that they have the final say.

diane227, LPN, RN · Nov 6, 2009

I won't let anyone leave who is under the influence of alcohol or drugs. I will call the police to have them picked up. I did a case in Houston was allowed to leave after narcotic pain medications because she SAID her husband was there to drive her home but no one saw him. And of course he was not really there. She drove herself right into the front of a very large truck and sustained a major head injury. These was LOTS of documentation on the charts and on all her old charts that she had been told not to drive under the influence of pain meds but she made her choice. And unfortunately, the hospital paid the price for her stupidity.

tewdles, RN · Nov 6, 2009

As has been noted in previous posts...patients have the right to decline treatment, therapies, etc. Our job is to make sure that the person has the information needed, in a form that is understandable to them, and that their questions have been adequately answered. Beyond that, we simply need to document appropriately and make sure that the prescribing professional is notified of any changes the patient makes to his/her medical plan of care. They are not prisoners or props, they are patients and they do have a voice in their medical care.

Bug Out, BSN · Nov 7, 2009

Remember you are the patient's advocate, not the facilities/MDs.

Ensure they have the most accurate up to date information possible and back them up.

mappers · Dec 26, 2009

While I agree that patients have every right to refuse treatment I question (to myself) WHY are they here seeking treatment?

LOL. I had this one lady who was admitted. She fussed and fussed at every med pass, "That's not my med. That's not when I take it. I can do this at home, better than you can." The doc finally just sent her home because she insisted that the hospital wasn't doing anything she couldn't do herself.

I have had another spouse of a patient who kept ******** because her husband's blood pressure was high. He came in with acute renal failure and had been on an ACE inhibitor for years, which controlled his BP. Well, ACE ihibitors can cause renal failure when used over time, so the doc dc'd it. Of course ARF can cause elevated BP. As much as we explained and explained to this woman, she was convinced that if we just put him back on his old BP med, he'd be fine. Every time the docs tweeked his meds, added one, added PRN BP meds, etc, she'd roll her eyes. What are they doing now? Why don't they just put him back on ....."

I sometimes just want to say, "You're in the hospital. Things have changed. What you did before may not work any longer. Stop focusing on what you used to do. If that was still working, you wouldn't be here!!!"

chaschata · Dec 27, 2009

[color=#339966]sometimes it is just the way the nurse(s) comes across to the patient. i was in the hospital for eight (8) days a couple of months ago. on the 4^th day two (2) rn’s walk into the room, neither one identified themselves nor did they state why they were there. i was eating my lunch, one (1) nurse approaches one side of my bed and the other nurse approaches the other side of my bed and proceeds to take off my nose cannula as i was taking the fork out of my mouth. i set down my fork and said what are you two doing. one of the nurses said we are skin specialist and then they both pull back my ears and look behind them. then one of them begins to untie my hospital gown and pull it off. i told them i don’t know what you are doing, what you are looking for or what you want, but you might want to explain yourselves. one of the nurses said since you are incontinent we are here to check your skin, get undressed. i told them i was not incontinent, i do not know where you got that information, but it is incorrect. one of the nurses said you wear diapers so we are going to check your skin. i told both of them i am not incontinent, i wear pull up underwear when i am in the hospital because i do not want to haul around dirty underwear, it is just more sanitary. i told them they might want to go check their information and they would see my fluid intake and output you will see are just fine, i get up to go to the bathroom as necessary. i also told them in the future you might want to tell the patient who you are and what you are doing before proceeding to come into a patients rooms and start ripping off their clothing. now please leave my room. one of the nurses told me i was being difficult and they would let my doctor know. i told them i was not being difficult and to be sure and let the doctor know and while they were at it, tell the doctor i want to talk to him as well regarding their behavior. i was not being difficult. i felt they should have identified themselves and made me aware of what they were going to do. it would have taken them a minute at the most to explain what was going on, surely they could have spared the minute.