I'm a new nurse working at a psychiatric facility. One day, an agitated patient refused to get his blood pressure taken. He had 2 blood pressure medications scheduled at 8 pm. I tried 3 times altogether to take his blood pressure, and the charge nurse saw all this happen. I told him that I was putting Refuse in the MAR, and he agreed.The next day when I came back to work, the nurse that took over my patient overnight had a discussion with me. She told me that because this patient had 2 blood pressure medication due, it was extremely necessary for me to take his blood pressure. I told her that I tried several time, but the patient refused his blood pressure to be taken, and I did not want to give him the blood pressure medication because I was worried that I would put him in to a hypotensive state. She told me that in this situation, I should have given a PRN Haldol or Ativan, and when he is more relaxed, then I should have taken his blood pressure.I did not give this patient a PRN because even though he was refusing for me to take his blood pressure, he was not agitated to the point where he was a threat to himself or others. He just wanted to be left alone. Keep in mind that this is a high functioning psychiatric geriatric unit.So my question is this: should I have given him a PRN Ativan or Haldol so I could take his blood pressure? Like I said, I'm a new nurse. I just want to learn. Please tell me what you usually do in this situation in your Psych unit.
Dec 28, '12
by Meriwhen, ASN, BSN, RN Senior Moderator
Many nurses (and I'm not referring to you) tend to forget that psychiatric patients have the same rights as any medical patient. This includes the right to refuse treatment and medications...and yes, this right is there even if the patient is being involuntarily held.
It would take a specific court order or the patient being an immediate danger to himself or others to force treatment or medication on a patient. Being agitated or ticked off alone does not meet criteria for danger to self/others. If the patient is assaultive and throwing chairs at staff, THEN you can give PRNs against their will. If they have a history of HTN and are angry but otherwise no threat, no.
If a patient is competent and refuses VS, you can educate them on why you need to take them and the consequences (i.e., not getting their HTN meds, risks of untreated HTN, whatever) if they don't allow you to. If they still refuse, document all this thoroughly EVERY TIME it happens, and let your charge RN as well as the physician know.
I tell patients that they have the right to refuse but that it is part of my job to continue to come around at the appointed time and offer said treatment/meds, and they can continue refusing if they wish. That way they don't feel as much like I'm nagging them, and I've done the CYA bit. Eventually most thaw after they've refused a few times.
Keep in mind that one thing many inpatient psych patients feel, even voluntary ones, is a loss of control. They're in unfamiliar and restrictive surroundings, with a lot of the little things that they've taken for granted in life limited or not allowed. Sometimes all patients want is to feel like they have some control or say in the situation. Often knowing they have the right to refuse helps with that.
Last edit by Meriwhen on Dec 28, '12