In the UK we have the ability to break confidentiality and send the paramedics if we truly believe life to be in danger. I would rather stand up in a court of law having done something in the best interests of the patient instead of explaining why I did nothing about it and someone died.
The telephone triage I do is for an advice line - it's their choice to choose whether or not they take the advice - it's annoying when you think they are not going to take the advice, but it's their life...
We've only had one case since I've been doing pedi triage that the doc almost called 911 on the parents. They eventually went to the ER but this was after several hours of possible seizures.
We had one just last night that was advised to go to the ER but they chose not to, they were seen in our after hours and got directly admitted to the ER 12 hours after the night nurse had said go to the ER by orders from the on call MD.
Some parents just don't get it.
I get frustrated when the patient truly needs to call 911 but insists upon having someone drive him/her to the ED.
For the family members who call & want to know how to "make" their loved one go to the hospital, I have to inform them of that person's right to refuse treatment until he/she loses consiousness. I further inform them that once that person has lost consiousness, they can no longer refuse treatment.
What do you do when the caller will not take your nursing advice?
i.e to make an appointment or .. to go to the Er
Do you every call 911 against the patient request?
Share with us your story...
There really isn't anything you can do to make them take the advice. I will usually reinforce why the recommendation was made and why it is so important. I once had a man call who had all the classic symptoms of a heart attack. I explained he should go directly to ER, he was driving when he called, or pull over and call 911. He refused and said "Please pray for me." then hung up. It leaves you sitting there thinking, 'what just happened here'. You do your best to reinforce but it is ultimately up to the caller to decide what they do. Document what they say they are going to do in your call note.
I once had a mom call with a kid having an asthma attack. The child was unable to speak. He was around 5, IIRC. According to our protocol, this was a "911" disposition. I told the mom that was what she was to do, yes, really.
Twenty minutes later, grandma calls back. They are still at home, and she called to argue with me about the 911 call; she just didn't think that he needed to go to ER by ambulance!
I told her what I'd told mom, that I could not advise them to take him by car if my protocol said to call the ambulance.
What I wanted to do was to reach through the phone line and slap her upside the head and maybe slap some sense into her. If they had left with the kid by car when I talked to mom originally, they would have been in ER before Grandma called me back! :trout:
Fortunately they finally did get the kid in and he didn't stop breathing on them on the way! :angryfire
The company I am with has specific protocol documentation if pt refuses to follow my recommendation. I am only to inform the caller that not following recommendation could lead to loss of life. It is then up to the caller. Now we do have other protocol if it is a "crisis call" but those are mostly Mental Health (suicide intent, etc).
I hear it all the time. I don't want to go sit in an ER for 6 hours, they say. Well, okay, don't then. But I can't just wave my magic wand and make it all go away. I actually had someone call me from the hospital ER lobby one time to say they felt like they were about to have a grand mal. I still can't quite believe that one.
I only call 911 against someone's wishes if they've given me a reason to believe they could be a threat to themselves or others.
Oh, then there was the gal who called me from her car phone to inform me she was driving home after just having passed out several times in an hour while at work... she had a headache, blurred vision and a recent hx of increased ICP. She did not want to stop her car and go to the ED. I finally convinced her to stop, call 911 etc.. then I called 911 to make sure she did it. At that point she was a danger to everyone else on the road and I was calling for their sake.
"As a Nurse I don't diagnose" Based on your symptoms my reccomendation is for you to...........................
Just read them the AMA statement
Patients tend to screw with your head allot. The make like they are in such horrible distress and achieve a high acuity on your assesment then when you make your reccomendation to go to ED "Oh do you really think I am that bad? I'm not really that sick! Then why the **** did you play this drama queen **** on me about how deathly ill you were?
I never force nor coerce anyone to go in . I just read them the AMA statement.
Once, when I was the house supervisor at a psychiatric hospital on the noc shift, I received a crisis call from a distraught individual with serious mental health issues. She was delusional, paranoid, and by her own admission, suicidal. Because she was in another city, I ended up having a coworker call 911 on another line and having her ask them to trace the call. Our PD contacted her PD, and I believe they were able to get her some help. Her agitated mental state and self-harm statements trumped privacy issues.
Some other thoughts to consider:
It's advice, not orders.
You may just be standing in for the part of themselves that wants to do the sensible thing. It's just so darn difficult to argue with yourself.
You can only do so much. The presenting problem might be heart attack s/s, but the chief complaint may be chronic stupidity. An MI doesn't improve the IQ.
You never know what seeds you might be planting. Even though the response may not be as timely as it could have been, going in an hour later (after the wisdom of this idea has had time to germinate) can still be helpful.
Sometimes it's good to let go of the tug-of-war rope and appeal to their better nature. "You're a good mom. I'm sure you'll do the right thing." It may be whistling in the wind, but it just might turn an argument into an affirmation of their love for their child.
Document. Then let go. Otherwise you'll burn yourself out.