Can a confused resident refuse care?

[pumpkinspice]

A resident in LTC in Ontario is confused and has COPD. They are often noncompliant with their supplemental oxygen and constantly removing nasal cannula. Consequently there O2 sat frequently drop to mid 70s with no resp. Distress noted. Do they have a right to refuse o2? Will I be guilty of neglect should they become hypoxic even though I frequently reapply their cannula? This resident is a DNR. I'm unable to find any articles online regarding this info, seems like a grey area. From other posts I have read, they can't decline if they're confused but also neglect if I don't reapply o2 constantly. Stuck between a rock and a hard place😟

[NotReady4PrimeTime, RN]

You could be in more trouble if you DO insist on replacing their cannulae against their wishes. Forcing treatment on a patient can be viewed as battery. What do the other nurses at your facility do when this resident removes his cannulae?

[pumpkinspice]

I was thinking that would only be battery if the patient is oriented. This pt is confused so not necessarily able to make best choice for himself. To be clear, I provide a lot of encouragement until he allows me to apply the NP. But resident will just remove them shortly afterwards. Some nurses say just keep offering and monitor. Other say "well you can't force him so leave it"

It feels like a no win situation. I encourage and it's battery or respect his wishes and it's neglect (because he's confused and demented) I don't know what to do😳

[Silverdragon102, BSN]

Have you discussed this issue with their POA? All I can see you do is offer and if they decline just chart and monitor

[RN_Erin]

I was a CNA in a LTC for 5 years before becoming a nurse. You can't ever force something on a resident. (I'm not sure what the policy is for nurses as far as meds and stuff). With residents that continuously pulled off their nasal cannulas, I'd just do my best to check on them frequently put them back on them. But if they fought me or refused, I never forced it. The best is to try and encourage them and explain why they need it and try to convince them. And that is difficult to do with someone who is confused. I'd never just give up and let it go the first time they refused, I'd give them a little time and then try again, but you can't physically force anything. I agree that it may be important to discuss the issue with their POA/Family. Maybe the POA/Family needs to make some decisions regarding how to proceed with patient care.

[aklindera1]

RN from Florida, I would ensure that your supervisor, MD, and POA are aware to CYA. Down here, a confused patient can refuse any treatment or medication. But always make sure the powers that be are in the loop. As long as there not being combative, or disruptive, you should be good. Also, I would develop a plan for when they do end up going into respiratory distress.

[CapeCodMermaid, RN]

Any one can refuse any treatment at any time. You can cajole, encourage, educate but you cannot force any one to do anything.