Can you ever enfore medical intervention?

[ali9802]

I know you cannot if the patient is oriented and lucid and refuses invasive treatments... and I have never even considered this issue until recently because I luckily have never had to deal with it. I had another nurse tell me that if a patient is cognitively impaired or drug/alcohol intoxicated that they cannot say no to any procedure and the nurse has every right to force protocol and doctors orders such as catheterization, IV, ngt, etc and be even be restrained during it if a doctor says ok. I have always been able to get my patients to verbalize to consent once I explain a procedure fully to them even when they are psychotic or intoxicated but some of them have hesitated and I'd have to wait a couple of hours or so and talk to them again.

I don't know how this isn't violating someone's rights to force an invasive procedure on them just because they are not in the best state of mind. Can staff really do this with a patient? I always thought people had the right to refuse no matter what but maybe I am not fully understanding this.

[toomuchbaloney]

If the patient is not competent to make decisions then you must advocate for the patient through their MDPOA. Consider an advanced dementia patient who has fractured an extremity and requires intervention which they DO NOT WANT. Clearly it is in their best interest for the health professionals to accomplish the remedy regardless of the patients objections.

Punitive or impatient interventions directed for the convenience of the professionals is not the answer. Interventions designed to minimize patient discomfort from anxiety, pain, confusion, etc while promoting safety, comfort, and achievement of health goals are appropriate.

If the patient is temporarily impaired and a life/limb threatening crisis is underway the team must either act on behalf of the patient or consult with the legal next of kin for guidance in the care. We see this in the ED all of the time. Imagine the DUI/MVA victim. That person is going to receive care even though they may be drunk beyond competence or experiencing the effects of a traumatic brain injury. That patient may be VERY combative about their care, yet the care is necessary for their restoration of health.

Yes, you may restrain them with an MD order. Your facility will have a VERY detailed policy regarding that activity.

[Esme12, ASN, BSN, RN]

If they are a danger to themselves or others and are temporarily not of sound mind. Yes you may sedate, place NGT's foleys restrain against the patients will. YOu need to follow the facility policy to the letter and document meticulously.