confused patients

[mediatix8]

Hello I am a nursing student and I have some questions about those difficult, confused, non-compliant patients. What do you do if they refuse to have their vital signs taken... do they have a right to refuse that or are you supposed to have other staff help you force them? I believe they do have the right to refuse meds, but what if they take the med like they are going to take it and then they put in in their pocket and wont let you get it back? Do you call the doctor, security, or just get other people to help you force it from them? If a confused patient starts to leave the hospital floor... I was told that you follow them and just yell out to another nurse to call security. Does that sound right? Do you notify the doctor in any of these situations? Thanks :)

[Antikigirl, ASN, RN]

A patient has the right to decline any and all medical interventions they wish if they are able to speak for themselves, and are of sound mind (which would include altered status r/t medications). If they are unable it goes to the POA or medical representitive.

If none of those are present, we have a right to try other implementations to try to convience the patient they are of benifit...but the bottom line..they can still refuse! Nurses are not strong arms for treatments..that goes against all our theories now doesn't it??? We are patient advocates...we listen to them and respect their rights!

The trick to this is solid documentation on any refusal, list your implementations clearly and responce for each time you try to explain or offer!!! (I use quotes from the patient..very helpful!). Then I notify the physician in charge of that patient either by phone, or fax about the declination...that covers your liablity (DOCUMENT WHAT THE MD SAYS!).

Remember, try at least THREE times (document big time) using different methods. Inform the patient clearly what may happen if they do not have this treatment/med...and make you feel they understand it! (for all declinations the patient must have informed concent basically..so you have to explain..document this solidly!). Then you may have to fill out a declination of treatment or med form (depending on your facility..akin to an Against Medical Advice aform or AMA).

I find more times out of any if you use patience and really listen to the client..you can find the underlying reasons behind a declination and you can solve the issues by forming other implementations. Depression is a biggie on this, lack of education is the other biggie! Find the reasons behind the declination...that is what separates us nurses from other fields!!!! Be a detective for your client..it can be something other than someone being "uncooperative"...it can be diagnostic to other problems (I have had a woman decline her meds only to find she had a UTI and was hypoglycemic...good thing I didn't look at it like "oh she is being a pain" as much as I was saying "okay..what is wrong...what are the underlying factors here!".

Another awesome bit of advice..look at your patients rights statement for your state! That will explain much..and all Nurses should know it!!!!! We have a federal one, states have another usually (about the same as federal), then some facilities have another...so check into it! It is vital to know these or you can't be a patient advocate with much power to help!