Doctor's orders or Resident's rights???

[mandykal, ADN, RN]

Question: Doctor's orders or resident rights? someone educate me on which is first??

Example; Diet

I read another post when someone wrote something about if a resident wants more food and they are on a diet, (house renal or diebetic and are educated enough to know the effects of eating more than required, "they shouldn't be denied because of resident's rights."

[elkpark]

Nursing staff are obligated to carry out (legal, ethical, safe) physician's orders, but patients/residents who are legally competent have the right to refuse all or any part of treatment (as in, not cooperating with a special diet). So, you offer the diet to the patient, and educate her/him about the consequences of not following the diet, but the patient/resident is free to refuse.

The same principle would apply to other situations/interventions, as well -- nursing staff are obligated to (attempt to) carry out the physician's order, but the competent patient has a right to refuse treatment.

Of course, if a patient's choices are putting her/his life in danger, the physician or healthcare facility can choose to pursue a court order for forced treatment, but that's a whole 'nother ballgame ...

[Dixiedi]

Nursing staff are obligated to carry out (legal, ethical, safe) physician's orders, but patients/residents who are legally competent have the right to refuse all or any part of treatment (as in, not cooperating with a special diet).

....

Of course, if a patient's choices are putting her/his life in danger, the physician or healthcare facility can choose to pursue a court order for forced treatment, but that's a whole 'nother ballgame ...

It's a whole 'nother story but one we should add here. If a person is of sound mind, there is no reason for the MD or facility to take away their rights to choose how they die! Every person has the right to choose treatment and that includes such things as diet; even if it does threaten their life!

[CHATSDALE]

There Is Something Else They Can And Will Be Discharged If They Do Not Follow Md Orders Because They Put All Health Providers At Risk Of Lawsuit...besides If They Are Not Going To Cooperate They Are Just Taking Up Space That Could Be Given To Another Patient Who Really Wants To Get Well.....i Have Seen A Surgeon Cancel A Cabg Because The Patient Had A Cigarette On The Morning Of The Procedure....she Could Not Understand That The Cigarette Would Shrink Vessels And Make Procedure Difficult..she Blamed The Nurse For "telling On Her" Go Figure

[Dixiedi]

There Is Something Else They Can And Will Be Discharged If They Do Not Follow Md Orders Because They Put All Health Providers At Risk Of Lawsuit...besides If They Are Not Going To Cooperate They Are Just Taking Up Space That Could Be Given To Another Patient Who Really Wants To Get Well.....i Have Seen A Surgeon Cancel A Cabg Because The Patient Had A Cigarette On The Morning Of The Procedure....she Could Not Understand That The Cigarette Would Shrink Vessels And Make Procedure Difficult..she Blamed The Nurse For "telling On Her" Go Figure

My take on this thread was talking about LTC facilities. "Pts/residents." They should not be discharged because they refuse to follow dietary or even medication orders. This is their place of residence and even if their choices shorten their life expectancy, it's their business and the nursing staff should (after educating them on the pros of following the orders) support their pts choices!

[leslie :-D]

My take on this thread was talking about LTC facilities. "Pts/residents." They should not be discharged because they refuse to follow dietary or even medication orders. This is their place of residence and even if their choices shorten their life expectancy, it's their business and the nursing staff should (after educating them on the pros of following the orders) support their pts choices!

who said they'd be discharged?

[kids]

I've encountered this with dialysis patients in LTC (and never got a good answer).

I understand that a mentally competent patient has the right to not comply with their diet and fluid restrictions (actually, an incompetent patient also has that right unless a guardian says differently).

I understand that very through documentation of patient teaching has to occur, detailing what the risks of noncompliance are and that they have been explained to the patient.

My question is are we then obligated to provide the food & fluids they request that are out of compliance?

Does their right to noncompliance obligate us to provide them the means act in violation of the physicians order?

(I worked, briefly at a facility that said yes. We had to do detailed documentation on patient teaching each time the noncompliant foods/fluids were requested and if the patient still desired we had to provide the food/fluids.)

[elkpark]

It's a whole 'nother story but one we should add here. If a person is of sound mind, there is no reason for the MD or facility to take away their rights to choose how they die! Every person has the right to choose treatment and that includes such things as diet; even if it does threaten their life!

I agree with you, and was not suggesting that I think the answer when someone refuses treatment is always to force treatment. I was just mentioning, for the sake of clarity for the OP who asked the question, that the patient's right to refuse treatment is not ABSOLUTE , either -- there are legal avenues that the physician or facility can pursue if they really feel strongly about a situation, and it is possible for a person's right to refuse treatment to be overridden by a court order. I'm not advocating doing so -- I was just trying to provide a complete answer to the original question.

[Angela Mac]

It is very tricky- I was caring for a diabetic pt. receiving dialysis. He wouldn't follow his diet restrictions. Even though I was swamped with paperwork, I documented his dietary intake and behaviors. He went into fluid overload and became touch 'n go. The MD was angry with the staff. I could not prevent people from buying him potato chips, I could not stop him from eating them. My point is- document everything...

[leslie :-D]

It is very tricky- I was caring for a diabetic pt. receiving dialysis. He wouldn't follow his diet restrictions. Even though I was swamped with paperwork, I documented his dietary intake and behaviors. He went into fluid overload and became touch 'n go. The MD was angry with the staff. I could not prevent people from buying him potato chips, I could not stop him from eating them. My point is- document everything...

you know angela, that cannot be emphasized enough. documentation goes such a long way in protecting yourself. document interventions, conversations, reactions....everything. i've seen many a nurse and facility get into hot water because of situations that were not documented. it's my 1st priority after direct pt. care.

[Dixiedi]

who said they'd be discharged?

In one of the posts someone was referring to acute care pts (specifically a pre-op) that would not follow Docs orders and was discharged without the needed surgery.

I was only pointing out that I thought the thread was speaking specifically of long term care folks and that it is not quite so black and white as in LTC it's not just the place for Tx, it also their home.

With that, not following Docs orders would not/should not mean discharge, but as noted in yet another post, it does mean a lot more charting!

[Hellllllo Nurse, BSN, RN]

I've encountered this with dialysis patients in LTC (and never got a good answer).

I understand that a mentally competent patient has the right to not comply with their diet and fluid restrictions (actually, an incompetent patient also has that right unless a guardian says differently).

I understand that very through documentation of patient teaching has to occur, detailing what the risks of noncompliance are and that they have been explained to the patient.

My question is are we then obligated to provide the food & fluids they request that are out of compliance?

Does their right to noncompliance obligate us to provide them the means act in violation of the physicians order?

(I worked, briefly at a facility that said yes. We had to do detailed documentation on patient teaching each time the noncompliant foods/fluids were requested and if the patient still desired we had to provide the food/fluids.)

I had the same problem w/ LTC pts on dialysis, and I also worked only briefly at the facility.

The place had non-compliant pts sign dietary and fluid restrictions waivers.

Here is a paraphrase of what the waiver stated:

"I know and understand the renal diet and fluid restrictions my doctor has ordered for me. I choose not to follow these restrictions, which is my right. I understand the health dangers, including death, which could occur as a consequence of me choosing not to follow prescribed fluid and dietary restrictions. I take full responsibility for any consequences, and choose to waiver my legal rights to sue the facilty or hold them responsible in any way."

The pts signed this document once, and then ate and drank however they wanted. We were required to give them whatever was available to eat or drink. I personally never directly handed a tray full of high K+ and phosphorus foods to a dialysis pt, as I did not feel comfortable doing this. I always handed these trays to someone else (who didn't mind) to give to the pts.

I also know that pts were never given their Phoslo with meals, as required.

This place had a lot of residents on dialysis, and every single one signed the waiver. The facility encouraged this, as they did not want to have to provide the renal diet$.

The place was a real hell-hole.