Turn Q2 and patient refuses

[AnLe]

It hasn't even been a month since I passed my boards and I'm orientating at a hospital floor I wanted. I am currently stuck though. I had a patient who is to be turned every 2 hours, but they do not want to turn. They are adamant about it. Even repositioning, placing pillows under the arms, or performing some ROM exercises, they refuse.

The patient had stated how previous shifts treated them like a bag of meat. A nurse who had them previously said that they made them turn. Then work is saying to increase patient satisfaction.

I made my rounds and I tried to convince them to allow me to turn them. I'm just very conflicted.

Should we just turn them on the bed even as they refuse? I understand we are trying to prevent pressure sores and I did explain it to the patient, but where is the line drawn?

[amoLucia]

And for God's sake, make sure it is documented that the family has been counseled also. It will be they who are first to be calling a lawyer when something negative occurs.

Like in a care conference with all the major parties present.

Like others have said, you can't force the pt, but you can CYA. Some facilities are very proactive in situations like this in that their legal dept likes to be informed of potential impending problems with pts and et al.

[hawaiicarl, BSN, RN]

This always cracks me up. Turn all patients every 2 hours? Why the hell would I turn an awake alert patient? Turn Q2H should be related to your skin risk assessment, and should only trigger when the patient is too weak or unaware to turn themselves. If I am ever a patient expect a bedpan in your direction if I ever actually manage to fall asleep just in time for some Rtard to come in and offer to turn me.

:-)

Cheers

[Here.I.Stand, BSN, RN]

It's not really a pt satisfaction issue -- it's a pt autonomy issue. If he understands why staff wants to reposition, if there's no modifiable reason (e.g. pain control -- or won't want to move if it hurts too much), and he is adamant, you document the refusal. To force him is battery.

[Mr. Murse]

how mobile are they? I mean if they're physically able to reposition themselves then chances are that they are repositiong slightly anyway, maybe not fully turning and tucking a pillow, but enough to relieve pressure points. Don't get too stuck on technically turning them if they're mobile enough to turn themselves. I often chart "turns independently" on patients who are able to do so, and I just remind them to move around in the bed.

Otherwise try to compromise. A lot of times patients are hard headed and refuse treatment just to feel like they have some control over their situation. So ask them if you could just pull them up in bed and slightly tuck a pillow every 4 hours, or when they're awake. Mechanically going through nursing tasks makes people feel like they're on a production line......or a piece of meat. Treat them like a person, ask them how you can keep them comfortable but still accomplish what evidence based practice has shown is best. Then if they still adamately refuse, just chart it.

[Been there,done that, ASN, RN]

This is no longer a nursing problem, it is a doctor problem. Has the attending been notified? They will then have to deal, most patient's will listen if they hear it from a doctor.

In the meantime, make sure management is also aware.. and document , document, document.

[Orion81RN]

"The patient had stated how previous shifts treated them like a bag of meat."

This is key. While they have a right to refuse, it is our job to advocate for them the best we can. If you reassured the patient you would treat her with the utmost respect, like a human being, is it possible she will let you turn her? Either way, documentation is your best friend here.

[Orion81RN]

It's not really a pt satisfaction issue -- it's a pt autonomy issue. If he understands why staff wants to reposition, if there's no modifiable reason (e.g. pain control -- or won't want to move if it hurts too much), and he is adamant, you document the refusal. To force him is battery.

I think OP meant her employers are looking at pt satisfaction. And if the pt is stating she is being turned "like a bag of meat" without her permission, her employers will hear about it on the satisfaction score. So if I interpreted correctly, OP is torn by doing what the patient wants (the legally correct thing) vs what her colleagues are telling her to do.

[Kuriin, BSN, RN]

Just document that they refuse and let the MD know. It is probably a good idea to let the nurse manager / charge nurse know as well, so that they are not caught unawares during patient satisfaction rounds (if they do it).

Look on the bright side...less work for you, right? Lol.

[Crystal-Wings, LVN]

If you've already explained the reasons to the patient why they need to be turned every 2 hours and they still refuse, document it and speak to the charge nurse or management about it. Maybe the doctor can speak to the patient about it and try to convince them?

You can't force them to do anything, and if you turn them without their consent that could be considered battery.

[KatieMI, BSN, MSN, RN]

I'm not sure what case management would be able to do about it? But I would definitely make sure the charge nurse is aware, as well as the medical team.

Case management can elaborate the following expression:

- at the present time, the patient's condition does not meet criteria of needing acute care placement.

Please fill that form if you like - the Second Coming of our Lord will happen sooner than it gets somewhere.

Then a poor soul like myself gets a phone call demanding to write d/c summary yesterday. And then the Mister whom we all just want to see to be wheeled out of there is discharged before he gets a chance to spoil the holy outcomes.

In addition, case management people can either independently request psychiatry eval or pressurize everybody till it is ordered. Once the patient is seen by Psych people, he will be 110% diagnosed with something justifying "something for anxiety" scheduled with PRN boosters, after what "compliance" typically improves.

[SopranoKris, MSN, RN, NP]

"Pt advised of need to turn Q2H to prevent skin breakdown. Pt verbalizes understanding of risk, refused turn"

Sometimes I can get people to agree by saying "we're just going to boost you up in bed so you're more comfortable". I find getting compliance with turns, bed baths, oral hygiene, etc. is easier to accomplish when you have a confident demeanor. If you approach them with a hesitant voice or a "may I do this?" request, the answer is usually "no".

However, if you tell the pt it's time for a turn, they say "no", you fully educate them, and they still say "no", it is their right to do so. Document the heck out of it so it won't come back to bite you later. If you've documented thoroughly and he ends up with a PU, no one can point the finger at anyone but the pt for refusing. Doesn't hurt to let your charge or manager know that the pt is refusing turns, as well.

[Nursetom1963, BSN]

Im curious, what did the director say about this?