I have noticed that I don't share the same view on Physician ordered fluid restrictions as most of the nurses I work with. I agree with educating the patient about why they need to limit their fluid intake as well as addressing issues that might be causing a patient's desire for water such as a dry mouth or chronic cough. I also agree that we shouldn't offer water beyond the fluid restriction when a patient isn't asking for water. I disagree with the idea that a patient who is capable of making their own medical decisions can be denied water even if they have exceeded their fluid restriction when they ask for water.
Some nurses draw the line at getting water for patients, saying that if the patient wants to get their own water then that is out of their control, leaving only ambulatory patients with the ability to obtain water. Other nurses take it even further, putting bed alarms on patients so they can yell at them when they get up to get water.
I agree it is frustrating to be treating a patient for fluid overload when they drink more fluids than they should, and care contracts are often appropriate (if we admit you to the hospital then you have to abide by your fluid restriction or you'll be discharged) but even prisoners of war can't be denied water, this strikes me as potential abuse.
I skipped the 500 pages of this thread... but since this was a response to my post...
When I am a patient I AM NOT A CHILD!!! If a woman goes in to labor and goes into the hospital, the doc wants an epidural, pitocin, NPO. So would you say that if I chose not to go NPO or to refuse the epidural and/or pitocin I should go have my baby in the alley? Thats pretty much what you're saying. Drink water and go have your heart attack elsewhere. The reason people hate hospitals so much is because they feel like they loose all control of themselves and their lives when they walk in there. How is a patient taking responsibility for themselves when you treat them like a CHILD??? It is a proven fact that bringing patients into the process of taking care of themselves improves compliance. Wetting their lips, bringing them a sip of water, talking to them about the reason for the restriction (and I dont mean quoting 'education' I am really listening to them) goes a lot further. It doesnt take all day to make a patient feel like a person, but treating them like a child with no control over the decisions of their care and their life can bring a feeling of hospital-phobia and helplessness that will last for a LIFETIME.
missjennmb,
your arguement is way out of context. This is a perfect example of crooked logic. Where do you come up with such things? I agree with Lola77 and was willing to consider your side until I read further.
When I am a patient I AM NOT A CHILD!!! If a woman goes in to labor and goes into the hospital, the doc wants an epidural, pitocin, NPO. So would you say that if I chose not to go NPO or to refuse the epidural and/or pitocin I should go have my baby in the alley? Thats pretty much what you're saying. Drink water and go have your heart attack elsewhere. The reason people hate hospitals so much is because they feel like they loose all control of themselves and their lives when they walk in there. How is a patient taking responsibility for themselves when you treat them like a CHILD??? It is a proven fact that bringing patients into the process of taking care of themselves improves compliance. Wetting their lips, bringing them a sip of water, talking to them about the reason for the restriction (and I dont mean quoting 'education' I am really listening to them) goes a lot further. It doesnt take all day to make a patient feel like a person, but treating them like a child with no control over the decisions of their care and their life can bring a feeling of hospital-phobia and helplessness that will last for a LIFETIME.
oh my gosh, lola77 did NOT remotely infer she treats pts like children.
rather, she contrasted nursing to be a parent, where tough love is sometimes warranted.
and for much of the pt population, this is spot on.
seriously, many of our pts DO act like demanding, self-centered and irresponsible children.
not all, but there's enough of them, for sure.
and then there are those who do feel vulnerable, frightened and do need a sense of autonomy.
ea pt presents differently, and our approach to care, should depend on the unique qualities of ea pt.
there isn't any one solution.
fwiw, i treat children with as much respect as i do adults.
i've raised my kids to believe in themselves.
a very crucial component of that journey, entailed me listening and hearing what they had to say.
so please don't assume that everyone treats kids as if they don't have a voice.
an effective nurse recognizes that we are all worthy of respect, from the very young to very old.
what i really wanted to point out however, is lola was comparing the nsg role to a parental role...
"I think the big thing here is that, unlike with prisoners of war, you aren't depriving the pt of water to punish them. It isn't a form of torture - you're trying to help the patient - that is the concept of beneficence -"
yeah...kind of like giving someone a shot in the butt with a big needle!:)
Specializes in med surg, cardiac step down, rehab, geri.
interesting thought however why is the patient in the facility? just to be non compliant? noooooooooo to be healed so if they are a/o x3 and have any type of restriction and they demand fluids prior to surgery and are given it because of their RIGHTS and they die what then? are we protected to say we acted wise and prudent? no because giving in is doing the wrong thing
they should be given an AMA form and told I am not giving in you are here for a reason
my license is to do no harm and you are asking me to do harm comply or leave
period
people are hurting themselves with their lists of rights
HCP's are becoming too powerful
I had an hcp stop me from giving oral morphine to a dying patient stating I don't want her too be doped up
forgive me for this but I had to stop and waste the drug and document for another half hr
when did the hcp become a medical professional?
I give up there is no winning there is no respect we have become waitresses with drugs
:DThis thread has been truly interesting....advocate for and against?
A question was posed about patient's rights....does a patient have a right to schedule surgery then break NPO status because they want to? If the hospital and staff then operate on said patient as is, will the patient and family sign off saying the patient had a right to eat or if something happens will the family say as medical professionals we knew better? We all know the answer to this question.
Going to the hospital entails many things including patient's rights to do what they want(without consequences); however in all fairness should "oriented" patients be able to skip dialysis, forgo fluid and dietary restrictions then follow up every 6 weeks for respiratory distress in the ER with admission to the unit without following those "skipped" instructions while admitted?
Lawsuits have driven many of our current hospital safeguards; while I am a believer in personal rights, I am also a big believer in personal responsibility and owning up to the situation. Standards, rules and orders are there for a reason and must be abided by patient's and staff. No one is thrown under the bus more than nurses who blindly follow the dictates of physician or patient......WHAT are the facilities' policies? Use them as your lead and you will never be wrong and will always have a leg to stand on....
As for those who are being kind.....kindness usually kills it's purveyor in healthcare. Give someone an inch and they will take a mile. It's sort of like cheese.... a serving size is the size of a die (dice); who actually eats it that way? Tell someone you can have sip, and I guarentee it will be a liter....the nurse said I could will be the response.....
The ER has definitely colored my outlook on some of these issues; however it has also caused be to become entrenched in sticking to my guns when it comes to doing what's right for the current situation. Alternative methods can be found, family must be educated as the whys or why nots, and the patient has to be held to a level of responsibility.
Overall, if the patient is that unhappy then sign out AMA and take full responsibility for killing themselves or causing irreparable damage.....as for nurses who don't agree and take it upon themselves to be pleasers...I think you are asking for license revocation....the responsibility to preserve life, and protect those in our care (even if they don't like us at the time) is the primary responsibility.....if they are discharged to live longer with those who love them then we are doing the right thing.
If the patient is choosing to do it their way, which is their right.....then they must take the "full" responsibility and become hospice and palliative care...acknowledge their lifestyle choices will be their death....and then no nurse or doctor will "tell them what to do"!
Just my opinion.....Maisy
PS...even though I do have several of those "repeat offenders" I like them, I treat them well, and hope that this time I will get through to them! Just a statement for those who think I am an A1 witch after reading this!
:DThis thread has been truly interesting....advocate for and against?
A question was posed about patient's rights....does a patient have a right to schedule surgery then break NPO status because they want to? If the hospital and staff then operate on said patient as is, will the patient and family sign off saying the patient had a right to eat or if something happens will the family say as medical professionals we knew better? We all know the answer to this question.
Going to the hospital entails many things including patient's rights to do what they want(without consequences); however in all fairness should "oriented" patients be able to skip dialysis, forgo fluid and dietary restrictions then follow up every 6 weeks for respiratory distress in the ER with admission to the unit without following those "skipped" instructions while admitted?
Lawsuits have driven many of our current hospital safeguards; while I am a believer in personal rights, I am also a big believer in personal responsibility and owning up to the situation. Standards, rules and orders are there for a reason and must be abided by patient's and staff. No one is thrown under the bus more than nurses who blindly follow the dictates of physician or patient......WHAT are the facilities' policies? Use them as your lead and you will never be wrong and will always have a leg to stand on....
As for those who are being kind.....kindness usually kills it's purveyor in healthcare. Give someone an inch and they will take a mile. It's sort of like cheese.... a serving size is the size of a die (dice); who actually eats it that way? Tell someone you can have sip, and I guarentee it will be a liter....the nurse said I could will be the response.....
The ER has definitely colored my outlook on some of these issues; however it has also caused be to become entrenched in sticking to my guns when it comes to doing what's right for the current situation. Alternative methods can be found, family must be educated as the whys or why nots, and the patient has to be held to a level of responsibility.
Overall, if the patient is that unhappy then sign out AMA and take full responsibility for killing themselves or causing irreparable damage.....as for nurses who don't agree and take it upon themselves to be pleasers...I think you are asking for license revocation....the responsibility to preserve life, and protect those in our care (even if they don't like us at the time) is the primary responsibility.....if they are discharged to live longer with those who love them then we are doing the right thing.
If the patient is choosing to do it their way, which is their right.....then they must take the "full" responsibility and become hospice and palliative care...acknowledge their lifestyle choices will be their death....and then no nurse or doctor will "tell them what to do"!
Just my opinion.....Maisy
PS...even though I do have several of those "repeat offenders" I like them, I treat them well, and hope that this time I will get through to them! Just a statement for those who think I am an A1 witch after reading this!
Say it as it is Sister!:yeah:Some nurses are just too opinionated with regards to patients' rights and put themselves and patients at risk. You're right on.
I work in a long-term psychiatric facility.
We offen get fluid restriction orders due to patients drinking too much and washing out their sodium. This also can interfere with their psych meds. I will not give these patients fluids once they have maxed their restriction amount; however, the nurse who comes on after me has this to say: "we cant keep them from killing theirselves". I'm sorry, what?! isn't that why they are in the hospital?! isn't that our primary goal when any patient is admitted...safety?!
I know for a fact that our patients manage to get more water than we know about. Psych facilities are extremely difficult to work at with policies changing constantly, patients with exacerbating symptoms and never enough staff.
You cannot force anyone who is in control of their faculties to abide by medical care; and providing food and fluids is a basic human right.
I would also get the "Leaving AMA" forms ready, since you know where THIS is going.
You cannot be fired for " Not following the doctors orders", once the pt. decides it's not going to happen, and the doctor was notified. You don't work for the doctor, you work for the hospital, and the patient.
With you on this. I'm thankful for every patient willing to be educated and to abide by medical advice as far as FR, but we are dealing with basic physiologic needs, adults, and free will. Our position is often one where there is a natural tilt in the power balance...our patients are not meeting us in their strongest, most empowered human moments and instead, are dependent on us for many of their needs. If they exercise their right to refuse medical advice, even the most defensible evidence-based advice, that is their right. Anything else is us insisting they let us fix them. We can decisively convey the risks/ likely consequences of their choice, but it remains their choice.
There is a lot to be said for creativity and compromise in this too. Some nurses just have that je ne sais quoi & seem to be able to get patients on-side without too much trauma. I really admire those nurses!
Just about everyone on this site knows by now that that isn't what I look for.
This gave me pause. I haven't read this whole thread or even your position on the issue at hand, but I think it's asinine to assume everyone knows you. For instance, my name may say "0" but I've been on and off this site since 2006 under usernames tethered to now-defunct email servers. In 19 years perusing here, I don't know that I've ever encountered you. With so much traffic and constant new faces, I would never assume I'm known even if I was a die hard regular.
Here I have to respectfully disagree. The patient does not have the education and experience to be a part of the decision making. Sure they can choose to comply or not, but there has to be an educated and expert opionion guiding the overall plan. Sometimes ignorance is bliss and sometimes it's fatal.
To me the very fact that the patient has come to the hospital gives the implicit consent that the patient has come to us for treatment. By coming to us they are giving us permission to develop a treatment plan relying on the knowledge that we as healthcare practitioners are experts in their particular ailment.
I'm all for patient choice, and if my patient refuses medication then I educate them on why we picked that medication. If the patient refuses I chart the refusal and contact their physician. I stil go back to my original point that their automony ends with me enabling them. If they are ambulatory (a rarity in the ICU I grant you) then they make their own choice and they have to live with the results, however if they are non-ambulatory I will not provide them with water past their restriction. Call me what you want, I will not do it.
Agree and disagree. If patient's presence in the hospital implied consent, there would be no consent forms to sign. Consent is an ongoing right. A patient may be on board with one aspect of their care and balk at another....leave, seek a second opinion, refuse a life-saving treatment even. Many times the patient is not the expert. However, they are the expert of themselves (as in have the right to exercise free will throughout their stay, and often, they have had the best education on their condition prior to showing up, compliant or not.) I keep reading that one's expert role versus the patient's novice role equals the right to exert force over their free will. Problematic when we're speaking of a vulnerable population in an imbalanced power situation.
I'm with the group that says the patient has a right to drink water, but they don't have the right to demand I help them. Yes, I'll do as many comfort measures as I can, and educate. If I think there is a medical need for them to be NPO, I won't be a part of making their medical condition worse.
If it's a judgement call, like a cup of water after midnight when they have surgery in the morning- I know water takes two hours to clear from the stomach. If it's 3am, I'll stretch the 8h NPO rule and document it. Never had a problem with that.
In the ER abdominal pains are technically NPO, but I give them ice chips, until we get a surgical diagnosis. (Except those that look like death, of course) If they are vomiting, NPO until they've stopped for an hour, then chips.
Those that are NPO and need it strictly held will get swabs. If the drink the swab water they don't get more. I've found that people saying "just a sip" will sip every minute they have water so they get 10cc and there's no more from me.
I've had a man fifteen minutes from going to the OR and NPO for two hours suddenly start vomiting 500ml clear fluid after his family showed up. Trust no one. But if they get the water, and then pneumonia, it will be their own decision, without my help.
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gusblom
81 Posts
missjennmb,
your arguement is way out of context. This is a perfect example of crooked logic. Where do you come up with such things? I agree with Lola77 and was willing to consider your side until I read further.