consent and refusal issues

Nurses General Nursing

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this is in reference to an old post concerning the effects being claustrophobic may have upon a patient's ability to tolerate certain procedures. i am very, severely claustrophobic to the point of being unable to accept any type of restraint or being held down. this even includes the inability to buckle and use the seatbelts in my car. if i were a patient in a hospital and my nurse entered my room to perform a procedure my claustrophobia would not allow, i would make my position very clear that i was NOT refusing the procedure itself, but only the method of doing it. i would hope that something could be worked out, satisfactory to both me and the doctor, enabling the procedure to be done. i simply wish to make clear that sometimes there exists very real reasons why a patient will refuse a certain procedure. some may be difficult to understand and i have endured incredulous stares and questions from nurses such as "you would rather take chances of suffering side effects, including maybe death, than accepting a little restraint?" oh if it were only this simple. my claustrophobia and the effects caused by its triggering are both certain and concrete. if i am conscious of restraint being applied my resulting actions are automatic. this would be made clear to the medical staff as i have no death wish and my desire is to live past 100 years old, and that my death be the result of being shot by a jealous young husband!!!!!!!!!!!!!!!!. all kidding aside, i have recurring nightmares of being in a hospital, strapped down unable to move, with a ventilator stuck down my throat, nasogastric tube jammed down my nose, and a foley catheter inserted in my bladder. this is frightening even while sedated, but CONSCIOUS????????????:no::scrying:

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Specializes in ICU.

knowing that up front, i think most would try to work something out with you, however, there will still come a time when, as you mention, you might be vented with an NGT, foley and restraints, bite block and too sedated to make any sense if given the opportunity to write. best deal with your claustrophobic issues now while there is still a possibility however remote to desensitize yourself.....or living to 100 might not be in the cards for you. :smokin:

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If you are too claustophobic to wear a seatbelt when driving then you really should seek professional help for this phobia. I don't mean this as any kind of slam. I've suffered from a phobia in the past and now being free of that phobia I know what I am talking about. It can be all compasitating and consuming, you'd be better spending your time on therapy then worrying about being on a vent, having a cath, NG, etc...

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Specializes in Neuro ICU and Med Surg.

I agree with the previous poster about getting professional therapy. If you can't tolerate a seatbelt then you have a severe phobia that really needs to see a professional.

I don't want you to think that I am making fun of you, because I am not. This can be made better with help from a professional.

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I agree with the previous poster about getting professional therapy. If you can't tolerate a seatbelt then you have a severe phobia that really needs to see a professional.

I don't want you to think that I am making fun of you, because I am not. This can be made better with help from a professional.

Yes I totally agree! It is a serious issue that you should take very seriously. Living to be 100 may not be possible not wearing a seat belt, do you belt in the kids or grandkids? How do you feel about belting them in?

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Just to echo the others...seek professional help. It would be in your best interest to do so. Worrying so much about things is bad for your health and if you want to live to be 100 get the help now to better your chances of getting there. Best of luck.

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Specializes in Cardiac, ER.

JR I too am very claustrophobic. I can and do however wear my seatbelt. I used to think a lot about what would happen if I were in an accident and EMS needed to place a c collar and strap me to a back board. It wouldn't happen,.I would hurt myself trying to get out. I can sit here and type this and see how totally silly this sounds. I can understand that no harm what so ever would come to me by being secured to the back board. That said I also know the uncontrollable fear and panic that would ensue if someone tried.

I work in a busy ER Trauma center and have had this discussion with my co workers. Believe it or not there are many out there who are just like us. We work around it. When a pt tells us that they are very claustrophobic we can deal with it. Now,.I've seen many people who like to throw that word around and I give them 0.5mg Ativan IV,.they sleep like a baby through whatever procedure they didn't think they could tolerate. Many others are very difficult to "knock out" and really fight the meds.

I had to have a MRI after a back injury. I could do the CT just fine as long as they didn't restrain me,.the MRI not so much. I went three different times to the "open" MRI (it's soooo not open) and was pre medicated the last two times. I don't remember ever making it to the MRI table the last two times but according to staff and family I freaked and they couldn't even start the scan. Now mind you I don't remember any of this so I really don't have an anxiety about it.

I finally had to go to the hospital and be put under general anesthesia (tube and all) for the scan. This was embarrassing, very expensive and way more risky than it should have been,..but I really couldn't help it. That said,.the staff was very kind,.I knew most of them from work and they kinda turned this into a joke about how I was a nurse,.the worse kind of pt, and that I had to be in control at all times because that's just how us nurses are! I became a bit apprehensive when they tried to place the bite block while I was still awake,...the DR said "RNCardiac, shut up and go to sleep girl, lunch will be here in 30 minutes and I want to get it while it's hot!" I giggled, he pushed the meds and in what seemed like seconds I was awake in a reg bed and could smell the Italian food in the next room!! All was good,..I felt fine and even got a piece of garlic bread for my good behavior!

I guess my point here is that it can work. Be sure that the people who love you and the people who will be caring for you understand your issues and all will be well!!

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thanks to all for your advice and your concern. the prevailing thought was to deal with my claustrophobia now while i am able. i have been claustrophobic all my life, but as time passes it is becoming more and more difficult to tolerate. i have read that claustrophobia is an "irrational fear" and i accept this. people are immobilized, restrained, and strapped down on backboards every day, and they do not die or suffer untoward consequences from it. i fully understand that what i fear will happen if i am restrained will not, but the all consuming, nightmarish fear remains, holding me prisoner. i have carried this with me for so long i have convinced myself that i will never be free. is there really therapy for this--therapy that actually works? i feel i have been "incarcerated" for so long that the reality of the cell door springing open seems like a fairy tale. thanks also to "cardiacrn" for letting me know there are others like me, and that EMT's and medical staff can and will work around this. sedation is something i am very willing to try, {ie .5 mgs ativan iv}. if i am in need of medical care that involves be being restrained or backboarded, understand that i WANT to be cared for. i just need a way of tolerating it. i guess my next step is to discuss the possibility of therapy with my personal physician, and ask him to recommend someone. i am serious about this as something needs to be done before my "warped irrational feelings" cause me to make medical decisions which may cost me dearly. again thank you all very much and say a prayer for me. joe

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