Ethical decision or Patient's right?

Nurses General Nursing

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A patient who is A&O x 4, but has a change in condition gets sent out to the ED. They ask you not to call their family because "they already have enough on their hands". Family members are listed as an emergency contact and you know they would want to know if something has happened. (You know both the patient and the family pretty well).

Respect the patients wishes or call the family?

I realize this is pretty vague information, perhaps if anyone has any questions I can reply without giving too much information.

Specializes in Geriatrics.
Some ALF and Nursing Homes have all residents sign paperwork stating that their designated point of contact will be notified in the event that they are sent to the hospital. (I'm not sure from your post if you are sending the patient out from the nursing home or receiving the patient at the ED).

I think this is a gray area for us... we do have emergency contacts, but I don't think we have any kind of guideline on when or when not to call. Maybe this is a learning experience, I'll def. talk to my supervisor first chance I get. Perhaps it's something I wasn't aware of.

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Specializes in LTC, Rehab.

That's a bit of a tough one, and I see why you were conflicted, but I have to go with other posters who said they wouldn't call. The person is A&O and requested that you didn't call.

...actually, no, after reading ruby jane's response i have to say that at my former facility we had to notify family when there was a COC. So hmmmmm, the plot thickens.

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Specializes in Geriatrics.
That's a bit of a tough one, and I see why you were conflicted, but I have to go with other posters who said they wouldn't call. The person is A&O and requested that you didn't call.

...actually, no, after reading ruby jane's response i have to say that at my former facility we had to notify family when there was a COC. So hmmmmm, the plot thickens.

I guess this comes down to policy which I think I know, but am not 100% sure. I will follow up with my DON and take this as a learning experience.

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Specializes in Med/Surg/Infection Control/Geriatrics.

Respect the patients' wishes. Not to do so would violate their rights.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I agree with not calling, but I can't help but think if they had gone downhill even further once they left my care, I'm sure they would have wanted the family there. I understand some patients not wanting family to know because of private matters but this one in particular just didn't want to burden the family and I don't think they understood how critical their condition was.

The thing is, you cannot be "sure" they would have wanted family there. Perhaps they have very good reasons for NOT wanting family there. An abuse situation, for example. Next of kin is a raging narcissist who makes everything all about THEM. NOK is in China and cannot get back in time to be of help. NOK is incarcerated and cannot do anything anyway.

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I agree with not calling, but I can't help but think if they had gone downhill even further once they left my care, I'm sure they would have wanted the family there. I understand some patients not wanting family to know because of private matters but this one in particular just didn't want to burden the family and I don't think they understood how critical their condition was.

Once you've explained this to the pt, and they still are insisting on not calling family, I would include that in the report you give to the ED nurse, and the ED nurse can take it from there. I've had that conversation in report a few times, and the ED nurses were wonderful with saying that they would have that talk with the pt once they know more of the pt's condition. And of course, document, document, document refusal to notify family.

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Specializes in Critical Care.

In order to abide by their wishes, you have to first understand what they actually are, so you would need to clarify. If a patient says they don't want to bother their family with what they think is just a routine trip to the hospital, that doesn't necessarily mean if they decline into a life threatening condition and where they can't make their wishes known that they wouldn't want family involved, you can't assume they would want family notified in that situation but you also can't assume that is what they meant, so you need to clarify that right there on the spot.

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Specializes in Psych, Addictions, SOL (Student of Life).

The only question you have to ask yourself is who is the POA. If the patient is his/her own POA then their wishes to not inform family must be honored. If however their is another family member who is POA that person must be notified each and every time the patient goes to the hospital.

Hppy

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Specializes in Geriatrics, Dialysis.

If the patient is alert, oriented and responsible for themselves legally you have to respect their wishes. If the patient directs you not to call family, you don't. If the family gets upset about it when they later find out their loved one was at the ED then do what you can to calm them. If they won't accept that you couldn't tell them anything per the patients wishes refer them to management.

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Specializes in orthopedic/trauma, Informatics, diabetes.

to me, that is up to the physician. I am an advocate for my patient and if that patient does not want me to contact family, I will not. If I feel that the family needs to know, I would discuss this with the physician and let them deal with it.

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