how to you deal with this?

Nurses General Nursing

Published

Specializes in Cardiac ICU.

Patient who is admitted for SVTs and sepsis

refuses O2 (even if saturation is below 88%)

refuses to turn (even if she has stage I on her bottom)

refuses beta blockers (HR 100's then shoots up to 149 sustained and elevated BP)

refuses pain medications (but complains of pain)

refuses respiratory treatment (but complains of shortness of breath)

complains the staff is not taking care of her -- translation: they're not here the second I push the call light

I tried various non-med interventions: warm compress, distraction by TV or music, etc. Dealt with an angry family member over the phone. I'm just drained. Anyway, by the time my shift was over, she was calm with stable vitals. At least I fixed that, but it's hard to fix everything else.

Looking forward for a better day.

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

document every complaint, intervention and results including quotes when the patient refuses. Not much else you can do. Some people just like to complain and don't want you to take away their reason to do so.

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Ditto. document, document, document.

Engage medical social work and/or psych.

Good luck.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

You wonder why people even show up to the hospital, get admitted and then refuse everything but still suck the life out of you. It's frustrating.

I agree with the above, make sure your documentation is accurate. Our facility has a refusal of treatment form the patient should sign.

You didn't meantion it and not that you call each and everytime, but I presume the physician is aware and it's documented that the physician is aware of the refusals.

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Document your tail off! I use quotations as well. When I notify physicians of patient's repeated refusals, I will document what the MD says as well. Doesn't hurt to have a witness either. I've documented, "Pt refuses to turn, even after discussing possible risk factors for skin breakdown. Witnessed by J. Smith RN".

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Specializes in Emergency.

Painstaking work of the great what you've done, although the patient refused all treatments, the other important work, according to another retake writing is full of all the details of what the patient was rejected in the process of nursing and treatment as well as to inform the physician of all what happened.

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Yup. Document and notify.

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Document, witness, notify, keep trying. Realize that the infection and low oxygen level might have made her rather delirious. Just keep trying, which you evidently did. Bless you for caring and keeping the faith.

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Specializes in Med/surg/tele/OR.

Difficult to deal with for sure. I often times wonder why in the world do these people come to the hospital then. Document, document notify physician and consult social work and psych are all great ideas. I never never argue with patients anymore about why they should not refuse treatment and such. I simply ask them why once state the reasons why they should receive said treatment and if they still refuse I document grab another RN to witness the situation and notify the physician.

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Specializes in Cardiac ICU.

I documented more on this lady than all my other patients combined. I have a feeling even if we did a psych consult on her, she would refuse this anyway. She's old--very old-- and I don't need to argue with her for anything.

Sometimes I think the underlying problem is her relationship with her children. She would call them over the phone and complain of how we neglect her, etc. WOW. That's how I got the angry phone call. She's possibly in desperate need of attention.

Anyway she's stable as far as I know. Hopefully she'll go home soon, where she probably wants to be. And her bed can be given to someone who is in need of and willing to receive care.

thanks for the replies!

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I really dont understand people like this, its like YOU came to hospital yourself. I didnt just show up at your house and force care upon you. Why the hell go to the hospital if you dont want care? You dont go to a restaurant if you dont want food. Ugh those people really get to me grrr

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If she's elderly do you think she might have short term memory loss? Some times this makes me people act very weird..especially when they don't their normal memory/orientation cues from home.

I would invite her children in to sit with her and let them witness her behavior.

If all else fails, when she goes unconscious you can take action.

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