Pts refusing to weigh

  1. I work in a specialist office but what do you do in the hospital if a pt refuses to get on the scale? It's not as big a deal with us, although I get tired of pts asking why they need to be weighed when they're seeing us for a sinus infection, but if someone's coming into the ER couldn't weight be a factor? We can document "pt refused" for the weight, or "pt states she weighs 125 lbs" but at what point, if ever, is a pt made to get on the scale? Women tell us their weight and they're typically way off, either under (in denial) by 10 pounds or over-estimating by 15-20. I know they have the right to refuse, I can cover the numbers on the scale when they're on it, and I can even have their family member stay back where they can't see the scale, but it bugs me when they cop an attitude about it. Just wondering what you all think about it. No harsh comments or judgements.
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    About T-Bird78

    Joined: Oct '12; Posts: 835; Likes: 1,334

    39 Comments

  3. by   Okami_CCRN
    We do our daily weights on the bed, so often patients don't even know they are being weighed.

    One of the most important things you can do is explain the importance of being weighed, from management of CHF to proper dosing of medication. And if they continue to refuse, document and inform the attending/resident.
  4. by   ruby_jane
    Is there a medical reason for obtaining the weight, as Okami said? No? Document the refusal and make sure the provider knows. I'd rather document a refusal then the patient's guess.
  5. by   Katillac
    Quote from T-Bird78
    I work in a specialist office but what do you do in the hospital if a pt refuses to get on the scale? It's not as big a deal with us, although I get tired of pts asking why they need to be weighed when they're seeing us for a sinus infection, but if someone's coming into the ER couldn't weight be a factor? We can document "pt refused" for the weight, or "pt states she weighs 125 lbs" but at what point, if ever, is a pt made to get on the scale? Women tell us their weight and they're typically way off, either under (in denial) by 10 pounds or over-estimating by 15-20. I know they have the right to refuse, I can cover the numbers on the scale when they're on it, and I can even have their family member stay back where they can't see the scale, but it bugs me when they cop an attitude about it. Just wondering what you all think about it. No harsh comments or judgements.
    It's unfortunate that you "get tired" of people not wanting to be weighed. Perhaps you aren't aware that many people who have eating disorders are triggered by HCPs focus on weight. Equally unfortunate you are bugged by patients copping an attitude about weight. I don't even discuss weight unless there's a medical reason for it, never mind get on a scale, and there have been times when I've needed to be quite firm about it. My anxiety, which by that point is off the charts because I'm being pressured, sometimes causes me to be less than gracious.

    A patient is never made to get on a scale any more than they are made to participate in any other assessment. Of course HCPs need to get an accurate weight to treat CHF and to does many medications. But have you ever known a patient refuse to be weighed when it really was medically indicated?
  6. by   Emergent
    A lot of people don't want to get on the scale, especially with their clothes and shoes on, and after they've eaten. They're going weigh 5 pounds more!

    I always weigh myself first thing in the morning, after peeing and before any oral intake, stark naked. That way I get t he lowest weight possible.
  7. by   brownbook
    It never bothers me. Of course a patient has the right to refuse any treatment.

    Just write patient refuses.

    As to needing weight for emergencies. No ACLS interventions are based on weight.

    ER staff and paramedics are pretty good at guesstimating a patient's weight for emergency treatment until the patient can be transferred to ICU with inbed scales.
  8. by   CrunchRN
    Declined is a much nicer word than refused. Respect that it is a very difficult issue for many.
  9. by   psu_213
    In the ED, the only time we would absolutely, no questions asked, get a weight is for a pt getting tPA. I can't imagine anyone consenting to tPA, but refusing a weight. The only other time is was absolutely required to get a weight was for a pt who was going to get chemo...it was required for 2 nurses to do/witness the weight. Again, I can't imagine a pt refusing a weight in that case.

    If a pt refuses, it is just like any other intervention/test. Explain why you should get an accurate weight; if they still refuse, chart that you counseled the pt and he/she still refused.
  10. by   KelRN215
    Quote from Katillac
    It's unfortunate that you "get tired" of people not wanting to be weighed. Perhaps you aren't aware that many people who have eating disorders are triggered by HCPs focus on weight. Equally unfortunate you are bugged by patients copping an attitude about weight. I don't even discuss weight unless there's a medical reason for it, never mind get on a scale, and there have been times when I've needed to be quite firm about it. My anxiety, which by that point is off the charts because I'm being pressured, sometimes causes me to be less than gracious.

    A patient is never made to get on a scale any more than they are made to participate in any other assessment. Of course HCPs need to get an accurate weight to treat CHF and to does many medications. But have you ever known a patient refuse to be weighed when it really was medically indicated?
    I agree with almost all of what you said, except if the patient is a child, sometimes he/she is made to get on the scale. Meds are weight dosed in pediatrics and some things, children just don't get a say in.
  11. by   Wuzzie
    Unless my weight is directly related to my complaint I do not get on a scale. I am a fit, appropriately weighted, middle-aged woman and there is no reason to subject me to the humiliation and trigger response from being forced on a scale so I can get a refill of my Albuterol. Nope, I ain't doin' it.
  12. by   blondy2061h
    Quote from Okami_CCRN
    We do our daily weights on the bed, so often patients don't even know they are being weighed.

    One of the most important things you can do is explain the importance of being weighed, from management of CHF to proper dosing of medication. And if they continue to refuse, document and inform the attending/resident.
    Are you seriously monitoring CHF with daily bed weights?
  13. by   psu_213
    Quote from blondy2061h
    Are you seriously monitoring CHF with daily bed weights?
    When I was on a step down unit, that is how we did it if a pt could not stand. Take off the "top" linens so that all that was on the bed was the pt, their gown, and the fitted sheet. Right before an admit, 'zero' the bed scale with a fitted sheet and gown on the bed.
    Last edit by psu_213 on May 12
  14. by   Have Nurse
    Quote from T-Bird78
    I work in a specialist office but what do you do in the hospital if a pt refuses to get on the scale? It's not as big a deal with us, although I get tired of pts asking why they need to be weighed when they're seeing us for a sinus infection, but if someone's coming into the ER couldn't weight be a factor? We can document "pt refused" for the weight, or "pt states she weighs 125 lbs" but at what point, if ever, is a pt made to get on the scale? Women tell us their weight and they're typically way off, either under (in denial) by 10 pounds or over-estimating by 15-20. I know they have the right to refuse, I can cover the numbers on the scale when they're on it, and I can even have their family member stay back where they can't see the scale, but it bugs me when they cop an attitude about it. Just wondering what you all think about it. No harsh comments or judgements.
    Yes, it can be a bit disconcerting not to have that data. Let me share with you why I don't get on the scale. It has nothing to do with embarrassment or ego or denial, honestly. I'm not obese either.

    I was taught in Nursing school, the best time to get an accurate weight is first thing in the morning, after the patient voided or had a BM, and before they got dressed. That was how we did it in the hospital and in LTC.

    There can be as much as a 4 pounds or more difference, due to clothing, shoes, eating, fluid intake, etc. so it wouldn't be accurate anyway, even if the scale was a good one.

    Due to my own regimen with my doctor, he prefers that I keep track of it for accuracy due to a tricky thyroid and such.

    With his endorsement, there is a certain plan that I follow which involves keeping track of weekly weights. I do that faithfully and that is what the Dr. uses, as it is more accurate.

    We all know that the patient has the right to refuse. Of course, if we are dealing with someone with dicey circulation or renal issues that can be scary if they do refuse.

    But rather than charting "refused," which sometimes has a negative connotation, I chart "declined".

    I think too, that part of it is the privacy concern. It's too bad that they don't put scales in the treatment rooms instead. They might get more cooperation if they did.

    Try not to take it personally. You are doing the best you can!

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