what is the legal term of this matter?

[esolmayor]

the patient is lack of mental capacity and unable to verbally express his medical needs; for instance asking for pain medication or anxiety; patient is showing sign of escalating agitation and screaming for 7.5 hours, patient has warrants of PRN; the charged nurse refused to give his prn medication. what is the legal term of this matter?

[madricka, BSN, RN]

the patient is lack of mental capacity and unable to verbally express his medical needs; for instance asking for pain medication or anxiety; patient is showing sign of escalating agitation and screaming for 7.5 hours, patient has warrants of PRN; the charged nurse refused to give his prn medication. what is the legal term of this matter?

There are so many questions I have with this!

- the pt is unable to VERBALLY express but I would assume they communicate with nurses/caregivers/family in other ways? How? What do the caregivers or family who know this pt think is going on?

- "showing signs of ESCALATING agitation and screaming" (my emphasis)... so it is noted that there is a change in behaviour that is unexplained. This should never be ignored, especially in someone who is non-verbal. Attempting to find the cause of the change is imperative in order to treat the cause.

- What PRNs are ordered? Analgesics? Sedation? Topical pain relief cream? Eye drops? There is a range and each type or PRN results in very different nursing judgement considerations. For example, if the PRN was eye drops because the pt becomes agitated when his eyes are dry, the nurse would need some interesting rationale to justify not giving. If the PRN is ibuprofen, that alleviates pain but is not a chemical restraint. So knowing that the PRN is & it's indications would be helpful.

- Rationale for the charge nurse's decision (who I am assuming has been assigned as this pt's primary care provider, otherwise it's not her concern) is necessary. It is not improper if there is legitimate medical or ethical reasons for withholding the PRN -- perhaps the drug/dose in the PRN order was incorrect and the nurse was awaiting a proper medication order before administering. Or there was an allergy concern. When was the last PRN dose? Is it safe to give the next dose (timing, method of admin, etc). A LOT goes into the process. Nurses do not refuse arbitrarily.

I'm curious about why you are asking the legal term. Is this for a class? Or has this been done to a loved one and you are pursuing litigation? Or snitching on a fellow nurse?

[tyvin, BSN, RN]

If medical treatment falls below acceptable practice guidelines the facility, doctor, nurse, or whatever has practiced below the "Standard of Care."

The standard of care is "The type and level of care an ordinary, prudent, health care professional, with the same training and experience, would provide under similar circumstances in the same community" (Nolo).

Is it acceptable to believe that screaming for hours is accepted normal behavior? Why is the patient screaming for x amount of hours and why isn't anything being done? Is it that the behavior is accepted by staff because the patient has always screamed for x amount of hours?

I worked a few years in a lock down psych unit. This screaming type of behavior is not acceptable. It's not good for the patient and we do need to think about how the behavior is affecting the other patients...especially in a psych unit.

Milieu therapy is the standard of care in a psych/behavioral units where I am from. I missed where you told us what kind of setting this is happening in...

[cocoa_puff]

Homework?

[srercg6]

we just say the patient in not "alert and oriented" or can not answer the required questions. Or you refer to their scale score -0-15.

[Kooky Korky, BSN, RN]

As others have said, it would be helpful to know more details.

It is not healthy for the patient or anyone else (staff, patients, etc.) to ignore someone who is screaming, particularly for such an extended period of time. If for no other reason than to keep someone from calling the police about this prolonged screaming episode, this patient needs to be helped to relax.

Hopefully someone knows the history, knows what has been ruled out and ruled in. If not, the physician has ordered PRN's and they should be employed. And VS and general physical exam should be done, any abnormalities reported to MD and addressed.

Legal terms? I don't know. but this pt needs attending ASAP.

Homework? What's the problem if it is?

[RNOTODAY, BSN, RN]

I'm confused...

failure to assess?

failure to treat?