Non compliance?

oceangirl1234 · May 19, 2018

I feel like the patients have the right to do what they want and as long as we educate and document, the rest is out of our hands.

^^This. We can't force feed patients. All we can do is educate, provide resources, and document. It's unfortunate but ultimately competent adults are responsible for their own health, especially when we assist with the tools we provide.

Glycerine82, LPN · May 19, 2018

Thanks. This is pretty much where I"m coming from. Her argument is that the MD has ordered a particular diet and if something happens to the patient as a result of he or she being non-compliant we could potentially be looking at litigation. I understand what she's saying, but we can hardly control what kinds of food he eats from the outside, which is why I document, document, document.

Just wanted to make sure my rationale wasn't flawed.

cayenne06, MSN, CNM · May 19, 2018

Thats craziness! People can whatever they want to. Our job is to ensure they understand WHY we recommend a certain diet, as well as the consequences of not following it. Its also our job to try and identify and address any barriers the patient might have to following the diet.

But what the heck is that nurse suggesting you do with these patients?! They are grown adults- no one else is responsible for their choices.

sallyrnrrt, ADN, RN · May 19, 2018

Sometimes you do not see them "hearing the message"....for several years.....

( some quickly, a significant #, longer )

cayenne06, MSN, CNM · May 19, 2018

Its very patronizing IMO, to assume you have that much responsibility for your patients' actions. We dont have *any* kind of authority over their choices.

Glycerine82, LPN · May 20, 2018

Its very patronizing IMO, to assume you have that much responsibility for your patients' actions. We dont have *any* kind of authority over their choices.

My question was in regards to the outcomes (namely potential negative ones) that stem from patients making their own choices, especially when said choices conflict with the MD orders.

Honestly, I was just getting opinions in light of a conversation I had with a colleague, I certainly don't go around telling my patients what choices to make. Yikes.

Glycerine82, LPN · May 20, 2018

Thats craziness! People can whatever they want to. Our job is to ensure they understand WHY we recommend a certain diet, as well as the consequences of not following it. Its also our job to try and identify and address any barriers the patient might have to following the diet.
But what the heck is that nurse suggesting you do with these patients?! They are grown adults- no one else is responsible for their choices.

I don't really know, to be honest. I've always been of the mindset that as long as I've educated the patient and I am comfortable that they understand, I've done my duty. I just recently came across this other mindset and I mostly wanted to make sure that I wasn't insane. Her argument is that in the event of a negative outcome it's essentially "nursings fault". I disagree, I think If we educate and provide resources (and of course document the crap out of everything) it's out of our hands. I'm a new nurse though, so I always like to bounce stuff off my internet colleagues just to see if I'm missing anything. I'd ask the folks at work but I don't want this nurse to think I'm trying to pick on her, etc.

JKL33 · May 21, 2018

I'm just curious what you all think...
I have a colleague who insists that when a patient is noncompliant regarding their diet, (diabetic CHF etc.) even when we document and alert the provider they are not adhearing to it, that we can ultimately be held liable?
Im in a sub acute rehab setting.
I feel like the patients have the right to do what they want and as long as we educate and document, the rest is out of our hands.
My colleague says the reason they have a diet ordered is to ensure they adhere to it. I just don't see how if I do everything in my power to keep the patient in compliance but they still choose to eat whatever they want, I've done all I can do.
What at do y'all think? What can I do differently?

Your coworker sounds woefully ignorant about all of this.

This centers around patient autonomy, a top-of-the-list ethical value.

The patient has the right to be properly informed of the risks and benefits of any suggested intervention, as well as receiving accurate information about the expected effects of declining a particular intervention.

The patient must have the capacity to take in and evaluate information and make decisions that reflect their own values.

There is ongoing discussion in the literature about not using the terminology "non-compliant" any more because it doesn't imply that the patient should and does have a choice.

Liability arises when it can be shown that the healthcare provider-associated elements that are a necessary part of informed consent were lacking.

chacha82, ADN, BSN · May 21, 2018

Sounds like someone else put the fear in her and now she is spreading it. If you have provided the resources for the patient and they still don't comply, you've done all you can do. Document it in the chart and move on. Some patients truly think they're being compliant. To them, diet coke with the Big Mac meal is complying because they're not drinking the regular coke. I ran myself into the ground one shift securing the "right" trays for my patients (renal, or something like that) and I walked in, they're eating Popeyes, Taco Bell. Mega eye roll and move on.

kbrn2002, ADN, RN · May 21, 2018

I work with a nurse that has a similar mindset. It's a SNF and many residents are there for the remainder of their lives, she will go as far as removing sweets from a residents room because they are diabetic and "can't have that." I am shocked she hasn't ever been in trouble for this, removing personal items from a resident is such a huge no-no. If the resident wants to be diet non compliant that's their choice, even if they don't have the mental capacity to make informed decisions for themselves.

MunoRN, RN · May 21, 2018

The term diet "order" is a bit misleading since it's really just a suggestion, all legally competent patients have the right to decline MD orders including diet. When nurses believe that orders can be forced on a patient competent to refuse them is when very bad things can happen, I've personally known a nurse who lost their license and was facing jail time because they were 'enforcing' a fluid restriction order.

The MD can suggest what someone should be eating through their diet order, but in the end it's up to the patient to take that suggestion under advisement and form their own dietary plan.