We currently have a baby on the unit whose parents refuse to allow necessary medical interventions. They refuse to allow this patient to use mist with the trach collar because they think it's too loud, they leave the floor with the patient without resuscitation equipment or even informing nursing, they refuse suctioning even if the patient is bubbling over and desatting (oh, they'll cough it up and come up, this happens a lot) and they won't allow chest PT despite the patient plugging.
They accuse staff of not responding to other patient alarms and are constantly eavesdropping on other patients and are hypervigilant for mistakes in care. They also will not allow nursing to assess the patient overnight and when this person is sleeping.
The parents have been spoken to repeatedly about at least informing nursing before leaving with the patient and to bring the BVM and safety equipment but they repeatedly state they'll be back soon and that they just suctioned the patient so bringing a portable machine isn't necessary. They absolutely will not grasp the concept that anything can happen at any moment (this patient has a critical airway), and just because they just performed suctioning does not mean the patient may not need another if they're a half hour away from the unit on a walk. The patient isn't even CLEARED to leave the unit.
Security has been involved, social work has been involved, and the parents don't care. "It's my child and I'll do as I see fit." It isn't for a lack of education as many MANY nurses and even practitioners have attempted to educate this family.
Our unit rotation is coming up and I'll be taking care of this baby. I want to make them write a statement saying I'm not responsible if something happens to their child due to their refusal of interventions. I want to put it back on them that "Okay, so I can document you're willingly risking your child's life?" if they refuse to take the resuscitation equipment.
I would actually like them to request me NOT to be their child's nurse, as I will refuse to withhold the necessary care like suctioning just because the parents don't want it done, UNLESS they are willing to release me from liability. Has anyone ever had this happen? Did you have any recourse other than documenting the parents' response?
Specializes in LTC, assisted living, med-surg, psych.
That's a great question, and my answer would be to involve the hospital's ethics committee and CPS. It doesn't make sense that the parents of this child can have it both ways---full code with no limitations, but they can refuse basic interventions like suctioning. What's wrong with this picture?
Granted, I'm a geriatric nurse who wouldn't work in a NICU or PICU if it was the last nursing job on the planet, but I can't understand how this is acceptable under any circumstances. How can it possibly be OK for these parents to refuse to allow staff to perform the simple cares that can relieve symptoms and prevent further deterioration in the child's condition when they'd doubtless expect you to provide expensive high-tech treatment, even at the cost of additional trauma and suffering for their child? WOW.
It's been said that God made humans in His own image; sometimes I think He did it so that skunks wouldn't think they'd been given a dirty deal. That poor baby.......I feel for all of you who are involved in his/her care.
AMA forms...they're not just for leaving before discharge, they are also for refusing treatment. Have them sign one for each different situation...refusal of CPT, refusal of suctioning, refusal of mist, etc.
If there's risk mgmt in the house, have them come as qell every time there is a situation of refusal.
Way back when I worked ped LTAC, there were kids who had had parental rights to medical issues revoked and a court appointed guardian instead b/c of similar issues.
Make sure when you document that you do word for word, in quotation marks. When it's read back at trial, you want their own words read, not your take on it. Also, try to make sure when they're taking the kid off the unit, refusing suction, etc., that a second nurse is present and they also document "parent x informed by this nurse that child needed suctioning due to o2 desaturation down to 71%, cyanosis observed on lips and fingers, and parent refused in presence of this nurse and nurse sally sue at 8:32pm 5/2/11. Asked parent x to let me suction child for desaturation to 69 percent at 8:39, parent x stated, 'leave them alone they all do that' in the presence of this nurse and nurse Jackie Jo." It could be this family wants the child to die just so they can sue and get money. Document who's in the room, who's present for any interaction, because this has "court" written all over it. And if/when something does happen to the child, take these posts down immediately, or they are admissible.
AMA forms...they're not just for leaving before discharge, they are also for refusing treatment. Have them sign one for each different situation...refusal of CPT, refusal of suctioning, refusal of mist, etc.
If there's risk mgmt in the house, have them come as qell every time there is a situation of refusal.
Way back when I worked ped LTAC, there were kids who had had parental rights to medical issues revoked and a court appointed guardian instead b/c of similar issues.
I'll reiterate others' suggestions to get risk management and ethics involved.
It might be necessary to have the parents evaluated for their fitness to make medical decisions.
How are they with the child otherwise? Do you see a normal give and take of affection? Do they ask appropriate questions? Are they involved with the child's care? Does this child have siblings? If so, how are they treated?
If normal behaviors are missing, it would make me wonder if this baby is being looked at as expendable in the name of reaping a settlement. The documentation that has been recommended will be your saving grace if it comes to that.
But I would hope that the combined efforts of docs, nurses, risk management, ethics and social services can head off a tragic outcome.
Make sure when you document that you do word for word, in quotation marks. When it's read back at trial, you want their own words read, not your take on it. Also, try to make sure when they're taking the kid off the unit, refusing suction, etc., that a second nurse is present and they also document "parent x informed by this nurse that child needed suctioning due to o2 desaturation down to 71%, cyanosis observed on lips and fingers, and parent refused in presence of this nurse and nurse sally sue at 8:32pm 5/2/11. Asked parent x to let me suction child for desaturation to 69 percent at 8:39, parent x stated, 'leave them alone they all do that' in the presence of this nurse and nurse Jackie Jo." It could be this family wants the child to die just so they can sue and get money. Document who's in the room, who's present for any interaction, because this has "court" written all over it. And if/when something does happen to the child, take these posts down immediately, or they are admissible.
Wow.....call CPS, refuse to care, parents may want their child to die for money gained from a lawsuit?! Good Grief! What happened to the child in the case that the parents refused the nurses request to suction? Did the child die? Become cyanotic? Code? Or did nothing happen? And maybe the parents acutally know their child and are involved in the plan of care which many nurses are not used to. Did this happen to the OP or is this all second hand drama retold like a fishing story....it just gets bigger and bigger. Maybe they are picky, maybe they dont want the child suctioned every 10 minutes because they have cared for them at home just fine, maybe they are not complete idiots just because they requested their child be able to rest at night. Sadly this whole thing probably could have been avoided if proper Interpersonal Communication was utilized instead of drawing lines in the sand and isolating the parents. Sad that a whole unit of professional nurses can't resolve something like this without threatening to call CPS.
Hi RLee. I am not talking about suctioning every 10 minutes, I'm talking about standard q4h suctioning, as well as in between should the baby need it. The parents will allow us to turn up the O2 if the patient persistently desats, but not to suction because they do not want the baby woken up. Again, this is a baby with a tiny trach and a critical airway without trach mist. It's not a far stretch for this baby to plug off - and has come close. The tail chasing goes in a circle until the parents decide to suction the baby. Unfortunately, this is an intensive care setting, assessments and vital signs must be done. At this time the baby is not able to step down to a lesser level of care because its condition is serious. I don't want to get into too much detail because of HIPAA.
I believe that nerdtonurse? was giving an extreme example of what could possible happen if the situation continues. As in IT WAS JUST AN EXAMPLE AND THIS HASN'T ACTUALLY HAPPENED TO THIS EXTREME YET. =)
Oh, and forgive my *Bold*...it went bold went I copy/pasted nerdtonurse?'s name and I can't get it to go back to normal...=/
Sounds like parents I've encountered in home health. Agency supervisors always throw up their hands and say the parents have all the rights in the world and if we want to work, we will do it the way the parents insist.
Document your butt off each and every single time, use lots of qoutes, keep personal documenation for yourself just in case with dates, names, times etc., write down the name and title of all of pple you tried to inform about the situation and their responses (SW, Doc, Manager etc.).
we have an issue like this at the moment on my unit. I will not get into details for legal reasons but the legal department at my hospital is involved and they have since been 100% banned from the hospital. We found that the legal department WILL back the unit up if it gets to situations like this, they just have to be notified
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VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
That's a great question, and my answer would be to involve the hospital's ethics committee and CPS. It doesn't make sense that the parents of this child can have it both ways---full code with no limitations, but they can refuse basic interventions like suctioning. What's wrong with this picture?
Granted, I'm a geriatric nurse who wouldn't work in a NICU or PICU if it was the last nursing job on the planet, but I can't understand how this is acceptable under any circumstances. How can it possibly be OK for these parents to refuse to allow staff to perform the simple cares that can relieve symptoms and prevent further deterioration in the child's condition when they'd doubtless expect you to provide expensive high-tech treatment, even at the cost of additional trauma and suffering for their child? WOW.
It's been said that God made humans in His own image; sometimes I think He did it so that skunks wouldn't think they'd been given a dirty deal. That poor baby.......I feel for all of you who are involved in his/her care.