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[soked]

If you are a nurse-manager or nurse just on a surgical unit & you are presented with a client who refuses to sign consent for treatment

how can deal with this issue?

[ChristineN, BSN, RN]

Is this a homework question? Is the patient alert and orientated and legally able to sign their own consent?

[schnookimz]

Generally they sign a consent for treatment when they walk into the ER. This should definitely be done before they get to the floor. And if they won't consent to be treated in the ER, then what the heck are they doing there?!

[soked]

Hi my dear

its not a homework question

but i want to know what i will do if face me this issue

Good practice in gaining consent is part of an ongoing process of communication that respects patient rights and takes into account a patient’s capabilities, concerns and circumstances including:

Good communication starts with the first interaction between the health worker and the patient. It takes into account the particular concerns and capabilities of the individual being treated.

..

their temperament, attitude and level of understanding;

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influences that are non-medical but may impact on their choice;

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disabilities or impairment;

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their individual circumstances and cultural norms;

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information provided to the patient in a form and language they can understand, and

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response to their questions and concerns .

[JBudd, MSN]

It is very frustrating to get a patient in who complains of a problem but won't let us do anything about it. Pts have the right to refuse any particular procedure despite their general consent for treatment. If a pt says no to an xray or IV, then the answer is no. Touching an A&O pt without their consent is battery. Had a pt with chest pain in the ED who refused an EKG! because the ambulance guys had done a strip in the rig and told her (which I doubt) that her heart was in perfect condition.

This is why most nurses are masters of manipulation; through education, explanations and encouragement, we can often talk a pt into something they need but likely didn't understand well enough to agree to.

For instance, we had an elderly man, seemed to be stroking out, was quite ill. Also had dementia but a fairly good quality of life. His wife didn't want us to use the DNR on file, because she was afraid we would quit taking care of him. The hospitalist was not explaining well enough what was going on, and actually started to leave the room with a full code directive, when I stepped in. I explained to her that DNR was not Do Not Treat, that we would continue all his supportive care, antibiotics, etc., but that if his heart actually stopped did she want us to do CPR (pounding on his chest) and put him on a breathing machine. She immediately said, NO, he wouldn't want that! The DNR (his prior wishes) stood, she was comforted, the pt got good care, and the doc was quite relieved. In fact, he thanked me outside the room, acknowledged he hadn't gotten the point across.

[JustBeachyNurse, LPN]

Patient refuses to consent you cannot touch them. Competency is determined by a court of law. However the nurse should ask why ( like in the example above where the spouse was not fully educated on what a DNR means) they are not consenting and perhaps educate to allay a fear or misunderstanding. If the answer is no, and a court has not designated a medical POA or the patient incompetent then performing the procedure is a criminal act known as battery. I don't believe you are in the US, therefore the laws likely differ in your country and a nurse's obligations and responsibilities may differ than US.

[NurseOnAMotorcycle, ASN, RN]

Recently had this exact thing happen. Man noncompliant with home medications going to lose his eye for diabetes, glaucoma, and massively increasing eye pressure. Immediate surgery needed.

Pt refused to consent. Refused IV, refused to get into a gown, and refused everything. No amount of 4 different doctors, 3 nurses, the social worker, charge nurse, family, etc could get this fully functioning and competent guy to consent to saving his own eye.

So you know what we did? We let him go after fully documenting his every word and our every attempt to convince him.

There's nothing you can do when you've done everything you can to help someone, and they still won't have anything to do with it. I hope he changed his mind and came back after I went home. Or went to a different hospital and got treated. But most likely, he is living the rest of his life half blind. At least he is fully informed of why.