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Discussion

patient capacity

being a beginning student i have been exposed to very little except classroom attendance. the question of determining a patient's capacity to consent to or refuse treatment options seems a very difficult and hard to understand concept, espescially when an otherwise fully alert and competent patient makes a decision that seems very irrational. i would assume that the next step would be to question the patient as to what factors led him to this decision? if, for example, he admits to a very extreme fear of the proposed treatment and therefore, has rejected it. this is a perfectly legitimate and solid reason --to the patient. how do you proceed from here. if the reasons for reaching this decision are sound and logical to him and he is otherwise competent, but seem irrational to nursing staff, is the patient's refusal accepted? if not, then what actions should you take as a nurse?

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If the patient is alert and orientated x3, is over the age of 18, and states refusal for something, you'd try talking to them first, get the doc to talk to them, then document document document the refusal.

I take refusals on a case by case basis. One must not be too quick to judge someone as incompetent, BTW just because they have had meds or are "acting out" in your opinion. Best to err on the side of caution.

A refusal doesn't have to be "rational." If they say no the dialogue begins. It may be something that can wait until later. If not I try to see why not. I explain my side. I am pretty good at changing minds. Arguments vary from laid back (this won't take long. Don't blame me, I just work here) to serious (you could die if you don't have this). I never lie. I never exaggerate. I don't pester the patient. After another refusal, you call the docs. And document, document, document!

Just pray you never find yourself in a position were the docs tell you to "do it anyway." (Okay, thats not too hard. Tell them no, explaining the definition of assault) The difficult day comes when a young doctor can't accept "no" for an answer, because the patient will die (and she is okay with this). And the nurses find themselves physically blocking the room to stop him from entering to "save her because she doesn't know what she is talking about. She is hypoxic." BTW, in this case, hospital lawyers got called in and told old boy not to touch that patient.

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