Patient refuses meds and treatment

[wifeygrooms]

Michael, a 35-year-old, was brought via ambulance to the emergency department after collapsing on the street. He was diagnosed with appendicitis and the surgical team was alerted to the potential surgery. The physician prepared to obtain informed consent and began discussing the simple effective surgery and the treatment with the patient. The RN was present at the bedside. The patient stated he did not want surgery. Based upon his beliefs as a Christian Scientist, it is against his practices. He requested a Christian Science practitioner. The patient rated his pain as 9 on 0-10 verbal pain scale so the RN prepared the narcotic analgesic to relieve the patient's pain. The patient declined the medication. The RN believes the patient should accept the pain medication and have the surgery thinking "If it were me I would proceed with the surgery and treatments proposed by the surgeon." The surgeon can be heard speaking to a colleague about how to go about changing the patient's decision.

1. State and discuss the legal and ethical considerations occurring in this scenario. Include supporting citations.
   
2. How can RNs support the patient's decision when the beliefs of the patient are contrary their own? List three (3) interventions, with supporting rationales, the RN would perform to ensure the delivery of culturally sensitive care.
   
3. Identify one (1) additional major religion, in which the same circumstances might also require the RN to advocate for the patient's refusal of surgery. Describe the beliefs behind why the identified religion could pose a moral conflict for a similar patient.
   

[TheCommuter, BSN, RN]

Thread's been moved to the Nursing Student Assistance forum.

[Kuriin, BSN, RN]

What is with these students who only post their assignment but without any additional information/research that they have done before?

[roser13, ASN, RN]

"

1. State and discuss the legal and ethical considerations occurring in this scenario. Include supporting citations.
   
2. How can RNs support the patient's decision when the beliefs of the patient are contrary their own? List three (3) interventions, with supporting rationales, the RN would perform to ensure the delivery of culturally sensitive care.
   
3. Identify one (1) additional major religion, in which the same circumstances might also require the RN to advocate for the patient's refusal of surgery. Describe the beliefs behind why the identified religion could pose a moral conflict for a similar patient.
   

LOL, did you seriously think that this is a homework hotline and that others will take the time to write out YOUR assignment? Which you apparently don't want to do.

I'm with Kuriin (above). I seriously do not understand the thought process behind this practice. Why go to school if you're not willing to do the work?

[OneDuckyRN]

5 words: patient's right to self determination.

But yeah, I agree with the PP. Show us what you've done thus far. We can't do your work for you.

[Emergent, RN]

Get the AMA form after doctor talks to pt, have him sign, remind him he can return at any time.

Then go take care of your pts who want care.

[cecile9155, BSN, RN]

When I was in nursing school, I did my own homework. You need to do your own too. Show us some of your work and then ask questions about where you're confused. We won't do your homework.

[wifeygrooms]

The nurse will need to reflect on his/her own beliefs and values, to gain a better sense of self-awareness and understanding of any biases he/she may have. This will allow the nurse to better respect the patient's choices, beliefs and values. The nurse needs to be an advocate for the patient. (Tres. Wilkenson. 2014). The nurse may not agree with the patient's choices but he/she should support the patient and be respectful.

How does the RN support the patient ‘s decision?

1. Ask the patient if he understand the diagnosis and complications that can stem from the condition if not treted.

Rationale- If the patient has all the details and understand then this will allow the patient to make an informed decision.

2. Be an active listener .

Rationale- By doing this there is a chance to gain the patient trust and it let them know that you are concerned about his/her well being.

This is what I have so far....Sorry if you thought I was waiting on someone to do my work!!!

[wifeygrooms]

The nurse will need to reflect on his/her own beliefs and values, to gain a better sense of self-awareness and understanding of any biases he/she may have. This will allow the nurse to better respect the patient's choices, beliefs and values. The nurse needs to be an advocate for the patient. (Tres. Wilkenson. 2014). The nurse may not agree with the patient's choices but he/she should support the patient and be respectful.

How does the RN support the patient ‘s decision?

1. Ask the patient if he understand the diagnosis and complications that can stem from the condition if not treted.

Rationale- If the patient has all the details and understand then this will allow the patient to make an informed decision.

2. Be an active listener .

Rationale- By doing this there is a chance to gain the patient trust and it let them know that you are concerned about his/her well-being.

3. Consult with persons who are more knowledgeable about the patient's beliefs as a Christian Scientist.

Rationale: So you can gain a better understanding of the patient thought process and not just be bias so the patient can get the best treatment for his condition without over stepping boundaries in his religion.

This is what I have so far....Sorry if you thought I was waiting on someone to do my work!!!

[Anonymous865]

You need to consider the competing ethical principles of autonomy and beneficence.

Consider the legal principles of medical battery, informed consent, informed refusal, and decision making capacity. Understand that signing a form does not constitute informed consent or informed refusal. Informed consent and informed refusal are processes.

For the first bullet regarding citations, cases like this are discussed extensively in medical ethics literature by ethicists. The AMA Journal of Ethics is available online for free. It has case studies and is organized by subject (e.g. autonomy). They have many case studies like this one. If you look at the citations at the end of the study, you can find articles from other journals. You can also use google scholar to find the many other journals discussing patient autonomy and beneficence. This is one of the most discussed medical ethics questions.

[bgxyrnf, MSN, RN]

Slam the drugs, knock him out, and do the surgery anyway.

It's for his own best interest, ya know?

[akulahawkRN, ADN, RN, EMT-P]

I had a similar-ish patient tonight. Patient needed a drug that would have made the patient feel better. Patient didn't want the drug because of the side effects. Patient was educated regarding benefits and risks of the medication. Pt still refused. Patients was competent, therefore patient is allowed to make that decision to patient's benefit or detriment.

In short, once you've educated the patient, the patient can make some seriously dumb decisions (from our perspective). Just remember to document the heck out of it...