Patient's right to refuse

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So last night, I had a patient who was refusing EVERYTHING! He hadn't had a BM in days, but was refusing his lactulose because "It doesn't work, so why take it!"

I checked to make sure he wasn't taking it for increased ammonia levels first, in which he w

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Oops!

He wasn't. It was just for constipation. So fine, I didn't give it.

But, he also refused the gait b

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...gait belt for transfers. He was very unsteady and was pulling on me every time. I couldn't get him to help me to help him the safe and right way! I asked my CN and she just said to document it and let him refuse. But what if he falls? Does documentation cover my butt?

I'm just really nervous about this. I will have him again tonight..

I'm still very new and don't know how to go about this.

Sorry for the premature posts...my phone is acting up!

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I let them refuse meds, but I will not be walking somebody who doesn't follow the rules. It's his safety and yours on the line. If you won't wear the belt, I cannot help you.

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Specializes in Hospital Education Coordinator.

I agree with SaoirseRN. The rules are there to protect both the patient and you. You will be held to a higher degree of responsibility than the patient because you did not follow policy and you should "know" what is best for the safety of the patient and for you. The patient can always say, well I am not a professional health care worker so I am not responsible for my decision. At the least, you do not want to injure yourself and should tell the patient that, as well. If he wants to meet goals and go home faster, he needs to do as requested. Otherwise I would document that he refused therapy. Someone, like a case manager, needs to talk to MD

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Specializes in LTC Rehab Med/Surg.

First of all, I think I've been a nurse too long. A pt can refuse anything, and it just doesn't bother me. You don't want to use your IS post op, and you're running a low grade fever? Ok.

You don't want to be awakened at 0300 for your HHN tx and your sats are 86%? Ok.

You don't want to be turned and the stage 2 decube is racing towards stage 3? Ok.

I do pt teaching extensively. I chart that I informed pts of consequences of their choices. I just don't worry about those consequences anymore.

Charting refusal well, will save you legally. It comes down to how YOU feel morally. As awful as it sounds, a pt's condition worsening because they make bad choices simply doesn't bother me anymore.

You almost HAVE to build some kind of protective barrier emotionally.

You can't save/help people who won't participate.

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Specializes in Hospital Education Coordinator.

I also agree with imintrouble, BUT the OP has to protect him/herself legally. Just saying the patient refused may not be enough, if the patient or family comes back later and states they didn't realize the implications of what was being requested. Document carefully and with the advice of the risk management officer

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Specializes in Psych ICU, addictions.
I also agree with imintrouble, BUT the OP has to protect him/herself legally. Just saying the patient refused may not be enough, if the patient or family comes back later and states they didn't realize the implications of what was being requested. Document carefully and with the advice of the risk management officer

Agreed. The OP needs to educate the patient on the risks of refusal...and then document that they educated the patient on the risks of refusal and that the patient verbalized understanding of said risks.

It goes without saying that your charge nurse and the patient's provider should also be made aware of any refusals.

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Thanks for the replies :)

I did let all the appropriate people know of his refusals, tried to educate him and I documented the crap out of each instance.

The thing about telling him I won't help him unless he follows the rules will not work. He will get up on his own...in which he then will most likely fall.

He is rude, nasty, verbally abusive and says he will do whatever he damn well pleases. He really tested my patience last night. I tried to be the best nurse I could, but you can only take so much. I was so happy to see 0700 roll around!!! But now, I'm dreading 1900...! At least this is the last of my 3 night stretch and I have a few days off in a row. :)

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This is going to sound mean, but if he wants to grab onto you instead of using the gait belt, both of you are going to get hurt. I've had several co-workers seriously injured because an unsteady patient began to fall and clutched at the nurse as he was going down. Don't let him touch you. Your back and arms are too important to risk. You can't make him do the safe thing; some people just have to learn the hard way, and if he ends up getting hurt, that's his choice.

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This is going to sound mean but if he wants to grab onto you instead of using the gait belt, both of you are going to get hurt. I've had several co-workers seriously injured because an unsteady patient began to fall and clutched at the nurse as he was going down. Don't let him touch you. Your back and arms are too important to risk. You can't make him do the safe thing; some people just have to learn the hard way, and if he ends up getting hurt, that's his choice.[/quote']

No, that doesn't sound mean..you're absolutely right.

Last night he wanted to get up and use the bathroom and tried to pull on me, got very angry when I refused do let him do so, (I'm 5'2" and he's 6'5") and I ended up pulling the bathroom emergency light for help AND paging security.

What goes through these patient's minds that it's OK to grab and pull on nurses? It's just so frustrating!

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I guess I should add that he was being verbally abusive again and threatening physical abuse...that is why I called for security.

Just didn't want you all to think I was overreacting because he wanted help getting up. Ha! :)

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