Patient's right to refuse

[julz68]

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

[brai9284rn]

I had a patient recently that was pretty similar. She had some abdominal surgery, which I understand is very painful. Everytime that any of us would come into the room to get her to the toilet, bed, chair, etc, she would cry and whine. She wanted to refuse everything. Did not want to do anything. But we still just pushed her to do stuff and reminded her that we couldn't let her go home unless she could do things for herself. She had come in for a rectal prolapse surgery and had sat around her house in dirty underwear for days before coming in for surgery. Sometimes I find that you just have to make them do things and not give them a choice.

[Vespertinas]

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.

Restraints! He is putting himself in immediate danger/at risk for serious injury by repeatedly ambulating without assistance despite numerous attempts to correct this behavior. (this is of course assuming that other interventions like bed alarms and a sitter would be unsuccessful too and obviously they would be)

Hahah if only it were so easy.

But seriously... someone like management should be taking this more seriously because the whole fall situation is going to be one heaping pile of dog poo that someone will wish they didn't have to deal with. At least consider a behavioral contract or consult with PT for more creative solutions.

[nurseprnRN, BSN, RN]

If he doesn't want nursing care, he can be discharged. If you read any health insurance policy, including Mcare, it covers hospitalization for nursing care (not doctor care). If he won't accept it, he should be discharged. Tell his physician to explain it to him and see if that changes his tune.

[DeeDee_RN]

I agree if he wants to refuse absolutely everything then he can be discharged. It is very frustrating to have patients that want to refuse (and sometimes argue) everything! I always wonder why are you here, if you just want to do whatever you want against the advice of healthcare workers then go home and do whatever you want!

[turnforthenurse, MSN, NP]

If he doesn't want nursing care, he can be discharged. If you read any health insurance policy, including Mcare, it covers hospitalization for nursing care (not doctor care). If he won't accept it, he should be discharged. Tell his physician to explain it to him and see if that changes his tune.

That is a very good way of putting it. But it makes sense. I remember I had a patient who I admitted, a lot of psych issues, but came in with SOB and severe hyponatremia. Came up on a 100% NRB but we were able to wean down to a venti mask. The patient had an IV but pulled it out just before coming up to me and the ER nurse said, "I think it's better off that we just get the patient up there." So here they are and I had to explain to them so many times that they needed an IV and WHY they needed it - the doc ordered a bunch of IV abx, too. The patient was c/o pain and kept asking for medicine and I told them I couldn't give it to them unless I had that IV. So they agreed, and as soon as I would try to start it, they asked, "what is that? what are you doing? why do I need it? I don't want that."

They refused AM labs, even after I told them that we needed to draw their blood because how would we know if they were getting better? Their response: "I don't know but I don't want any of that stuff done. They already got my blood, that should be enough." Well you know what? Just leave. If you're not going to let us do what needs to be done then why are you here? You're just wasting a bed that we may need for another patient. Ugh.

[Vespertinas]

You're just wasting a bed that we may need for another patient. Ugh.

Remember, you said "a lot of psych issues"

You'll hate me for preaching but please try to still be compassionate to people like this. They're not trying to make life difficult for you and ultimately, they're making life even more difficult for themselves so you understand they're not thinking rationally.

[morte, LPN, LVN]

Yeah, a little iv lorazepam sounds like a good idea....maybe more than a little.

[Vespertinas]

Nah. I've had trouble getting treatment for autonomous patients with MR. No lorazepam for that. It's so sad seeing them walk out AMA knowing the trouble they'll have ahead.