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Discussion

Pt not allowed to refuse care?

I work in LTC doing wound care. We have this very cantankerous patient that came in with a small wound to a lower extremity. He is well known for verbally abusing many staff members (especially non-caucasions). On numerous occasions Ive gone in to do his wound care only to be verbally assaulted, called ungodly names and sent out with a big fat refusal to perform his care. He also refused meds, showers, baths, weights, and vitals. Well, without regular treatments to that wound it began to deteriorate and he of course blamed the facility. He called the 'state' with allegations of neglect. Would you believe, that although we had documented his refusals out the wazoo, his allegations were still found to be substantiated!! This man is completely alert and oriented, his own RP in fact, but because he has a dx of schizophrenia, we are not to allow him to simply refuse. Now I must go in and offer to perform care for him when he refuses I must leave and come back within 2 hours to offer it again and accept whatever verbal assaults he throws at me for bothering him again. When he refuses that time, I must ask another nurse to attempt. When he refuses that person we must contact administration at home if need be to come in and convince him to accept care. This is the only person we do this dance for because he caused that big stink with the state. Any other A&O person is allowed to refuse care, its their right, right? Is it just me or does this happen in other facilities? I feel like its a waste of my time trying to convince one person to allow me to care for him when there are so many more that want and need my help.

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    i'd really like to know why investigation was substantiated.

    there has to be more to the story.

    leslie

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    • Author

    The investigation was substantiated because they claimed we were not meeting this patients "psycosocial needs". When they interviewed the staff, 90% of them quoted the exact same line....."I only go into Mr.X's room if I absolutely have to,I do whatever he needs and I get out of there quickly". Its not that anyone was intentionally neglecting him but he was so rude and mean to the staff that no one went out of their way to offer anything more than what he asked for. Of course the aide would go in and offer a bath/shower, but once he refuses that aide would move on the other 10 people she had to care for that day.

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    Schizophrenics can refuse their psych meds but they cannot refuse their care? Something is wrong there. I think, for your facilities sake however, you need to find a way to get that patient out of there. If he is refusing to be treated or monitored in your care, you guys are still liable for complications especially if it ends up is sepsis/death!

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    sounds like he needs a psych referral!

    We had a man with advanced MS, wheel chair bound, who would just refuse to go to bed and re position him self. So what did this one nurse do???? Let him stay on his but for hours on end. And low and behold he developed on nasty stage 4 and one nasty stage 3. Once they healed up a little he was only to be up for one hour at a time twice a day. Usually it was mid am and late afternoon. Well one eve he didn't want to go to bed, he wanted to stay up and watch the game. So by hour three when I took over for the nurse my first priority was to get him to bed and change his dressing that some how that nurse just couldn't find time between yelling at the LNA's and smoking to change his daily dressing change.

    Yes, I think to a certain extent people can refuse, but then it gets to a certain point when they can't. And you can educated them till you are blue in the face as well.

    Oh, that man, when I rolled him over to change his once daily dressing change, there was the nice lovely dressing I had put on 3 days ago. Some how, no one found the time in three days to do this. The supervisor was with me and had the DNS on the phone as soon as we were done. He ended up dying from sepsis with in a few weeks.

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    Schizophrenics can refuse their psych meds but they cannot refuse their care? Something is wrong there. I think, for your facilities sake however, you need to find a way to get that patient out of there. If he is refusing to be treated or monitored in your care, you guys are still liable for complications especially if it ends up is sepsis/death!

    I did an ethics paper on this very subject. And yes, if you've built your castle in the sky and moved in, then yes in Vermont you can refuse any and all medications to help you get better, that is unless you are posing a danger to your self or others, then that falls under a different set of regulations and paperwork.

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    I did an ethics paper on this very subject. And yes, if you've built your castle in the sky and moved in, then yes in Vermont you can refuse any and all medications to help you get better, that is unless you are posing a danger to your self or others, then that falls under a different set of regulations and paperwork.

    This is what happens when we let the stupid people make the laws. Nursing now a days is all about CYA (Cover Your A--you know what) and is getting less about patient care. UGH UGH UGH!!!

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    • Experts
    The investigation was substantiated because they claimed we were not meeting this patients "psychosocial needs". When they interviewed the staff, 90% of them quoted the exact same line....."I only go into Mr.X's room if I absolutely have to,I do whatever he needs and I get out of there quickly". Its not that anyone was intentionally neglecting him but he was so rude and mean to the staff that no one went out of their way to offer anything more than what he asked for. Of course the aide would go in and offer a bath/shower, but once he refuses that aide would move on the other 10 people she had to care for that day.

    That is one smart old coot......:lol2:. I probably shouldn't think it's funny but I do.....he is one smart manipulative old dude...:rolleyes:.

    Ok, first the law. The lovely staff substantiated the claim BECAUSE when interviewed "90% quoted I only go in Mr.Sly foxes room if I absolutely have too.......and I get out of there quickly" Therefore affirming this old coots accusation, "They don't help me", "They are in and out so quick I'm not getting what I need...I have schizophrenia you know and I just need more time...I get confused when I'm hurried":rolleyes:. This guy has been in the system a long time and he knows how to work it to his advantage. He reported the facility because you wouldn't leave him alone and do it his way. With new medicare regulations his non compliance can get him denied claims so he blamed the facility, now the facility pays the bill. What a hoot....:smokin:.

    Now, technically, you aren't doing anything against his will by repetitively requiring multiple attempts and people to beg this guy to bathe and accept care. This sounds to me like a corrective action taken with the State to placate them and document what a bean head this guy is....unfortunately his schizo dx protects him even if he is A&O. giving care against his will would consist of forcing him to bathe by throwing him in the tub or hosing him off while he refuses care and yells for help.

    :hug:...I know this is frustrating for you and I must say admirable for the facility for their dedication to the action plan. Just Offer, document, offer document, and follow the treatment plan. You don't want this jerk getting your license revoked because he says you are negligent. It's funny against the facility, but it's not so funny against you.......:redbeathe

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    BTDT...Do what you need to do...ask, if refuses educate and return and ask, get the other nurse and of course call the DON at home if that is the policy that they want to follow. Are they able to get him to accept the care?

    Since he has the psych dx...they should be in on getting a plan together for him.

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    I say let the state come in and give him his bath and wound care - call them every time he refuses.

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    Don't forget to document all these refusals. Of everything.

    8:00am. "AM care offered.. Resident refused."

    9:00am. "Refused 9am meds"

    9:30am- "AM care offered again.. Resident refused."

    11:00am- "Refused dressing change to right foot."

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    Also need to be sure there is a psychiatrist (not the admitting doc) who has declared this guy able to act on his own rights, even if he is his own RP. A personality disorder dx wouldn't hurt either, if he can substantiate one.

    What a mess. We had some schizophrenics in a couple of LTCs I've worked at, and most were great since they got their meds. Once in a while we'd have someone get loopy- but it didn't last long.

    I'm sorry you're having to put up with this....such is the outcome of "mainstreaming" mentally ill patients who truly need pure psych care...and a psych hospital can change a dressing. :up:

    :twocents:

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    • Experts
    Don't forget to document all these refusals. Of everything.

    8:00am. "AM care offered.. Resident refused."

    9:00am. "Refused 9am meds"

    9:30am- "AM care offered again.. Resident refused."

    11:00am- "Refused dressing change to right foot."

    You also need to explain the risks and document what you said, every time.

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