Pt refusals

Nurses General Nursing

Published

So I had this post-op pt who absolutely refused to do anything. No ambulating, convinced the PA to let them keep their foley. All the while screaming "I know my own body!!"

I told them in gory detail all of the complications of refusing to move at all, I cajoled, I demanded, I sent comrades in arms. The pt absolutely refused to budge an inch. I finally convinced them to at least wear their teds and SCDs and to use their inspirex. I gave the heparin and made them move to one side or the other every other hour. Ibasically did everything in my power to prevent all of those complications.

How much do you want to bet that the pt will go home complication free and say "I told them so!"

different when its a child. you can take that to the ethics committee.....or to the courts

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Patients do have the right to refuse. I just try to educate and discuss the rationale behind the treatment. If they still refuse, then document, document, document! (not to mention pass on to the attending physician)

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Specializes in Case Management.

Sounds like you would breath easier if Mr. Knowshisbod throws a clot, so you can say . . .

Told you SO!!!!:thankya:

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Specializes in Surgical, quality,management.

It is the elective patients that resist that frustrate me more. You knew that you were going to have surgery, pre admissions advised you of what would happen.

Don't be surprised that it hurts when we cut your belly open..............of course it is going to hurt. and yes you need IVs and bloods. We are not doing for fun but to help get you home!

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Specializes in PACU.
Altra, I wish nurses could say stuff like that. If I said that to a patient at my facility, I would be fired.

That's sad. Your facility would fire you for providing honest education regarding the importance of ambulation, deep breathing, and so on? Motivating the patient is key to education being worthwhile. I can't think of anything much more motivating than avoiding unnecessary transfer to a nursing home.

Patients should certainly be treated with dignity and respect, but if they're going to make seemingly poor decisions they need to be educated thoroughly and truthfully regarding the potential implications. It would be truly tragic for someone to make a life-altering decision without being aware of the ramifications. Any barriers to compliance should be considered and addressed as possible. If pain is a limiting issue, perhaps the patient requires a modification to the pain management regimen.

I can't say I've warned someone about possibly ending up in a nursing home, but I'm not with them far enough post-op that it would be a consideration yet. I do, however, frequently warn patients regarding their increased risk for pneumonia and pulmonary embolism (and yes, even death) if they don't get up and move as soon as possible.

To address the patient satisfaction score issue, a nosocomial pneumonia or pressure ulcer is going to look a lot worse than a little less satisfaction. And affect the bottom line more. The key is to be tactful, but honest with the education. If you can make the patient realize you're only being a little "mean" because you truly care and want him to get better he can still likely be "satisfied."

That said, there are definitely those people who'll never make rational decisions nor be satisfied even if they receive optimal everything. I find the thing to do with those folks is just smile, do what needs to be done, and move onto someone who wants the help and who will benefit from it.

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Specializes in Adult/Ped Emergency and Trauma.

DOCUMENT DOCUMENT DOCUMENT,. . .

God Help Us.

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Many patients are not auditory learners and I can tell them something repeatedly, but often it does not result in a change the patient's behavior. However, when I use pictures or diagrams of potential complications, it often results in patients gaining a clearer understanding of and the motivation to prevent secondary complications.

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Patients do have the right to refuse. I just try to educate and discuss the rationale behind the treatment. If they still refuse, then document, document, document! (not to mention pass on to the attending physician)

They do, to a certain point. If their refusal can lead to serious complications of death of the child, we have an ethical and professional obligation to step in. Children have some rights too, that sometimes supersede the parents'. It's why we have DHS and mandatory reporting of abuse, and why there is a legal infrastructure in place for handling parental refusal of lifesaving care for their children. In my experience involving social work and some blunt education with the parents and addressing their fears about the proposed treatment is often enough to get consent.

And OOPS. I got to the end of my comment and realized you were talking about patients not parents. DOH. I agree with what you said in that case!

I need some coffee stat.

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Specializes in GICU, PICU, CSICU, SICU.
I am not sure why all the worry. Teach them, if they refuse, document. If they die, shame on them. Move to next patient.

I don't often agree with you mindlor but this time I do. And thank god we work in an environment were we can say these things to patients.

Some patients react very well to a shock effect. I once said to a patient that refused any and all care that to me it doesn't matter if he lives or dies. I don't get payed per patient and at the end of the month I have my salary regardless of what happens with him. But I suggested it could be in his best interest in doing his best to comply to our advice since it should probably matter to him and his family if he was dead or alive. He promptly started to accept care and got well in the end.

An interesting discussion in our ethics session a few weeks ago was if we should continue to treat complications if an alert and oriented and cognitive fully able individual refused preventative measures.

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Specializes in Case Management.

Handing out LOVENOX for these lazy idiots.:devil:

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"way back when..." Patients often didn't get to refuse.....but their families were more likely behind the doc/nurse then the patient, so no likelyhood of a suit....

For the seasoned nurses....

Was there a time when most patients were less likely to go against doctors' orders? It seems like the anthem nowadays is me-me-me-my-choice-customer-is-always-right, please the patient to get Press Ganey scores up etc. etc.

I am wondering if there was less of that mentality back then when it came to refusal of the plan of care.

Thanks.

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We had a Trisomy 21 kid going into CHF, the mom refused to give a dose of lasix until she researched, then once she was done she comes and refuses to give the lasix until we got a Magnesium level. Apparently lasix can lead to low Magnesium in a Downs kid. I wanted to tell her that's nice, but CHF will KILL your child before that Magnesium level gets back if you don't let me give the beaver dam lasix!! (And ironically, she didn't care anything about the potassium level.)

I love how people consider Googling to be good "research." Drives me nuts. I wish I could have smacked every patient who has come into my preceptor's office citing Jenny McCarthy as a "source" in the whole I-think-vaccines-cause-Austism-But-I-Never-Bothered-To-Acknowledge that Wakefield made-it-up-and-no-longer-is-allowed-to-practice-medicine.

Call me crazy, but I don't consider PlayMates of the Month to be scientifically credible. :nono:

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