Pulling G tube?

[jschut]

ADult child gave ok to have tube placed after parent had a stroke.

Now, child is insisting that it be pulled on patient who is alert and oriented, and learning to eat again PO. Pt also walks, is continent of bowel and bladder, and talks (although with slurred speech).

Child does have POA and is healthcare POA.

Is this allowed to be done? Puling the tube, I mean?

Patient very tearful and afraid after child visited, and patient confided in a nurse (although begged nurse not to say anything to the child). Is there anything the nurse can do?

Is there anything anyone can do?

[jschut, BSN, RN]

I don't think that the child is "giving " them anything, per se, it's just the way that the patient is treated and talked to that throws her into a state of disorientation (upset, spacing out, hysteria...).

The last conversation known (to me) was after the child left, and the patient began to sob and told me that, "*** wants me dead." and " My own *** wants to kill me!" Then in the same breath begged me NOT to tell the child.....

[Jolie, BSN]

The last conversation known (to me) was after the child left, and the patient began to sob and told me that, "*** wants me dead." and " My own *** wants to kill me!" Then in the same breath begged me NOT to tell the child.....

Document, document, document. Then call APS.

[Batman24]

Just to echo some others you need to get others involved TODAY. Get your supervisor, the doctor, social worker, ethics committee, hospital lawyer/risk management involved NOW. I ditto calling APS immediately as well.

The POA doesn't override a conscious patient with his full faculties. The son is completely and utterly out of line and needs to be told that at once.

This man is abusing his father and your patient is vulnerable and scared. I wouldn't even let him in the room again until this situation is rectified. I wouldn't leave the son alone with the father for one second. See if other nurses, your supervisor, the CNAs can help you both out and stay in the room when he is there.

And DOCUMENT everything and then document some more. I would also call security if needed. This patient should feel safe and not fear dying by the hand of his son while in the hospital. What the hell is wrong with some people?! Dear Lord.

[CoffeeRTC, BSN, RN]

Based on the information you've given here, it sounds like the patient is fully aware of the implications of pulling the tube and has expressed a clear desire NOT to have it done.

A healthcare POA is used only when the patient is incapable of understanding and expressing his/her own wishes. The child doesn't get a vote in this situation.

Please clearly document your interactions with the patient, notify the physician, consult social work and call the ethics committee, and if that doesn't work, consult adult protective services.

Yes!!!!!

The pt is still aware and able to express their own wants and needs. Who cares what the POA wants now???

[stalsrn]

As a former social worker and APS worker I can say that all the advice is correct in this instance. The pts child will need to hire a lawyer at his own expense if he wants the tube pulled. He can try to have his parent deemed incompetent to make own decisions by a judge in a court of law. Even with a POA, if the pt does not have specific instructions then the court may have to be involved if medical and social work professionals deem that the POA is making irrational decisions. Your license may also be at stake if you go with the POA and it is later determined the pt was in fact competent to make own decisions. Definetly get your supervisor involved as well as the social worker and MD.

[burn out]

I question the competency of the patient. If the patient can express their concerns of having the tube removed would they not be competent to make their own decisions and thus nullify the state of the medical power of attorney. On our medical surrogate forms in the hospital it is explicit and states that when the patient can make their own decisions the surrogate will no longer be bound ..is that not so with MPOA?

[leslie :-D]

we don't know if the pt has a psych dx comprised of paranoia, delusions.

i would think that would be a factor re capacity to make competent decisions?

leslie