Refusal of treatment in nursing journals

[hajordan]

Hi everyone,

I am currently doing my post grad diploma in critical care and I need to focus on an episode of care I gave of a cardiac patient.

This particular man had been diagnosed with dilated cardiomyopathy, and was prescribed the appropriate medications and follow up. However, he decided to go down the natural remedy route (I'm struggling to write this without any bias!) and consequently he ended up in hospital in end stage heart failure, and required a dobutamine infusion. (Don't get me wrong, natural remedies do work, I just wish he'd picked another part of his health to try it out on...)

Has anyone come accross any good journal articles that would reflect that kind of refusal of treatment? The only articles I'm able to find are in regards to Jehovas' Witnesses, and if possible, I'd like to stay away from the religious belief reason for refusal articles.

Thanks!

[twozer0, NP]

I didn't do a journal search but I'm sure that particular area is in very limited quantity if any. Jehova's witness will have some because they are a religeous belief in which they refuse blood products. Due to them being a religeous belief, it encompasses more than just opinion or morals of one person, much like what you talked about the gentleman having the cardiomyopathy. If its not tied to a religion, race, creed, or something more than just personal preference in a population, it likely hasnt been researched!

You may be able to find a qualitative survey and thats probably the best you'll get. At any rate, good luck in your research, I'de actually like to know if you find anything!

[dishes, BSN, RN]

The patient didn't refuse treatment they chose alternative/complementary therapy, whether their choice was fully informed or not is questionable. Look for articles on the medical/nursing ethics of alternative therapy, also statistics on complementary therapy. Also, look at the code of ethics and nurses ethical responsibilities 'nurses respect the informed decision making of capable persons including choices in lifestyle and treatment not conducive to good health'.

[cayenne06, MSN, CNM]

It is haaard to watch the patients we care about decline treatments that could seriously benefit them. poke around on sciencebasedmedicine.org. Some really good discussions about the ethics involved in situations like this. I might choose to focus on what other health care "professionals" that patient may have sought advice from, and how that impacted is relationship with his primary medical team and his decisions regarding treatment. Lots of juicy ethics there.