Today at clinicals in the etended care facility, I had a resident refuse "skin prep" to her heels. She was in the hall in a wheelchair. She didnt just say "No" , she screamed that she did not want it,while planting her feet firmly on the floor. Tried explaining what it was for, that it did not hurt, would only take one minute. I tried.
NO!!!!!!!!!!!!!
Charted in the TAR her refusal. Told her nurse. No problem.
Husband comes in in the afternoon. She tells him we tried to force her into it.
Clinical Instructor informs me that the pt does NOT have the right to refuse "cause she isn't in her right mind." And I could lose my licence for "not doing the treatment".
I told her exactly HOW she refused. Practically kicking and sceaming. Literally.
She says, "Doesnt matter. Just do it quick."
Isn't this against the law?!
The pt remembered well enough what happened that morning, to tell her husband about it in the afternoon. She fully understood what I wanted to do.
But "She doesnt have the right to refuse" ???!!!
HELP !
One of us will have her again tomorrow morning!
And if she refuses again, our instructor will try to force us to do it anyway .
Perhaps someone with experience can expand on this idea but I know in psych facilities a patient has the right to refuse any and all treatments until a court order is in place. So if there is no court order and she is refusing and you document it... It's not like heel treatment is a life threatening condition. I'm hoping someone who has "feild" experience can comment as I'd love to know.
Specializes in LTC,Hospice/palliative care,acute care.
In LTC a competent resident has the right to refuse treatment but we have to figure out why they are refusing and come up with some way to encourage them to accept it. And then we write page after page of documentation. When dealing with an in-competent resident you have to be crafty -approach and re-approach as if it is a whole new day.I try to do all of my feet and leg treatments before the resident gets out of bed.It's more comfortable for both of us and saves time when you don't have to do the socks and shoes dance.Try applying the skin prep first thing in the am when she is still in bed.
In LTC a competent resident has the right to refuse treatment but we have to figure out why they are refusing and come up with some way to encourage them to accept it. And then we write page after page of documentation. When dealing with an in-competent resident you have to be crafty -approach and re-approach as if it is a whole new day.I try to do all of my feet and leg treatments before the resident gets out of bed.It's more comfortable for both of us and saves time when you don't have to do the socks and shoes dance.Try applying the skin prep first thing in the am when she is still in bed.
The CNAs already have many of the residents up and out of bed by the time we hit the floor for clinicals, and we have 60 residents to do treatments on .
It could just be that I was someone she wasent used to, and it was out of her routine to have it applied while she is already up for the day.
The concern that I had was that I was being told I had to FORCE HER into the treatment while she was screaming "No" . That she had no RIGHT to say no.
And I was in no way comfortable with that. It was not life threatening in any way.
I explained what it was, what it was for, and was going to take her to her room to apply it. That is when she began to scream and firmly plant her feet on the floor, so I could not wheel her into her room.
This was in front of the nurses station in front of other residents and family. My instructor wanted me to forcibly take her to her room and apply it, even though she had screamed "No".
She said she did not want it, she did not need it, her feet were fine. And yes, I did explain this was to help keep her heels healthy.
thanks for clarifying....nope, no tx for this patient, at that time....even if she is "not in her right mind" which isnt for a nurse to say.....the emotional distress isnt worth it.......
If I had to follow the instructions of the clinical instructor vs the nurse, I would pick the nurse.
The clinical instructor is a guest in the hospital and should NOT be overriding the decisions given by the nurses that performs regular care.
That is a horrible situation for your clinical instructor to put you in. She should have handled that situation by consulting with the nurse before instructing you further.
I don't do anything if the patient refuses...just document it. I would report the instructor. My rule of thumb is, if you don't feel comfortable with something...don't do it. I was in clinical in a nursing home, and witnessed things that the CNA's were doing that was inappropriate. I reported them- in a professional manner, and am glad I did.
I'm with everyone else here. As a LPN in LTC, I have had that happen. You try to approach it a few times and if they still refuse, let the charge nurse and/or nurse manager know. The regular staff may be aware of tips or tricks that might make this resident open to the treatment. But utimately it is up to the charge nurse to decide what direction to go in, not the instructor.
that is wrong. When I was working in ICU we had to give bed baths at night and there were some patients who refused to be bathed at 3 am and I can't say that I blamed them. I told the nurse the pt refused a bath and I still got wrote up for not giving the patient a bath. This patient was not on a vent.
Well, as an RN student, I would absolutely NOT go along with the instructor in the same situation. I would have asked the CI what determined that the client was "not in her right mind" besides the CI's own judgement. I'm fortunate that my instructors so far have not asked me to do anything that could be detrimental to my education and our school's reputation with the medical community. Any of the instructors we have had would have told us to discuss the matter with the charge nurse or a staff nurse. They know the client's history and the CI and students are visitors (I'm lucky if I get to stay somewhere long enough to remember where most items are in the clean supply room). Hospitals in this area are not always receptive to students and the instructors want us to shine at clinical so that the school-hospital relationship is strengthened. Good luck!!
Your clinical instructor knows better. And if she is proposing that you go against someone's refusal because they are "confused anyway", she is still wrong. You pointed out that the resident was clearminded enough to relate the incident (the way she wanted to present it) to her husband later on that day. Caregivers in facilities that go ahead with treatments/procedures/meds with residents that are not cooperative do so with residents that really are confused. And that does not make it right. It just means that they do this with people who are not likely to be able to complain about something. Everybody has the right to refuse. Sounds to me like this resident was plain and clear about what she didn't want. You should suggest to your instructor that she show you how to convince the resident to allow the treatment.
Oh, and as for CI's having it all together and teaching us the right way to do things: The CI that I had who was a gem in the eyes of the devil, suggested to me that I steal needles and syringes to practice injections at home. She said that was what she did. Fortunately for me I was wise enough not to follow her advice. I imagined what would happen if I had been caught stealing them or otherwise caught with them in my possession. Instructors have an obligation to provide legal and professional instruction to students. Unfortunately, not all instructors are good instructors.
This should be up in every LTC facility you come across.
The pt has the right to participate in plan of care including RIGHT TO REFUSE. Ask an employee where this is located as it must be in an open area and if the instructor tells you to do it, ask about the resident's bill of rights.
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tothepointeLVN, LVN
2,246 Posts
Perhaps someone with experience can expand on this idea but I know in psych facilities a patient has the right to refuse any and all treatments until a court order is in place. So if there is no court order and she is refusing and you document it... It's not like heel treatment is a life threatening condition. I'm hoping someone who has "feild" experience can comment as I'd love to know.