Respecting pt's wishes vs doing what's best

[HappyNurse2005, RN]

Chronic vent dependent pt. alert and oriented. came from nursing home, already on vent. extremely limited mobility-can't turn and reposition self.

When ask pt if she wishes to be turned "Mrs XXX, are you comfortable, do you want to be turned on your side" she shakes her head in such an emphatic "NO" that there is no doubt about it. Document.

Pt later refuses bath. Continues to refuse turning even when told that she will get pressure sores on her bottom/back, etc.

I documented this and told the doctor,too. I figure that being alert and oriented, she has a right to say whether or not she wants to be turned. I was also very sure she understood b/c she answered all questions appropriately, mouthed words, was able to rate her pain,etc so there is no question of whether or not she understands.

Another nurse told me I should have made her turn. She's not big, so it wouldn't have been difficult, and she's not strong enough to resist. I told said nurse that she didn't want to. She still said that I should have gone in there and done it anyways.

What do you think?

[Antikigirl, ASN, RN]

Geri psych consult for depression sweety! Lets get in a pro to find out the foundational probelm with her emotions and personal view of the situation. It has done wonders for my pts and the people that care for them!

Also, with the bath thing...sometimes letting a pt choose times and products is helpful! Like getting a nice bath basket of their favorite product to use, a nice robe, and make it a nice relaxing experience. I typically will have family help with this by getting the necessary products and put it into a nice waterproof basket or tote so they feel family involvement too :).

Turning is much harder, but I have gotten around this some times by getting a body pillow of their choosing with a nice material pillow case they like. Some like flannel, some velvet..stay away from the silks because they fly off a bed fast, or body parts slip off the pillow.

Try to get her insite on what would be most comfortable for her, give her some power of choice in the right proactive direction, and make it a part of her care plan! :)

[KellieNurse06]

A nursing instructor who taught me well gave us a little way to handle situations just as this very one......you don't give the option of yes or no..you would give the option for example for a shower..." would you like a shower at 9am or at 11am?" Not "would you like a shower or not" ....it really does work because they are given a choice AND they feel like they are in control...........Imagine how that poor woman feels...depressed????? To say the least........she was probably independant and now she relies on everyone for her care...not to mention being tied up to a vent ...............maybe see if she can get a small vent if she isn't already using a small one...............they make some that are the size of a laptop computer...........how great would that be if someone could walk or wheel themselves in a wheelchair that had a small vent like that..or carry it in a backpack like thing for more independence.........I personally have never seen anyone who has a vent that has been independently mobile.........but I am sure there are some who are due to some type of pulmonary issues.............that would be interesting to see if there are any who do use them and are mobile....hmmmmm:idea:

[begalli]

When ask pt if she wishes to be turned "Mrs XXX, are you comfortable, do you want to be turned on your side" she shakes her head in such an emphatic "NO" that there is no doubt about it.

I would personally sit down at the bedside of this patient and go over the plan of turning with her and allow her some input. I wouldn't really give her the choice of whether or not she gets turned but I would give her some input.

I may be nit-picking or taking this too literally, but when she shakes her head NO is it in response to "Are you comfortable?" Or is it in response to "Do you want to be turned?" Those are questions that should be asked separately and and enough time for her to respond to each should be provided.

I agree with the psych consult.

While this patient is being asked so many questions and she's responding and alert, has anyone ever taken the time to ask those hard questions about whether or not this is the way she wants to exist?

[TazziRN, RN]

If she's that emphatic about not being turned, has anyone asked her WHY she doesn't want to be turned? I'm sure she's been told the rationale until her ears are numb, but if she doesn't want to be turned, she might have what SHE feels is a valid reason. Maybe she's afraid that if she's turned the vent tubes might disconnect accidentally? Maybe this has happened in the past so she's afraid of it happening again? I agree with not giving a Yes or No choice, but when the pt does say No, you need to find out why.

[HappyNurse2005, RN]

I personally have never seen anyone who has a vent that has been independently mobile.........but I am sure there are some who are due to some type of pulmonary issues.............that would be interesting to see if there are any who do use them and are mobile....hmmmmm

by independently mobile, i mean they can shift themselves in bed, pull themselves over, etc. We have had vent pt's before, some with enough upper body strength to pull themselves over, some who were quite strong but needed assist getting up, etc.

may be nit-picking or taking this too literally, but when she shakes her head NO is it in response to "Are you comfortable?" Or is it in response to "Do you want to be turned?" Those are questions that should be asked separately and and enough time for her to respond to each should be provided.

She is asked separately. I was summing it up for the sake of posting.