RN ethical dilemma

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As an RN for the California Dept. of Mental Health, if a patient decides to refuse treatment (i.e. refused lab draws, Hep C treatment, dental work, ECG, EEG, ect...), we are being required by the Dept. of Mental Health to attempt to change the patients mind via education on at least a monthly basis. Is this ethical and if not, where can I find the info to substantiate this.

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Specializes in Family Nurse Practitioner.

Personally I don't think there is anything unethical about educating and urging patients to consider basic health care for an improved state of health.

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Specializes in Critical Care & ENT.

Seems like this should be a standard practice even if the patient has a documented mental health history or not. Seems like there should be a declination form that they sign saying they refuse treatment. I'm sure if they have something that is highly communicable such as active TB in their lungs, there would different guidelines.

The goal of patient education is to help the patient make an informed decision about their health care. All patients should have a choice (with a few exceptions) on how their care should be directed. This is probably an attempt to cover the organization because something may have happened in the past that did not work out in their favor?

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As long as it stays patient education rather then patient persuasion I think it is ok.

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Specializes in Psych ICU, addictions.

There is nothing illegal or unethical about educating a patient, even in mental health...if anything, they're one of the patient populations who need it the most.

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I don't think this is unethical, especially for mental health patients. Sometimes it takes several sessions for things to sink in, or behavior to change. They may be in a clearer frame of mind the next visit, and covering a topic again, briefly, is part of pt education. Just don't let it doesn't turn into preaching!

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It's just like smoking or anything else that you have in your career. You know that your ed is PROBABLY not going to change their minds. When I go in to a person that smokes or is an alcoholic, I usually ask them (in a bit nicer way) if they are receptive of what I'm trying to educate them on. If they don't, I tell them they are able to refuse anything they desire. If they say, "Yeah I'm not really interested, then a big fat "DECLINED (or) REFUSED EDUCATION" is placed on my ed logs. Saves time, and if it's not going to help someone that isn't interested to stop smoking, so be it. You're not going to change a persons mind by repeating what they already know. Also, if a person is not interested in change, you're wasting your time and theirs (and vice versa).

I don't think it's unethical at all, btw. Every time a person comes into the hospital, even if their last admit was 1 month ago and they are in for the same thing, you MUST redo smoking cessation, diebetic diet ed (if requested), CHF, MI, Pneumococcal / Flu, etc. etc. etc. etc. etc. etc. etc. You *have* to as core measures. That being said, no it's not unethical. It's annoying for both parties, but not unethical.

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Specializes in Critical Care, Pediatric.
As long as it stays patient education rather then patient persuasion I think it is ok.

I am with this poster.

Education is central to our profession. Persuasion and coercion are nasty weeds that find their way in. I've seen (and I think we all know) the difference. Scaring a person into treatment and/or diagnostics is unethical, but professionally and sensitively educating a patient about their condition and the consequences of seeing or not seeking treatment is just a part of the job.

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If you think that by attempting to teach health information on at least a monthly basis, you will be disrespecting the patient's right to free will, you can ask the patient if they wish to have information each time they visit, if they agree... teach and if they decline document it. If they decline and say they do not want to be asked again in future visits, document it and respect their choice, also flag the chart so colleagues will respect the patient's decision in future visits.

dishes

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As an RN for the California Dept. of Mental Health, if a patient decides to refuse treatment (i.e. refused lab draws, Hep C treatment, dental work, ECG, EEG, ect...), we are being required by the Dept. of Mental Health to attempt to change the patients mind via education on at least a monthly basis. Is this ethical and if not, where can I find the info to substantiate this.

Hi,

Maybe you could share why you think this may be unethical. I ask, because I'm not sure why someone may think it, so wonder if there is something I'm not considering. As far as I'm concerned, educating a patient can't be unethical - asking a patient to make a decision *without* education would be, though.

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Specializes in Hospital Education Coordinator.

I think you are confusing "education" with "talking them in to doing something". I generally tell my patients that what they decide is fine with me, but I want to give them enough information to make a good decision. Then I approach it in a factual manner. NEVER ask "WHY?". That makes people defensive. Sometimes I add "here is this fact by this organization. It will affect you in this manner. What is your opinion on that ?" Overall, people still have the right to be crazy

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