The right to refuse has so many interpretations

Nurses General Nursing

Published

Specializes in retired from healthcare.

Inside one nursing home I have been adamently told, "You should not force her to do anything..." about an ill patient who said she wanted to stand up but was too weak.

In the same facility on other patients and other shifts, I have heard the phrase, "You have to....."and I have heard a charge nurse say, "Nope, nope nope, she HAS to come downstairs," in response to me saying, "She needs to finsish her breathing treatment."

In school, I was taught, "You can use powers of persuasion but you can't force them," ie, "They are all afrain you might fall out of bed..."

Some nurses still insist, "She has a right to refuse," and end off the conversation. They won't lilsten to any discussion about this.

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.
Inside one nursing home I have been adamently told, "You should not force her to do anything..." about an ill patient who said she wanted to stand up but was too weak.

In the same facility on other patients and other shifts, I have heard the phrase, "You have to....."and I have heard a charge nurse say, "Nope, nope nope, she HAS to come downstairs," in response to me saying, "She needs to finsish her breathing treatment."

In school, I was taught, "You can use powers of persuasion but you can't force them," ie, "They are all afrain you might fall out of bed..."

Some nurses still insist, "She has a right to refuse," and end off the conversation. They won't lilsten to any discussion about this.

Yes-all residents have the right to refuse -however in LTC we can't just walk away. We must meticulously document what they refused and every intervention we tried that failed. Our careplan has to reflect that we are doing everything in our power to figure out why they are refusing and what measures we are taking to encourage them to comply.

In the first instance-I don't really understand but I think you mean that the resident refused to stand due to weakness. So couldn't two staff assist her to stand and transfer? Or try the standing lift. I'm sure she is afraid of falling-also maybe offer a pain med prior. Then document all of the above. Maybe order a physical therapy evaluation.Is she depressed? A psych consult could be considered. Nurses in LTC that stick to the "she has to..." "She must." and browbeat residents to try to make them comply make my blood run clold...It is NOT about control but it is about what is best for the resident. Unless you have someone actively dying then getting washed , coiffed, made up , joining activities, and socializing are the goals.

Up Vote Up Vote ×
Yes-all residents have the right to refuse -however in LTC we can't just walk away. We must meticulously document what they refused and every intervention we tried that failed. Our careplan has to reflect that we are doing everything in our power to figure out why they are refusing and what measures we are taking to encourage them to comply.

In the first instance-I don't really understand but I think you mean that the resident refused to stand due to weakness. So couldn't two staff assist her to stand and transfer? Or try the standing lift. I'm sure she is afraid of falling-also maybe offer a pain med prior. Then document all of the above. Maybe order a physical therapy evaluation.Is she depressed? A psych consult could be considered. Nurses in LTC that stick to the "she has to..." "She must." and browbeat residents to try to make them comply make my blood run clold...It is NOT about control but it is about what is best for the resident. Unless you have someone actively dying then getting washed , coiffed, made up , joining activities, and socializing are the goals.

Unless you have someone actively dying then getting washed , coiffed, made up , joining activities, and socializing are the goals.

When I get to a nursing home please don't try to coiffed, and make-up me...I don't do that now...and sometimes I don't care to socalize...just give me my laptop, and tv remote, and I'm a happy camper.

Up Vote Up Vote ×
Specializes in PICU, NICU, L&D, Public Health, Hospice.

A cna told my patient the other day....eat the rest of your sandwich and THEN you can have your pudding...I took the cold cut sandwich off the table, gave the old girl her pudding and advised the cna that Mrs R was 94 years old and if she wanted her pudding rather than her sandwich she could have it. I do work in hospice, and no, Mrs R is not actively dying.

I was told the other day that Mr. M can't just stay in his room or bed all day everyday...I asked why...and the staff told me that he needs to socialize. Mr M is a widower of many decades, he has no children, he is VERY accustomed to being alone and is uncomfortable in groups of people...NO he doesn't have to socialize, moving into a LTC setting is unsettling enough for him without forcing him into groups of people that he has no desire to join.

These people are cognitively intact, they simply cannot safely remain independent and cannot provide for their ADLs without assistance...they are not children. They may have issues with weakness, and fear, and fatigue...that does not make them incompetent to make their own choices.

I agree with Nebrgirl...if you try to coiff me or paint my face in your nursing home I may bite you...don't enjoy that now and doubt I will enjoy it then, and will certainly not be happy if someone insists.

Up Vote Up Vote ×
A cna told my patient the other day....eat the rest of your sandwich and THEN you can have your pudding...I took the cold cut sandwich off the table, gave the old girl her pudding and advised the cna that Mrs R was 94 years old and if she wanted her pudding rather than her sandwich she could have it. I do work in hospice, and no, Mrs R is not actively dying.

I was told the other day that Mr. M can't just stay in his room or bed all day everyday...I asked why...and the staff told me that he needs to socialize. Mr M is a widower of many decades, he has no children, he is VERY accustomed to being alone and is uncomfortable in groups of people...NO he doesn't have to socialize, moving into a LTC setting is unsettling enough for him without forcing him into groups of people that he has no desire to join.

These people are cognitively intact, they simply cannot safely remain independent and cannot provide for their ADLs without assistance...they are not children. They may have issues with weakness, and fear, and fatigue...that does not make them incompetent to make their own choices.

I agree with Nebrgirl...if you try to coiff me or paint my face in your nursing home I may bite you...don't enjoy that now and doubt I will enjoy it then, and will certainly not be happy if someone insists.

I could not agree more. There is a balance to be struck in which we may try to persuade and problem solve to encourage people to do what we think is good for their health. But we are their nurses not their keepers. Old people are not children. The closer I get to that age group the more I get annoyed by nurses who insist on treating the elderly like children. I work in acute care, so some of the imperatives are a bit different, but I also don't like to hear a sharp, intelligent, self sufficient older person described as "cute" or addressed by demeaning pet names like "dear" or "honey".

Up Vote Up Vote ×
Specializes in Health Information Management.
A cna told my patient the other day....eat the rest of your sandwich and THEN you can have your pudding...I took the cold cut sandwich off the table, gave the old girl her pudding and advised the cna that Mrs R was 94 years old and if she wanted her pudding rather than her sandwich she could have it. I do work in hospice, and no, Mrs R is not actively dying.

I was told the other day that Mr. M can't just stay in his room or bed all day everyday...I asked why...and the staff told me that he needs to socialize. Mr M is a widower of many decades, he has no children, he is VERY accustomed to being alone and is uncomfortable in groups of people...NO he doesn't have to socialize, moving into a LTC setting is unsettling enough for him without forcing him into groups of people that he has no desire to join.

These people are cognitively intact, they simply cannot safely remain independent and cannot provide for their ADLs without assistance...they are not children. They may have issues with weakness, and fear, and fatigue...that does not make them incompetent to make their own choices.

I agree with Nebrgirl...if you try to coiff me or paint my face in your nursing home I may bite you...don't enjoy that now and doubt I will enjoy it then, and will certainly not be happy if someone insists.

Wow, what you described is Exhibit A for why I'll fight like a convalescent four-year-old to stay in my home if I last till deep old age! May a benign Providence keep my cognitive faculties intact so I can verbally eviscerate any nurse or CNA who tries to tell me to eat my lima beans or force me to take part in group activities when I want to read. If I don't like doing something now, I'll probably be a lot more stubborn about it when I'm 92.

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.
Unless you have someone actively dying then getting washed , coiffed, made up , joining activities, and socializing are the goals.

I think you all misunderstood. If you've been a hermit all of your life you can certainly continue that but our GOAL would be to encourage you to take part in activities in the facility.We may never reach that goal,we know. However the way we are regulated in LTC requires us to document and careplan out the wazoo. Activities of daily living and the resident's performance of them are quality measures and tracked by the state dept of health and the government. Check out the medicare.gov website and follow the nursing home compare link for more information. If you walk into a nursing home and get in your bed and refuse to move we HAVE to address it. Oddly enough I have lost count of the number of times I have heard families remark on how well their loved one is doing because after a lifetime spent as a hermit they actually enjoy the company of their peers in the LTC. You can continue to lay in your bed and read all day every day but we still have to invite you to daily activities and document that we have done so and your reason for declining to attend.

The other things described on this thread are abuse-trying to shame some old soul into eating a sandwich before pudding is ABUSIVE. So is a daughter telling her 88 yr old mother 'If you don't eat I won't visit" .Ditto "honey" "dear " and "sweetie"

Up Vote Up Vote ×
Specializes in Geriatrics.

I disagree with the title of this thread. The right to refuse means just that... they have the right to refuse. No means NO! Granted we have to ask, and we have to document the heck out of it, but, no one can be forced to do anything they don't want to. Our company policy states we have to ask a minimum of three times when a resident says no. Usually they get upset when I come back the second time to ask the same thing, they think I'm not listening to them. I explain company policy and tell them I will be back to ask one more time. They understand I have to follow policy, but, that even tho I have to keep asking I will not force them nor will there be reprocussions from the staff for thier refusal.

Up Vote Up Vote ×
Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Any patient can refuse any treatment at any time. We are not allowed to force them in Oz land anwway.

However when you tell a CN

Up Vote Up Vote ×
I think you all misunderstood. If you've been a hermit all of your life you can certainly continue that but our GOAL would be to encourage you to take part in activities in the facility.

WHY WOULD YOU WANT TO DO THAT?

Why would this be anyone's goal?

Is this how stupid we have all gotten to be, to think that it is some social workers crowning glory to change the habits of a lifetime?

If I should be placed in an SNF for 1 week for PT for an ankle fracture, would I have to be continually harassed to go to wheelchair volleyball if all I want to do is sit and read my book? And how does my love of solitary endeavors make me a "hermit"?

Up Vote Up Vote ×
I think you all misunderstood. If you've been a hermit all of your life you can certainly continue that but our GOAL would be to encourage you to take part in activities in the facility.

WHY WOULD YOU WANT TO DO THAT?

Why would this be anyone's goal?

Is this how stupid we have all gotten to be, to think that it is some social workers crowning glory to change the habits of a lifetime?

If I should be placed in an SNF for 1 week for PT for an ankle fracture, would I have to be continually harassed to go to wheelchair volleyball if all I want to do is sit and read my book? And how does my love of solitary endeavors make me a "hermit"?

these regs were put into place to address the allegations of neglect/warehousing of the LTC resident.....

Up Vote Up Vote ×

So I get that it has to due with regulations, but the regulations are kind of BS...no I don't want to see the elderly warehoused, but isn't that the whole point of the regulations, treat them like they are indviduals who have their own preferences....which they should only have to tell you ONCE. My sister, who in many ways was still very "young" fx her hip due to met. CA. She ended up in skilled care for 10 days rehab. This place also had LTC blended in, so the CNA kept bugging her that they would "fix" her hair...she relented...when I came in that night here she was with "little old lady hair" not the way I knew her at all. I laughed....but she was not humored at all..

Up Vote Up Vote ×
+ Add a Comment