The right to refuse has so many interpretations

Nurses General Nursing

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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 patients/residents ultimately have the right to refuse. But that doesn't mean that we don't do our best to convince them to tale ordered meds/treatments anyways.

If mrs smith says she doesn't want a shower this week, we don't just say "okay" and walk away. A good nurse knows the tricks of the trade to gently persuade. "Your daughter called and said she wants you to have a shower today" or "the activities girl is coming in tomorrow to do your flowers so you need to be nice and clean."

In LTC "they refuse" is often just a convenient excuse for aides to skip baths or leave someone in bed.

Do it's better to lie and bully a patient into complying with your wishes? I hope no one catches on to what you are doing because you'll be out of a job if they do. Residents have rights-who cares how you feel about their behavior.

My Mom had one nurse that was bossy like this and she was yanked from the unit the minute I complained. No long after she was gone from the NH altogether.

If my grandmother (the unhealthy one) was put in a nursing home that allowed her to drink and smoke all day, I would be ****** and ask for my money back.

So you would disallow your grandmother what ever pleasures she has in life just because you don't approve of them?

How sad.

Yes, all patients/residents ultimately have the right to refuse. But that doesn't mean that we don't do our best to convince them to tale ordered meds/treatments anyways.

If mrs smith says she doesn't want a shower this week, we don't just say "okay" and walk away. A good nurse knows the tricks of the trade to gently persuade. "Your daughter called and said she wants you to have a shower today" or "the activities girl is coming in tomorrow to do your flowers so you need to be nice and clean."

In LTC "they refuse" is often just a convenient excuse for aides to skip baths or leave someone in bed.

It's the same with medications. As a 3rd shift LPN, I'm responsible for bowel care protocol. I have residents who flat out will refuse milk of mag or suppositories no matter how many days they are without a BM. The key here is they would refuse..... if they know what they're getting. I'll hand a resident a cup of MOM and when they say "what's this?" I'll say "oh, just some medicine the doctor ordered." Technically they never refused and thecnically I didn't lie.

We can't not even try to administer care as ordered.

It is clear from what you wrote that you are aware that the resident doesn't want this particular medication. You say that the resident would refuse if they knew what you were giving them.

"Technically" does not matter one iota. Not one. You are aware of the resident's wishes.

Surely "trying to administer care as ordered" shouldn't include deception?

I find the way you choose to administer the medication both unethical and paternalistic.

If I were the patient I would be furious if my nurse tricked me, and it would ruin all and any trust and respect I felt towards that individual.

How would you react if it happened to you?

Wow.. I have certainly seen some scary posts. Patients have the right to make choices. We may not agree with them, but at the end of the day they can eat, smoke, drink, and stay in their rooms. My God how terrible it would be to have someone making all of your decisions for you just because they don't agree. No thanks.

Specializes in hospice, home care, LTC.

I had a hospice patient living in an ALF. Pt was bedbound, on scheduled morphine. Facility policy was repostion Q2 hr, Pt consistently refused in spite of education. I directed LNAs to stop repositioning attempts (some had been repositioning against Pt's wishes). Administrative Director insisted nursing MUST reposition because it is policy. I had quite the discussion with her. She just wouldn't budge. I refused to assault the Pt.

Wow.. I have certainly seen some scary posts. Patients have the right to make choices. We may not agree with them, but at the end of the day they can eat, smoke, drink, and stay in their rooms. My God how terrible it would be to have someone making all of your decisions for you just because they don't agree. No thanks.

I know and it makes me angry. Angry because they use lies and deception to get a resident to do what they want them to do so it makes their job easier. Or trying to dictate that one shouldn't smoke or that they shouldn't eat sweets because they feel the residents are making horrible choices. You're a nurse and these are not your underage children who you CAN dictate to, lie and deceive.

I also want to mention the shower thing. Alzheimers or other dementia residents don't take showers because they are afraid of the water. When I asked my Mom she told me she was afraid of drowning. So to bully one into taking a shower is abuse IMO.

What makes it even worse is they get away with it because the facility is understaffed and there is no family member to advocate for them because they don't give a damn about Mom or Dad.

ETA:My Mom isn't dead because she ate the boxes of candy that we gave her, because she smoked for most of her life, because she refused to take a shower or didn't have a bowel movement. She died because of negligence because fall precautions were not put into place for an at high risk resident. Maybe if people had stopped spending so much time worrying about her showering or eating the candy she loved so much and more time making sure she didn't fall she'd still be here.

I still agree with BrandonLPN.

I am just to practical. If your patient is lying in bed, stinky, dirty, getting rashes, but refusing to get into the shower, and hasn't pooped in a week. Do you just let them lie there?

It would be wonderful if every LTC facility had a psychiatrist/social worker, 1:1 nurse to go into the deep psychological reasons the patient didn't want to get clean.....however since LTCs don't have this luxury the patient needs to be cleaned and needs to poop!

I am sorry old people get confused, scared, angry, forgetful, etc. But they do, and they lose their ability to make safe, rational, decisions about their care.

I don't want to die lying in a stinky dirty bed all constipated! I want Brandon!

I was acquainted with the managers of a SNF that had a whole houseful of people like that, people that no other SNF would accept. They put an incredible amount of care and love into those people in order to give them good care. They did it by carefully observing behaviors and teasing out the ways to lead the residents to safety and cleanliness in comfort and trust.

If you don't want to lie in a stinky bed all constipated you don't have to have an LPN to lie to you to compel you to be otherwise. As to your decision about whether someone is able to make decisions...

Let's be very clear that declaring a patient incompetent is not a decision made by physician, nursing staff, or family. It is a legal decision by a court of law. If that wasn't done, then in my state a HCP could not be activated to compel a patient to do something s/he doesn't want to do. People are entitled to refuse medications and care even if we don't think they should.

There's a very famous case in the law and medicine arena. Mrs. Candura in NJ was an elderly diabetic with a gangrenous leg. She refused surgery. She completely understood that if she didn't have it off she would die from it, and said she was ready to die. Her physicians agreed not to amputate because that was her wish. After a time she began to fail (die), and was not longer alert and oriented. At that time her daughter went to court to compel her mother's physician to amputate the leg to save her mother's life. The court refused to so order, saying, in effect, it would be unconscionable to know what her wishes were and then wait until she could no longer defend herself against unwanted medical intervention, in this case, amputation.

Is there an ethics committee in your facility, or within your facility's corporate structure? That's the next step if the ANA Code of Ethics-- which binds all of us-- isn't good enough for you.

I still agree with BrandonLPN.

I am just to practical. If your patient is lying in bed, stinky, dirty, getting rashes, but refusing to get into the shower, and hasn't pooped in a week. Do you just let them lie there?

If they want to do that it's their right to. It's not about YOU and how YOU feel about it-it's the resident's right to do whatever they chose to regardless if they are unable to make safe, rational decisions IN YOUR OPINION about their care.

You can't force them to do what YOU want them to do. I have seen nurses and CNAs fired from the facility where my Mom was at because they decided to force the patient to do things they don't want to, got mouthy with them or abusive. People think that just because they are forgetful and not rational they have no rights? Well, think again. Every complaint from a resident is taken seriously and investigated even if it is unwarranted. You might find yourself the subject of one of these complaints if you are working like this. (when I say YOU I mean anyone in general who feels this way and treats their residents with deceit and lies)

Specializes in ortho, hospice volunteer, psych,.

Some of these posts are downright scary! I hope no one like Brandon ever takes care of me. I demand that I be treated with respect and dignity both now and when i'm 109. I do not sense he gives all of his residents such respect. If I would ever ask what a specific med was and he answered, 'oh, just something the doctor ordered." there would be xxxx to pay, because that would not have been treating me with the dignity I deserved. Nurses do make meds mistakes.

If I choose to stay awake and read or stay in my room and watch TV, or sit alone and use my laptop or tablet, I do NOT expect to be dragged off by my big toe. At that age, I expect do be allowed to do what I want within reason, without some smug kid overriding my desire. I take my ordered meds but as long as I remain alert enough to realize whether or not I feel uncomfortable and stuffed, thn it remains my decision whether or not to take a PRN med such as MOM.

Okay...I completely agree....I don't want my gangrenous leg cut off...that is my decision.....I want to smoke, eat double bacon cheese burgers and milk shakes, yes. I am old, confused at times, not legally declared incompetent, I itch and stink because I am so dirty because I keep telling the CNA I don't want a bath. I feel stuffed, bloated,, bad stomach pains because I haven't pooped in a week but keep telling the nurse " I don't have to take that medicine" and you as my wonderful caring nurse just let me lie there?

Nope....I still want Brandon

Okay...I completely agree....I don't want my gangrenous leg cut off...that is my decision.....I want to smoke, eat double bacon cheese burgers and milk shakes, yes. I am old, confused at times, not legally declared incompetent, I itch and stink because I am so dirty because I keep telling the CNA I don't want a bath. I feel stuffed, bloated,, bad stomach pains because I haven't pooped in a week but keep telling the nurse " I don't have to take that medicine" and you as my wonderful caring nurse just let me lie there?

Nope....I still want Brandon

You still don't get it and I guess you never will. It's not about the "caring" nurse, it's about the resident who has rights.

I'm getting a little sick of the "caring" nurse routine. If my Mother had more "caring" nurses she's still be here. But they were too busy harping on the boxes of candies that she loved and not taking a shower. Instead she fell through the cracks. Preventing injuries to residents is a lot more important to me that whether Mom or Dad spends her days eating candy or not taking a bath. Those things are not going to kill her. Preventable falls, on the other hand will.

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