Jump to content

The right to refuse has so many interpretations

Nurses   (17,473 Views 123 Comments)
by Saiderap Saiderap (Member) Member

Saiderap has 25 years experience and specializes in retired from healthcare.

15,118 Profile Views; 522 Posts

You are reading page 7 of The right to refuse has so many interpretations. If you want to start from the beginning Go to First Page.

Are you a credible source? Add your Credentials, Experience, etc.

240 Posts; 6,430 Profile Views

"the right to freedom from abuse, mistreatment and neglect" means we should never give demented Grandma even a bed bath because she refuses? We should let her lie in her own urine/feces, not reposition her, or attempt to provide basic hygiene because she refuses? That's not neglect? There are ways to provide basic nursing care in these situations and professional LTC givers do so based on not only their knowledge/experience but their having spent so much time with Grandma (often more time than family, sadly). Not all LTC facilities consistently provide quality care... neither do some hospitals or home health agencies. If anyone following this thread has experienced poor care for themselves or a loved one, my heart goes out to you.

If you ever find yourself demented and refusing basic nursing, do you seriously want to be left in your own urine/feces or never given even a bed bath? If you're demented and I find you eating your own feces and try to clean you up and you get verbally or physically combative with me, IOW demonstrating refusal, I'm supposed to just let you lie there snacking away? Because if I walk away from that situation, I'm respecting your "right to freedom from abuse, mistreatment and neglect"?

If I clean your poop out of your mouth at the risk/certainty of my getting bitten, I'm abusing your right to eat your own crap? Yes, I did take it to that extreme. And may you or your loved one NEVER find yourself in that situation. On either side of that fence!

Share this post


Link to post
Share on other sites

pinkiepieRN has 8 years experience and specializes in adult psych, LTC/SNF, child psych.

6 Articles; 385 Posts; 16,637 Profile Views

At my facility (LTC), we have to notify both the family and doctor if a patient refuses care or medications. Coaxing patients to take their medications is not easy and refusal on their end hurts themselves more than anything. Unfortunately, there's only so much I can do to make taking medications "easier" or more appealing.

Share this post


Link to post
Share on other sites

Glycerine82 has 3 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

1 Article; 2,011 Posts; 25,799 Profile Views

" I'm supposed to just let you lie there snacking away?

I just spit my soda all over myself. :geek:

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

3 Followers; 5,465 Posts; 26,700 Profile Views

BINGO! If I were poochies mothers nurse, my impression from her posts would have been a family that didn't care much about her.

Wow, that is harsh, and unfair, I think....

Let's be civil here.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

11,191 Posts; 53,721 Profile Views

i think several posts may be overlapping, because of 2 separate continuums that we're referring to:

nsg continuum - when residents refuse care, on one end of the spectrum are nurses who shrug shoulders and say "ok" and chart accordingly...to the other end of the spectrum, with some nurses wracking their brains (after hours) trying to come up with ideas in getting their pts to comply/cooperate.

resident continuum - those who are alert & oriented at one end, and those with total cognitive dsyfunction at the other.

reading through all these posts, you just don't know what type of nurse is talking about what type of resident.

i'm certain there are nurses who chart "refused care" with absolutely no effort on their parts.

just as i'm certain there are residents who retain a notable amt of cognizance, yet dementia is prominent in other aspects of brain function.

my experience has been that the most resistant of pts, will/do inevitably find that one person (title irrelevant) who they trust won't harm them, or who they trust to make the dreaded experience, as pleasant and timely as possible.

it may not be every week, sometimes showering once a month is the best you will get.

and finally, to me, honoring one's dignity entails NOT allowing a resident's condition to deterioriate to the point where they languish to the point where their physical and mental health are affected.

i have never, ever encountered a pt/resident where they refused care throughout their stay at the ltc facility.

eventually there was always at least one person they entrusted enough with care.

as nurses, we have to pick our battles wisely.

and i'll tell you quite frankly - if i had a resident that was known to refuse any/all care consistently, i for one had no problem dropping some lactulose in their drink and watched them swallow every drop.

same concept with mom.

again, this isn't for every pt but if it works for that particular pt, i'm good with that.

every pt and situation is unique, and you need to customize ea intervention that reflects the pts known strengths and weaknesses.

as long as we do everything humanly possible in honoring the pts needs of body, mind, and spirit, i do believe that's what counts.

we as nurses walk many fine lines.

in the end, it's finding that balance that dictates the desired outcome.

leslie

Share this post


Link to post
Share on other sites

BrandonLPN has 5 years experience as a LPN.

3,358 Posts; 35,244 Profile Views

I think Leslie^^ is absolutely right. We aren't all talking about the same thing here.

I'm sure poochiewoochie doesn't advocate leaving residents unbathed and filthy any more than I advocate forcing patients to do things against their will. The truth, as usual, is somewhere in-between.

Share this post


Link to post
Share on other sites

LadyFree28 has 10 years experience as a BSN, RN and specializes in Pediatrics, Rehab, Trauma.

8,427 Posts; 75,424 Profile Views

Leslie I think your post has reconciled the continuums.

I think, at the end of the day, we can reconcile these issues.

Nursing is gray, not black and white, and I believe most (if not all-NOT getting into THAT) nurses practice ethically, humane, with the BEST practice for their patient...it truly comes down Maslow's and making sure we have the best outcomes, and respect. I believe that happens 99.9% of the time as well.

It's very interesting how this thread is turning out. The OP view of "refusal" made me wonder how can refusal be misconstrued, but end up with me wanting a nurse like Brandon and others whose techniques I admire and support, while the personal experiences of many who have been in such vulnerable states, including myself-I decided not to share, but the understanding is there.

I think we all agree that dignity and respect is the forefront of the nursing care that we do. :yes:

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

103 Posts; 3,276 Profile Views

I really think the over all goal is to look at everyone as a person. Want to hold your Lasix because you have a outpatient follow up and don't want to wet yourself. Understood. Telling a liver failure with a pickled brain and still clearing mentally. Here is a shot of (whatever) to get them to swallow their lactlose. Anger at the world because you had a CVA in your 40s and try to take it out on nears when tey try to suction you. Both nurse and patient need a time out. Force someone to go to activities when they are a hermit, uncalled for. Allowing someone to lay in pee and poop for days unbathed. that is just nasty and neglect. Some people trust others and not others. I have had confused people call me a white devil (I am Latina, but fair skinned). I understood where the personal history came in. Just treat people the best you can and try to remember to look at it from their side of the bed.

Share this post


Link to post
Share on other sites

lmccrn62 is a MSN, RN and specializes in Pain, critical care, administration, med.

384 Posts; 7,527 Profile Views

There is a very fine line here. Patients have the right to know the medications they are taking and we are required to be honest. Our job is to explain to the patient the why's , if they refuse that is there choice. It then needs to be reported to the physician.

It is no different for anything else we do for patients we can't trick patients because we feel its in their best interest. So if a patient had cancer and they made a decision to not have treatment does that mean we should do it anyway? Of course not.

As for what the patients sign for when they are admitted they still have rights which we must respect.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

1 Follower; 6,978 Posts; 32,429 Profile Views

wasn't being uncivil at all. that is the impression she left me with. and I have to wonder if the nurses caring for her mom picked up the same feelings.

Wow, that is harsh, and unfair, I think....

Let's be civil here.

Share this post


Link to post
Share on other sites

ktwlpn is a LPN, RN and specializes in Med Surg, Homecare, Hospice.

3,844 Posts; 30,699 Profile Views

I took care of my Mom for 8 years so don't patronize me.

Here is the Nursing Home Resident's Bill of Rights. Some of you who work on the industry need to brush up on it...[/quote

]Here is another quote from an earlier thread by the same member over a year ago...

QUOTE>>Oh, and for the record, the NH did a great job with taking care of my Mom. In my heart I know they gave us extra years with her because the way she was going before we placed her she would have been dead in a short time. She was controlling and refused basic care from me-she needed to be in a controlled environment and for the most part the nurses in the NH were wonderful with her. >>>QUOTE

Many of the more polarizing comments on this thread have been made by non-nurses or RN's with NO LTC experience. You just can't have an intelligent debate with people why are flying off the handle based on their emotions and their own personal experiences with their own illness or that of a mother or grandfather.We learn quickly in LTC that the fastest way to burn out is to personalize every resident's care plan. It's NOT about us and our feelings-it's always about federal regulations in LTC-the DOH swoops in and you get a big fat citation because some poor demented soul was hospitilized with a bowel obstruction or lost 8 LBS in a month or took to their bed and refused to get up and walk after being admitted.I,too have cared for my own family and I'll be the first to tell you that it is difficult to set limits for your own loved ones and many LTC admissions occur because of that fact.

The most demented deserve to be treated with respect and allowed to maintain their diginity and it is an art to cajole them into accepting the care they need to maintain their safety and comfort-that's what Brandon is talking about.I also work on a secure dementia unit an I agree with EVERYTHING he said.The rest of the facility is populated with folks of varying levels of congnitive function and even the 450LB smoking IDDM has the right to eat a giant Hershey bar a day-and don't you dare talk to her like she is a 4 year old .Maybe that is the kind of nurse some of you are speaking about.For the first resident I'll pull out my complete bag of tricks to get them to accept the care they need.If you say the word "bath" or ""shower" to an Alzheimer's pt you have almost guaranteed that it is NOT going to happen.Every alzheimer's association recognized training teaches caregivers to give 2 and 3 word simple commands,ready the room and say something like " Please come with me" and hold you hand out to the resident and proceed from there.If you consider that "lying" or unethical you obviously don't have much experience in that particular area of expertise. It IS called "therapeutic lying" and is also a recognized approach with this population.Would you tell the 90 year old sobbing LOL who wants to go home because her mother is looking for her that her mother is dead because to "lie" would be unethical? You have alot to learn if you would do that. The other type of resident,the higher functioning non-compliant one gets a whole team approach-SW,psych etc.In LTC there are "sentinel events" (quality indicators) which will bring down the scrutiny of the DOH and you had better exhaust all avenues available and document it well or you are screwed. LTC is one of the most highly regulated industries in this country.If you want to lie around in your own swill for the last years of your life you had better barricade yourself in your house and hope no one in your family calls the dept. of aging on you because if you come to LTC you will have a roommate that won't appreciate the stink. The regulations are to protect the populations across the country who live in LTC that nurses like Brandon and myself would NEVER work in.

Last night I watched a CNA scold a resident like he was a 4year old with ADHD during dinner.She was attempting to feed him and he kept turning his head away and putting his hands in the tray and around her face.The water ice that he receives at every meal which was ordered by speech therapy to use between bites of food to stimulate him to open his mouth or swallow a mouthful was not even open.She was saying" Stop it,sit still-don't do that,I'm trying to feed you,you know I can't do it if you won't hold still" and the like.This is a brand new CNA who actually flunked her certification testing last week.The resident is an elderly gentleman,a former minister and educator who was actually persuing his doctorate in religious study when he was stricken with Alzheimer's disease.I could feel myself letting my emotions take over and had to take a step back and gain control and then enter the dining room and intervene.I knew I had to not only stop what was happening but I had to TEACH alternative methods and deliver the info in a way that she would accept.I knelt beside them and explained that her repetitive commands were only agitating him and explained why,I explained how to use the water ice,I encouraged her to give him something else to hold in his hands.I hope to see a difference in her the next evening I work her shift.This is the type of staff member who would accept a refusal of care simply because it would make her list of tasks much shorter..I could see she was close to just giving up with her attempts to feed the man and just calling it "refusal" I hope you all can see the difference. I hope we all can learn something from each other on this thread.

Share this post


Link to post
Share on other sites

tewdles has 31 years experience as a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

3,156 Posts; 30,748 Profile Views

I believe these are largely matters decided using critical thought and nursing judgement.

I see distinct differences in the practice settings and requirements, as previously mentioned by Leslie. It stands to reason then, that priorities, goals, interventions, strategies will all vary dependent upon practice setting.

Trying to create a "black and white" rule for nursing function in this area is more of an intellectual exercise than one that has a real legs in the practical world...IMHO.

Acute care nurses don't see constipation as a big deal and it is often not on their radar for extended days.

Home care, hospice, LTC, SNF, and ALF nurses all see constipation as a very BIG deal that has caused more than one medically frail patient to be hospitalized, or more importantly...REHOSPITALIZED.

As nurses we have different focus and different goals with our patient populations.

I am cool with that.

If the ICU and acute care nurse keep me alive I will count on my SNF nurse to take care of my butt. I expect them to convince me even if I really don't want to have that enema. Just don't try to put a pretty face on me or I will bite you.

Share this post


Link to post
Share on other sites
Guest
This topic is now closed to further replies.
×