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.

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

I pity the introvert........ Anyway---yep---"sweetie" , "cutie", "precious" set my teeth on edge. I had a receptionist at a mammo center call me "sweetie" one time.....I about came unglued. I'm not anyone's "sweetie"...except for my husband.....come to think of it, even he doesn't call me that.....hmmm.....

Specializes in LTC,Hospice/palliative care,acute care.
I pity the introvert........ Anyway---yep---"sweetie" , "cutie", "precious" set my teeth on edge. I had a receptionist at a mammo center call me "sweetie" one time.....I about came unglued. I'm not anyone's "sweetie"...except for my husband.....come to think of it, even he doesn't call me that.....hmmm.....

Unless you are pretty wealthy you'll end up in a semi private room or the county facility with 3 room mates.Precious little privacy there,that's the sad fact.As more baby boomers age newer facilities are being built with more modern living areas and more privacy but again,there's that price tag.

We've beaten the "sweetie-honey -cutie-doll face" crap to death on allnurses.Some continue to defend it as a cultural thing-I only know that in this area in LTC it's not permittted. In LTC even nicknames are regulated-this is something many of you RN's with mega years of experience in acute care and education may not know.We have to care plan what the resident wants to be called ....

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

I believe that identifying what the patient prefers to be called is part of nursing care planning across the spectrum of specialties and practice environments.

Specializes in Transitional Nursing.
I pity the introvert........ Anyway---yep---"sweetie" , "cutie", "precious" set my teeth on edge. I had a receptionist at a mammo center call me "sweetie" one time.....I about came unglued. I'm not anyone's "sweetie"...except for my husband.....come to think of it, even he doesn't call me that.....hmmm.....

I use sunshine a lot. One day I walk in to this gentleman's room and say "Morning Sunshine" He relplied "Well hey, moonbeam"! I try to use names when I can remember but If it escapes me they get Sunshine. Its better than honey and it's unisex. I live in the south though, where even the grocery clerks give you a term of endearment. Its weird.

Specializes in Transitional Nursing.
Unless you are pretty wealthy you'll end up in a semi private room or the county facility with 3 room mates.Precious little privacy there,that's the sad fact.As more baby boomers age newer facilities are being built with more modern living areas and more privacy but again,there's that price tag.

We've beaten the "sweetie-honey -cutie-doll face" crap to death on allnurses.Some continue to defend it as a cultural thing-I only know that in this area in LTC it's not permittted. In LTC even nicknames are regulated-this is something many of you RN's with mega years of experience in acute care and education may not know.We have to care plan what the resident wants to be called ....

Thats how they do it at the LTC facility i work at PRN. Its soooo hard for me coming from the hospital where everyone calls everyone some kind of endearment. Even the nurses call me (a cna) sweetie, and i get Darlin' a lot. I've gotten used to it. For me the worst is Mam. UGH! 31 and getting called Mam. Haaate it!

Specializes in LTC,Hospice/palliative care,acute care.

I guess anything beats being called "Hey,dumb bell" and that's what I got today! Whatever happened to the nice little old ladies? Why am I now caring for there evil twins? Is it still a full moon? Is the barometric pressure dropping? What?

...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.

Those SNF nurses are going to take care of more than your butt but if you're A&O x 3, why should they have to convince you if you really don't want to have that enema (which would prolly be a supp or MOM but anyhoodles...). Refuse, that's your right. If you're NOT A&O x 3 and haven't had a BM for 3 days (facility policy protocol in place), pls don't bite the nurse who is following her facility's policy. If you're A&O x 3, the nurse won't have to put a pretty face on it; you'll refuse or you won't and it will be documented. If you're NOT A&O x 3, hopefully the nurse will be be able to find a way to satisfy your wishes and her obligation to follow policy procedure.

Or did you mean that 'pretty face" to mean they give you smokey eyes and pouty lips when you're not a make-up wearer?

Specializes in LTC, Acute Care.
Poochie, I think we're talking about two different things.

I still say the worst thing a nurse could do would be to just say "ok" and walk away when a confused, elderly pt refuses meds or a shower.

And where are you seeing lies??

Is it a lie that their daughters said they want them to have a shower?

Is it a lie that the cup of pills I'm handing them are medications the doctor said they need to take?

For better or worse, most of my old residents still have an amount of blind reverence for doctors. Of course I invoke the name of the doctor to get them to take their meds. Again, where's the lie?

Brandon, I totally get where you're coming from. I worked LTC for three yrs and have worked acute care for 4 yrs and they are 2 totally different horses when it comes to pt care. I can so relate to people NEEDING showers/meds and refusing. In LTC you're damned if you do and damned if you don't.

Brandon you are the type of nurse I want if I ever end up in long term. Tell me it is a shot of booze so I do not end up with a bowel obstruction. Throwing up feces. Distended painful tummy. Smart enough to listen if someone is alert to explain you concerns. I am still alert enough to make my final decision. Talk me into trying to eat part of my veggies and then we can have ice cream. Listen to where I come from emotionally. Even demented have feelings. You learned to read them. I hope that if I can not express myself clearly I have a nurse that listens to my words and feelings. Frankly if I am so confused I fight laying in filth for days and fight, please someone give enough drugs to so I can not be so scared or in pain. Forget right to refuse. I want to be comfortable and respected for the whole life I lived. Don't and I will come back to haunt you the spooky Capser in the building. I thing the biggest thing is long term needs more funding to we can offer solutions and chart our butts off, but that is a another subject. Frankly I want out of long term care. Work is hard and a minefield to work.

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 have not read all the responses yet, so I apologize if this has already been discussed. If I had a *confused* resident who was losing weight and/or not consuming enough to get their proper nutrition, I have no problem saying something along the lines of, "let's try to eat a little of your sandwich first so you can enjoy this delicious ice cream." I don't know, its in the wording and tone. Key words though, confused and imbalanced nutrition. If they then still refused, I'd give them the ice cream, then document and collaborate with others on ways to get the resident to eat more. Getting access to their favorite foods for example, and including something like ensure in their diet. Get to the bottom of why they are not eating. It may be as simple as they don't like that food. I've been hospitalized and thoroughly disgusted with some of the food, so I wouldn't eat it. If the resident is a&o x 3, I would briefly and respectfully educate them on the importance of their nutrition and then leave them alone and document. Its definitely what I would want done for me if I were confused.

Okay so I am volunteering at nursing home, and I am shock at what the nurses/staff allow patients to do. They allow them to take "smoking breaks" as well as feed them unhealthy foods (icecream, lollipops, and cake). I thought a nursing home was supposed to be about keeping the patients' healthy, not feeding them poisonous food and allowing them to smoke the rest of their lives away.[/quote']

A long term care facility is a person's home. So why would we take away the rights they had before they had to move to LTC? as for junk food, if proportion is reasonable and they get their proper nutrition with their meals, what is the problem?

"If the resident is a&o x 3, I would briefly and respectfully educate them on the importance of their nutrition and then leave them alone and document."

I sometime feel uncomfortable telling a 98 year old that something is good for them...

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