Turn Q2 and patient refuses

[AnLe, ASN, RN]

It hasn't even been a month since I passed my boards and I'm orientating at a hospital floor I wanted. I am currently stuck though. I had a patient who is to be turned every 2 hours, but they do not want to turn. They are adamant about it. Even repositioning, placing pillows under the arms, or performing some ROM exercises, they refuse.

The patient had stated how previous shifts treated them like a bag of meat. A nurse who had them previously said that they made them turn. Then work is saying to increase patient satisfaction.

I made my rounds and I tried to convince them to allow me to turn them. I'm just very conflicted.

Should we just turn them on the bed even as they refuse? I understand we are trying to prevent pressure sores and I did explain it to the patient, but where is the line drawn?

[Davey Do]

A gray area, as yes, the patient has the right to refuse and we could get in trouble for touching a patient but it's over so quickly by saying, "Oh this will only take minute" pull on the bed pad, stuff the pillow and we're done!

I see Sour Lemon down there... I wonder what she's going to say?

[JBudd, MSN]

Forcing them to turn can be considered battery; touching without consent. Explaining, teaching, being as gently as possible, but in the end the patient has the right to refuse.

Get the doctor involved, possibly case management, write an incident report (we have forms for things that are not mistakes but potential problems to give a heads up notice to the hospital).

Being the whole team together and try to come up with a plan that the patient will accept.

[AusSRN]

In this situation, I think the most important thing to establish is why? Why does this patient not want to be turned. Are they in pain? Coginitive deficit? Or do they simply just not want to. If possible education on the importance of regular repositioning and explain the risks of pressure areas to this patient. Can you suggest to them to get out of bed for atleast an hour a day?

You cant force them, but you can understand and education and feel as if you've done your best, atleast.

And lastly, document the patients refusal.

[AnLe, ASN, RN]

Are they in pain? Coginitive deficit? Or do they simply just not want to. If possible education on the importance of regular repositioning and explain the risks of pressure areas to this patient. Can you suggest to them to get out of bed for atleast an hour a day?

The patient was alert x4. They had cellulitis to the legs and they had received pain medication prior to me going in to turn them. I informed them why turning every 2 hours was important. They were already frustrated with being at the hospital and we were just awaiting placement for them.

I overthink things a lot, which my preceptor has stated. She says to just go in there, inform them of what you will do and it won't take much of their time. It's easier to say that in the morning, than at night when they're sleeping.

[AnLe, ASN, RN]

All in all, I will go and speak with our director and get their input on a few questions I have; also to see how my performance has been.

Thank you for your responses! It has given me more things to think about and get settled with before returning to the hospital.

[AnnieOaklyRN, BSN, RN, EMT-P]

Document that the patient has refused to turn, each time they refuse, and that you have explained the risks and benefits to them with regards to position changes, AND that they verbalize and understanding of those risks and benefits.

Annie

[ruby_jane, BSN, RN]

You've already gotten great advice. Google motivational interviewing (this is more for the next time you run into a patient declining their care plan). There may be a reason why here. There may not be a reason why. But the bottom line is that you can't care more than the patient about his/her health. I would document my numerous attempts in a variety of ways to move the patient, though, as opposed to just charting "patient declined."

[brownbook]

As others said it is assault and battery to do something to a patient that they adamently refuse.

Of course do some low level interventions, therapeutic questions, therapeutic listening, ask co-workers if they have had success with the patient, etc., but if the patient still refuses don't do it. Always notify the doctor of what treatment they are refusing.

[Crush]

Forcing them to turn can be considered battery; touching without consent. Explaining, teaching, being as gently as possible, but in the end the patient has the right to refuse.

Get the doctor involved, possibly case management, write an incident report (we have forms for things that are not mistakes but potential problems to give a heads up notice to the hospital).

Being the whole team together and try to come up with a plan that the patient will accept.

Absolutely. Document, document, document. However, don't forget patient teaching and trying to find out reasons why such as, why did she/he say they were treated like a bag of meat. Maybe they need something for pain before turning? You have to document each time they refuse too. Oh, and notify your manager of the situation.

[KelRN215, BSN, RN]

"Pt refusing to be turned." Every time he refuses, document his refusal.

[Julius Seizure]

Forcing them to turn can be considered battery; touching without consent. Explaining, teaching, being as gently as possible, but in the end the patient has the right to refuse.

Get the doctor involved, possibly case management, write an incident report (we have forms for things that are not mistakes but potential problems to give a heads up notice to the hospital).

Being the whole team together and try to come up with a plan that the patient will accept.

I'm not sure what case management would be able to do about it? But I would definitely make sure the charge nurse is aware, as well as the medical team.