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?
Everyone had great suggestions. I'm curious what the Braden score of the patient you mentioned is. If patients at my facility are at higher risk for skin breakdown (low mobility, poor nutrition, moist skin, etc.) we are able to put an RN intervention order in for a wound-ostomy consult. That team of nurses is great at doing a chart review, and then talking to the patient about their recommendations. Would that be an option at your place of work?
Another thought...would your patient be able to participate in turning by using a trapeze bar?
Specializes in LTC, Wounds, Med/Surg, Tele, Triage.
And for God's sake, make sure it is documented that the family has been counseled also. It will be they who are first to be calling a lawyer when something negative occurs.
Like in a care conference with all the major parties present.
Like others have said, you can't force the pt, but you can CYA. Some facilities are very proactive in situations like this in that their legal dept likes to be informed of potential impending problems with pts and et al.
This! Without giving too many details - when I worked med/surg a quadriplegic pt was refusing turns (and other forms of care too, dressing changes, compression stockings, etc) and later developed complications related to not being turned. Ended up passing away after discharge while in a SNF and family attempted to come back later and sue for negligence. The same family that was often present when pt was refusing care in the hospital. So yes, just document, like others have stated.
Just chart the refusal and the education that you gave regarding what can happen. Other than that, what can you do. Patients do this all the time and they have the right to.
Specializes in Med/Surg/Infection Control/Geriatrics.
You can always smile and gently explain that bed sores, constipation, pneumonia and blood clots which can happen when one chooses not to follow the doctors orders and nursing care plan, will prolong their hospital stay. I once had a dr. tell me it was ok to tell the patient who was not being cooperative (alert and oriented) that no one likes to leave in a body bag...........
Nursetom1963, BSN
68 Posts
Im curious how your director responded to this dilemma