What are your personal standards when a patient "refuses care"

[DesiDani]

For example personal care and/or ADL care. Do you keep asking, find out why, or just leave it at that. No, I don't think that every patient who refuses care is mentally incompetent. They may just be angry, scared, or suspicious.

I do believe that when some healthcare workers and even Drs hear those magical words "patient refuses", that translates into never having to bother with that patient again. Hey after all, they refuse care and they have the right to refuse care. Yet I've seen patients who are like this and they are the ones who have 4 pressure sores, constantly on isolation, etc.

So do you just accept that a patient refuses care and when do you just give up and let it go?

[CryssyD]

I just let them refuse whatever they want--they have the right to refuse; but I do document everything--exactly what the patient said.

Sometimes you have to push the issue, though. I had a patient once on a long-term psych unit who had steadfastly refused to remove his boots for, like, two weeks; maybe more. I told the aide that those boots were coming off, and I didn't care what the patient said; when he pulled the boots off (the patient was agreeable after some intense sweet-talking by me and the aide) the sight and smell were indescribable--I think there was mold growing between his toes. Something was growing there, anyway, and it was totally gross.

[SubSippi]

I'm not in the business of begging grown people to take a bath.

Of course, I let them know that they can always change their mind. I do like to ask if it's a pain issue (I work in a CVICU, lots of post-op pain) and let them know we can wait until their pain meds set in.

[friggasdistaff]

'Others have a different approach, I've noticed, especially phlebotomy. The patient needs only to shake the head once, and the phoebes are outta there so fast with a perfunctory call to the nurse. But, then again, they'll use any excuse to skip draws, including lying about patient availability (I've caught that lie two times and reported it.)'

If you've got Phlebotomists who are lying about patient availability then they should be absolutely be reported. However, I will say that it is no way a Phlebotomist's job to convince a patient to agree to a blood draw. They aren't privy to the reason the tests have been ordered, or the patient's current medical condition. I will say that once they notify a nurse of patient refusal they should wait around a bit to see if the Nurse can convince the patient to agree to the blood draw.

[CBlover, BSN, RN]

Well I don't think I've ever had a patient refuse all my care. But definitely lots of little cute old folks that think the pills I'm giving might be poisonous :). I'll put the pill in anything I can hide it in and still try to give it to them. But after it ends up on my uniform I usually chart "refused."