When a Resident Refuses

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A resident where I work has been refusing care. I don't want to say too much and risk violating Hippa but in general, This resident is somewhat new to our facility and as of late has been repeatedly refusing to be turned, changed, repositioned. She takes a LOT of pain medication but apparently it is not helping to alleviate the pain sufficiently to allow us to provide the necessary care. we have been documenting, documenting, documenting care refusals. I want to make sure this is approached correctly, before it potentially turns in to something much bigger. Can anyone please offer their thoughts.

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If pain is the reason that the patient is refusing to be properly cared for I think you need to bring the fact that the patient’s pain isn’t adequately managed to the treating physicians’ attention as soon as possible. Maybe the patient needs a higher dose of the medication he or she is on. Perhaps they need a different kind of pain medication if the current one isn’t working. Perhaps the timing of med administration needs to be changed to coincide with the time that the various turning and changing activities take place. Properly managed pain should allow for the patient to move or be moved. If not I consider the patient’s pain undertreated.

With proper pain management the need for the nurses to document care refusals might actually go away and more importantly the risk the patient runs of suffering from skin breakdown and pressure ulcers is decreased. That’s a win-win situation in my opinion.

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I think it is time for some sort of interdisciplinary meeting, however informal or formal. A nurse can only document so many times before the question is asked, "Well, what else did you do about it?" I agree with macawake's suggestion to report to the physician. If it is not an issue of pain management, it could be an issue of depression, anxiety, addiction etc.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Couldn't agree more with the above posters.

Refusals are not the problem, WHY the patient is refusing is the problem and MUST be addressed ASAP.

You indicate that the resident takes a great deal of pain medication but still has pain. You are obligated to act on that information as the patient advocate.

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Specializes in HH, Peds, Rehab, Clinical.

Educate. Document. It's HIPAA!!! NOT HIPPA....

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Educate. Document. It's HIPAA!!! NOT HIPPA....

And not Hippa, either. :)

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I would ask her primary for a pain management referral if he is hesitant to change/increase her meds.

Continue documenting refusals of course, and also be sure to document that pt was thoroughly educated on reasoning behind turning/etc. and possible negative consequences of non-compliance.

If all avenues as to why she is refusing are addressed, and she is still refusing...

Like we used to say at a former job, "people have the right to make bad decisions."

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Right. exactly. and of course that had been addressed (i.e., proper pain management). Her narcotic dosages had been bumped up several times. This is an individual with a history of addiction and substance abuse (NOT to imply this means she doesn't deserve "Proper pain management"!) Again, more I could say about the situation, but due to privacy concerns, I'm going to withhold. The situation seems to be resolving, I'm happy to report.

If pain is the reason that the patient is refusing to be properly cared for I think you need to bring the fact that the patient’s pain isn’t adequately managed to the treating physicians’ attention as soon as possible. Maybe the patient needs a higher dose of the medication he or she is on. Perhaps they need a different kind of pain medication if the current one isn’t working. Perhaps the timing of med administration needs to be changed to coincide with the time that the various turning and changing activities take place. Properly managed pain should allow for the patient to move or be moved. If not I consider the patient’s pain undertreated.

With proper pain management the need for the nurses to document care refusals might actually go away and more importantly the risk the patient runs of suffering from skin breakdown and pressure ulcers is decreased. That’s a win-win situation in my opinion.

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@toomuchbaloney: You are obviously assuming I/we have not considered this already. "WHY the patient is refusing is the problem and MUST be addressed ASAP."

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This is a good response, and it addresses the question from a broad theoretical standpoint. This is more along the lines of what I was looking for. Thank you kiszi.

I would ask her primary for a pain management referral if he is hesitant to change/increase her meds.

Continue documenting refusals of course, and also be sure to document that pt was thoroughly educated on reasoning behind turning/etc. and possible negative consequences of non-compliance.

If all avenues as to why she is refusing are addressed, and she is still refusing...

Like we used to say at a former job, "people have the right to make bad decisions."

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Educate. Document. It's HIPAA!!! NOT HIPPA....

@BuckyBadgerRN: I see the resident spelling police has descended upon the one spelling mistake I think I have ever made in 30 years. I posted this message while in a rush and was less concerned with the accuracy of spelling than the meaning behind the message. Yes, I am well aware it is HIPAA not HIPPA.

I will not hesitate to say I am thoroughly annoyed by your response. I posted a serious question and was hoping and looking for serious, thoughtful responses.

Here is a clue. Stick to the topic.

That is all.

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A resident where I work has been refusing care. I don't want to say too much and risk violating Hippa but in general, This resident is somewhat new to our facility and as of late has been repeatedly refusing to be turned, changed, repositioned. She takes a LOT of pain medication but apparently it is not helping to alleviate the pain sufficiently to allow us to provide the necessary care. we have been documenting, documenting, documenting care refusals. I want to make sure this is approached correctly, before it potentially turns in to something much bigger. Can anyone please offer their thoughts.

My talent as a mind reader isn’t all that impressive even when I can see and hear the person I’m interacting with. Over the internet this already rather underdeveloped talent of mine becomes non-existent. So you’ll have to excuse me if I didn’t understand that you had already taken all these other steps when all you mentioned in your original post was documenting, documenting and more documenting…

You asked for thoughts. You got a random selection of thoughts. It’s unfortunate if they were not to your liking or deemed superfluous. You seem offended by some of the suggestions offered. You provided very little background about the case. You didn’t mention what attempts had already been made to solve the problem.You provided no insight into your own experience as a nurse. This made it rather difficult to figure out what kind of thoughts and suggestions you were looking for.

All I and others could go by was the information that you originally provided.

Right. exactly. and of course that had been addressed

If I’d had this information my response to your original post would obviously have been different.

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