Pt refusals

6 So I had this post-op pt who absolutely refused to do anything. No ambulating, convinced the PA to let them keep their foley. All the while screaming "I know my own body!!"

I told them in gory detail all of the complications of refusing to move at all, I cajoled, I demanded, I sent comrades in arms. The pt absolutely refused to budge an inch. I finally convinced them to at least wear their teds and SCDs and to use their inspirex. I gave the heparin and made them move to one side or the other every other hour. Ibasically did everything in my power to prevent all of those complications.

How much do you want to bet that the pt will go home complication free and say "I told them so!"
I recently observed an ortho surgeon comment to a patient, "It's unfortunate, but every once in a while a patient of mine doesn't do well ... not able to tolerate the standard things we do to minimize complications, not able to take small incremental steps towards their own recovery. These people end up in nursing homes because they're unable to care for themselves." (sigh, shake of head while walking away)What a miraculous turnaround in that patient's participation in his own plan of care!

I had a pt like this once and he developed all the complications (blood clots, pneumonia, ileus- ended up with NG tube). I thought it was hard to get him up and moving prior to the complications, but once he got the complications he was even more resistant. Some people are just so irrational it is very hard to deal with.... he went home and died. I hate when it is the patient who does everything right and ends up with complications, makes me feel so bad for them.

For the seasoned nurses....Was there a time when most patients were less likely to go against doctors' orders? It seems like the anthem nowadays is me-me-me-my-choice-customer-is-always-right, please the patient to get Press Ganey scores up etc. etc. I am wondering if there was less of that mentality back then when it came to refusal of the plan of care. Thanks.

Quote from CuddleswithpuddlesFor the seasoned nurses....Was there a time when most patients were less likely to go against doctors' orders? It seems like the anthem nowadays is me-me-me-my-choice-customer-is-always-right, please the patient to get Press Ganey scores up etc. etc. I am wondering if there was less of that mentality back then when it came to refusal of the plan of care. Thanks.

Altra, I wish nurses could say stuff like that. If I said that to a patient at my facility, I would be fired.

Nursing school 101 right? The patient ALWAYS has the right of refusal. We smile and document.Remember autonomy?

we can't obligate anyone to do anything therefore, we can only educate the pt.

For those who are only moderately difficult, what I find works is flexibility. If they want to refuse PT, I tell them they must go today but if now is not a good time, please tell me when would be better for you. That way they still feel like they accomplished their mission of exercising their independence but I got them to go to PT by the end of my shift. For those who flat out refuse everything, I have started to get cocky enough to ask them whether we should discharge them now because it seems there is nothing more we can do for them. Sometimes they may even benefit from a psych visit.. perhaps they're too depressed to participate in their own care.

Quote from NurseOnAMotorcycleSo I had this post-op pt who absolutely refused to do anything. No ambulating, convinced the PA to let them keep their foley. All the while screaming "I know my own body!!"I told them in gory detail all of the complications of refusing to move at all, I cajoled, I demanded, I sent comrades in arms. The pt absolutely refused to budge an inch. I finally convinced them to at least wear their teds and SCDs and to use their inspirex. I gave the heparin and made them move to one side or the other every other hour. Ibasically did everything in my power to prevent all of those complications.How much do you want to bet that the pt will go home complication free and say "I told them so!"

I am not sure why all the worry. Teach them, if they refuse, document. If they die, shame on them. Move to next patient.

Quote from nguyency77 every other day we would have some hysterical patient come in with a thousand print-outs from WebMD of possible but irrelevant diagnoses.

different when its a child. you can take that to the ethics committee.....or to the courts