Results: When a patient refuses nursing care, nurses respond by giving information until the patient finally accedes to the procedure. Nurses will go to great lengths to achieve patients’ agreement to the procedure, but the extent to which the agreement remains voluntary cannot be ascertained by the data collected in this study.
Full Answer
What are nursing interventions?
Nursing interventions are actions a nurse takes to implement their patient care plan, including any treatments, procedures, or teaching moments intended to improve the patient’s comfort and health. 2 Nursing interventions can be as simple as adjusting the patient’s bed and resting position—or as involved as psychotherapy and crisis counseling.
What do we know about nursing interventions to prevent falls?
The following findings were revealed: Appropriate nursing interventions had been initiated for 72% (58 patients). Of all patients considered at a moderate-to-high fall risk, 79% wore armbands, 76% wore yellow socks, and 70% had the falling star applied to their doors.
Why do patients refuse medical interventions?
According to Holeman, understanding why a patient refused an intervention is important because the decision could be irrational or based on misinformation. "An extreme example is a patient with an elevated PSA who refuses a prostate biopsy because he is afraid it would make him sterile.
What should a nurse do when a patient refuses treatment?
Once a nurse understands the reasons for refusal, the nurse should try to discuss the logic behind the patient’s thinking (Noonan MD 2016, October 26)) Information is a powerful tool.
What Are Nursing Interventions?
Nursing interventions are actions a nurse takes to implement their patient care plan, including any treatments, procedures, or teaching moments intended to improve the patient’s comfort and health. 2
How many categories of interventions are there in nursing?
Nursing interventions are grouped into three categories according to the role of the healthcare professional involved in the patient’s care:
What can a nurse do after a diagnosis?
After gathering all essential information during the assessment process, the nurse can use clinical judgment to formulate a nursing diagnosis. Based on the assessment and diagnosis, the nurse can develop a care plan that outlines which interventions to include. 4 For example, a nurse diagnosis may conclude the patient has a lack of appetite due to post-surgery pain. From this diagnosis, the nurse can set goals to resolve the patient’s pain through actions such as administering pain-relief medication and assessing the patient’s pain levels every few hours.
What are the duties of a nurse?
On-duty nurses routinely perform certain nursing interventions as part of their daily tasks. In addition to educating the patient on their care and recovery progression, nurses will typically perform the following each shift: 1 Pain control: Ensuring that the patient is comfortable and monitoring their intake of pain medication, if applicable 2 Position changes: Promoting a change of the patient’s resting position to prevent bedsores 3 Active listening: Listening to the patient and repeating back information so they feel heard 4 Cluster care: Informing other nurses and medical staff of the patient’s needs each shift to help consolidate trips and avoid frequent traffic in the patient’s room 5 Fall prevention: Educating the patient, generally someone who is elderly or recovering post-surgery, of instructions to avoid the risk of fall and injury 6 Adequate oral intake: Promoting fluid consumption by mouth for patients currently receiving fluid through IVs as a means to decrease and discontinue IV use
What is NIC in nursing?
The Nursing Interventions Classification (NIC) system categorizes a wide range of possible treatments that a nurse may perform.
What can a nurse use clinical judgment for?
Medical history. Current neurological functioning. After gathering all essential information during the assessment process, the nurse can use clinical judgment to formulate a nursing diagnosis. Based on the assessment and diagnosis, the nurse can develop a care plan ...
What is community nursing intervention?
Community Nursing Interventions. Some hospitals and clinics focus on public health initiatives to educate patients, their families, and local communities. These community nursing interventions are organized efforts that encourage general health and wellness.
Why is it important to understand why a patient refuses an intervention?
According to Holeman, understanding why a patient refused an intervention is important because the decision could be irrational or based on misinformation. "An extreme example is a patient with an elevated PSA who refuses a prostate biopsy because he is afraid it would make him sterile. It would be important to address this concern in the discussion because you may be able to overcome it and obtain consent," says Holeman.
What to do when a patient refuses therapy?
Use any community resources available. "Our advice is to use bioethics, social work and psychiatry services early in the process of therapy refusal, especially when the consequences of such refusal are severe, irreversible morbidity or death." (10) Having the patient obtain a second opinion may be effective, as hearing the same concerns strongly voiced by two physicians may convince the patient to proceed.
What was the issue in the case of the cardiac catheterization?
One of the main issues in this case was documentation. Essentially the case became a debate regarding a conversation with the cardiologist and the patient about whether cardiac catheterization was offered and refused. The physician admitted at deposition that he made a mistake in not documenting the patient's refusal to have a catheterization. However, he was adamant that he did discuss the matter with the patient and the patient refused the procedure.
What is prudent practice?
Prudent practice involves comprehensive documentation. As with the informed consent process, informed refusal should be documented in the medical record. In the case study, the jury found in favor of the plaintiffs when faced with a deceased patient and an undocumented patient decision of great importance.
Why are some patients unable to make medical decisions?
(4, 6) Other patients may be suffering from impaired decision-making capacity caused by intoxication, hypoxia, sedation, stress, or fever. "Every effort should be made to reverse potential impairments in capacity, to assure that the patient is making the most rational, autonomous choice." (7)
What is informed refusal?
INFORMED REFUSAL. Texas law recognizes that physicians must obtain consent for treatment and that such consent be "informed.". A variant of informed consent is informed refusal, in which a patient refuses treatment after having been informed of the risks and benefits of the intervention. Many physicians associate the concept ...
Why do patients refuse to see a doctor?
"The patient's decision may arise from many sources, including the denial of the potential seriousness of the medical condition; lack of confidence in the physician or institution; disagreement with the plan of management; conflicts between hospitalization and personal obligations; and financial concerns." (2)
What to do if it is unclear whether the patient has capacity to refuse treatment?
Seek specialist advice (for example, from a psychiatry team) if it is unclear whether the patient has capacity to refuse treatment and which legal framework should be used
What are the three legal frameworks for treating someone who refuses treatment?
In essence, there are three legal frameworks for treating someone who refuses treatment: (the) common law, the 2005 MCA, 4 and the 1983 MHA. 5 All clinicians need to be familiar with these frameworks (table 1 ⇓ ).
When acting against a patient's wishes, is the MCA used?
As a general rule, when acting against a patient’s wishes, the MCA is used to treat physical disorders that affect brain function and the MHA is used to treat primary mental (psychiatric) disorders. In part two of the case scenario the patient’s behaviour has changed.
Why is informal treatment no longer appropriate?
The full reasons why informal treatment is no longer appropriate are documented; include mental state abnormalities and potential risks to the patient or others (or both)
What is the first step in a mental health case?
The first is to determine the urgency of treatment to see whether common law is applicable. The second is to determine what is being treated—a primary physical (organic) disorder or a primary mental (psychiatric) disorder. We will now explain how to work through these two steps as we look at the evolving case scenario.
Who should assess a patient's capacity to make a decision?
The code of practice stipulates that a patient’s capacity to make a decision should be assessed by the person directly concerned with the patient at the time the decision needs to be made. 10 In most instances of hospital inpatient care, the professional within the multidisciplinary treating team responsible for the patient’s treatment will be responsible for ensuring that a capacity assessment has taken place. However, when the existence of a disorder of the mind or brain, or the presence of capacity, is unclear, specialist support should be sought from a psychiatry colleague.
Can patients be treated against their wishes?
Patients can be treated against their wishes only if their decision making capacity is impaired and if the proposed treatment is for something serious enough to warrant over-riding their wishes.
When treatment over a patient's objection would be appropriate?
KP: A simple example of when treatment over a patient’s objection would be appropriate is if a psychotic patient who had a life-threatening, easily treatable infection was refusing antibiotics for irrational reasons. Treatment would save the patient’s life without posing significant risk to the patient.
What are the first few questions in a treatment plan?
The first few questions consider the imminence and severity of the harm expected to occur by doing nothing as well as the risks, benefits, and likelihood of a successful outcome with the proposed intervention. Other questions consider the psychosocial aspects of this decision—how will the patient feel about being coerced into treatment? What is the patient’s reason for refusing treatment? The last question concerns the logistics of treating over objection: Will the patient be able to comply with treatment, such as taking multiple medications on a daily basis or undergoing frequent kidney dialysis?
Is there anything out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients?
And there are fairly clear policies and laws concerning the ethics and legality of delivering psychiatric care to patients who refuse it. But there is nothing out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients who lack decisional capacity.
Can you force dialysis on a patient who resists?
As Dr. Rubin stated, one cannot force three times weekly dialysis sessions on a resistant patient even if it means that the patient will die without the treatment.
What is the unique patient who refuses conventional treatment?
The unique patients who refuse conventional treatment are at times self-directed, confident, and active, and have thought deeply about the meaning of life and cancer and about their cancer treatment options.
What is the survival rate of women with diseases at the same stage who did not receive chemotherapy?
It was 26%.
How does communication affect cancer care?
The quality of communication in cancer care has been shown to affect patient satisfaction, decision making, patient distress and well-being, compliance, and even malpractice litigation [22, 23]. Treatment decision making is an ongoing process; thus, patients who initially refuse treatment may later choose to undergo conventional cancer treatment if given the adequate support, information, and time necessary to make the decision. Even if patients have declined oncologic care, they may continue to see their primary care providers and family physicians. Patients need to feel that they have not been permanently excluded from the health care system even if they make choices that are contrary to the recommendations of their medical team [24].
Is the number of patients that decline conventional cancer treatment substantial enough to warrant close attention?
The number of patients that decline conventional cancer treatment is substantial enough to warrant close attention. Effective patient-doctor communication is crucial in addressing this challenge.
Is refusal of cancer treatment a serious concern?
Although the refusal of cancer treatment is a serious concern and has been shown to reduce the effectiveness of treatment and decrease survival duration after diagnosis [1, 2], the phenomenon itself has been scarcely studied. The number of patients who make this decision is not very well-known, but the number appears substantial enough to warrant close attention [3]. Studies have reported rates of less than 1% for patients who refused all conventional treatment [4] and 3%–19% for patients who refused chemotherapy partially or completely [5–9].
What does an increase in fall incidence mean?
Problematic outcomes such as an increase in fall incidence could indicate flawed policies or shortcomings in staff adherence. In this case, a thorough baseline assessment revealed variability in complying with existing policies and procedures related to knowledge deficits, nursing practice inconsistencies, and lack of leadership engagement.
What is the leading cause of fatal and non-fatal injuries among Americans 65 and older?
FALLS ARE the leading cause of both fatal and non-fatal injuries among Americans 65 and older. 1 These incidents are also costly for hospitals and other healthcare institutions, which are financially responsible for inpatient falls. To address a recent spike in falls, nursing leadership within a moderately sized, ...
What is postfall management?
Conduct postfall management, which includes a postfall huddle; a system of honest, transparent reporting; trend research and analysis of falls, which can inform improvement efforts; and reassessing the patient.
What are the recommendations of the Joint Commission?
The Joint Commission's recommendations on falls prevention. Lead an effort to raise awareness of the need to prevent falls resulting in injury. Establish an interdisciplinary falls injury prevention team or evaluate the membership of the team in place.
What is the lack of consistency in both policy and procedure compliance and education provided?
Identifying the lack of consistency in both policy and procedure compliance and education provided may reflect on staff turnover and leadership engagement. To address these issues, executive and midlevel leaders were first educated about the results of the audit, and staff were reeducated on requirements of existing policy and procedure. This also served as the launch for a standardization of all patient education using the “teach-back” method.
What is shortage of breath in nursing?
Here’s what you need to know about nursing interventions for shortage of breath; Most times, shortage of breath is a pointer to a health condition that needs attention. When a person gasped for breath, the first thing is what to do to make the person breathe properly.
Why is it important to intervene in a shortage of breath?
Nursing intervention for the shortage of breath is a crucial concept to master as it explains actions taken by nurses to preserve the health of their patients.
How to help a patient who is struggling with breathing?
It can demand a lot of patience and understanding. Patients can be helped in communication through the use of flashcards or written notes to save them from the stress of speaking much. During this period, it’s more important for nurses not to assume on behalf of the patient as they could answer with a nod or shaking of the head. A further limitation of communication could be the use of nasal cannulae. It will help the nurse in monitoring the lips movement and more.
Can a nurse help with anxiety?
Such patients need the company of the nurse. The presence of nurses who show support and talks calmly to them can help them improve significantly. The instructions on how to breathe and doing the same with these patients can be useful as it helps them breathe effortlessly.
What Are Nursing Interventions?
- Nursing interventions are actions a nurse takes to implement their patient care plan, including any treatments, procedures, or teaching moments intended to improve the patient’s comfort and health.2 These actions can be as simple as adjusting the patient’s bed and resting position—or as involved as psychotherapy and crisis counseling. While some nu...
The Role of Assessments
- The nursing assessment is the first step in the nursing care plan. During the assessment process, both physicians and nurses might ask questions and perform tests to gain information about a patient’s health and state of being. Professionals gather information from the patient’s: 1. Vital signs 2. Physical complaints or concerns 3. External body conditions 4. Medical history 5. Curre…
Nursing Interventions Classification System
- There are several types of nursing interventions aimed at meeting the variety of medical needs and conditions of patients. The Nursing Interventions Classification (NIC) system categorizes a wide range of possible treatments that a nurse may perform. The book Nursing Interventions Classification (NIC), 7th ed. evaluates this system, defining over 550 nursing interventions from …
Key Nursing Interventions to Perform Each Shift7
- On-duty nurses routinely perform certain nursing interventions as part of their daily tasks. In addition to educating the patient on their care and recovery progression, nurses will typically perform the following each shift: 1. Pain control: Ensuring that the patient is comfortable and monitoring their intake of pain medication, if applicable 2. Position changes: Promoting a chang…
Case Study
Informed Refusal
The Process of Informed Refusal
Assessing Decision-Making Capacity
Documenting Informed Refusal
Other Risk Management Considerations
- In addition to documenting the informed refusal discussion, the following recommendations may help minimize the risk of lawsuits related to patient refusals. 1. As part of routine care, inquire about and encourage patients to complete advance directives before serious illness or capacity questions arise. "If the patient has an Advance Directive or ...
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