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
Can nurses manage patients who refuse nursing care procedures?
Objectives: The aim of this paper is to examine the way in which nurses manage patients who refuse nursing care procedures. Design: This paper reports on a qualitative study which was undertaken to explore the way in which nurses obtain consent prior to nursing care procedures.
Why would a patient refuse treatment?
Patients may refuse treatments for many reasons, including financial concerns, fear, misinformation, and personal values and beliefs. Exploring these reasons with the patient may reveal a solution or a different approach. Involve Family Members and Caregivers
Do competent patients have a right to refuse medical treatment?
Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law.
When to seek specialist advice when a patient refuses 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 Knowing when and how to treat patients who refuse treatment is challenging.
What can a nurse do if a patient refuses treatment?
Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication.
How would you handle it if a patient refuses care?
Taking the following steps can protect your patients' rights and your practice.Patient Education, Understanding, and Informed Consent. ... Explore Reasons Behind Refusal. ... Involve Family Members and Caregivers. ... Document Your Actions. ... Keep the Door Open.
Is it ethical to refuse a patient?
The fourth edition of the American College of Physi- cians' Ethics Manual reaffirms the right to refuse nonemer- gent care to an individual patient when treatment is other- wise available.
What should the nurse do if the client refuses to take a medication?
If the client refuses and gives no reason, wait a few minutes and then offer the medication again. If the client refuses again, try again in another few minutes before considering a final refusal.
What is the nurse's legal and ethical responsibilities toward the patient who refuses medical care or treatment?
They must maintain patient confidentiality and observe the right to refuse treatment. Nurses should also be involved in informed consent, medical treatment in an emergency, and continuity of care.
Do patients have the ethical right to refuse treatment?
Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life.
Do nurses have the right to refuse a patient?
The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
Why must physicians respect the patient's refusal of treatment?
In general, ethical tension exists when a physician's obligation to promote a patient's best interests competes with the physician's obligation to respect the patient's autonomy. “When you don't take your medication, you're more likely to get sick.”
What is the right to refuse treatment called?
Under federal law, the Patient Self-Determination Act (PSDA) guarantees the right to refuse life sustaining treatment at the end of life.
What strategies can the nurse employ to ensure drug compliance for a patient who is refusing to take his her medication?
The following are ten strategies that providers can use to boost medication compliance.Understand each patient's medication-taking behaviors. ... Talk about side effects. ... Write it down. ... Collaborate with patients. ... Consider the financial burden to the patient. ... Assess health literacy. ... Reduce complexity. ... Follow up with patients.More items...•
When documenting that a patient has refused a treatment you should include?
Terms in this set (15)Documentation of the refusal of treatment should include: ... Informed consent upholds the ethical principle of. ... informed consent involves telling the patient: ... Signing the Notice of Privacy Protection as mandated by HIPAA is the same as signing an informed consent document for treatment.More items...
Why did nurses not respect the refusal of the patient?
The nurses in this incident did not respect the refusal of the patient. They proceeded with nursing care because they felt it to be essential . In another incident, a patient was in great pain and unable to sit in a chair because of the backache this caused.
What is the tension of refusing nursing care?
On the one side, nurses are aware that care cannot be carried out without the patient’s consent. There is evidence in the study that they will go to great lengths to achieve the agreement of the patient.
What happens when a patient does not agree to the administration of a nursing care procedure?
When a patient did not eventually agree to the administration of a nursing care procedure, the tension between respect for patient choice and the perceived duty to care could not be resolved. In these instances, nurses did what they indicated they would do in earlier incidents.
Why did a dying patient refuse a nasogastric tube?
In a third incident, a dying patient refused a nasogastric tube. This refusal was upheld because there was no clear benefit to be gained from continuing the feeding. In a fourth incident, a patient’s refusal of antibiotics for a severe chest infection was respected.
Is consent necessary in nursing?
In their view, consent can be described as desirable but ultimately not essential. Nurses demonstrated some knowledge of ethical principles and were concerned to incorporate these into their practice but seemed unaware how to do so when faced with a patient who refused nursing care.
Can nurses be absolved of their duty to care?
It is therefore argued that nurses are absolved from their duty to care if the patient (informed, voluntarily and competently) refuses that care. As a result, care, even life saving in nature, cannot be administered if the patient refuses.
Is there evidence that nurses use information to persuade and inform only?
Although the data collected in this study did not allow for examination of whether the nature of the patient’s agreement prior to nursing care procedures, was or was not voluntary there is no evidence that nurses use information to persuade and inform only . Indeed, the lack of choice indicates an element of coercion.
What happens when a patient refuses life-sustaining treatment?
When a patient refuses initial life-sustaining treatment, respectfully explore the underlying reason for the refusal. This allows the healthcare team to identify alternative options that may be equally medically effective and also acceptable to the patient. In the end, the patient has the right to accept or refuse life-sustaining medical treatment.
What ethical dilemmas can a nurse face?
A: One of the greatest ethical dilemmas a nurse can encounter is when a patient refuses life-sustaining treatment—any procedure, medication, intervention, or use of medical technology that can postpone death. As healthcare providers, we're instilled with the primary objective to save lives. However, when treatment options are aimed ...
Why do some people refuse blood transfusions?
Some patients may elect to refuse specific medical treatments, such as blood transfusions, because of religious beliefs, but will accept synthetic blood plasma expanders that aren't made of donor blood. When a patient refuses initial life-sustaining treatment, respectfully explore the underlying reason for the refusal.
What does it mean to be competent in healthcare?
The term competent means the patient understands that refusing to accept treatment will result in eventual death.
Is it illegal to force a patient to take medication without their consent?
Forcing treatment on a patient without his or her informed consent is illegal . Ensure that the risks and benefits of all treatment options are discussed with the patient so that he or she can make an informed decision that reflects his or her values and beliefs.
Can you stop curative treatment?
However, when treatment options are aimed at prolonging the patient's life, and no acceptable curative treatment option is available, patients may opt to cease medical treatment. Even when curative options are available, patients may not be willing to undergo the physical trauma, time involved, or associated emotional distress.
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.
Can unwise decisions be made?
Unwise decisions can be made: it is not the decision but the process by which it is reached that is being assessed. Decisions (and actions) made for people lacking capacity must be in their best interests. Decisions (and actions) made for people lacking capacity must be the least restrictive option (s)
Is common law a doctrine of necessity?
View inline. Common law is more informatively known as the “doctrine of necessity” and is only one form of common law, which is based on judgments of individual cases (also known as case law). This differs from statutory law, which is based on acts (of parliament), such as the MCA and the MHA.
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.
Can a section 5 order be used in an outpatient setting?
The patient is already admitted: a section 5 (2) order can be used only in the inpatient setting (but not emergency or outpatients departments, although in some trusts or health boards the clinical decisions unit may count as an inpatient setting)
Can a delirium patient use the MCA before the MHA?
Where possible, the MCA should be used before the MHA. In this case, it would also be appropriate to use the MHA to keep the patient on the ward to treat his mental disorder. If he refused treatment, ongoing treatment of his physical health conditions (femoral and pelvic fracture) would need to take place within the framework of the MCA.
Develop a plan to address the refusal and support staff
Addressing the issue of patient refusal of a nurse assignment requires understanding three factors: the patient, the nurse, and the organization.
Case exemplar
A 60-year-old White man arrives in the emergency department with shortness of breath caused by an asthma exacerbation. When he’s admitted to the telemetry unit, he’s greeted by a Black female staff member. The patient immediately asks if she’s the nurse’s aide.
Groundwork for understanding
Addressing a situation in which a patient refuses to be cared for by a specific nurse requires clearly defined terminology related to inclusivity and discrimination. Although each incidence of refusal is unique, the terms below may be relevant.
Addressing the situation
A patient’s refusal of a nursing assignment opens up a host of questions. If hospital management accommodates the patient’s request, are they discriminating against the nurse? What guides the nurse manager’s or nursing leadership’s decision-making process? Frequently, the affected nurse is from an underrepresented group.
Algorithm to address patient refusal
This algorithm, developed by Camelo in collaboration with staff, provides guidance for nurses when patients refuse their care.
Supporting staff
During the refusal incident, the nurse manager should allow the primary nurse to take the lead in determining what type of support they need. Some nurses may want to handle the situation themselves, while others may require assistance from the manager.
Work in progress
Nurses are expected not only to be expert care providers but also competent in dealing with challenging patient behaviors, implicit bias, and microaggression. Unfortunately, the skills required to address these issues are rarely taught in nursing school.