Question

In: Nursing

1. What is proper process to refuse care for an adult patient or parental guardian? 2....

1. What is proper process to refuse care for an adult patient or parental guardian?

2. Are patient centered care and collaborative care the same thing?

Solutions

Expert Solution

If your patient refuses treatment or medication, your first responsibility is to make sure that he's been informed about the possible consequences of his decision in terms he can understand. If he doesn't speak or understand English well, arrange for a translator. Your documentation in the medical record must include that you and the primary care provider informed him about:

  • the problem needing treatment or diagnosis
  • the proposed treatment, medication, or diagnostic test
  • the anticipated benefits, risks, complications, adverse reactions, and consequences of the proposed treatment
  • the risks and possible consequences of refusing the treatment, including threats to safety, health, and life
  • the reasons for his refusal of treatment, such as wanting alternative treatments or a lack of insurance coverage.
  • Informed refusal also depends on the patient's capacity to make sound decisions. A jury would expect you to perform a careful neurologic and psychological assessment. If, based on this assessment, you suspect that the patient isn't capable of making an informed refusal, immediately notify his primary care provider and your nurse-manager. The primary care provider should evaluate the patient and determine whether to request a psychiatric or social service evaluation.
  • Your documentation needs to tell a clear story. First, document the results of the mental status assessment, including patient statements and behaviors. Then, document the information you provided to your patient and his response, in his own words. Note any additional written information you gave him. Ask if he has any questions; if so, document them and your response.
  • When charting, use objective terms, not innuendo, generalities, opinions, or assumptions that couldn't be defended in front of a jury. Ideally, you, the primary care provider, and your patient should sign and date this documentation.
  • Depending on your facility's informed refusal policy and procedure, you may use a “refusal to consent” form that the patient must sign. If he refuses to sign such a form, document that too.

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