Adminestering Medication to Non-Compliant Patients

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The Event An 80 year old female patient with admitting diagnosis of Congestive Heart Failure was refusing care. She presented with unremarkable vital signs, shortness of breath on exertion, decreased air entry right lower field, heart sound 1 muffled, heart sound 2 regular. She had oedematous legs bilaterally. Due to excessive oedema, she had ecchymosis to dorsal left foot, her dorsalis pedis were not palpable and experienced foot pain exacerbated with passive range of motion. She also had a small open coccyx wound. Again, patient was non-compliant with care, refused to be repositioned and refused administration of all medication. My previous experiences In the past I have argued with non-compliant patients while trying to convince them to take medications. Sometimes these arguments were to no avail and sometimes met with begrudging compliance. In both outcomes I felt stressed, exhausted, non-ethical and non-effective. My personal assumptions I assumed I must administer medications as ordered by the doctor despite what the patient is telling me. I assumed her condition is going to worsen into a medical crisis that will be stressful for me and the health care team if she does not comply. I also assume this non-compliance indicates this patient is not competent to determine what is good for her at this time. I also assumed that what I believe my role is as a nurse is best for the patient. Other ways of looking at the situation Another, and what I have come to appreciate as a better, way of looking at the situation is to attempt to know this patient as a person having an experience. This experience is the amalgamation of recent and present happenings affected by her past experience real and perceived. The pa... ... middle of paper ... ...ach person and respect their autonomy. I understand this acknowledgement and insight will require skill, practice and patience. References Blockley, C. (2003) Experiences of First Time Hospitalisation for Acute Illness. Nursing Praxis in New Zealand, 19(2), 19-26. Bungay, V. (2005). Module 1: High Acuity Nursing Practice. Burnaby: BCIT School of Health Sciences. Irurita, V., & Williams, A. M. (2001). Balancing and Compromising: Nurses and Patients Preserving Integrity of Self and Each Other. International Journal of Nursing Studies, 38, 579-589. Jenny, J., & Logan, J. (1992). Knowing the Patient: One Aspect of Clinical Knowledge. Image: Journal of Nursing Scholarship, 24(4), 254-258. Kasch, C.R. & Dine, J. (1988). Person-centered communication and social perspective- taking. Western Journal of Nursing Research,10, 317-326.

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