There is always a situation in which a patient does not want to comply with the nurse and doctors and believe that it is them and only them that knows what is best. That is far from the truth. This is the reason that if a nurse comes to face to face with situation that is being described the first thing that they should do is immediately contact the attending physician so they can determine the competency of the client or patient.
The patient could be going through stress such as delusions or lack of sleep which would be leading them to think irrationally. The physician would be the best person to be able to explain to the patient that going against the treatment protocol could be a very bad thing.
While the patient is entitled to be able to deny and refuse any treatment that is prescribed by the patient, it is the physician who morally has the reponsibility to explain to the patient what some of the adverse things that could happen if they didn't go with the preferred treatment plan. In the end, it is the physician and the physician only that can make a decision on the outcome of the route of treatment.
Notify the physician immediately so he can determine client competency.-rationale: three requirements are necessary for informed decision-making: the decision must be given voluntarily; the client making the decision must have the capacity and competence to understand; and the client must be given adequate information to make the decision. in light of the clients respiratory acidosis and hypoxemia, the client might not be competent to make this decision. the physician should be notified immediately so he can determine client competency. the physician, not the nurse, is responsible for discussing the implications of a dnr order with the client. the patients bill of rights entitles the client to make decisions about his care plan, including the right to refuse recommended treatment. the clients family may oppose the clients decision. consulting the palliative care group isnt appropriate at this time and must be initiated by a physician order.client needs category: safe, effective care environmentclient needs subcategory: management of carecognitive level: analysisreference: craven, r.f., and hirnle, c.j. fundamentals of nursing: human health and function, 5th ed. philadelphia: lippincott williams & wilkins, 2007, p. 92.
