What if a Patient Won't Follow My Advice?

Question
What is a nurse's responsibility when a patient wants to do something that is unsafe?

Response from Carolyn Buppert, MSN, JD Healthcare attorney, Boulder, Colorado

The nurse who asked this question provided the following example: A patient who was admitted to the hospital because of increased seizure activity leaves the unit to go outside to smoke, against the nurse's advice.

The nurse's responsibility is to give the patient evidence-based advice, to explain the rationale for the advice, to advise the patient of the consequences of not following the advice, and to give the patient a time frame -- when the patient should do whatever is advised. The nurse should then document the advice given and the patient's response. What happens next depends on the nature of the advice and the risk. For example, if the patient with increased seizure activity goes outside to smoke, against advice, the nurse has no responsibility or authority to detain the patient. However, if the patient is threatening to jump out the window or otherwise hurt him- or herself, clearly the nurse's responsibility moves to a higher level: Call for help and make every effort to dissuade the patient from jumping.

Usually, the situation is somewhere between the extremes of these 2 situations. For example, a patient needs some sort of follow-up (diagnostic test, consultation from a specialist, medication, or lifestyle change) but doesn't comply. Then, the nurse's responsibility is to persist; that is, attempt to find out why the patient isn't complying, urge the patient to comply, repeat the explanation of the necessity for compliance, continue to teach the patient, and enlist other healthcare providers to reinforce the advice. The level of assertiveness of the nurse must be titrated to the severity of the consequences if the patient doesn't take the nurse's advice.

One class down.....

 All the grades aren't in yet but I am glad with all the work I've done in my first class of  my  Master's Program. 
The class, which was Theoretical Foundations for Nursing Roles And Practice, was very interesting.  I learned a great deal about nursing theories and the different schools of thought on the how, what and why of what we do as nurses.  There were days were I felt like I was not given all I needed to be the best nurse.  I most days than not asked "Why weren't we taught this sooner?"  There is so much ADN and BSN should be exposed to before they hit the unit and I hope as a future educator to impress upon my students and colleagues the value of being committed to live long learning.  Right now I have the skills, the critical thinking, the passion to be a nurse, but there is so much more and I want it!
My new class starts today...Nursing Research & Evidence Based Practice!  If its similar to my research class while getting my BSN I hope to do well.  I liked learning about research and it was interesting to see all the different types of questions researchers ask and investigate.  I don't see myself, at this point, being an active researcher, but I could see myself collaborating with others on certain projects.  That brings up my other topic, team work.  I realize as a nurse, I must work with others and I want to work with others,especially when dealing with patients and their health.  Now when it comes to my grades/points I want to be the responsible party.  Having to work with others who may not be as zealous as I am, concerns me because I want to give my very best each and every time....no half stepping.  I learning that isn't always the case, even in this setting,which is sad to me but you see it work, in organizations, everywhere.  No one puts care into anything unless they can get something out of it.  Why waste the time?  Well I see this as a learning ground for me to have to deal with this people, maybe be a good example/role model and store this information for when I am practicing, which I hope will be soon!
Well got some more reading to do for this first week.  Here's to another great 8 weeks & prayerfully an "A" not an A- (missed by .07 last class)!  

Times flies and I'm still having fun!

It has been 8 weeks since I went back to school and despite the hard work and dedication I must have I am loving it.  In many ways this class is preparing me for the next step....working.

There have been so many things that I have learned that I wish we were learning at the baccalaureate level.   Because we are with patients when they are at their most vulnerable we should want to be at our personal best.  Life and death should not be watered down to a collection of skills.
All in all it has been an awesome 8 weeks and I am confident the next 8 will be just as great, especially since I'll be adding working to the mix!