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Question

Difficulty: MediumClient Rights and Advocacy

A client receiving intravenous antibiotics for a severe skin infection unplugs their infusion pump, puts on street clothes, and states, 'I am going home right now.' Arrange the following actions the practical nurse (PN) should take in the correct chronological order.

  1. 1Inquire about the specific reasons why the client wishes to leave the facility.
  2. 2Notify the charge nurse and the healthcare provider about the client's intent.
  3. 3Reinforce the healthcare provider's explanation regarding the health risks of leaving early.
  4. 4Witness the client's signature on the Against Medical Advice (AMA) document.
  5. 5Document the client's exact statements, provider notifications, and all interventions.

Answer

First, inquire about the client's reasons. Second, notify the charge nurse and provider. Third, reinforce the provider's explanation of risks. Fourth, witness the AMA signature. Finally, document the event.
The correct sequence prioritizes the nursing process and client advocacy. Gathering data by asking the client why they want to leave comes first. Communication with the healthcare team follows so the provider can address medical risks. The PN then reinforces the provider's teaching. If the client still wishes to leave, witnessing the AMA form ensures legal compliance, followed by comprehensive documentation of the entire event.

Step-by-Step Solution

1
Determine the first action based on the nursing process.
Inquiring about the client's reasons for wanting to leave.
Gathering data is always the initial step. Understanding why the client wants to leave may reveal a problem that the nursing staff can resolve, such as uncontrolled pain or anxiety.
2
Identify the need for collaboration and escalation.
Notifying the charge nurse and healthcare provider.
Leaving against medical advice is a significant safety risk. The healthcare provider must be informed so they can evaluate the client and legally disclose the specific medical consequences of leaving.
3
Determine the practical nurse's role in client education.
Reinforcing the provider's explanation of the health risks.
While the healthcare provider is responsible for the initial disclosure of medical risks, the PN acts as an advocate by reinforcing this information and ensuring the client fully comprehends the consequences.
4
Address the legal requirements if the client refuses to stay.
Witnessing the client's signature on the Against Medical Advice (AMA) form.
If the client remains resolute in their decision to leave, the facility must have legal documentation proving that the client was informed of the risks and chose to leave anyway.
5
Complete the nursing responsibilities for the encounter.
Documenting the entire event in the medical record.
Accurate, factual, and objective documentation of the client's statements, notifications made, education reinforced, and forms signed is legally required.

Key Concept

Client Rights and Advocacy during Refusal of Care
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Topics

Client Rights and Advocacy

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