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Difficulty: MediumClient Rights and Advocacy

A practical nurse is providing care for a client who suddenly packs their belongings and states, 'I am leaving this hospital right now without treatment.' Arrange the following nursing actions in the correct chronological order to properly manage this situation and advocate for the client's rights.

  1. 1Ask the client to explain their underlying reasons for wanting to leave the facility.
  2. 2Notify the supervising registered nurse and the healthcare provider of the client's intent.
  3. 3Reinforce the healthcare provider's explanation regarding the risks of refusing treatment.
  4. 4Witness the client's signature on the facility's Against Medical Advice (AMA) form.
  5. 5Document the client's exact statements, the interventions provided, and the departure time.

Answer

The correct sequence is to first explore the client's reasons for leaving, notify the supervising nurse and provider, reinforce the provider's explanation of risks, witness the AMA form signature, and finally document the event.
When a client wishes to leave against medical advice, the practical nurse must first assess the root cause of the client's distress. Next, the practical nurse must escalate the situation to the registered nurse and healthcare provider, as it is the provider's responsibility to explain the specific medical risks of leaving. Once the provider has explained these risks, the practical nurse reinforces the education to ensure the client understands. If the client maintains their decision, the practical nurse witnesses the signature on the AMA form. Finally, comprehensive documentation of the entire event is required to complete the process.

Step-by-Step Solution

1
Explore reasons for leaving
Identifies if the client's concerns can be resolved without them leaving.
Initial assessment of the client's motivation is required to provide targeted advocacy and potentially resolve the issue.
2
Notify supervising RN and provider
Involves the appropriate personnel to address medical risks.
Explaining detailed medical prognoses is outside the practical nurse scope of practice; the provider must be informed immediately.
3
Reinforce education on risks
Ensures the client fully understands the consequences of their decision.
The practical nurse acts as an advocate by verifying the client has true informed refusal.
4
Witness AMA form signature
Legally protects the facility and confirms the client's informed choice.
Clients have the right to refuse care, and the AMA form formally documents this right being exercised.
5
Document the event
Creates a permanent, objective legal record of the situation.
Thorough documentation must be completed after all client care events are finalized to maintain accurate health records.

Key Concept

Client Rights and Refusal of Care (Against Medical Advice)
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Topics

Client Rights and Advocacy

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