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Difficulty: HardClient Rights and Advocacy

A practical nurse (PN) is caring for a client who suddenly packs their belongings, becomes upset, and states, 'I am leaving this hospital right now without treatment.' In which order should the PN perform the following actions? Arrange the actions in the correct sequence from first to last.

  1. 1Ask the client to explain their reasons for wanting to leave the facility.
  2. 2Notify the charge nurse and the healthcare provider of the client's intent to leave.
  3. 3Reinforce the healthcare provider's explanation of the risks associated with leaving without treatment.
  4. 4Witness the client's signature on the Against Medical Advice (AMA) form.
  5. 5Document the client's statements, provider notification, and all actions taken in the medical record.

Answer

First, the PN assesses the client's reasons for leaving. Second, the PN notifies the charge nurse and provider. Third, the PN reinforces the provider's explanation of the risks. Fourth, the PN witnesses the AMA signature. Finally, the PN documents the entire event in the medical record.
When a client wishes to leave against medical advice, the practical nurse must prioritize actions based on the nursing process and scope of practice. Assessing the client's reasons comes first to determine if a resolvable issue exists. If the client insists on leaving, the chain of command must be activated to involve the provider, who is responsible for explaining the medical risks. Following the provider's explanation, the PN reinforces the information, witnesses the legal AMA document, and concludes by thoroughly documenting the entire encounter.

Step-by-Step Solution

1
Assess the underlying reason for the client's distress.
The PN identifies exactly why the client wants to leave.
Addressing an immediate need (such as fear, anger, or pain) might resolve the underlying issue and prevent an unsafe departure.
2
Notify the healthcare provider and charge nurse.
The primary provider is alerted to intervene.
It is outside the PN's scope to provide the initial disclosure of complex medical risks; the provider must be present to fulfill this legal requirement.
3
Reinforce the provider's explanation of medical risks.
The client receives consistent information confirming the dangers of leaving.
While the PN cannot initiate the primary risk disclosure, reinforcing the provider's education falls squarely within the PN scope of practice.
4
Witness the signature on the AMA form.
The client signs the legal document refusing care.
Competent clients have the legal right to refuse treatment. Witnessing the signature validates that the client signed it voluntarily after being informed of the consequences.
5
Document the event thoroughly.
A clear legal record is created in the client's chart.
Documentation should occur after the situation is fully handled to ensure all client statements, provider notifications, and signed forms are captured accurately.

Key Concept

Client Rights and Advocacy: Leaving Against Medical Advice (AMA)
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Topics

Client Rights and Advocacy

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