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Question

Difficulty: MediumLegal Rights and Responsibilities

A competent adult client admitted for an acute exacerbation of heart failure states, "I am tired of being here. I am going home right now." The client begins to gather their belongings. In what order should the registered nurse (RN) perform the following actions? Arrange the actions from first to last.

  1. 1Explore the client's reasons for wanting to leave and attempt to address their underlying concerns.
  2. 2Explain the potential health risks and medical complications of leaving before completing treatment.
  3. 3Contact the healthcare provider to report the client's intent to leave against medical advice.
  4. 4Ask the client to read and sign the facility's Against Medical Advice (AMA) document.
  5. 5Remove the intravenous (IV) catheter and provide the client with written discharge instructions.

Answer

The correct chronological sequence is: 1) Explore the client's reasons, 2) Explain the health risks, 3) Contact the healthcare provider, 4) Ask the client to sign the AMA document, and 5) Remove the IV catheter.
Handling an Against Medical Advice (AMA) situation requires balancing client autonomy with the duty to provide safe care. The nurse must first act as an advocate by assessing the client's reasons and attempting to resolve them. If unsuccessful, the nurse ensures informed refusal by explaining the risks. The provider is then notified so they can intervene or prepare a safe outpatient plan. The AMA form is signed for legal protection, and finally, the client is safely discharged with their medical equipment (like IVs) removed.

Step-by-Step Solution

1
Assess the client's concerns.
The root cause of the desire to leave is identified and potentially resolved.
Assessment is always the first step in the nursing process. Resolving the concern may prevent the AMA discharge entirely.
2
Educate the client on the risks of leaving.
The client achieves informed refusal.
Clients have the right to autonomy, but their refusal of treatment must be informed. The nurse must clearly state the medical risks of leaving.
3
Notify the healthcare provider.
The provider is informed of the client's status.
The provider must be aware of the change in condition and intent to leave, allowing them an opportunity to speak with the client or prescribe outpatient treatments.
4
Obtain the AMA signature.
Legal documentation of the client's decision is secured.
The AMA form provides legal protection for the hospital and staff by proving the client left against advice of their own volition.
5
Remove medical equipment and provide discharge instructions.
The client leaves the facility safely.
Refusal to remove an IV could be considered battery, and preventing the client from leaving is false imprisonment. The nurse must facilitate a safe exit even if it is AMA.

Key Concept

Client Autonomy and Against Medical Advice (AMA) Procedures
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Topics

Legal Rights and Responsibilities

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