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Difficulty: HardLegal Rights and Responsibilities

An interdisciplinary team is reviewing the case of a client admitted for osteomyelitis who has a documented history of severe substance use disorder. During the shift, the client becomes visibly agitated, accurately states the current date and location, and loudly declares the intention to leave the facility immediately before receiving the next scheduled dose of intravenous antibiotics. The client's visiting sibling insists the nursing staff must keep the client hospitalized against their will. Which nursing interventions demonstrate compliance with legal rights and responsibilities? Select all that apply.

  1. Contact the primary healthcare provider immediately to report the client's intent to leave against medical advice.Answer
  2. B
    Delegate the task of explaining the medical risks of untreated osteomyelitis to the unlicensed assistive personnel.
  3. Request the client's permission to remove the peripheral intravenous catheter prior to their departure.Answer
  4. D
    Administer an available as-needed sedative to reduce the client's agitation and prevent them from leaving.
  5. E
    Question the client's decision by stating, "Why do you want to leave when your infection is still so severe?"
  6. Document the client's orientation status, their stated reasons for leaving, and all collaborative notifications in the medical record.Answer

Answer

The legally sound actions are contacting the healthcare provider, requesting permission to remove the intravenous catheter, and documenting the client's orientation status and notifications.
A client who is alert and oriented has the legal right to refuse care and leave against medical advice (AMA), regardless of their family's wishes or past medical history. The nurse's legal responsibilities include notifying the provider so they can explain the medical risks, attempting to remove medical equipment (such as IV catheters) to ensure safety upon departure, and comprehensively documenting the client's competency, statements, and the actions taken by the healthcare team.

Step-by-Step Solution

1
Evaluate the client's legal competency to refuse treatment.
The client is alert, oriented to date and location, and explicitly expressing their wishes.
A documented psychiatric history does not automatically render a client incompetent; if oriented, they retain the legal right to leave Against Medical Advice (AMA).
2
Identify the mandatory nursing interventions for an AMA discharge.
The nurse must notify the provider, attempt to safely remove medical equipment like IV lines, and document the event thoroughly.
These actions ensure the client has the opportunity for informed refusal (via the provider), prevent harm from retained equipment, and protect the facility legally.
3
Eliminate interventions that violate the client's rights or nursing scope of practice.
Delegating education, administering forced sedatives, and using confrontational communication are rejected.
These actions constitute improper delegation, false imprisonment/battery via chemical restraints, and non-therapeutic communication.

Key Concept

Against Medical Advice (AMA) protocol and client competency
Estimated Time:2m 0s
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Topics

Legal Rights and Responsibilities

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