Julia Brown RN (January 2010) Telemetry



What do you do when a patient balks at signing a consent for a medically
necessary procedure? When Mr. X was advised to have a cardiac cath to
determine the reason for his NSTEMI admission, he would not sign the
consent and insisted he was fine and wanted to be discharged, as he was
(1) very busy running his own business, (2) 90 employees needed him at
this time, (3) he had no chest discomfort, and (4) we were wrong & he
didn't have a problem with his heart because he never had classic chest
pain symptoms (note: his admitting sxs were atypical). Julia tried
everything she could think of to change his mind, but nothing was
working. It took hours & untold energy but finally what worked was "I
explained the difference between the electrical and mechanical pumping
of the heart; the engineering details" and this finally did the trick.
Later, Mr.X needed (2) stents in his LAD for serious blockages. I firmly
believe Julia indirectly saved this man's life. The easy way would have
been to allow him to sign the AMA form and leave, after all the patient
was within his right to refuse any procedure; most busy, time-pressured
nurses would have done it. It reflects how much Julia really invested in
this patient's nursing care.