Group 4: Right to Refuse Vs.

Patient Safety
Synopsis: Mrs. Brown, a 69 year old female admitted for a stroke 1 month ago, is currently on a
pureed diet with nectar fluids. She has become dysphagic following her stroke. Her family
usually assists her during meal times and the nurses have been noticing that theyve been
bringing food with them for the past few days. Mrs. Brown has been known to have a poor
appetite and is very picky. During lunch, an RN noticed Mrs. Brown eating and saw that she ate
all the food that her family brought. When the nurses questions the family of what she ate, the
family states she ate a hamburger steak lunch plate from loco moco. The RN educates the family,
but they become argumentative saying that their mother is losing weight and is unhappy with
the meals provided. Mrs. Brown says its either she eats the food her family brings or she wont
eat at all. The RN is bound between continuing to allow Mrs. Brown to eat whatever she wants
knowing that she could aspirate and possibly die or continue her pureed diet and increase her
risk for further illness and injury due to poor nutrition.
Patient Safety:
ANA Code of Ethics- Provision 8: Collaboration of health, human rights, and health diplomacy
Nurses must address the context of health, including social determinants of health such

as poverty, access to clean water and clean air, sanitation, human rights violations,
hunger, nutritionally sound food, education, safe medications, and health care
disparities.
Risk for aspiration pneumonia
Educate patient and family on importance of compliance with pureed diet to prevent
health complications that could lead to death
Potential for further health complications if we allow patient (and family) to eat solid
food
Consult with physician about other forms of receiving nutrition to prevent malnutrition
and dehydration (GT tube)
Nurses have responsibility to educate on health, address hunger, nutritionally sound
food
No ambiguity regarding the potential risk and consequences to the family; constant reeducation and reinforcement needed, if chooses to be noncompliant
Right to Refuse:
American Hospital Association (1973)
Association of American Physicians and Surgeons (1995)
Joint Commission (2015)
Respect for autonomy-the right to refuse or choose treatments

References

Glad, K., & Riedinger, V. (n.d.). Patients on modified diets: Can we compromise?
Retrieved March 19, 2015.
Grier, J. (2010, May 1). National dysphagia diet in-service. Retrieved March 19, 2015,
from http://anfponline.org/Publications/articles/2010_05_dysphagia.pdf
Ignatavicius, D. D., & Workman, M. L. (2013). Medical-surgical nursing: Patient
-center
ed collaborative care. St. Louis: Elsevier Saunders.
Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/
CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html
Retrieved from
http://www.jointcommission.org/assets/1/6/Know_Your_Rights_brochure.pdf
Retrieved from http://www.aha.org/advocacy-issues/communicatingpts/pt-carepartnerships.html