What should be done if a patient is restrained and refuses to eat and nurses think he should be fed?
Nancy Brent replies:
Your question did not include any details from which a response could be made, so only general questions can be raised. However, from the onset, it is important to note that if there is a clinical concern that the nursing staff has about a particular patient who has been restrained and is not being fed, the chief nursing officer or the long-term care facility administrator should be contacted immediately so that the staff and nursing administration can dialogue about this patient care situation and make any necessary changes to the decision that prompted this action.
If your facility has a nurse ethics committee or nursing grand rounds, this would be another forum within which to raise this concern. The nursing staff can also seek a consultation with a nurse attorney or attorney in your state as soon as possible to determine how best to proceed in this situation.
The initial legal issue that bears comment is the use of the restraints with this patient. Is the patient out-of-control and a danger to him- or herself or others? Is the patient on an in-patient psychiatric unit or in a long-term care facility? Who gave the order for the restraints and why? Is the order and the reason clearly documented in the patient record following facility protocol (based on state and federal guidelines for the use of restraints)? Is the patient being carefully monitored during the restraint use?
A second legal concern is the non-feeding of the patient. Does the patient have a medical condition that rules out oral feeding? If so, are IVs or other means of feeding (e.g., NG tube) being used? Or has the patient refused food and fluid? If so, was this consent informed and the patient competent to make the decision?
A third legal question is whether or not the restraint and lack of feeding are being used as a punishment of the patient for some reason. Clearly, using these means to punish a patient indeed using any means to punish a patient is not legally or ethically acceptable.
Although the details of this situation are not known, it is important for nursing staff to raise their voices of concern to appropriate nursing administration officials and perhaps to others outside the facility when they are not comfortable about patient care. The legal duty to do so is, at a minimum, required in most state nurse practice acts and their rules.
Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.