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Refusal, delay, or limitation of medical treatments, including vaccines, is an increasing phenomenon facing nurses and other healthcare practitioners daily. When a patient or family refuses treatment—maybe even lifesaving treatment—because it is contrary to their social, religious, or cultural beliefs, it can plunge healthcare providers, families, and patients into a difficult, emotionally charged conversation. Complex and diverse ethical dilemmas such as this can profoundly impact the health, welfare, and mental and emotional well-being of everyone involved. What’s more, today’s nurses and healthcare professionals will almost inevitably face this situation or one like it. Against Medical Advice details many of the medical, legal, social, cultural, and religious factors associated with treatment refusals. Authors Luanne Linnard-Palmer and Ellen Christiansen prepare healthcare professionals to compassionately assess and understand people’s beliefs, cultures, and philosophical perspectives. Their proven strategies and step-by-step examples guide providers to consider the patient’s and family’s point of view, share concerns with other healthcare team members, and negotiate the best possible outcome for all involved. TABLE OF CONTENTS Chapter 1: When Medical Treatment and Patient Needs Clash Chapter 2: Overview and Reasons for Treatment Refusals Chapter 3: Childhood Vaccines, Hesitancy, and Refusals Chapter 4: Pediatric Healthcare, Ethics, and Children’s Rights Chapter 5: Legal Implications and Consent: Informed Consent, Assent, and Parental Permission Chapter 6: Legal Perspectives of Treatment Refusal: Refusal Defined Chapter 7: In the Name of Religion: Historical Influences to Legal Exemptions Chapter 8: Adult Medical Treatment Refusals, Limitations, and Delays Chapter 9: Overview of Religious Doctrines Chapter 10: The Importance of Cultural Competence Chapter 11: Professional Groups’ Reactions to Treatment Refusal: Nursing, Medicine, Researchers, and Journalists Chapter 12: Overview of Professional Interventions: Power Distance, Negotiation, and Safety Appendix A: Reasons for Parental Decisions to Refuse Medical Treatment Appendix B: Guidelines for Staff Facing Parental Refusal of Pediatric Vaccines or Medical Treatments Appendix C: Guidelines for Staff Facing Adult Refusal of Medical Treatments Appendix D: Loss of Parental Guardianship: Court Overriding of a Parent’s Right to Refuse Medical Treatment Appendix E: Common Concerns About Vaccine Administration Appendix F: Pandemics and Trust in Rapid Vaccine Creation, Distribution, and Mandates Appendix G: Best Interest and the Law: Should State Statutes on Child Abuse Be Modified? Appendix H: Spiritual Abuse Defined Appendix I: Resources for More Information AVAILABLE ON THE SIGMA REPOSITORY · Chapter 2: Overview and Reasons for Treatment Refusals · AMA Quick Facts ABOUT THE AUTHORS Luanne Linnard-Palmer, EdD, RN, CPN, is a Professor of Nursing at Dominican University of California in San Rafael, California, and a Pediatric Educational Consultant and Pediatric Clinical Nurse at Sutter Health’s California Pacific Medical Center in San Francisco. Ellen Christiansen, DNP, RN, FNP-BC, PHNA-BC, is an Associate Professor of Nursing at Dominican University of California, where she teaches Community and Public Health Nursing.
This first-of-its-kind text provides a multidisciplinary overview of a significant problem in hospital-based healthcare: patients who decline inpatient medical care and leave the hospital against medical advice (AMA). Compared to standard hospital discharges, AMA discharges are associated with worse health and health services outcomes. Patients discharged AMA have been found to have disproportionately higher rates of substance use, psychiatric illness, and report stigmatization and reduced access to care. By providing a far reaching examination of AMA discharges for a wide academic and clinical audience, the book serves as a reference for clinical care, research, and the development of professional guidelines and institutional policy. The book provides both a broad overview of AMA discharges with chapters on the epidemiology, ethical and legal aspects, as well as social science perspectives. For clinicians in the disciplines of hospital medicine, pediatrics, emergency medicine, nursing, and psychiatry, the book also provides a patient-centered analysis of the problem, case-based discussions, and a discussion of best practices. This comprehensive review of AMA discharges and health care quality will interest physicians and other health care professionals, social workers, hospital administrators, quality and risk managers, clinician-educators, and health services researchers.
In the middle of a painful divorce and becoming a single mother, Simone, a beautiful 30something-year-old, suddenly falls ill.She finds herself in the resuscitation room of the hospital, fearing for her life, having just suffered a stroke.What caused Simone to have a stroke at such a young age, no doctor could answer.Frustrated with the lack of answers and by being treated like older stroke patients, she decides to take healing into her own hands and starts rebuilding her life on her own terms. Simone reclaims her life against medical advice.
An authoritative guide to the legal and ethical issues faced daily by nurses, this handbook includes real-life examples and information from hundreds of court cases. It covers the full range of contemporary concerns, including computer documentation, workplace violence and harassment, needlesticks, telephone triage, pain management, prescribing, privacy, and confidentiality. An entire chapter explains step-by-step what to expect in a malpractice lawsuit.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
This book presents the first comprehensive review of all major government-supported health insurance schemes in India and their potential for contributing to the achievement of universal coverage in India are discussed.
This book provides a clear pathway through the common yet complex legal dilemmas frequently encountered in emergency medical practice.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
For any woman who has experienced illness, chronic pain, or endometriosis comes an inspiring memoir advocating for recognition of women's health issues In the fall of 2010, Abby Norman's strong dancer's body dropped forty pounds and gray hairs began to sprout from her temples. She was repeatedly hospitalized in excruciating pain, but the doctors insisted it was a urinary tract infection and sent her home with antibiotics. Unable to get out of bed, much less attend class, Norman dropped out of college and embarked on what would become a years-long journey to discover what was wrong with her. It wasn't until she took matters into her own hands -- securing a job in a hospital and educating herself over lunchtime reading in the medical library -- that she found an accurate diagnosis of endometriosis. In Ask Me About My Uterus, Norman describes what it was like to have her pain dismissed, to be told it was all in her head, only to be taken seriously when she was accompanied by a boyfriend who confirmed that her sexual performance was, indeed, compromised. Putting her own trials into a broader historical, sociocultural, and political context, Norman shows that women's bodies have long been the battleground of a never-ending war for power, control, medical knowledge, and truth. It's time to refute the belief that being a woman is a preexisting condition.