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.
Ethical Principles:
Autonomy, Beneficence, Nonmaleficence and Veracity
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
re-education 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
centered 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/ptcare-partnerships.html