A patient wants to get LAMA. What is the most appropriate action by the nurse?

AIIMS Delhi NO-2016

Nursing Foundation

Medium

Appeared in: AIIMS Delhi NO-2016

Explanation

The most appropriate initial action for the nurse is to inform the physician when a patient requests to leave against medical advice (LAMA).
This action is critical because the physician is responsible for discussing the potential medical risks, benefits of continued treatment, and alternatives with the patient.
This process, known as informed refusal, ensures the patient's right to autonomy is respected while also making sure their decision is well-informed.
The nurse's role is to facilitate this communication and ensure the proper protocol is followed, which begins with notifying the physician.

Option A: Physically preventing a competent adult patient from leaving the hospital against their will constitutes false imprisonment, which is a serious legal offense.
Option B: Restraining a patient for the purpose of preventing them from leaving is illegal and can be considered battery and false imprisonment. Restraints are only used when a patient is a danger to themselves or others and all less restrictive measures have failed.
Option C: This is a premature step. The LAMA documentation is signed only after the patient has been fully informed of the risks by the physician. The nurse's action of simply providing the documents bypasses the crucial step of informed refusal.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing responsibility and legal-ethical principles in 'Leaving Against Medical Advice' (LAMA) situations to guide bedside assessment, documentation, and the next nursing action.
A competent patient's right to autonomy and self-determination includes the right to refuse medical treatment, which extends to leaving a facility even if it is against medical advice.
Nurses must be aware of the legal boundaries of their practice. Actions like unlawful restraint or preventing a patient from leaving can result in charges of battery and false imprisonment.
Thorough documentation is a nurse's best defense in a LAMA situation. It should include the patient's reason for leaving, the information provided, the patient's understanding, and the details of the departure.

How to Approach the Question

First, identify the core of the question. This is a priority-of-action question concerning a patient's rights and the nurse's legal/ethical duties.
Analyze the situation: A patient wants to leave against medical advice (LAMA). This brings up a conflict between patient autonomy and the healthcare team's duty to provide care (beneficence).
Evaluate each option based on the nursing process and legal principles. Ask yourself, 'What is the nurse's immediate, most critical, and legally sound responsibility?'
Option A (Don't allow) and B (Restrain) violate the patient's rights and are illegal for a competent patient. Eliminate them.
Compare the remaining options. Option C (Sign documents) is part of the process, but is it the first step? Option D (Inform physician) involves escalating to the person legally responsible for explaining risks.
Conclude that informing the physician is the necessary first step to initiate the proper, safe, and legal LAMA protocol. The other actions are either incorrect or follow this initial step.

Concept Tested & Keywords

Concept Tested: Nursing responsibility and legal-ethical principles in 'Leaving Against Medical Advice' (LAMA) situations.
Stem keywords: LAMA, patient wants to get LAMA, appropriate action, nurse
Lead-in keywords: most appropriate
Negative lead-in flag: false

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E6 Textbook of Nursing Management and Leadership I. Clemen — Subpart C (pp 655-967 of 982) p. 279-281

E6 Nursing Fundamentals Taylor p. 296-298