ETA:"Because the patient was admitted with problems affecting the brain and had initially exhibited poor level of awareness by the time he was aware and could answer questions by nodding his head or writing down what he wanted on a piece of paper he already had a PEG tube in because of the daughter and other measures had been made to keep him alive."
Sorry, I misread this part.
1. Is he oriented x3?
2. After he was a/ox3: Did he want the peg tube? Does he want the tube feeds to continue?
3. If he wasn't a/ox3 at the time of peg insertion and stated in his advance directive that he didn't want a peg tube: Why was one put in?
I didn't get a chance to look at his chart (who has time when you're ancillary staff and have a hundred things to finish at the same time?) but was told by multiple nurses that his advance directive (from a previous hospital visit) directly stated no life saving measures were to be taken to save his life especially r/t to tube feeding. For some reason he was not a DNR at the time, and the health-care team had a hell of a time convincing the daughters that just because we wanted him DNR it did not mean we were going to unhook him from everything and let him die, but merely that we wanted him DNR so if he did code that we weren't going to take any extreme measures to resuscitate him.
The doctor mentioned during rounding while the patient was in CCU that it wouldn't be a bad idea to throw a bipap on the guy at night especially since he had had some periods of apnea (but no previous known history of apnea), the daughters seemed to interpret it as "your dad needs to be on a bipap or he'll DIE!!!!!" And no amount of explaining, even from the doctor who said it, would convince them otherwise. Whether it was some weird anticipatory grieving process or if there really was something off kilter in their thought processes they absolutely refused to listen to reason.
Since he was in our neuro step-down unit he was hooked up to a monitor that constantly monitored his O2 saturation as well as his breathing rate and pattern, and his heart rate and rhythm. And the nurse told the daughter this as well, as well as telling her that she, the nurse, only had 3 patients to care for so she was constantly with him and able to keep an eye on him most of the time. So the restraint was placed per the doctors order if it was an "assault situation" (as you mentioned above, jahedg) who was the person committing assault? The doctor, the nurse or the daughter? Ultimately the doctor would face the brunt of it if an ethics committee was involved and the nurse would be held responsible as well for not questioning the doctors orders, but could there also be legal ramifications towards the daughter?