It is always very frustrating when your patient refuses to comply. In the case of the man who wouldn't have his blood glucose drawn -- you were concerned about what could have been a very serious hypoglycemic event. In a situation like that, some of the questions one might ask are: what else was going on with the patient during the time of his refusal? What was his emotional state? Was he weary of being in the hospital -- perhaps feeling like a pin cushion from all the lab draws in addition to blood glucose draws? What type of sleep did he have? Patients in the hospital for any length of time simply become exhausted from lack of good, solid sleep -- the night time noise, the routines of the nursing staff -- all serve to disrupt a patients rest. (I know from recent experience!). Also, what was going on with his family issues? Was he having family problems that might have impacted his mood and compliance on that day? Was he missing work? Were their monetary issues weighing heavily on his mind? Is he an older man -- with other complications that have him scared and depressed and maybe giving up?
Sometimes we become angry with our patients -- lets face it, we're human too. We know the reality of what can happen to them. And maybe, in this man's case, he understood too the risk he was taking -- but at that particular moment in time his feelings over-rode logic.
So often there are many other issues impacting how a patient responds to what we ask of them. Let me share what was an eye opening experience for me recently -- where I "missed the mark" with a young, new mother-- (and hey, I've been in nusring since 1976!)
In the state of California, we are currently in the process of the trial phase of the Expanded Newborn screening program, which will test for a large number of Metabolic disorders. As the nurse for our Regional Metabolic Clinic - the presumptive positive cases are called to our office and I contact the parents of the infants to arrange the necessary repeat testing.
In once case, I called a mother who had triplets - the infant girl required retesting. When I placed the original call to "mommy" - she seemed almost disinterested and hostile. She insisted on speaking with the doctor - not a "nurse". Her right -- no problem by me. I connected her with my Physician who discussed the issue with her, then told me to call her again and set up the lab draw.
So I called her a second time-- and again was met with resistence and seeming hostility. She refused to go into the lab for another 3 days...."the doctor said I didn't have to go over the weekend." So I set the lab draw up for the next Monday -- then called her.
On the third call --I am told, "We can't go until maybe Friday."
Well by now, I am somewhat steamed. And I am thinking-- what's with this lady???? Her newborn might have a serious medical problem and she keeps refusing to go in for testing? Sheesh!
Thoughts of - great, do I have to call Department of Children's Service's in on this one?
But then -- she made a statement that caught my ear: She said "WE'll all go to the lab on Friday when my husband has off."
I paused and said: "ALL? You mean you're going to take all 3 of the babies to the lab with you?
"Yes." She answered.
"But, can't you have somebody else stay with the boys while you and your husband take your baby girl to the lab?" I asked.
"We have nobody else who can do that," she told me.
I was floored! It was then I realized -- WAIT A SECOND! RED ALERT!
I then questioned what was going on -- and learned that this poor sweet mama had 3 tiny babies, with NO HELP! Her husband had to return to work -- her family was from out of the country and didn't have their visas approved yet -- the couple was new to their community and had no friends to turn to -- and somehow, in the day to day world of medicine, their needs were missed by the Discharge planner and by their Physician and the nurses in the clinics on follow-up visits.
The poor woman was frazzled -- no sleep -- trying to feed and take care of 3 babies at once - alone. Just trying to survive!
No wonder she was overwhelmed when I come along and call and demanded her to grab up one of the babies and high tail it over to the lab.
Well -- I put the brakes on -- and realized we needed to get this mama some day to day help with her babies, as well as getting her little infant girl in for testing.
I contacted their Pediatrician, as well as our High Risk follow-up clinic. I also got our team Social Worker involved. I stopped and really listend to this mama -- and ya know what, the anger and hostility went away. And the baby was tested. And the results were normal, thankfully.
But I learned -- or relearned -- a valuable lesson once again. That I need to listen to my patients -- and also listen between the words. And ask questions. And not get so focused on the single GOAL that I HAVE -- that I forgot that maybe the patient has other needs more pressing to them at that moment in time.
And we all need to remember that Nursing isn't just task oriented. The greatest thing that Nurses bring to the world of medicine is our ability to get into the Patient's total SCOPE of needs....to become their advocates on many levels. Sometimes they will gladly accept our help and follow the advice, the plan of care. Other times, they might want the help, but for whatever reasons fail to follow through. And we are disappointed or worried or even angry.
The population I work with are "live long" patients -- with complex needs. And there are times when I am driven to grey hairs by them! And there are times when I wanna give some of of them "what for!" -- but when I reach that point-- I know it is time for a breather -- and to call upon another member of my team to step in and talk with the patient/family. Or work with them for a time. I am NOT tossing the family aside for good -- if I did - then I also should toss my nursing license into the shredder -- I am giving myself a human break.
And maybe --- especially with the day to day stresses of floor nursing, which I did for many, many years -- there might be times when a patient doesn't click to one nurse's approach -- won't have the blood glucose drawn -- that it might be worth asking another nurse or even the social worker to step in and see if they might be able to achieve a different outcome. Or maybe, the next time you encounter what seems to be a noncompliant patient bent on harming himself -- try to listen between his words and see if there isn't something else there that is happening -- some other need the patient has that is crashing in on common sense and the choices he makes.
I am very excited -- and want to welcome you, Junior member, to the world of nursing! We and the patients out there -- new "new blood" and your knowledge and engery and spirit! :-) I think you will find, as I did, that the real learning of nursing happens once you leave the class room and are working one the floors. And there will be lots of ups and downs. Lots of good times and days of total frustrations. But always hang in there and know-- that while you might never get rich in this noble profession of ours (at least I haven't as yet! LOL!).... you are impacting human lives and giving of yourself in a special way.
Best of luck in all you do!
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