The Dirtiest Word in Chronic Health Care - page 5

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The Dirtiest Word in Chronic Health Care Our treatment of patients with chronic health conditions often looks more like a wrestling match than a collaboration. But what are we supposed to do with cardiac and renal patients... Read More


  1. 0
    Quote from nursesante'
    hi everyone

    not true , no nurse or dr or any health care provider takes away pts freedom of choice when asking or providing care that require specific actions for better or improved health. dr 's orders or prescription meds as we all know from what we learned in nursing/ medical school are provided to help cure/treat / improve or manage disease allowing pt or the ill to reach their optimal heath
    so i see nothing wrong with using "non-compliant " or "compliant" these are terms chosen to help communicate among care provider . would it make a difference if a different term was used instead?
    i understand that at time the provider may jump to quick conclusion labeling of "non-compliant" a pt who wakes up on a random day and don't feel like taking her/his morning pill ,but come on ....are all of these post advocating that we shouldn't make mention in charting as "non compliant "or "compliant " even when it is clear to be the case ??????? the original post in my opinion is a prime example of overthinking on a clear and simple subject of pt care . let face it !!!! before going to medical/nursing school we knew nothing about disease process- care and tx. after getting some knowledge we can now make sense of this medecine/science, therefore when patients come assuming they don't know what we owe to guide them in their care process and not over think about us taking the choice from them because we are not ! telling someone to drink water to keep hydrated is not taking their freedom of choice... just like advising a pt to comply with insulin tx is not imposing our choice or goal on them ! encouraging a diabetic pt to loose weight base on the data we have on hand is not being insensitive , if that what needed to get back on track with their health than it our job in the field to remind them of it knowing the right way to do this is what matter and will help in the end otherwise they wouldn't come to seek help in the first place. when the pt come to seek treatment to you ( hospital , dr , nurse ect...)they are saying clearly --i trust you to care and guide me with my health -therefore we have the duty to help them understand and follow the regimen which will help , unfortunately that implies meds, injections,surgery and all the ugly stuff we know is needed to fight disease.-although we should be taking into account before charting on a pt about their specific and individual habits on compliance to follow a prescribe regimen , i personally see it fit to communicate"compliant " or " non compliant " in charting in a way that will be clear and precise for others providers to realize how they should approach each pt base on that... it the word is offensive than there many ways to say pt didn't take or pt refuse meds 20 times ..... .yes the pt should be responsible for their care but when they come seeking help that means it is time for us to implement what we know and have learned to work for specific conditions and the disease . it seems to me that the confusion here in many post is letting the pt determine what should be done in their care , which defeat the purpose of science and medicine . we know insulin work to regulate glucose so the pt will have to agree or reject to have the insulin .if or when they agree than starting to choose when and when not to get their injection than " non compliant " will be appropriate .remember the only time there is a charting about compliance there was an agreement to the plan of care on bothe side pt& provider right? so if all of the sudden the pt starting to back up why not wanting to use the "dirty word"? . the pt coming to us asking for our professional advice and care , we give it and if the choose to back up after they have agreed that being non compliant hun???????????
    if enough dialysis was being given, you would not have these problems. being thirsty is a primal urge that you will not get rid of, it is not the patient.
  2. 0
    Quote from julieanneb
    I won't. Ever! If my pt.,drank 4 vodka's a day,smoked a pack of cigs,had open heart,comes home,recovers nicely,is retired,Misses his old routine/habit's of having his nightly vodka and cigs,I say,go for it.Ive seen this type of pt. go down if their old routine is not resumed. To expect someone like vodka/cig/retired guy,to not go back to his old routine and be compliant compliant compliant, is soooooooooooo completely unrealistic. Ive seen the the vodka/cig/retired guy try to be fully compliant,and their spirit,zest,ferver for life is zapped and they go down quickly. Thats when I talk to them human to human,and tell them "I understand,tht must be hard" Ive talked to the docs,and have several docs agree with me,and vodka/cig/retired guy...is told,have a vodka,maybe TRY to kick the cigs,but above all,for godsakes,enjoy your life,and guess what?.....Vodka/cig/retired guy....may decided he does want to stop vodka/cigs. Regardless,he is still a human. When a pt. is non-compliant,lets be honest with ourselves,its not about them,its about you. They get on YOUR nerves,YOU feel like YOU are working and getting nowhere so YOU are burnt out. As I said in an earlier post...I am a nurse with a disability,and after my disability,ive become what every nurse should be. EMPATHETIC. Put YOURSELVES in THEIR shoes.

    I have never been a drinker, a smoker, my body fat is in the normal range, was an athlete, what else do you want me to do?
  3. 0
    Quote from kooky korky
    you can lead a horse to water but you can't make him drink. i think you are correct that we don't give the patient time to accept the dx. i have a friend at church who could not accept the dx for 10 years - when the feet became painful enough that md care was sought. he went on insulin, by request, thinking it would allow eating whatever was desired.

    even then, being an emotional overeater, someone who used food to relieve stress and fear, he could not, for another 10 years, determine and accept that using insulin to cover high sugars during the many accuchecks he did every day and sugar to cover the frequent hypoglycemic events he experienced every day was not really very good diabetes care.

    gradually, after 20 years, the pt was able to start some mild exercises, which helped get a few pounds off. very gradually and with all the trepidation and terror that a drug addict or alcoholic endures, he began to cut back on sweets and add some leafy green vegetables and low glycemic berries to the diet. he continues to struggle but is moving forward, ever so slowly. the wt loss stands now at about 20 pounds, some of which were lost and regained and lost again. but that's ok. at least he's able to work on it now. he has increased intake of water and is able to do chair exercises when various health problems and pains prevent much other activity.

    the wt loss will take time, but the body is just amazing in its ability to recover. so even if he only loses 1/2 pound per week, it's a good thing. progress is being made on the body as his mind is renewed. we encourage him realistically. he doesn't like trumpets blared over losing wt or making positive dietary changes. just a quiet "thumbs up" seems to be all he needs. i might, at some point, see if he might be willing and able to help others. in aa, they teach that the recovering alcoholic who wants to stay sober must give away his sobriety by reaching out a helping hand of encouragment to others who are struggling with that powerful enemy. i think this friend's harmful way of using food is the same thing and i think he could keep his food sobriety by helping someone else to achieve theirs.

    i guess the point, now that i think about it, is that he came to realize that he had some challenges to face. he came to realize that other people could encourage him and help him figure out how to improve his lot, but they couldn't make the changes for him. he was the captain of his ship. like most of us, he liked that idea, even if it was also scary. i think there were also some anger issues, some learned helplessness and anger about that. just a guess. once he could realize and confront and move on in spite of these side-tracking thoughts/beliefs, he was able to begin his fantastic journey.

    he found motivation for change in various things, such as learning that he'd soon be walking his dtr down the aisle. he wanted to look good and be able to walk her and then dance at the wedding. he did lose about 10 pounds. not much considering how much he needs to lose, but it was a start and he now had a huge victory under his belt.

    when he learned later that there was a grandchild on the way, he wanted to be able to thoroughly enjoy and help that grandbaby, he lost another 10 pounds. another huge victory.

    he's got a dtr graduating from college in a couple of years. we are hoping this will motivate him to lose more weight and get his a1c's down even more, by thinking of how he will want to look good for the camera on that momentous day.

    change can be really hard. disciplining ourselves requires making new habits. and it requires that the person building these new habits have the inner strength and the motivation to do a huge amount of mental work and physical work in order to succeed.

    i think that our society, with its present economic challenges, is reverting back to the historically common view or is more verbal about expressing the view that's always been there; the view that accepts survival of the fittest as just the way life is. after all, should those who are struggling to keep their own heads above water really be burdened by those who are draining their energy and their resources?

    this is a legitimate question. societies have historically agreed that there is definitely a limit to how much help they can give the sick, the weak, the disabled. that's not altogether wrong. it sounds cold and hard, but there really are limits of food, medications, money, and other survival elements of life. sometimes, it's as harsh as who gets the only warm blanket orthe only food and drinking water. we saw this with hurricane katrina. what the limits are and who determines them is the tough part.

    i hope we don't have to endure severe deprivation in america. i hope we can continue to help people who are struggling. as nurses, we have a great opportunity to help, as neighbors and relatives we also affect people other than our patients and can
    apply our knowledge of various diseases and our knowledge of human nature in many other relationships.

    the cause of diabetes is unknown. -cleveland clinic
  4. 0
    Quote from Kukla RN
    Yes, yes, and YES... to the article and to all the comments thus far.

    I've sat on the nurse's side of this equation often enough, and yes, it was pretty easy for me to gaze at a patient and think "Wow, you've already lost one arm, and yet you still persist in blithely managing your 400+ CBGs with insulin coverage alone." Then one day I actually paid attention as her face lit up with the first taste of her non-diet Mountain Dew - and wondered what I would do if I suddenly had to cut down or eliminate my Sprites, french vanilla coffee creamer, and the myriad other little treats I partake of without another thought. It's quite easy to think "Well, I'd just cut all of it out and deal with it as I should" rather than really reflect on whether I could, or would even want to.

    I think one thing I've gotten a little better at is listening, rather than "educate, reinforce, and repeat." Thanks for reminding me I need to do it more often.
    The cause of diabetes is unknown-Cleveland Clinic. We get tired of do as I say, not as I do.
  5. 0
    Not enough dialysis is being given, that is why there are so many issues and problems.
  6. 0
    Quote from nursesante'
    hi everyone

    not true , no nurse or dr or any health care provider takes away pts freedom of choice when asking or providing care that require specific actions for better or improved health. dr 's orders or prescription meds as we all know from what we learned in nursing/ medical school are provided to help cure/treat / improve or manage disease allowing pt or the ill to reach their optimal heath
    so i see nothing wrong with using "non-compliant " or "compliant" these are terms chosen to help communicate among care provider . would it make a difference if a different term was used instead?
    i understand that at time the provider may jump to quick conclusion labeling of "non-compliant" a pt who wakes up on a random day and don't feel like taking her/his morning pill ,but come on ....are all of these post advocating that we shouldn't make mention in charting as "non compliant "or "compliant " even when it is clear to be the case ??????? the original post in my opinion is a prime example of overthinking on a clear and simple subject of pt care . let face it !!!! before going to medical/nursing school we knew nothing about disease process- care and tx. after getting some knowledge we can now make sense of this medecine/science, therefore when patients come assuming they don't know what we owe to guide them in their care process and not over think about us taking the choice from them because we are not ! telling someone to drink water to keep hydrated is not taking their freedom of choice... just like advising a pt to comply with insulin tx is not imposing our choice or goal on them ! encouraging a diabetic pt to loose weight base on the data we have on hand is not being insensitive , if that what needed to get back on track with their health than it our job in the field to remind them of it knowing the right way to do this is what matter and will help in the end otherwise they wouldn't come to seek help in the first place. when the pt come to seek treatment to you ( hospital , dr , nurse ect...)they are saying clearly --i trust you to care and guide me with my health -therefore we have the duty to help them understand and follow the regimen which will help , unfortunately that implies meds, injections,surgery and all the ugly stuff we know is needed to fight disease.-although we should be taking into account before charting on a pt about their specific and individual habits on compliance to follow a prescribe regimen , i personally see it fit to communicate"compliant " or " non compliant " in charting in a way that will be clear and precise for others providers to realize how they should approach each pt base on that... it the word is offensive than there many ways to say pt didn't take or pt refuse meds 20 times ..... .yes the pt should be responsible for their care but when they come seeking help that means it is time for us to implement what we know and have learned to work for specific conditions and the disease . it seems to me that the confusion here in many post is letting the pt determine what should be done in their care , which defeat the purpose of science and medicine . we know insulin work to regulate glucose so the pt will have to agree or reject to have the insulin .if or when they agree than starting to choose when and when not to get their injection than " non compliant " will be appropriate .remember the only time there is a charting about compliance there was an agreement to the plan of care on bothe side pt& provider right? so if all of the sudden the pt starting to back up why not wanting to use the "dirty word"? . the pt coming to us asking for our professional advice and care , we give it and if the choose to back up after they have agreed that being non compliant hun???????????

    losing weight does not improve health-jerome kassirer, former head editor of the new england journal of medicine, nephrologist
  7. 0
    Quote from rn/writer
    Many dieticians are woefully behind the times. The ADA diet is not the "magic bullet" some medical folks seem to think it is. If you are hospitalized with, say, a cardiac problem (a common occurrence with diabetes) the combined ADA/AHA diet is so restrictive as to be laughable. Two egg whites on a lettuce leaf is a recipe for "noncompliance."

    Many diabetics do well on a modified Atkins diet (includes more fruits and veggies than the original) and I think the Atkins people themselves have altered the diet some. A low-starch diet, rather than a low-carb diet is similar and helps diabetic patients feel like they can actually have a satisfying meal. Low starch means you eliminate white potatoes, white rice, pasta, white bread and you have only small amounts of sweet potatoes, brown rice, whole wheat pasta and whole grain bread. But you can have meat, eggs, dairy and all manner of vegetables and most fruits. You can even have a small amount of sweets in your diet in the form of gelato or flourless desserts. A diet is doable if you don't have to be hungry.

    Most dieticians gasp when they think of this. Eggs? Meat? Dairy? What about all that cholesterol? New research has found that dietary cholesterol and serum cholesterol do not correlate directly as once was thought. Our bodies produce cholesterol even if we don't eat eggs or meat. Why? Because we're animals and animals make cholesterol.

    The ADA diet (especially if combined with the AHA diet) can make people crazy. And hungry. But this is still what's being trotted out and handed to patients as if it were etched on a stone tablet delivered from the heavens. Fortunately, there are some dieticians who listen. I know of one patient whose HA1c dropped two full points in four months on a low-starch diet. That dietician was amazed and said she would be checking out the latest research.

    The ADA diet is a tiny wagon that's easy to fall off. And this is only one of the crazy-making aspects of diabetic care. Is it any wonder that many diabetic patients rebel?

    I hope that dieticians will be given updated information and feel energized by the changes. But something tells me that it's going to be years before that happens. The old ADA diet will continue to be the sacred cow of many instead of being turned into burgers and steaks that are a wonderful part of a low-starch diet.

    My mom was a diabetic and my Dad(Chemist) said the diet for diabetics had too much sugar. Yes, that is correct, our bodies make tons of cholesterol for brain functioning, nerves, etc. If you eat little cholesterol, your cholesterol will be very high and if you eat tons of it, it will be very low(Uffe Ravnskov, Professor of Nephrology and Chemistry) "Statins are worthless," Jerome Kassirer, Former Head Editor of the New England Journal of Medicine-Nephrologist
  8. 0
    Quote from julieanneb
    I wouldn't. Ever. I would EMPATHIZE you. A. Insurance-smurance. Thats sucks fo you,and I have had many pts. without insurance,can't speak english,I am homecare so i see them when they come home....Paralyzed from nipple line down,spanish speaking,no insurance,I call the docs said pt. saw in hospital and than in rehabilation facility,pts. rx are running out,no pcp,get social work involved who EMAILS spanish speaking pt. form to get started on medicaid/medicare,they can't read English. Several phone calls later,thee doc has nothing else to say to except label that pt. non-compliant!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! As I said before and I will say it again. EMPATHY!!!!!!!!!!!!!!! Where is the humanity in healthcare????? Non-compliant,compliant,icd9...Its all a bunch of BS and I believe Florence N. is screaming from the sky. I don't know bout any of you other nurses,but I often wonder,how I can sleep at night. And most of the times I can't. Labels like non-compliant and compliant borders on the edge of being slightly self-important and sociopathical. Crazierthanyou,if I were some a-hole millionare making money to do put a ball in a whole on the grass or read some lines from script and pretend to be someone else,I'd take care of you.But,Im not a millionare for doing basically nothing,I would never,ever LABEL you. Thats not why I became a nurse. Wow. I sound like my hero,George Carlin?!?!?!?! hahahahahaha.
    It is called being a control freak.
  9. 0
    Quote from NDXUFan
    It is called being a control freak.
    What is called being a control freak? Elaborate please.


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