Ethical/moral issue - page 3

Background: Patient is inpatient in an acute care facility due to dialysis non-compliance. Patient had to have security called during admission due to behavior. Patient is verbally abusive to... Read More

  1. Visit  Esme12 profile page
    1
    Good Lord! What a cluster! Unbelievable.......here is what makes me angry. You are a new nurse, something I think the patient was perfectly aware of....you had your hands full and it sounds like you have a difficult population. Where was your charge nurse and supervisor before this escalated to this.....and if this patient is known for this behavior a plan should be available to the staff to NOT deal with this a 1030 at night.

    If the write up was for the IV....ok.....or maybe the write up was to cover her behind because she should have been involved early to prevent this escalation. Going forward...this patient is now going to pull this EVERY time. Patients like these present challenges. I have worked at facilities that let the patient know they are discharged....period. They are escorted to the door goodnight. I have worked at facilities that are afraid of a "lawsuit" and will mollycoddle these patients endlessly I have worked at places that find respite beds for them, a homeless shelter, or will place them in assisted living or PC to police custody.

    These patients are extremely difficult each one present challenges. They know the system and they know how to use it. As a supervisor.....I would have postponed the discharge until days and made it clear to the patient that this will not be tolerated and from now on there will be a plan b and they will be discharged on days to a place of their choosing....or perhaps this is an indicating they require a higher level of care like a SNF. Change his meds to PO (they should have been already) and remove all IV access. But unfortunately......sometimes you just get stuck. Involve your charge early on and call the supervisor ASAP.....pass the buck.

    You had a difficult night..you did the best you could. Many patients will say the pain med doesn't work if they don't get the med they want....falling asleep in not an indicator that the pain med is working....it's an indicator that they want a specific pain med. I think you did a good job.

    Let us know how it goes and if the patient finally goes....Good Luck!
    Blindsided likes this.
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  3. Visit  dee78 profile page
    17
    Update: I got an email back from my assistant nurse manager, she assured me that there will be no write up. It was a messy situation, she said I handled it to the best of my ability. So lesson learned, no black cloud over my young career.
    Hoozdo, 3aremyjoy, dudette10, and 14 others like this.
  4. Visit  cienurse profile page
    1
    I am curious about a patient being discharged to a home where he has no key of his own and is dependent on someone else to open the door for him........or NOT? That can't be a good living situation in the first place and its up to the social services department to make sure that it is a SAFE discharge or to notify protective services when a patient insists on going to an unsafe place or leaves against medical advice.
    mrsmamabear2002 likes this.
  5. Visit  dee78 profile page
    1
    I don't believe they knew about this situation. We talked quite a bit the first night I had him and he lead me to believe he LIVED there with his sister. It wasn't until the moment of discharge that he said he didn't have a key.
    Last edit by dee78 on Nov 30, '12 : Reason: Redundant
    Esme12 likes this.
  6. Visit  tewdles profile page
    2
    In my opinion this is a failure of the discharge planners or whatever you call them in your facility.
    The MSWs should have been all over the readmission risk factors for this guy and setting up a reasonable plan for his DC.

    You did fine. We all forget things and make mistakes, it is a good day when our weaknesses don't kill someone or cause harm.
    Nursing is a profession that requires ongoing learning...you are in the midst of it, so don't be hard on yourself.

    Per the much beloved basketball coach John Wooden..."once you're through learning, you're through"...
    dudette10 and jadelpn like this.
  7. Visit  Paul'in'FL profile page
    7
    Sorry you had to learn this the hard way, but most out-of-control, out-of-compliance patients with ANY chronic disease have personality disorders....which is why they wind up blind, with a BKA, or trach, etc. You will this patient again and again, in both genders and with COPD, ESRD, CHF, diabetes and the gamut. They are masters of manipulation and feast on the youngest and kindest nurses. They will claim to love YOU above all nurses, until you say "no", at which time they will become a raving, drooling, screaming banshee, threatening you and world that if they don't get _________, they will sue you, have your license, beat you up....you get the picture. Sometimes a good administration will back you up, but 85% of the time, everyone will cave to the patient, which is exactly how s/he learned that this routine is almost always rewarded.

    I apolgize for being blunt, and lots of decent folks have chronic illnesses.....but this sub-group will take your sanity if you let them. Shame on your charge nurse for putting you in this position. I get these patients a lot, as I am 6'4'', with a shaved head, tats, and I can bench press 400lbs. As a gay man, no one in administration messes with me, lest I be the one complaining up the chain. Wish you luck in learning to deal with these jerks....sorry, honey, but you won't forget this harsh lesson.
    Hoozdo, psu_213, jadelpn, and 4 others like this.
  8. Visit  dee78 profile page
    0
    Yeah that night I had 4 HD pts, 1 was blind, 1 had an AKA, 1 had a partial foot amputation, the other had an awesome wife that took very good care of him to prevent these things. The 5th was a semicompliant type 2 diabetic with acute renal failure due to narcotic abuse. I am all too familiar with this segment of the population.
  9. Visit  wooh profile page
    13
    This wasn't a failure of discharge planners, social work, case management, ANYBODY at the hospital. This was a grown man who knew he was going home and doesn't realize until he's leaving that he doesn't have a way into the house? And this is the hospital's problem?

    This "realization" at the point of discharge was manipulation to spend another night in the hospital, plain and simple.

    I locked myself out of my house. Realized at WalMart. WalMart didn't put me up in a hotel overnight, I had to figure out how to get into my house. Because that's what you do when you're an adult.
    Hoozdo, Sun0408, psu_213, and 10 others like this.
  10. Visit  BrandonLPN profile page
    5
    Too bad we can't just write patients up for their own failures.
    Sun0408, psu_213, SHGR, and 2 others like this.
  11. Visit  barbyann profile page
    1
    Forget the cab, dc him straight to the ED so he can start the process all over again. These are the folks that keep us employed.
    redhead_NURSE98! likes this.
  12. Visit  imintrouble profile page
    1
    We would have sent him on his way. Probably kicking and screaming.
    Discharge = exit the hospital.
    I can see where liability could be an issue.
    Personal responsibility is underrated in this country.
    psu_213 likes this.
  13. Visit  tewdles profile page
    2
    Quote from wooh
    This wasn't a failure of discharge planners, social work, case management, ANYBODY at the hospital. This was a grown man who knew he was going home and doesn't realize until he's leaving that he doesn't have a way into the house? And this is the hospital's problem?

    This "realization" at the point of discharge was manipulation to spend another night in the hospital, plain and simple.

    I locked myself out of my house. Realized at WalMart. WalMart didn't put me up in a hotel overnight, I had to figure out how to get into my house. Because that's what you do when you're an adult.
    With due respect wooh, and I do respect your opinions...
    Getting locked out is different from getting discharged from the hospital, I know that you know that and that you made a good point, but...

    in general to the thread...
    I know these patients are difficult, demanding people (my mother was one of them for quite some time before she died), but they are sick, chronically, and many of them do not cope "well". It is our job to advocate for them and care for them with unconditional regard no matter how unloveable or down right mean they are.

    good discussion.
    jadelpn and grid_iron_gurl like this.
  14. Visit  That Guy profile page
    0
    Quote from dee78
    Background:
    Patient is inpatient in an acute care facility due to dialysis non-compliance. Patient had to have security called during admission due to behavior. Patient is verbally abusive to staff and threatens lawsuits any time he doesn't get his way.
    Do you call the cab and send him on his way to wherever he wants to go?

    Do you call security to escort him to the cab?
    **** him. I hate that we have to deal with *******s like this that dont take care of themselves, then expect the world in return for whatever their woes are. Im sorry but the second you stop taking care of yourself, you lose the right to complain.

    Forget the security, call police. have him arrested for trespassing and enjoy a vacation from him for awhile.


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