Hospital frequent flyers??? Whatever happened to it being an acute care facility!

xtxrn, ASN, RN · Sep 1, 2011

Psych doesn't do hyperglycemia bad enough to be admitted to a hospital ..... But I hear you- someone who is able should do it themselves. Maybe an OT consult- they can drive a person nuts- maybe it will motivate 'butt challenged' to get the lead out, and deal with his own back door and insulin at home :)

I wouldn't wipe someone's butt who could do it themselves. It's not therapeutic.... however, if they are that psych-sick that they'd end up with skin breakdown, you're sort of stuck.... if it's just some weirdo getting is rocks off by having the nice nurse diddling the jewels' neighborhood, then a bath bag would be in the bathroom or at the bedside at all times w/trashcan next to the bed for easy disposal..... I don't do adult babies (an actual fetish that is weird.... old episode of CSI was disturbingly enlightening !!)

nerdtonurse?, BSN, RN · Sep 2, 2011

Send in male CNA/nurses for personal care for those guys if you've got them.

We had a patient who essentially used the hospital as a flop house. He'd get kicked out of where he was staying (read: mooching) and so he'd literally sit down with his last 5 bucks and eat a bag of sugar by the spoonful until he blossomed into DKA. Then he'd keep doing things to keep his sugar up -- I found handfuls of sugar packets in his bed. And while he could walk to the cafeteria and try to bum change from visitors, he suddenly was in capable of either giving himself a bath or holding little Johnny in the urinal when it was time. When we got an order for a catheter, that need for urinal assistance magically stopped He had no desire to live an independent life, when he'd get discharged, he'd drop by a friend's house and in reality move in until they kicked him out -- at which time, he'd go get another bag of sugar. When placed on any kind of healthy diet, he'd order Domino's and tell the driver that the nurses would pay for it! We tried mental health, we tried getting an involuntary commitment for suicidal behavior -- eating pounds of sugar when you're a diabetic!!! -- we tried reconnecting him with family, who'd gotten tired of him "dropping by" and staying until it took the sheriff's dept to get him out and divest him of all their property that had just "happened" to end up in his bag. No nursing home would take him since he wasn't "sick" just lazy -- no medicare to pay his bills. Nothing worked, until the hospital told him he would be held in the ER under suicide watch (naked under a paper gown, no where to hide his sugar packets) until the DKA resolved, and then DC'd straight from there -- no bed upstairs, no tv, no 24/7 meal service, just the prepackaged snack boxes. He went to the next town and set up shop there. For all I know, he's made it all the way to the coast doing this.

And people wonder why hospitals run in the red! He was 23 years old.

NeoPediRN · Sep 2, 2011

After 5 admissions they get the tough love special :)

Anna Flaxis, BSN, RN · Sep 2, 2011

Why oh why can Nursing not be so simple ...A policy may be used for this this but tweek it just a little it can be used for that. For instance, a patient could be a young gentlemen continuously being admitted for hyperglycemia and stay for weeks on end acting like a baby due to the fact that we MUST help this perfectly independent young man wipe his butt and accomadate his every need (i.e. pain meds, food at 2 am, crying for no reason). Because it is our job, we have to make sure no skin break down, pain under control... Why can we not refuse to clean his butt and make him do it hisself....Oh that is right...A nurse would get in trouble for not doing it!!!

I think we do the patient a huge disservice by enabling learned helplessness. In my opinion, part of being a nurse is being a promoter of self efficacy.

rnccf2007, BSN, RN · Sep 2, 2011

I think we do the patient a huge disservice by enabling learned helplessness. In my opinion, part of being a nurse is being a promoter of self efficacy.

LOL, nursing is a respected profession? Gallup can kiss my A$$, because I sure don't see any respect.

Anna Flaxis, BSN, RN · Sep 2, 2011

LOL, nursing is a respected profession? Gallup can kiss my A$$, because I sure don't see any respect.

What? I'm confused. Nowhere did I mention respect or Gallup...

StrwbryblndRN · Sep 2, 2011

I try and assign the lazy pt's who are capable to the nurses who will kick their butts into gear (or at least best possible outcome). Generally works.

We have a few nurses who have been known to bathe ambulatory 30 year olds.

Ends up setting the tone for the patient's stay. I either warn them or avoid assigning the pt's. Nothing like an extended stay because the nurses have babied them into feeling like they have to do nothing. The patients do not improve due to lack of mobility.

Esme12, ASN, BSN, RN · Sep 2, 2011

I agree with Neopedi.......after 5 admission it's tough love time.......and a social service intervention

NurseyPoo7 · Sep 2, 2011

The nursing school I went to was based on Dorothea Orem's theory of self care.

This theory is based on the patient being self-reliant. We were taught specifically to NOT do anything for the patient that the patient can do himself.

It drives me nuts when I see family members enabling the patients... e.g. wife cutting up food for her husband and feeding him when he is fully capable for doing this himself!!

RN-ing, BSN, MSN, NP · Sep 2, 2011

Oh the money we could save by not admitting these patients. I have had many DKAs like this come up from ER on an insulin gtt with a BG of 110...sounds like they're cured, send 'em home! Or maybe standing orders that say "may discharge after three consecutive blood glucose readings

Ohhhhh.....the money we could save!

Altra, BSN, RN · Sep 2, 2011

OP, the horse has clearly left the barn in your unit's situation with that patient, if y'all are wiping his behind for him.

DKAs are mostly med-surg/tele admits at my hospital -- 1-2 days max, then discharge -- unless they're really jacked up enough to require an ICU admission.

Refusing to bathe or toilet themselves? Noncompliance with diet / insulin regimen? DISCHARGE.

There are also a sizable number of folks we see in the ER with blood sugars > 600 -- a couple of bags of fluid and some sub-q insulin ... then DISCHARGE.