NONCOMPLIANCE, why be at the big H? in the first place? - page 2

I was discussing with fellow coworkers the unwillingness of patients at my hospital to get with the program: COPDers with pneumonia receiving a breathing treatment followed by a dose of morphine... Read More

  1. by   GardenDove
    I understand the frustration, but otoh I'm a big advocate of pt rights. I think that people should be free to pick and choose what treatments they'll accept while there, even if the nurse disagrees. The important thing it to educate them on the possible consequences.

    These people aren't our prisoners or our children. They are adults who make choices that we might disagree with. They over eat, smoke, don't exercise, and so they land in the hospital. Think of it as job security!
  2. by   RNsRWe
    You make very good points, and I appreciate them. I, too, advocate for pt's rights, but I suppose I fall more into the category of "my patient WANTS this treatment" or "this pt is in pain and his MD doesn't want to be bothered? CALL AGAIN", like that.

    I get frustrated and/or angry when a pt's non-compliance with standard medical care in the hospital prevents me from helping him heal, or actually gives me more work to do (calls to make, extra documentation, and of course the EFFECTS of his refusing to do anything his MD requires).

    Every pt should have the right to refuse any treatment, of course. But if they're going to refuse to do the stuff that is the REASON they're in the hospital, then....GO HOME! Don't take up the valuable resources of the hospital (that likely they aren't paying for anyway, and neither is whatever insurance they have, if any). If they want a five-star luxury hotel to stay in while recuperating, sans medical care, then they ought to find one and pay for it, and stop wasting the time and resources of the community hospital.
    Last edit by RNsRWe on Feb 2, '07
  3. by   GardenDove
    Take, for instance, the pt refusing to wear O2 or BiPap. As long as you inform them, inform the doc, and document, then I think that's their choice. There may be other aspects of their treatment that they accept, such as neb treatments and antibiotic therapy.

    Yes, they might be an annoying smoker or another type of social outcast with an addiction on top of it. I figure, it's not my problem, it's theirs.
  4. by   all4schwa
    Quote from GardenDove
    Take, for instance, the pt refusing to wear O2 or BiPap.
    there is not much treatment the a pt can refuse in my book, certainly not these two. mostly, i can be persuasive and informative enough for a pt to understand why such treatments are important. and when they are getting out of line i get near the line and ask them why they are there, if not to be treated?
  5. by   Tweety
    I agree with GardenDove on all points. We are a free country.

    However, I understand the frustration of a patient coming back from smoking and callling for a breathing treatment. Or the diabetic patient who eats the meal we provide, plus candy bars, cokes and McDonalds Burgers, and says "I wonder why my blood sugar is 400".

    Sometimes you want to say "no I'm not giving you a breathing treatment" "no we are not treating your hyperglycemia". Both of you have to go home now.
  6. by   GardenDove
    That's nice, but sometimes people just cannot tolerate things. I'm glad you're so persuasive. Some people have severe claustrophobia. They have a right to refuse treatment of any kind. Yes, there are some people who totally don't co-operate with any aspect of their care and there is no reason for them to be in the hospital, but most will accept something.
  7. by   NeosynephRN
    sorry...I will stay out of it
    Last edit by NeosynephRN on Feb 2, '07 : Reason: did not belong
  8. by   GardenDove
    Exactly Tweety. We are not going to change lifelong personality traits or addictions in one hospital stay. We are there to do the best we can with the pt based on their individual needs. We shouldn't impose our value system on our pt, but educate and respect their choices.
  9. by   GardenDove
    I'm not a smoker, but I think society has gone overboard in villifying them. It's only one of many unhealthy habits that people have. I get tired of the puritanical outlook that people have about this habit. As long as I don't have to breathe it, I think people should not be crucified for this vice.
  10. by   Tweety
    Quote from GardenDove
    Exactly Tweety. We are not going to change lifelong personality traits or addictions in one hospital stay. We are there to do the best we can with the pt based on their individual needs. We shouldn't impose our value system on our pt, but educate and respect their choices.
    Agreed but with one nitpick. I don't respect their choices, but I allow them and accept them. If that makes sense.

    The smoking topic is an entirely different thread, do we really want to go there when we have page after page after page of threads? LOL
  11. by   GardenDove
    Quote from Tweety
    Agreed but with one nitpick. I don't respect their choices, but I allow them and accept them. If that makes sense.

    The smoking topic is an entirely different thread, do we really want to go there when we have page after page after page of threads? LOL
    Yes, your wording is better. Tolerance is the word, not necessarily respect. We can act respectful without really feeling respect.
  12. by   RunnerRN
    Quote from GardenDove
    Take, for instance, the pt refusing to wear O2 or BiPap. As long as you inform them, inform the doc, and document, then I think that's their choice. There may be other aspects of their treatment that they accept, such as neb treatments and antibiotic therapy.

    Yes, they might be an annoying smoker or another type of social outcast with an addiction on top of it. I figure, it's not my problem, it's theirs.

    Here's my issue with just letting the pt remove their bipap (when he was obviously huffing and puffing, had a poor sat without it, and had to breathe between every 2 words): poor oxygenation and dyspnea make people feel panicked. Add a bipap on top of that which makes you feel suffocated, and claustrophobic. No, of course you can't glue the mask to his face, but you have to take into account the other factors. We kept telling him to give the Lasix some time to work, because I think once we got some fluid off his lungs he would breathe easier. We also pushed some Ativan in hopes it would calm him down.

    While smoking/overeating/etc may not be my problem, I feel like it is pretty telling when someone comes in c/o "I can't breathe" is barely hanging on with a NRB, and wants to know if he can go outside to smoke. Ummmm no. I use pt's ability to walk self outside to hide in the bushes and smoke (we have a nonsmoking campus) as part of my assessment.

    The bipap pt I'm referring to above was in his mid-40s, approx 300 lbs, had been smoking since his teens, dx COPD/CHF/DM late-30s, and had not changed a single poor habit. I understand your point regarding being patient and nonjudgmental, but it is very frustrating when my education goes in one ear and out the other. The hospital is not a hotel (contrary to popular belief today) and I just don't get why someone takes all the time to come in, and ignore EVERY RECOMMENDATION we give them.
  13. by   ElvishDNP
    This may be a bit OT, or maybe not. To me it depends on the pt's age/severity of her illness. If my pt is 80, diabetic, eats like crap & doesn't want to check her sugar, I really don't care. Is it really a good use of my time to get in her face & preach? Nah. A 45-yo, OTOH, who eats crap, smokes, & has an A1C of 12, well, that bugs me. Do I say anything to the younger person? Depends. Some people don't do what they're supposed to but keep coming to the hospital/clinic because they desperately want someone to call them on the carpet & offer them some help.

    The story is, in my mind, different c each patient. I have a 15yo cousin who has had a seizure d/o for 14 years now, some days the sz are intractable. She is getting close to the end and what she really wants more than anything is a Wendy's Frosty. Let her have 10 every day if that's what will make her happy, seriously.

    I am of the license to reproduce camp too. You have to have a license to hunt, drive, and fish, but any people with the right parts can create a human being that they have no intent of ever caring for. (Like the crack addict I cared for who had had babies 1-4 taken away from her...and went on to have 5, 6, and 7.) That is just wrong.

    I for one do not do all I am supposed to do. Just this week my doc read me the riot act for not doing my BSE, even though I am an OB/GYN nurse and am forever teaching my patients how to do it.

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