Patients who refuse to cooperate with medical/nursing treatment.... - page 2

I have just about had it with patients who think the hospital is a joke. I took care of a patient recently who basically refused to cooperate with the medical/nursing treatment and plan....This... Read More

  1. by   sjoe
    Just remember to document all patient education and refusals in these cases. "The land of the free" even entitles age 6 inpatient children to refuse psych meds, so there is not much to be done on that score.

    Just document and let it go.
  2. by   bossynurse
    Sometimes you just pray for an AMA!!!! Had a guy once that had a hx of heart and kidney transplant. Was admitted for "frequent falls". 1st I do not work on neuro unit I work on surgical unit but apparenty we had the only private room available. This guy was seen getting out of a car after a 1 hour disappearance from floor. He sent me down to security with a large sum of money to hold. AT 5pm I had done accucheck and given him some regular and longer lasting insulin(dont remember type and dose) Anyhoo at 1830 he isisted on another accucheck and told tech he would take his own insulin. He had apparently brought some from home and refuse to give it up. who knows what other meds he had hidden in room. I tried to tell him not to take it and why not to and he started cussing at me telling me to stay the f out of his room. Threatened to have his g/f meet me after my shift over. I recorded everything informed doc that pt may have taken own insulin but refused to tell me how much. He did same thing two night earlier. I heard the next day that night shift found him non responsive and had to inject dextrose. DUH! Next day tox screen drawn since he had left hospital day before. Positive for canibas. dcd home. the other night I found out he was found dead at home--too much insulin ! And to think that someone died waiting for a heart and someone had to die to give this idiot one.
  3. by   zudy
    I also work in ED, and I try not to let it make me crazier than I already am. Had a 20 yr old male come in a few weekends ago, c/o STD. Said,"I can't believe I've got the clap! I have ELEVEN kids, so you know I've been w/ a lot of women and this has never happened to me!" The dr told him where to go to have a free AIDS test done, pt demanded to have it done in ED. ( No insurance or job,natch.) Iwanted to ask him how he could afford 11 kids when it's all I can do to support 2 kids and work 2 jobs, but I'm tired of getting written up for my smart mouth.
  4. by   Q.
    When I hear of these patients, I always think of the line my husband always says:

    Life's tough when you're stupid.
  5. by   deespoohbear
    Originally posted by sjoe
    Just remember to document all patient education and refusals in these cases. "The land of the free" even entitles age 6 inpatient children to refuse psych meds, so there is not much to be done on that score.

    Just document and let it go.
    Oh, believe me I covered my butt pretty well as did the nurse before me you had this patient....my documentation has saved my butt from the frying pan several times in my career....

    CYA is my motto!!!


    Susy K-love your husband's saying. Priceless.... I will have to add that to my collection.....
  6. by   EmeraldNYL
    Deespoobear, I feel your pain. Unfortunately these patients are all over the hospital, not just in the ER. You just have to do the best to help the ones you can (and who are willing to listen). It is sooo frusturating though.
  7. by   hoolahan
    They aren't any better when they are at home, let me tell ya from the HH perspective. But fortunately, I just tell them like it is, in the language they understand, and then we can discharge them for non-compliance. They get re-referred back, but after a few episodes of non-compliance documented, our agency won't take them back anymore.

    I like that diagnosis, TSTL, I may use that!
  8. by   deespoohbear
    I bet it is worse in the home because you are on their turf.... At least in the hospital I feel like that is "my" turf...and gives a little bit of an advantage....(sometimes).
  9. by   Stargazer
    Originally posted by Susy K
    When I hear of these patients, I always think of the line my husband always says:

    Life's tough when you're stupid.
    Okay, that made me laugh out loud, but I actually think the opposite. Life must be relatively easy when you're too damn dumb to even know how dumb you are.

    And ERNurse, the complete version of that saying is, "Too stupid to live, too annoying to die."
  10. by   Tweety
    I know you're just venting and I feel you pain. They come to the ER and say "fix me". The come to the floor and it's a completely different story.
  11. by   K O'Malley
    We had a patient the other day with severe arterial blockages and way too young to be having these problems. She also happened to be a very heavy smoker. When we told her and explained how smoking can cause blockages she just said "that is the most ridiculous thing I have ever heard!" OK, lady, keep on smoking yourself to death and let everyone else pick up the tab for all your medical procedures.
  12. by   kimberle
    Well, I've been on both ends. I'm an RN who has to deal daily with pts. who c/o "I'm going to sue if they don't get my dinner right this time." "Why does Susie have sores on her butt?" (Well, it's probably because she refuses to turn/follow protocol for pressure relief even though it's all been explained to her. (I work on a long term care ventilator unit.) But I have also been the mother bringing her child in for a fever of 105 and I've refused the spinal tap. I understand the rationale for and the consequences of. It was just my choice. And I understand the rationale of using selective antibiotics based on cultures, but at that time it didn't feel right to do and I told them I chose for them to treat him the most appropriately based on other info (lab draws, VS, O2 sats, etc.) He ended up getting Rocephin shots. Everything turned out OK. Maybe we were just lucky, but sometimes you just have a strong gut feeling about whether or not to do something, then I agree with the others. All you can do is educate (including making sure they understand the information) and document response to and do the best you can do from there. (Of course, always keep a heads up about pt. competency!)
  13. by   NurzofFaith
    I'm still a new nurse...been in the CVICU for 8 months now and am amazed at the stupidity of people. I also see the end results of thier actions more than I want to. For a couple months it seems all I did was bag bodies of people that used and abused what they were given..their bodies and life. I dont think these people understand how selfish they are being and the impact they have on those left behind nor do they care.

    Recently we had a pt. who is a frequent flyer for chest pain..he comes in gets the work up, bath, warm bed and food. Less than 24 hours is out the door AMA, this last time he was told if he refuses treatment to not come back....there will no longer be an ICU bed for him. Can we really do this...most likely not. But I see them putting him on the floor. Why come in if you dont want treatment...for him we were the Motel 8.

    ~Channa

    P.S. When I have a demanding pt. I often think of the saying...This isnt Burger King and you cannot have it your way...LOL To bad its not the truth.

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