Can I give frank unsolicited advice?

  1. I am caring for a 60 y/o female that is one of those needy-whinny types that has been on my unit for 6 mos. She likes to put the blame on her problems on everyone else--nurses, doctors, her illness etc.--she just plain refuses to take charge of herself to get better. Besides having a crush on me, I really believe she thinks there is a majic pill that will make her all better. I'm sure you've all had this type. While taking her BS she tells you all her woes (the same one's she had for months), you come back with her insulin and routine meds, then she decides she needs a PRN. After bringing that she needs a supp. Then she needs HOB up two inches, no, down one inch. I don't dislike this resident, but I don't see any improvement physically or mentally and she is becoming high maintenance for me.

    PT tells me she now has the leg strength to where she should be using a FWW, but she has all kinds of excuses on why she can't. She developed a bladder infection and has trouble voiding. Her urologist wanted an indwelling cath, but she refused saying she didn't want to be carrying around a bag for people to see. Heck, she never leaves her room. She sits in her w/c a couple hours a day and the rest is spent in bed. Since she refused the Foley we have to in and out every shift. So now she has something else to c/o since she is getting sore. She wants a female to do the the cathing so I have to bother another nurse from a different unit who also has more than 8hrs worth of work to do to come and do the procedure. I can't figure out why I can give her a supp, but can't do the straight cath. And then I have to hear about how the other nurse wasn't friendly when doing the procedure.

    I really want to tell her that she needs to start being a participant in her care. That laying in the bed the majority of the day will not help strengthen her injured heart, that the statis in her legs is caused from her inactivity, that her negativity is slowing her recovery, that I care, but I'm tired of hearing about her woes when she refuses to help herself. That she will never leave the facility unless she gets off her butt. That I'm tired of listening to her whine. Can I do this?
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  2. 11 Comments

  3. by   gwenith
    Initiate a "wllness contract" with her. Start with asking her if she wants to get better - she almost HAS to reply with a yes to that one - then go about setting goals that will ensure that she reaches that target.
  4. by   Chaya
    Maybe you could help her turn the situation around if you told her the things you have said here: that you are worried and concerned about her, that you do believe her attitudes and efforts will make a definite difference in her care, that you believe her to be capable of more than she herself may think she is capable of, that you very much would like to see her begin to make definite progress, and that you are willing to support her in all positive efforts in this direction. Offer as specific goals some of the actions you have mentioned here. And be firm! Good luck! She's lucky to have you as her advocate.
  5. by   VivaLasViejas
    Sounds to me like she could be dealing with some pretty significant depression......sometimes people behave this way because it's the only control they feel they have. It becomes a vicious circle---the less they do, the less they THINK they can do. And that takes some therapy and/or medication to straighten out.

    It might be worthwhile to explore this with your patient, and don't be put off if she refuses to acknowledge at first that it might be a problem. This generation prides itself on its self-sufficiency, and many of them see any kind of mental disorder as a sign of weakness and thus tend to deny the need for assistance.

    Please, whatever you do, don't be too hard on her.....she doesn't need to be coddled, but neither should she be told to "stop whining" as if she were a child (even though she's acting that way!). If she IS depressed, this will only make her feel worse and cause her to withdraw even further.

    Just my $.02 worth.
  6. by   Destinystar
    t[font=system]he fact that you stated that this pt. has a crush on you gives you the leverage to put in a sexual harassment complaint and request to be reassigned. does not sound like either you or the pt. are benefitting from the relaitonship. after you do that you can move on to other things and she can be someone elses problem.
  7. by   CapeCodMermaid
    Certainly you can tell this patient that she needs to be a participant in her own care and be somewhat responsible for her health. You might try to get her doc to come in and tell her the same thing. But for heaven's sake , DON'T tell her you're tired of hearing her whining or YOU will be the one in trouble.
  8. by   angel337
    it sounds like this lady is suffering from major depression. does she have family? friends? if not, it probably contributes to her need to feel important. i would talk to the doc about a psych consult or subscribing her antidepressants. and yes it is ok to promote self care with patients. nurses are there to help patients maintain the most optimal health to their best ability and encourage wellness.
  9. by   leslie :-D
    - my 1st thought is a 60 yo in a ltc facility.....now that is depressing.
    - secondly, i smile when i think of all my elderly female pts. outright flirting with anyone remotely looking like the male species. so a sexual harassment suit? please don't even go in that direction, it's an insult.
    - thirdly, i agree a psyche eval would be in order.
    - and finally, there are those patients that in spite of saying they want to go home, they really do 'enjoy' playing the sick role, for there are benefits to be derived from that too.
    - in your nursing career, there are going to be so many pts. that try your patience. don't enable her dependency; respect what is rightfully hers (such as her modesty re: catheterization) and be supportive with her in a firm but loving manner. social worker might be helpful also.
  10. by   dotter
    There is a patient like this in every home I've worked in. You can't please them, they are demanding of everyone's time and they just want to keep someone in the room with them all the time. I think it's just the kind of person they are. I have a patient just like this now. She calls you to come do one thing then she remembers all these other things that she wants and keeps you trotting back and forth. She does the same thing with the cna's. She's a "me" person. Probably has been that way all her life. This probably sounds harsh to some of you but I think it's the truth.
  11. by   Dixiedi
    My least favorite pt type is the just over the hill female. All so often demanding, unappreciative, unfriendly, and always complaining!
    Give me a man pt anyday! Even if he has 50 Xs the medical problems!
    Often times, I agree, it is depression. These women have taken care of everybody in their lives all their lives and now they can't. They have a lot of problem allowing themselves to be weakened and become so depressed over the whole thing it just gets worse! Everything is wrong! They are just never going to get better, etc etc etc.

    Give me a man anyday! or leave me to my kids in home care, much beter choice!
  12. by   nurse555
    We have had several like your lady. Just a thought was she a spoiled child who became a spoiled adult? Also was she married or have children? It seems like a lot of women who were never married or childless have this type of behavior. It is almost as if the family and friends enable this type of behavior by giving them excessive attention or they will cater to them. Not trying to sound judgemental but this has been the case in my experience with ladies like this.
  13. by   mscsrjhm
    Quote from gwenith
    Initiate a "wllness contract" with her. Start with asking her if she wants to get better - she almost HAS to reply with a yes to that one - then go about setting goals that will ensure that she reaches that target.


    Loooove this idea- would work for ltc and acute.

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