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Help! Problems At Work Re: Diabetic Pt, Rights



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Jun 20, 2008 09:30 PM

Help! Problems At Work Re: Diabetic Pt, Rights


I Work In A Ltc And Rehab Nursing Home. I Have A Pt With Diabetes That Wants To Eat Sugar, Sugar,and More Sugar. Surprisingly Her B.s. Is Finally Under Control With Po Meds. But I Have Another Pt. That Is Able To Go To The Store And Buy Her Sweets So When I Asked The Pt To Quit Buying Her Sweets (with The Diabetic Pts Money Of Course) This Pt Turned Me In To The Don . The Don Said I Was Wrong Because Alert & Oriented Pts Have Rights And She Can Eat Whatever She Wants And All I Have To Do Is Chart This? I Thought We Are To Discourage And Take Care Of Pts, Not Let Them Go Into Diabetic Coma? Anyone Know What Is The Right Answer ? I Just Find This Hard To Believe Due To Pts Rights? Help In Florida Thanks

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24 Comments
No. 1
from nightmare
Old Jun 21, 2008, 05:25 PM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
I have one like this and unfortunately because she is alert and in her right mind that is her choice! No matter what we say she is non compliant with her diabetes management and there is nothing we can do about it.I fact the more we try and persuade her the worse she gets.
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No. 2
from Batman24
Old Jun 22, 2008, 04:45 PM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
Your DON is right. The patient has the right to eat sweets even if it will harm her. Chart, chart and chart some more to protect yourself. Your intentions were good here so don't feel bad but make sure you document.
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No. 3
from nightmare
Old Jun 22, 2008, 04:49 PM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
Moved to Geriatric and LTC for more input.
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No. 4
from bluegeegoo2
Old Jun 23, 2008, 05:01 AM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
We had a similar situation with a man who was ESRD, out to dialysis 3x wk, A/O, who INSISTED on as much fluid as he wanted. As his nurse, I would yet again reiterate why he was on fluid restriction and the possible complications of drinking too much water and then would give him his water. I would chart something like: Res requests fluids beyond restricted parameters as rx'd. Res taught reasoning for restriction, voiced understanding of poss complications. Given 120cc fluid per res request. There! Covered my butt, and saved myself the aggravation of trying to get him to stay in compliance. We can only help those that want to be helped.
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No. 5
from Bronx_RN
Old Jun 23, 2008, 05:55 AM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
I have numerous residents that are non-compliant diabetics. I do the best I can to educate them about their choices and I document very thoroughly when they are participating in self-destructive behaviors. Alert and oriented patients always have the right to refuse care even if refusing care results in increasing illness or death. It used to really bug me when I was doing my best to care of a non-compliant resident but at this point I throw up my hands because I cannot care more about a person than they care for them self.
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No. 6
from psalm
Old Jun 23, 2008, 07:00 AM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
AND we wonder why our kids don't listen to us!!!
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No. 7
from michelle126
Old Jun 23, 2008, 08:59 AM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
Yep...you can't do much except provide them with the risk of not following docs orders. We also have a form for them to sign.
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No. 8
from CapeCodMermaid
Old Jun 26, 2008, 04:48 PM

Default Re: Help! Problems At Work Re: Diabetic Pt, Rights
As long as the resident is competent he or she can decide for themselves. Document that you've discussed the possible ramifications of eating all that sugar and be done with it. It's hard for providers to 'let' residents do what we know is bad for them, but it is their right. I have MY care plan written already in case I have to go to a SNF some day:
No thickened liquids, NO dietary restrictions, DNR, no g-tube, no shoes no socks, NO BINGO (!), and wine with dinner.
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No. 9
from Daytonite
Old Jun 28, 2008, 10:16 AM

Do you think that maybe it was the way you approached and interacted with this other patient that brought up the issue of patient rights? Rather than tell the resident who is able to go out to quit buying the diabetic patient sweets, perhaps another way to have approached this would have been to educate the resident about diabetes, sugar substitutes and why they would be better choices for the diabetic patient, but still let her make up her own mind.
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