Should patients be allowed to refuse LPNs and CNAs? - page 9

Last night on our med/surg unit, we had an elderly woman who was in wiht consitpation. Very stable patient, vitals within normal limits, fairly negative past medical history, no home meds,... Read More

  1. by   renerian
    I won't flame you. I am always open to different interpretations.

    Glad your still posting as such.

    renerian
  2. by   ktwlpn
    Quote from lpner
    borderline personality disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. i don't believe in any borderline pshych dx. go ahead and flame me... i'm ready for my opinion to get blasted, but i will hold firm to it.
    by diagnosing this behavior disorder you can care plan it and staff can present a united front thus minimizing the up-roar to the unit and helping to insure that everyone gets the care they need... this behavior goes way beyond that of an ordinary jackass borderlinesare difficult to live with and even worse to work with...and no-one is flaming you-just voicing an opinion that differs from your own-thick skin helps with that on boards like this....that and loosing the need to have the last word..that will bring down a good thread fast and it's a shame when a good dialogue is going on to have it shut down.. this might help -----[ borderline personality: persons with this personality disorder--predominantly women--are unstable in their self-image, mood, behavior, and interpersonal relationships. this personality disorder becomes evident in early adult years, but it tends to become milder or to stabilize with age. such persons believe they were deprived of adequate care during their childhood and consequently feel empty, angry, and entitled to nurturance. as a result, they are relentless seekers of care. this personality disorder is by far the most common type seen in psychiatric and all other types of health care services.

    when persons with a borderline personality feel cared for, they appear like lonely waifs, who seek help for depression, substance abuse, eating disorders, and past mistreatments. however, when they fear the loss of the caring person, their mood shifts dramatically and is frequently expressed as inappropriate and intense anger. the shift in mood is accompanied by extreme changes in their view of the world, themselves, and others--from black to white, from hated to loved, or vice versa (see splitting in table 191-1). their view is never neutral. when they feel abandoned (ie, all alone), they dissociate or become desperately impulsive. at times, their concept of reality is so poor that they have brief episodes of psychotic thinking, such as paranoid ideas and hallucinations.

    such persons have far more dramatic and intense interpersonal relationships than those with cluster a personality disorders. their thought processes are disturbed more than those of persons with an antisocial personality, and aggression is more often turned against the self. they are more angry, more impulsive, and more confused about identity than those with a histrionic personality. they tend to evoke intense, initially nurturant responses in caretakers. but after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, caretakers--including the physician--often become very frustrated with them and view them as help-rejecting complainers. splitting, acting out, hypochondriasis, and projection are common coping mechanisms ------
    that is from the merck manual-lots of info on the web if you are interested...i,too have come to this board with lots of conviction but have learned to be open to learning from others-i have taken alot away from the people that post here-i hope others do also...... ps-i am certainly not claiming to be a psychologist here,either......just thowing out some ideas....
    Last edit by NRSKarenRN on Mar 20, '05 : Reason: fixed quote
  3. by   zacarias
    Quote from LPNer
    Borderline Personality Disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. I don't believe in any Borderline Pshych Dx.

    Go ahead and flame me... I'm ready for my opinion to get blasted, but I will hold firm to it.
    While I might agree that some folks indiscriminately use "Borderline" to define anyone with slight neuroses, 'Borderline Personality Disorder' IS an Axis II condition and is defined in DSM-IV.
  4. by   mercyteapot
    Quote from zacarias
    While I might agree that some folks indiscriminately use "Borderline" to define anyone with slight neuroses, 'Borderline Personality Disorder' IS an Axis II condition and is defined in DSM-IV.
    I agree. I also think that it is dangerous to not "believe" in diagnoses that are defined and accepted by the DSM-IV, since it might mean we don't end up making appropriate referrals that could get our patients the help that they need.
  5. by   renerian
    My thoughts are diagnoses do change periodically and I have seen many mental health patients misdiagnosed. That is where I was coming from.

    Sorry I also did not remember it being part of original post.

    Everyone have a great day!

    renerian
  6. by   ProfRN4
    Quote from cotjockey
    btw...yesterday, the rn was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. when she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only rns would come into her room and rns don't know enough about moving patients...
    :smackingf i guess you guys can't win with this one, can you? what would she have said if the cna was with her? i guess you need pt's on hand for all transfers (now there's an idea... )
  7. by   mattsmom81
    Quote from bonemarrowrn

    :smackingf i guess you guys can't win with this one, can you? what would she have said if the cna was with her? i guess you need pt's on hand for all transfers (now there's an idea... )
    i for one would love this...'wait for the pt mrs jackson'...hehe! yeah that would really fly..
  8. by   pediatriclpn
    Did anyone notice, this was a woman in for constipation? Definitely someone anal.

    Just kidding folks. :wink2:
  9. by   ProfRN4
    Quote from pediatriclpn
    Did anyone notice, this was a woman in for constipation? Definitely someone anal.

    Just kidding folks. :wink2:
    :yeahthat: I love it!!!! BTW I can't understand these 'constipation' admissions. Can't you take care of that at home? Without getting personal, I can thing of a number of things I'd try before I decided to go to the ER. Hust go down the isle at the drug store (or the supermarket, for that matter!!!)
  10. by   UM Review RN
    Quote from bonemarrowrn
    :yeahthat: I love it!!!! BTW I can't understand these 'constipation' admissions. Can't you take care of that at home? Without getting personal, I can thing of a number of things I'd try before I decided to go to the ER. Hust go down the isle at the drug store (or the supermarket, for that matter!!!)
    I have a patient who's c/o constipation despite being on several stool softeners and a mild laxative.

    She told me what she takes at home:

    Fibercon, dulcolax, sennakot, miralax, colace, and about three others--EVERY DAY.

    So yeah, I guess once you're THAT dependent on laxatives, you can get stopped up just by not taking them.
  11. by   dazzle256
    Quote from ddd
    While this exact scenario has not been asked before, similar requests have been discussed (students, gender, race, ethnicity, etc.)

    When a hospital receives such a request, it is put in a terrible position. If they insist that the patient accept care from someone they have requested NOT to participate in their care ... both the hospital and the care-giver place themselves at an EXTREME risk for a lawsuit. While it may seem unreasonable, or offensive, to the person "not allowed" to care for the patient, the hospital is actually protecting that caregiver (and itself) by honoring the request.

    It can cost many thousands of dollars to defend yourself in a lawsuit -- even if you do nothing wrong. Why take the risk?

    It's sad ... but honoring the patient's request is often the prudent thing to do.

    llg (ddd is my home account)
    I had a patient once refuse to have a certain aid come in for his cares because this person was Filipino. So, everyone started redoing the work assignments... It was a real mess I just said to the man look she is a good aid very kind and gentle.....if you want to refuse care from this person thats fine but we aren't changing everyone elses assignments.
  12. by   SmilingBluEyes
    Quote from Angie O'Plasty, RN
    I have a patient who's c/o constipation despite being on several stool softeners and a mild laxative.

    She told me what she takes at home:

    Fibercon, dulcolax, sennakot, miralax, colace, and about three others--EVERY DAY.

    So yeah, I guess once you're THAT dependent on laxatives, you can get stopped up just by not taking them.
    well these "emergencies" really burn me up. Does NO ONE talk to these folks about laxative dependency and its dangers??? GOOD GOD. There are people out there dying and they come into the hospital for constipation!
  13. by   Overland1
    So, was she started on a Colace drip? :chuckle

    A lot of bogus admissions occur because it is often easier to admit the patient, especially when the family is standing there in the ER and demanding that the doc must admit their family member and will not take "no" for an answer. A few such family members have been known to just drop Uncle Fred or Aunt Ethel off in the ER at night and leave, so there is no other way but to admit the patient.

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