Non-compliant home care patient with stage three decub

Sticknurse. I took care of a spinal cord injured man for 11 years. The first three years for an agency and when I quit the agency, he called me a while later and asked if I could work privately for him which I did for the next 8. He was injured when he was 25 and passed away when he was 49. During that 11 years, I tended to more Stage 3 and 4 wounds than I care to remember. Not only did he have wounds, he had burns constantly from smoking, and tending to a wood stove that was the only heat source in his house(he lived alone). He also drank heavily. He sat in his chair for days at a time. He refused to be bathed, he refused dressing changes some days. I would go out and sit for 2 hours at a time, waiting to assist him into bed to clean him up and do his ischial dressings only to be refused, cussed at and items thrown at me. I allowed him to refuse as that was his right but not without letting him know the consequences of his refusal. He also refused to let me do foot care which is so vital with spinal cord injured people. His feet were caked with dry skin and each admission to the hospital brought questions about the care he was getting at home due to a horrible body odor, from MRSA infected wounds. I also worked at this hospital so the staff knew that this was not the type of nurse I was. It was the most frustrating years of my life but in many ways so rewarding. I often wonder what I could have done different but I'm not sure I could have changed his course. He told me he didn't want to live in his body and his refusal was a quicker way out. I tried to get him to counseling with no success. His primary MD had many talks with him. It did no good. Fortunately he had a family who loved him and supported him no matter what decisions he made. Things got so bad that I told him that I could no longer be his nurse and things changed. (I didn't do this as a threat, I felt that I was not the nurse he needed) I hired another nurse to come in and help, hired home health aides which he had refused prior. I set up a support network and we kept him busy and he was required to be 100 percent compliant through our personal contract. I'll say that the last two years, he was at his healthiest of all those years and he stated he felt better. Unfortunately he got a bad case of pneumonia in 2004 and succumbed to it. I don't think you are going to change things but just know that you are an extremely important part of his life even if he does not admit it. You do make a difference. Let him know that he has the right to refuse but you are legally obligated to document the refusal as well as educate him on the consequences. He is angry and much of this anger, he may never resolve. All you can do is the best job possible to make his life a quality one.

"Suicide by non-compliance."

I think that nails it.

sticknurse, don't feel bad; you're not alone. We have a resident who refuses to take baths or showers. She is "with it" enough that when she asserts her wishes we respect them and do all the right things such as nicely talking to her about the importance of taking baths, charting, etc...but 2 or 3 days you can't get past the smell and something has to be done. She is already taking psych meds but something is definitely lacking.

When all else fails~Try God! Treat the patient; mind, body, & soul~You already know his physical ailments, now attend to his spiritual ailments~

His spirituality is his business. Inform him of the consequences of his noncompliance with medical advice, chart that you informed him, and leave him alone. Talk about sports, politics, his shoes...
I don't have any problem with non compliant clients/patients. Treat others as you would want to be treated. If they refuse, inform them, chart, and go on about your business. I don't appreciate people trying to talk me into anything- be it medical treatment, religion, spiritual issues, etc, and I'm not going to do that to other people.
Life, liberty, and the pursuit of happiness. Maybe his noncompliance is what makes him happy. Not our jobs to "fix" him- not our place to decide what makes him happy. If he dies due to noncompliance, then he dies. It is what it is, and is nothing more.
Leave it alone.

Who is paying the bills for this guy? Are you hired as a private duty nurse or do you see him as part of home health services? If he wants to fire you for doing your job, then so be it. You have to report what you see. You can't make this guy get better and agree to the plan if he does not want to. He probably is abusing his meds. I would say keep documenting what he is doing and what he says and have someone review his chart. Perhaps they need to pull care from him completely.

He is used to practically being begged or cajoled into accepting services, and I'd bet he enjoys the rise he gets out of the nurses. I would stop giving him the pleasure of being the center of the world. Immediately upon refusal of services or a request to not document appropriately, I would state, "It seems that you do not want to receive nursing services today, so I will leave." Then leave, documenting why.

He also needs to be asked to refuse services in writing whenever he refuses an ordered treatment. An addict would not be above trying to manipulate things so as to make it seem like nobody offered to do things for him.