Dealing with an uncooperative patient? - page 2
Hi everyone! I was wondering if I could get some input from you all about how you feel about uncooperative patients. Do you feel like a loss of control in care is the biggest reason patients are... Read More
Mar 2, '10Too many times the patient is just looking for someone to be responsible for the awful situation they are in. Anybody, but themselves. My dialysis patients hate that they have to give up a huge part of their lives to come in for 3 hour treatments, 3 days a week. They have no control left in their life. So they blame their health care provider when they can't remove the 6 kg of fluid during their dialysis treatment, that they have put on over the last 2 days. Heaven forbid they should take responsibility for having put on that much fluid in the first place or for not controlling their diabetes so they are thirsty all the time. It is not my fault that you have CRF. It is not my fault that you are fluid overloaded. It is not my fault that you can't breathe and your legs look like giant tree stumps. But, it is my duty to explain to you what this is doing to your body, and give you all the information you need to make an informed decision about your care. I will continue to provide the best care I can, if you will let me. You can choose to continue drinking fluid like a fish. That is your right. Just stop blaming me for how bad you feel. (ooooh, that rant felt good...)
Mar 2, '10Quote from mappersSure sounds like a knowledge deficit...LOL. I had this one lady who was admitted. She fussed and fussed at every med pass, "That's not my med. That's not when I take it. I can do this at home, better than you can." The doc finally just sent her home because she insisted that the hospital wasn't doing anything she couldn't do herself.
I have had another spouse of a patient who kept ******** because her husband's blood pressure was high. He came in with acute renal failure and had been on an ACE inhibitor for years, which controlled his BP. Well, ACE ihibitors can cause renal failure when used over time, so the doc dc'd it. Of course ARF can cause elevated BP. As much as we explained and explained to this woman, she was convinced that if we just put him back on his old BP med, he'd be fine. Every time the docs tweeked his meds, added one, added PRN BP meds, etc, she'd roll her eyes. What are they doing now? Why don't they just put him back on ....."
I sometimes just want to say, "You're in the hospital. Things have changed. What you did before may not work any longer. Stop focusing on what you used to do. If that was still working, you wouldn't be here!!!"
Mar 2, '10I think HDNurse has raised a very important point. So many of our patients, especially the chronically ill ones, do feel helpless and this is a big factor in how well they cooperate with their care. Most of these people have prided themselves on being independent all of their lives, and now their lives are reduced to endless restrictions, medications, etc.
We should keep this in mind when we're teaching our patients. Emphasize that we're not trying to limit them or cripple them; we're trying to help them become as healthy and happy as they can be.
I try to give my patients as many choices as possible. Instead of "it's time for your bath", I'll say, "when would you like to get washed up?" or whatever else I can do to give them some control.
I'm willing to bet everything that the compulsive call light users are trying to exert some control. As an example, I had one awful patient once who was completely immobile, had lost most of his appendages to amputation, and was in and out of the ICU all the time. He was on the call light every 3 minutes. Fluff my pillow. Move my left stump over an inch. Rub my head. Once I recognized that this was the only way he had to exert any control in his life, I was much more empathetic.
I doubt my patient who refused to take "rat poison" will change his mind. He's decided not to take the coumadin, and that's that. His actions may be self-destructive, but at least in his mind he's maintaining his integrity.
Mar 2, '10I hate to give IVP nausea meds when my patients insist on eating greasy fast food their fam/friends bring in. I suggest they "work with" their bodies by eating nonoffending foods to rest their tummies.
Mar 3, '10uncooperative is such a broad definition and I can think of so many different examples of how this could apply. In my experience, I find many just want someone to "really" listen. I usually give them time to discuss their concerns, worries, questions or even just vent. From that information, i attempt to determine what it is the patient needs....is it education? are they concerned about finances? do they need to be empowered? do they need to be re-directed? I almost always offer a choice and usually introduce it as "you have (enter # here) <enter number=""> possible options..." and i let them know that the choice is ultimately up to them. I'm leaving out some of the things I do but people and situations are so individual that I often try to "feel out" the situation. Hope this helps...</enter>Last edit by MomBSN on Mar 3, '10