body image, not helping in care

[anon456, BSN, RN]

I had a patient last week who was not old, and had a life-altering surgery that would impact them socially and physically. Although the pt was prepped ahead of the surgery on what to expect, they were in shock and did not want to look at the changes after the surgery. This is to be expected for awhile but the pt kept refusing to look at or participate in care and soon it was time for discharge. The pt had healed enough to go home but still would not demonstrate proper care to show they could do this at home for themselves. The pt was eventually discharged when I was not there and I'm not sure what happened.

What do you do in this kind of situation where the pt just never comes around to accepting and caring for their needs? That was one of the criteria for discharge, but what if they just never want to do it-- they can't stay in hospital forever if they have physically healed.

[ProBeeRN, BSN, RN]

Was homecare referred? We are usually the "bridge" between hospital and home. Worked with many a new ostomy with trouble coping with body image changes who refused to even touch a wafer until they got home and it really "hit" them

[anon456, BSN, RN]

I was not able to follow the pt after I left, so I'm not sure what happened. Hopefully they did have follow up care.

[cb_rn]

people sometimes just need time to grieve for loss of body image. I did home health and hospice with a super dooper WOCN and she told me out of all of her many years she only had one patient that never would assume care of their ostomy until the HHA finally had to "fire" her. It just takes time and good teaching and sometimes some prodding after an ample amount of time has passed. I would say its very rare for someone to get sent home with something life changing without home care or clinic followup. Even in the case of mastectomies I have gone in to care for the patient at home and help her with dressing changes even if it wasn't really "necessary" from a wound standpoint to help with coping

[PostOpPrincess, BSN, RN]

Social work to intervene. If patient refuses, that patient is just setting herself up for major infection and if she were readmitted, a review of the chart would show that social work/follow-up care should've been put into place.

[nlion87]

incorporate family members/spouse/significant other in aftercare i.e suggest having them reveal altered body to a spouse or significant other and involve them in aftercare withsome they trust who is already accepting of them so mabey they willnot feel as self conscious

[diane227, LPN, RN]

When people go through such a life altering experience, they usually will not come to acccept their situation quickly. They need time to adjust. It will take time and often they may not want to participate in their care. It takes time and compassion.

[flip/flop]

I would have requested a psych consult, if they were not already following.