Clinical Woes

[vickymarie]

I'm about halfway through my first semester of clinical, and up until now it has been fairly smooth sailing. Yesterday, though, I had my first experience where I felt like i just couldn't communicate or connect with a patient at all, and it was a difficult experience.

One of the worst parts was towards the end of the day while I was administering oral meds, the patient told me to just leave the meds on his bedside table and leave, and he would take them when he felt like it -- but we're definitely not allowed to do that, because the MAR on the computer would read it as administered even if the pt didn't take it, the patient could spit it out, etc., and if there were complications, it would be hard to trace what was going on. Anyway, I tried to gently let him know that I had to be there to see him take his pills to be sure. The charge nurse had realized he had missed a dose of something earlier in the day and it was showing it his labs. He kept insisting to just leave them on the table, and he would take them "if he felt like it, later". I asked if I should come back later with the meds, if now was a bad time, and he refused that.

The patient was just so mad, and he snatched the meds out of my hands. He took them, but obviously felt some hostility towards me now, no matter how much I tried to explain that it was just for his safety.

Anyway, I just feel like my little bubble has been burst. It was my first bad experience with something like that -- the first month or so, I had always had patients who were fairly "easy" and personable. I knew it wouldn't always be that way, but I just feel thrown off now that I have my first patient who actually didn't like me.

[Galaxy1]

Not everyone will like you. Chart patient refused meds in 3 or 4 different places. Write a note that the patient refused after charting it in 3 or 4 other places. Inform the MD and chart that also (time, who MD is, throw in some VS, patient mental status), let your supervisor know, let the next shift know, let the family know (if authorized). CYOA cuz no one else will.

[Woodenpug, BSN]

Truthfully, OP, that is not so bad. You are in for far worse experiences, weekly, if not daily. Seems that you had been lucky for a long time.

[Esme12, ASN, BSN, RN]

Well, I had gone in to confirm identity and everything and he watched me prepare them and everything and he said he felt fine. It was just, all of a sudden, once they were out of the packages, he decided that he just wanted them left on the table. I think that was what threw me, was that he seemed perfectly fine with taking his meds as I prepared them and opened them, but changed gears when I held them out to him. There was another med he refused to take, and he brought it up when I held up the package to tell him what it was, so I thought that he would do the same for any other meds.

He was yanking your chain, he knows better. Even though you opened the meds you can waste them and document them as wasted refused. At least he didn't spit them at you....

I've had that happen:smokin:.

There will be people that you will make unhappy just because they are in the hospital and you are breathing. Don't take it to heart. The reality of nursing and how much crap we put up with is usually an eye opener to the non-medical. Don't take his grumpy beahvior personal.

:hug: You did nothing wrong. Now take a deep breath and study and be a good nurse!

[wish_me_luck, BSN, RN]

I personally would have said something like your labs are off and so, it is obvious your not taking them. Is there a reason for this? It could be horifice side effects. Sometimes, you can do stuff to help this area. Just my two cents, sorry for your experience.

[JBudd, MSN]

There are nasty people out there.

He didn't like You? Nah, he has no idea who YOU really are; to him you are a face in a uniform who has control over him and his circumstances. This is all about control, and you did exactly the right thing. Keep a good eye out for this kind, the potential for violence is real: when he grabbed the stuff out of your hand it was the first signal. Where was your instructor? Our students are never allowed to give meds without the RN or the CNI with them.

[Hygiene Queen]

Just remember: you are not a failure if you cannot get someone to take their meds. You can't force anyone to do what they don't want to do.

Chart them as "refused" because that is exactly what he did.

Next time, don't open meds until you are with the pt. I go through the meds with my pt to do a re-check for myself, and it gives the pt a chance to ask questions, make a correction, raise a concern or flat out refuse.

If they refuse before meds are opened, then they can be returned.

If they are opened, they must be wasted... and they truly are expensive to waste.

However, if that ding-dong (I mean your pt!) watched you go through the meds and watched you open them and did not say a word (!!) until it was time to take them, then don't feel a bit sorry about the waste. I would not credit the pt.

I doubt he was even going to take them. if he was going to really take them, he would have just done it... or would have let you take them back until later.

He could be throwing out his meds... or hoarding them. You would need to check on that.

So, good for you about not leaving the meds.

I have long long ago, waaaaaaaaay before I became a nurse, come to the conclusion that I am not there to be anybody's pal. If I have a great rapport with my pts-- great. If not-- meh!

I just do my job.

Shove that steel down your spine and chin up!

I mean that kindly.

[nurseprnRN, BSN, RN]

you did it just right. brava. you explained the rationale and he didn't like it but he chose to take them.

now, to the main point. i hear your being "stung," but this whole incident is so not about you. at this point the question to be asked is not, "why is he so mean to me?"

there is some reason this man refuses his medications to the point of harming himself. people are entitled to refuse their meds, or any care, at any time and for any reason. at some later time when things have cooled down, a nurse might sit down (contrast with standing over) in a chair next to him, or maybe on a walk in the hall together, and see if s/he could find out what's going on here.

first thing to remember is that someone who is angry is usually afraid of something. it may take awhile to figure out what.

maybe he thinks he's sicker than he is.

maybe his dad died at this age from something like this.

maybe he is sick, really sick, and he's scared.

maybe his sister-in-law told him something totally off the wall about his meds.

maybe it's really hard for him to swallow pills and he's embarrassed to show that.

maybe he thinks that his illness is a result of something bad/evil/sinful/illicit that he wants to keep secret.

maybe he's really angry that now he knows you can check up on whether he takes them or not by checking his labs-- will he refuse to have his morning labs done tomorrow?

maybe he's saving them to take home because he can't afford to buy them?

maybe he's saving them to take home because his wife needs them and they can't afford them for her?

who the heck knows?

point is that when you can figure out what his problem is, you can help him understand and address it. you may not make him take his meds, although...after you explained, he did take them. that may be important data. that is nursing.