diabetic/ chf and NONCOMPLIANT!!

[Purple Princess]

we have a resident at our facility who has both CHF and diabetes. He requires oxygen and breathing treatments because of the chf and alot of insulin because of the diabetes. He is also on fluid restriction as well. He will not listen, he goes to the pop machine and gets pop and his wife brought in a box of candy around the holidays. Guess what? his bs went to almost 600 and they almost had to send him to the hospital. He doesn't seem to get it about the restrictions and why it must be done. he is with it too but is very manipulative and cruel. He lies and sais that I didn't offer him a snack to the nurse, blames me when his bs drops, gets mad when his roomate gets fluid. But his roomate is not on fluid restriction and has been running a fever and vomiting lately. i'm sure if he had a fever we would make exceptions. i'm tired of being the mediator but the nurses know it's like talking to a brick wall and even a patient person like me can only take so much of the lying, belittling, tantrums, and being told to go to hell. if he behaves he gets his drink, or popsicle, crackers and pb or half a sandwich or diet cookies. if not he just gets a snack and nothing to drink. i tried to tell him that he doesn't cool it he's going to end up in the hospital again, he has two serious conditions. and also i can't ignore him when i give the roomate stuff and he'll put on his light and we get in trouble if we ignore a light cause lord knows they could be in trouble, ( we got a lotta every 5 minuters) :uhoh21:

[meownsmile, BSN, RN]

This guy will get water if he wants it. There is a sink in his bathroom and he knows it. Noncompliance is ultimately his decision if he is "with it". He has lived through the years determining his own life before he was there and im sure it is difficult for him to turn over control to "a woman", depending on what era he is from.

Maybe its time to turn the problem over to the doctor. Next time he comes in if he doesnt go see the patient,, bring the patient to the doctor and have him explain why the restrictions. Then if he still remains noncompliant its his choice. There isnt much you can do, these residents still have decision making power. Maybe let him make the choice to have a little less for his meal and a little more for a evening snack? Turn some of the decision making power back to him. After all they are already told when to eat, when to sleep , when to get up for breakfast,when to shower, having people insist they participate in activities they may not care the least about. Guess what he can control,, what goes in his mouth.

[Antikigirl, ASN, RN]

I know this can be so very very frustrating...but it is his choice to do what he wishes to do with his life. A nurse is not there to take over and rule someones life, but to inform and try via different methods, to encourage someone to be more compliant with a physicians order and guidelines to help with conditions.

We are not strong hands, we are educators...and patient advocates. If my patient does not want to comply..I try to find the underlying reasons why, which most times is from pure lack of education compounded by total utter denial. Education...well that can be easier to deal with than denial...but denial, only the one with it can overcome it.

If your resident is non compliant let the PCP know, document fully (CYA), and REALLY document your implementations you performed for patient education...even the little talks about it (appropriate quotes say volumes...use them!!!)!!! That way when he suffers for what he wants to do vs what he should do (which is his choice), you can show you tried to inform the client, and he went on with..here are some key word for you..."informed consent"!

Sorry, but according to the Patients Rights Act, he can do whatever he feels he wishes to...it is our job to educate, inform, and encourage and document results and communicate with the healthcare team...now how you do that is your own special art of nursing!

Good luck to you...I have hit my head against walls on this one over and over again and finally came to terms as far as my role of a nurse and patient advocate. The Ying and yang of nursing as far as I am concerned...(not evil and good..but black and white and the area of grey inbetween ).

[ktwlpn, LPN]

It is nursing's responsibility to document this behaviors and their attempts at educating him-you have to get along with him because you have more direct contact with him-let the nurse's do their jobs.... He has the right to be as non-compliant as he wants and his snacks can not be withheld because of his behaviors.Believe me-he "gets it" and he is pissed off about it.He is alert and living in LTC-people tell him when to get up,when to go to bed,when to bath,when to eat.the only thing he CAN control is his intake....Try not to take it personally-Make sure you give him his prescribed snack and fluids during your shift-maybe try giving him the stuff at the start of your shift and tell him he can eat and drink it when he wants to-then he is in control....If he wants more fluids tell the nurses-they can re-calculate his resriction taling into consideration his med passes and his meals...Maybe he would rather have more fluid at a certain time of the day.The more control he is given the better it will be for all.....The manipulative and cruel behavior takes 2-if you don't play that game then he can't abuse you..Look at it this way-his body is slowly giving out-his non-compliance is going to bring it to an end sooner rather then later and maybe that is what he wants...It is not a f*ck you" to you and the rest of the staff----don't fight with him.And let him know that you do understand his feelings-maybe no-one else has made the effort.Who knows-you 2 may end up with a special bond-He certainly is a challenge and I think his purpose is to teach you some important lessons....

[Antikigirl, ASN, RN]

It is nursing's responsibility to document this behaviors and their attempts at educating him-you have to get along with him because you have more direct contact with him-let the nurse's do their jobs.... He has the right to be as non-compliant as he wants and his snacks can not be withheld because of his behaviors.Believe me-he "gets it" and he is pissed off about it.He is alert and living in LTC-people tell him when to get up,when to go to bed,when to bath,when to eat.the only thing he CAN control is his intake....Try not to take it personally-Make sure you give him his prescribed snack and fluids during your shift-maybe try giving him the stuff at the start of your shift and tell him he can eat and drink it when he wants to-then he is in control....If he wants more fluids tell the nurses-they can re-calculate his resriction taling into consideration his med passes and his meals...Maybe he would rather have more fluid at a certain time of the day.The more control he is given the better it will be for all.....The manipulative and cruel behavior takes 2-if you don't play that game then he can't abuse you..Look at it this way-his body is slowly giving out-his non-compliance is going to bring it to an end sooner rather then later and maybe that is what he wants...It is not a f*ck you" to you and the rest of the staff----don't fight with him.And let him know that you do understand his feelings-maybe no-one else has made the effort.Who knows-you 2 may end up with a special bond-He certainly is a challenge and I think his purpose is to teach you some important lessons....

DARNED GOOD way of saying what was in my mind!!!!! LOL~! Good advice!!!!!!!

[ktwlpn, LPN]

Thanks-Purple Princess is the kind of cna we all wish we worked with every day.She obviously cares about doing the best she can for the residents in her care.She takes her responsibilty seriously...PP-I hope you think about furthering your education-we need nurses like you in LTC...I -and others on this board-will support you...

[lovingtheunloved, ASN, RN]

Thanks-Purple Princess is the kind of cna we all wish we worked with every day.She obviously cares about doing the best she can for the residents in her care.She takes her responsibilty seriously...PP-I hope you think about furthering your education-we need nurses like you in LTC...I -and others on this board-will support you...

Amen! PP rocks!

[CapeCodMermaid, RN]

"if he behaves he gets his drink, or popsicle, crackers and pb or half a sandwich or diet cookies. if not he just gets a snack and nothing to drink. "

If he behaves????? Are you doing a behavior mod. program or just punishing him? Somehow I must be reading that the wrong way. You can't withhold fluid because of a behavior problem. Maybe the doc should reiterate the reason for the fluid restriction...tell the guy exactly what can happen if he has too much fluid and then make it the patient's choice...all very well documented of course. The man wants to have control of his life and since he can't have that, he's picking something he feels he CAN have control over.

[kathi yudin]

when all is said and done.. it is ultimately his and his wifes choice to comply or not.. hold an idt meeting with him and the wife.. give him all of the risks and consequences of his non compliance.. write it all down.. have the resident and his wife sign it as well as the idteam.. place it in the assessment part of the chart.. document in the careplan their non compliance.. and.. make sure that it is frequently documented in the nurses notes.. what he is doing and how the nurse again went over the risks/consequences with him.. this will help keep you out of trouble.. have dietary do really good documentation as well.. hope that this helps..

I know this can be so very very frustrating...but it is his choice to do what he wishes to do with his life. A nurse is not there to take over and rule someones life, but to inform and try via different methods, to encourage someone to be more compliant with a physicians order and guidelines to help with conditions.

We are not strong hands, we are educators...and patient advocates. If my patient does not want to comply..I try to find the underlying reasons why, which most times is from pure lack of education compounded by total utter denial. Education...well that can be easier to deal with than denial...but denial, only the one with it can overcome it.

If your resident is non compliant let the PCP know, document fully (CYA), and REALLY document your implementations you performed for patient education...even the little talks about it (appropriate quotes say volumes...use them!!!)!!! That way when he suffers for what he wants to do vs what he should do (which is his choice), you can show you tried to inform the client, and he went on with..here are some key word for you..."informed consent"!

Sorry, but according to the Patients Rights Act, he can do whatever he feels he wishes to...it is our job to educate, inform, and encourage and document results and communicate with the healthcare team...now how you do that is your own special art of nursing!

Good luck to you...I have hit my head against walls on this one over and over again and finally came to terms as far as my role of a nurse and patient advocate. The Ying and yang of nursing as far as I am concerned...(not evil and good..but black and white and the area of grey inbetween ).