Patient behavior that ticks you off

jnette, ASN, EMT-I · Mar 2, 2005

And I always tell my patients "You don't have to know my name to ask for help. Just say I don't feel good or I'm sick" I also tell them some of the feelings they might experience . Such as lightheadness or nausea. And I try hard to keep an eye on those yawning patients or the one's with a far off look in their eyes.

Yep... same here. We do inform our new patients of what to expect, and the s/s of a dropping B/P, and to always let us know immediately if they are feeling warm, flushed, nauseous, sweaty..weak.. lightheaded, etc. They are real good about doing this.

I'm fine with the call bells.. can see the advantages. We just have never been required to have them, or it has never come up. But as stated, htey could come in quite handy if we were busy with other patients at the time and these s/s were coming on.. no argument there. :)

jnette, ASN, EMT-I · Mar 2, 2005

While I think it is noble of you ( Medicalzebra) and your fellow patients to want to change your behavior to suit the nurses - you have it wrong! The nurses should change themselves to suit the patients! You shouldn't need to be in that role.
In fact this leads me to a pet peeve I have about some nurses I work with. They complain about patients who are independent, want to make their own choices and don't want to do what the nurse wants when the nurse wants it. They are real people who don't want to be manipulated. The could be the core reason why the nurses get pissed at eldery people. Plus they probably don't move fast enough to please them. Nurses love control, and if they don't have it...watch out.
Opps just realized you were asking in particular about HD folks - my comments aren't related to that population, but in general may still apply.

Emphasis mine.

I won't attempt to comment on this, as this is way out of line and a perceived, subjective generalization. I choose to avoid these comments as they are not conducive to intelligent dialogue.

jnette, ASN, EMT-I · Mar 2, 2005

my issues are mostly identical to jnette... the patient who refuses to be patient even when it is explained to them the prior patient had a medical issue.
and the few that gain huge amounts of weight and don't take their quinine before treatment...and cramp and cramp (very, very painful i know). however, we can only teach them and keep encouraging them to comply with doctors orders...we are not a babysitting service.
or that one that feels the dry weight is incorrect, and wants his edw increased, even though his chest xray shows fluid in his lungs... that is irritating to listen to and deal with day after day after day.
regarding geriatric issues and call bells...
we do not have call lights except in the restroom and the isolation station, and i tell my patients at admission and off and on during their time with us that if they need our attention, they can do anything to get it...if it is an emergency or they are concerned about something. that includes throwing their remote control on the floor...anything to get noticed during the frenzy of turn-over.
the main issues i discuss with new teammates regarding our elderly population is 1. don't ever talk to them like they are babies and 2. don't yell at them, most don't have a hearing deficit and those that do, wear hearing aids! oh, and don't be disrespectful by saying, "honey", "sugar", "baby", etc... most adults don't appreciate that.
it is also interesting about how things are so different depending on where your unit is located. we are small-town mid-west. most of clients are middle-class white farmer-types. they generally all have insurance of some type, have had good health-care, are generally compliant, and we have no no-show people. this obviously makes our job easier.
very interesting...

we do not change dry weight at the patient's request, but rather will look into the matter and see what, if any changes need to be made and why. if it is merely a matter of total non compliance and the patient refuses to do his/her part, we pull as much as we can without doing harm, and continue to encourage the patient to do better. if we find that the patient is gaining tissue weight, has been eating better, etc., or is regaining function, then these are areas we look closely at to readjust dry weight. we look at edw issues daily .. and adjust accordingly... daily.. using our best judgement and through communicating with the patient.

re callbells/geriatrics..ditto.. same here.

re yelling at patients??? :coollook: we never yell at our elderly patients.. why would we? we know which ones are hoh, and we addresse these accordingly and appropriately. and, as i said, we dearly love our patients and consider them family, so "yelling" at any of them wouldn't even enter our mind!

as for "honey,hon", etc... while it is a well known subject area in all nursing books and proper nursing "etiquette", it truly depends on the local culture you find yourself working in. our patients would be more offended if we did not addresse them in this familiar manner which is so popular and expected in our geographical area. these people here care less about "political correctness" and would not appreciate the "coolnes of tone" missing the sweetness they are so used to here. i prefer to go with what is expected of the locall patient population.

when we have a "transplant" patient from another region of the country, i would not addresse him/her in the same manner.. but according to what they are accustomed to. but i can assure you, that with our population, you had better be giving them their due, and that includes "honey/hon" because this is what they like and expect.. and they reciprocate in kind. these are sweet, kind, openhearted folks here.. without pretenses. :)

jnette, ASN, EMT-I · Mar 2, 2005

My first question would be -- Why is the patient wanting their EDW increased? Why is the patient drinking too much fluid? Why is the patient being non compliant with treatment? After these questions are answered, then there is a better avenue for communicating between patients and staff. AND>> "Can you (patient) tell me what is happening when you have to wait in lobby as we are busy that makes you impatient?" Asking thepatient what is happening with them or why they are reacting and trying to find out the reason often will lead to resolving the problem Perhaps, this is where the social worker can enter into thje picture.

As to your questions above, surely you do not think we have not addressed these issues with the patient? Time and again? Goodness, imperial, we are NURSES here, give us a bit of credit ! :chuckle

Of COURSE we have asked these questions, worked with them, probed every area. But you have to simply accept that these are human beings just like all of us, and are going to do just what they WANT, regardless of outcomes.

You can lead them to water but cannot force then to drink.. we all know this, and so do they. These few non compliant patients will come right out and tell you they don't WANT to reduce their fluid intake, they don't WANT to, nor WILL they give up their cheese, tomatoes, potatoes, beans, buiscuits, breads, bananas, etc. Even when the consequences are dire.. they would rather live a shorter time enjoying thier favorite foods and fluids than cut back or do without. Not that I can blame them... BUT.

Then there is the "educational" factor to consider. Many in our area are not very educated.. and this is by no means a negative reflection on them.. it is what it is. The majority have little or no high school education at all.. have been hardworking folks all their lives in farming, etc. and have raised most of their own food and love their country cooking and have no desire/intention to change their eating habits. It is again, a cultural thing in many places.

Cetainly these issues have been addressed not only by the social worker, but on a weekly basis by our dietician as well. You can only do so much. The DESIRE/UNDERSTANDING has to be there first before the changes in behavior can take place.

We have patients who still don't understand why basic first aid is no longer the norm on ambulance duty.. they don't understand why one would have to have all that "high-fallutin' schooling" to be an EMT..(and God forbid, a Paramedic) instead ! I had one patient tell me the other day" why, to ride the ambulance now-a-days you pretty much have to be a doctor!" Only very few of my patients have any real understanding of what a nurse truly is/does, or the schooling it requires or the reason behind the schooling.

These are all aspects that need to be taken into consideration when attempting to educate our patients. We can do only so much. :)

imperial · Mar 2, 2005

I was not implyling that this was not done, just providing feedback. As I have said, you all certainly seem to be expertised in your area of work, however, as you agree, there are those that are not.

Yes, you can lead a horse to water but ya can't make it drink" is so true.. And, teaching on the level of understanding (patient) is most important. And, I would guess that staff really don't have time to even teach patients what they would like to considering all the factors coming into play, esp short staffing.

J'nette.. your point well taken, tks.

jnette, ASN, EMT-I · Mar 2, 2005

I was not implyling that this was not done, just providing feedback. As I have said, you all certainly seem to be expertised in your area of work, however, as you agree, there are those that are not.
Yes, you can lead a horse to water but ya can't make it drink" is so true.. And, teaching on the level of understanding (patient) is most important. And, I would guess that staff really don't have time to even teach patients what they would like to considering all the factors coming into play, esp short staffing.
J'nette.. your point well taken, tks.

Sure thing, imperial. :)

RRN · Mar 3, 2005

I was not implyling that this was not done, just providing feedback. As I have said, you all certainly seem to be expertised in your area of work, however, as you agree, there are those that are not.
Yes, you can lead a horse to water but ya can't make it drink" is so true.. And, teaching on the level of understanding (patient) is most important. And, I would guess that staff really don't have time to even teach patients what they would like to considering all the factors coming into play, esp short staffing.
J'nette.. your point well taken, tks.

Imperial . Adults learn differently. I don't teach every aspect of dialysis. I teach almost every time I give medicines to the patient. I tell them what they are getting, I aske them how they are doing. I talk to them about their weight or diet. Maybe not all these things but a little bit of it at a time.

You are having a difficult time with this dialysis stuff. Do you suppose a patient can absorb all of it in one sitting???

nosonew, BSN, RN · Mar 3, 2005

Imperial . Adults learn differently. I don't teach every aspect of dialysis. I teach almost every time I give medicines to the patient. I tell them what they are getting, I aske them how they are doing. I talk to them about their weight or diet. Maybe not all these things but a little bit of it at a time.
You are having a difficult time with this dialysis stuff. Do you suppose a patient can absorb all of it in one sitting???

Actually, I think Imperial was speaking about those that either don't have the experience to do what we do (as Jnette stated) or those that just don't care enough anymore to do it...and just want to complain about it.

I am all with Jnette on that one too. My particular patient who wants his EDW raised wants to do so because "I used to weigh 20 pounds MORE than what I weigh now...and I am trying to gain weight, and you just take it off"...we explain that we do not pull MUSCLE or FAT off of the machine, only fluid. His BP is stable, his lungs still have fluid. Therefore, his EDW actually needs decreased SLIGHTLY (.5 or 1.0 kg) etc., etc. It is like talking to a brick wall. The doc actually told him the other day that if he did raise his EDW it was AMA and he would just wait for the call stating he was admitted for fluid overload...

And to the poster who generalized all of nursing as control freaks...not so. That is the same as saying everyone with long hair smokes dope and all bikers beat people up. Which are also examples of horrific stereotyping.

imperial · Mar 3, 2005

It certainly difficult to absorb all the information as the dialysis process is overwhelming. Learning how the machine works is important. I am aware of several situations where techs made a mistake and because the patient was trained the mistake was caught in time. This is ok as the patient and staff are a team and I see nothing wrong with bringing observations to staff. Also. as far as EDW, I am sure and I have heard many families states their loved ones eat and eat and drink and drink. Yes, some patients will not be able to hear what you are saying. But, what is the reason they are not hearing? Then, what about the nurse who insists on bringing the EDW down and down and not re evaluating the patient each treatment, only going by past weight and present weight. The patient's EDW is only evaluated every few months. I always thought that on dialysis one needs weight evaluated each treatment.

RRN · Mar 3, 2005

It certainly difficult to absorb all the information as the dialysis process is overwhelming. Learning how the machine works is important. I am aware of several situations where techs made a mistake and because the patient was trained the mistake was caught in time. This is ok as the patient and staff are a team and I see nothing wrong with bringing observations to staff. Also. as far as EDW, I am sure and I have heard many families states their loved ones eat and eat and drink and drink. Yes, some patients will not be able to hear what you are saying. But, what is the reason they are not hearing? Then, what about the nurse who insists on bringing the EDW down and down and not re evaluating the patient each treatment, only going by past weight and present weight. The patient's EDW is only evaluated every few months. I always thought that on dialysis one needs weight evaluated each treatment.

Was that a new experience for you..Thinking I mean?

They don't hear us cuz they don't want to..Simple concept. Ever see a smoker read the side of cigarette package?

EDW is not an exact science any more than medicine is. First you say patients should be listening to us and in the next sentence you say patients should have a say in their treatment. Well, guess what all those who don't take our advice, and that's what it is, are having a say in their treatment.

I think the government shouldn't pay for treatment when a patient is blantanly non complient..Should an insurance company not pay for cancer treatment when a patient smokes for 30 years. We aren't dealing with textbook cases here . We are dealing with human beings and all their issues.

nosonew, BSN, RN · Mar 3, 2005

In every dialysis unit I am aware of, and EVERY company out there, patients are weighed both pre and post. Taking into issue illnesses, poor or good appetite, both positive and negative behaviors, the EDW is changed as needed, and in our unit, I would say our patients on average have an EDW change every 2 months. Some more, some less. NEW patients have an ever-changing EDW until their EDW is determined and then we focus on them gaining their real weight back, thus changing their EDW as needed for real weight gain.

I would have to say that CONTINUITY of care is of utmost importance in dialysis. Those units unfortunate enough to have high turn over, obviously have issues regarding this as they don't know their patients.

EDW is not a science, but it isn't hard to do. When in doubt, get a CXR, and be sure to observe and LISTEN to your patients.

I also highly recommend a floor scale with a printer for printing out the weight. We have one and it has made a world of difference! No more re-weighing the patient when they forgot or having a short staffed unit have a team-member stand by the scale to ensure the patient is remembering correctly.

And if there are nurses out there who don't look at EDW's frequently, they probably shouldn't be working in dialysis or haven't been taught properly.

Just my two cents.

spiderman630 · Jun 24, 2006

I agree that sometimes patients do not understand that things happen that will cause the next shift of patients to get put on late. There are unexpected mechinical problems or a patient is bleeding or having chest pains. Rushing through getting a patient on and off increases the risk that a mistake will be made such the wrong perameters being put in a machine or wrong dialysate bath or something more serious. There are times when a staff member may do somthing that causes a patient to be put on late that was avoidable...I will admit that. If your auto mechanic rushes makes a mistake, he has to do the work over. If your nurse or tech rushes and makes a mistake, you may end up being taken to a hospital or lose a lot of blood due to heparin being forgotten and your blood could not be returend due to clotting.