I've come to the conclusion that I may not know how to adequately deal with what I call difficult patients. Setting: ICU with 2 patient load.
I had a 71 y/o woman who was A+Ox3 that complained she could not lie on her back due to arthritis. So the plan was to have rotate side to side. She had a PCA and was encouraged to use it. It seems as this was working in the beginning. The first complaint was that the lift team was taking too long to get her out of bed. Then the lift team was taking too long to get her back into bed. She was still NPO (post op). She insisted on prune juice. Got the doc to change her diet and got prune juice. Then she calls me back and insists on an enema. I tried to tell her she hasn't eaten since surgery, sometimes it take a while for the stomach to wake up (postanesthesia). In the meanwhile she gets nauseous and I hate to run to treat her for that.
Once back in bed, she wanted the bed flat. Even with the bed flat at 0 degrees she kept calling me to come back to lower the bed more. I told her the bed is flat. I can't lower it anymore. She kept saying, "I want my head down more" or "I want my feet down more". I did dismiss this because I thought it was nonsense. The bed is flat,what more do you want me to do??? I need to tend to my other patient. If you are having pain use your PCA and it may make you more comfortable. It wasn't long before she called me back. Forget that I have anything else to do but tend to her. I spend literally 5-10 minutes raising the bed, lowing the bed, putting a pillow behind her, removing the pillow, raising the feet, lowing the feet. I felt I tried everything I could to help her.
Per management/protocols the HOB should be >30 degrees and for a while I allowed the patient to lie flat. For the second time the patient desaturated. Respiratory came to the bedside and sat the patient up to 30 degrees and explained to her she needs to sit up for a while, told her about pneumonia prevention, lung expansion, etc. The patient begin complaining she wasn't comfortable. Her daughter tried to comfort her and get her to tolerate being up. She still insists on getting an enema. I speak to the doctor who told me he wasn't going to order that. I go back and tell her that the doctor feels she doesn't need one at this time.
I felt this was the most demanding patient, I've had. Every time I leave her bedspace after each episode, I ask her if there is anything else I can do for her. When she said yes, she tells me the same thing: enema, lie flat. Whenever she did say no she would call me back within minutes to adjust the bed. Two times she called me back to say she had gas. The firs time, I asked was she having belly pain, she said no. Told her I needed to tend to my other pt who was in a-fib (I need to call the doc, mix meds etc). She continued to ask for an enema. I begged the doctor to please see the patients about her bowel concerns and he agrees to see the patients. I return to the bedside and she continues to complain. I say nothing else because all the time I spent explaining everything, she wasn't hearing me. The doc finally came, said that Milk of Mag and PRN enema won't hurt her. Told the patient he was ordering these things. She seemed to more satisfied. I did keep the HOB at 30 degrees as respiratory left it and the patient did not voice anymore complaints. Again I asked if there was anything else I could do for her and she stated no for the remainder of my shift.
It was so bad that my other patient told me, "I hate to bother you because she seems like a handful over there".
The next day, my managers call me in to tell me that this patient requested that I not be her nurse. Reason: that nurse doesn't care about my comfort at all. I feel that all of the things I did didn't matter. I might as well just left her lying in bed for 12 hours and this complaint I feel would have been justified.
My managers want to send me to classes, feel that I need counseling etc. I feel that this isn't fair. I'm left to wonder if this patient just didn't like me. Was she messing with me (head up, head down, wanting the bed lower even though it was flat)??
Only thing I could think of in retrospect was to have called management in to deal with her in the beginning when she was making all of these demands. I was getting overwhelmed, felt I was neglecting my other patient and fell behind in other tasks (giving meds, charting etc). I have no idea of what else I could have done. Management is concerned because this is the 2nd time in one month I was requested to not be the nurse. 4 times in 2.5 years that a patient has complained not being rude, disrespectful, unsafe, dirty etc but of me being "non caring" or "cold". I feel that it does come to a certain point that I feel a patient is being unreasonable and I stop responding to him/her WHILE I WORK ON THE ISSUE WITH ANOTHER TEAM MEMBER (respiratory, physicians, anethesia etc). I have called everyone but management because i feel don't want to bother them.
Your thoughts?? I'm open to any advice at this point to take into consideration. Sorry so long but I tried to sum it all up. Thanks for reading.
Every time I leave her bedspace after each episode, I ask her if there is anything else I can do for her. When she said yes, she tells me the same thing: enema, lie flat. Whenever she did say no she would call me back within minutes to adjust the bed. Two times she called me back to say she had gas. The firs time, I asked was she having belly pain, she said no. Told her I needed to tend to my other pt who was in a-fib (I need to call the doc, mix meds etc). She continued to ask for an enema. I begged the doctor to please see the patients about her bowel concerns and he agrees to see the patients. I return to the bedside and she continues to complain. I say nothing else because all the time I spent explaining everything, she wasn't hearing me. The doc finally came, said that Milk of Mag and PRN enema won't hurt her. Told the patient he was ordering these things. She seemed to more satisfied. I did keep the HOB at 30 degrees as respiratory left it and the patient did not voice anymore complaints. Again I asked if there was anything else I could do for her and she stated no for the remainder of my shift.