Feeding patients

GeauxNursing · Jul 13, 2009

you're joking, right? Man, sounds like your MD wants you to act as room service, in addition to entertainment staff. What's next? Laundry service?

HDNurse · Jul 14, 2009

No joke. The dietician is about ready to pull out her hair. The protein popsicles are ok, I guess, as there is some benefit for the pt. But the popcorn and sno-cones are strictly entertainment. Give me a break....

Natkat, BSN, MSN, RN · Jul 23, 2009

I have seen patients drag rolling duffels in with them. Jeez. It's crazy. They practically bring their whole house with them.

The other reason we don't let them eat is because, without fail, 20 minutes later you will hear the dreaded "I have to go to the bathroom". Gaaaaah!

Our dietician used to do a lot for the patients, like giving them a meal on a holiday, but she noticed that the more she did for them, the more ungrateful and entitled they became. So she stopped doing nice things for them and pretty soon they all settled down and behaved themselves.

NDXUFan · Aug 27, 2009

we just have a water fountain in the lobby. Just yesterday I had a pt say to another "the clinic down the street, they have a coffee machine, a soda machine, and a snack machine in their lobby! They just don't want us to have anything over here." I said, "Well we don't want you guys to be drinking sodas and eating cheetos and fritos all the time." (we already have a hard enough time controlling phosphorus with these ppl.) "Well yea but the administrator over there must understand that the salt in the fritos helps with blood pressure, ya know. She must care about the pts not falling out in her lobby!" Oooh, that made me so mad. I'm thinking, you don't need any help with your BP OR your phosphorus! You don't take your binders, EVER, and you gain 5+ kilos b/t every tx, so naturally your BP goes in the crapper when we try to pull it all every time. That's why you want fritos in the lobby? Frankly, I just get so tired of hearing certain pts bad mouth the company and the boss and the clinic for not, basically, waiting on them hand and foot and supplying their every desire!
I know I'm a nurse and I am supposed to always try to educate and be sincere and CARE and stuff, but I find that chronic HD pts can be such VICTIMS! Everyone is just out to screw them.
Is it not bad enough that we have one tiny little lady that orders pizza to the clinic for herself? Sweet talks another pts son into running out to Whataburger for her, then brings it ONTO the floor for her to eat while she is on the machine? Then, "Susie, can you bring me the butterfinger that's in my bag? It's not there? Okay, just bring me the SNickers bar then." Agh! That's why your p04 is 10!!

As a dialysis client, I really respect the Nursing profession. My mom was a Registered Nurse, so is my sister and my aunt. I only had to eat once on the machine, when my blood sugar was dropping, it was awful. Honestly, I just wanted my treatment so I could go home after working for eight hours at night. I worked with individuals with many mental and physical challenges for eighteen years. Yes, I have been on both sides of the fence. I started dialysis when I was thirty eight years old. Before you stereotype me, I played on the offensive line and I was a heavyweight wrestler, last bench press 330 pounds, 20 times. The first time after my first dialysis treatment, it felt like someone had beaten me with a baseball bat. I know and understand that the majority of dialysis nursing personnel want the patient to be independent, I would agree with those thoughts. However, many nursing individuals try to control the life of the dialysis patient/client. "Do not have this, do not drink that, control, control, and more control. Yes, I know a fair amount about controlling people, I worked as a police officer. How would you feel as an adult with people trying to treat you as a small child?

It is a natural question for a dialysis patient to ask, "Why me, why is this being done to me?" I can relate because for the vast majority of my life, I was in perfect health. My father has the mentality of many people in dialysis, they are really clueless to what it is really like to be very sick. This is just not my opinion, it was the opinion of my R.N. mom. My mom said, "When it comes to sickness, your father is clueless."

I read the comment about fluid intake. If you are a diabetic, as I am, In-center fluid restrictions are like putting a diabetic in the desert without any water for days. I think it would be a great idea for dialysis staff to have to live by the restrictions that they demand from us for a week or two.

Now, I am on home dialysis and I would never, ever go back, to In-center dialysis. Sadly, some people in dialysis look at the patient as a small child to be controlled by adults. They fail to realize that not every dialysis client is the same, physically, emotionally, or mentally. In other words, they have a one size fits all mentality. I knew I had to leave the center when I need salt water for cramps and the R.N. said she did not have time for me. Many times, when I have heard comments by In-Center staff, it sounds like people I knew in Corrections talking about the individuals in the jail.

I was always afraid that I would have to use the restroom, because I still have kidney function. When I have to use the restroom, it is immediate, because of a few operations that I had in the Summer of 1996. The surgeon with many years of experience told me that because of the operations, I would have to use the restroom, immediately and there was nothing he could do to stop it. Yes, this is when I was healthy, just like you.

I did not really want anything from the dialysis staff, just to watch my television set and go home. By the time I arrived for my treatment, after work, I was tired and just wanted to be left alone. I never abused the staff and nor did I let anyone else. I wanted my treatment in peace and since I was much larger than the other patients, obnoxious behaviors were not tolerated. I know some of the Nursing personnel were frightened by some of the patients. Yet, having worked as a police officer, I was not going to listen to their nonsense and neither was the nurse. "Either come to the center and act with some sense or get out." Pretty simple, huh?

Trauma Columnist · Aug 27, 2009

NDXUfn - thanks for the pt perspective. Many of my patients are just like you: compliant, interested in their care, and wanting to play an active part in their care.

I have always said that dialysis is not for the faint of heart. It takes a lot of guts to sign up for three times a week, 4-5-6 hours/at a time and face the fact that unless you get a transplant, it will be for the rest of your life.

Take care.

Chisca, RN · Aug 27, 2009

Thanks for posting your experiences NDXUFan. I've only been performing dialysis for two years and I've pretty much come full circle in my attitudes towards dialysis patients. What really struck me was the reference about treating patients as children. So many dialysis nurses behave that way and I think it comes out of the belief that we as nurses can fix everything. We can't. We ease the fall and if we can do that while allowing some dignity and respect for a fellow human being then I think we should consider our job done.

NDXUFan · Aug 27, 2009

I have a B.A. in Government and Economics, we are not idiots because we have to sit in that chair to have our blood cleaned. When I hear the world, compliant, it makes me feel that I am in a jail. You are right, human beings have failings and it is not a perfect world. I think many in the Nursing community need to walk in our shoes.

Yes, many dialysis patients have a prosecution complex. Yet, if you sit and think what is being asked of them, versus other people, you might start to have an understanding of their feelings. Dialysis patients need to be treated as adults. Has anyone at the dialysis clinic asked the patient what they wanted in their dialysis treatments? Many times, in the home dialysis field, when the clinic, lab or NxStage screws up, the patient/client has to work harder. No refund, no apology, or anything else. In the normal business world, the offending party would be told, "Look, either you get your act together or you are fired, along with a refund of charges." Dialysis needs to become a consumer focused field, sadly, right now, it is anything but consumer focused. To honest, the mentally challenged field is more consumer focused than the dialysis field, along with the retirement communities. I know this from experience in working in those fields. Dialysis needs to come out of the dark ages.

81Bubbles, BSN, RN · Aug 27, 2009

NDXUFan you sound like the ideal patient until I read you latest post. I'm sorry you had such a bad experience, and a nurse saying she didn't have time for you when you had cramps was out right wrong of her, that's her job.

However,Dialysis is a medical procedure. And the staff that works there wants you happy but our priority is your health. We are part of the medical field not the consumer field. When you go to dialysis you are going for a medical treatment not to hotel/hospitality joint.

And if the focus shifted form what is going to keep you alive to what is going to cause the least amout of Rucus I'd quit. Honestly I'm not willing to lose my Nursing license when someone dies or go to court the family of said patient also decides to sue.

You are an adult and so are the other patients, the restrictions that are advised of you by the MD, Nurse, and Dietitan are not some warped way of us trying to micromanage your life it's a way for making the dialysis treaments work the best for you and keep your clearance high and treatment times short. If you decide not to follow them that is totally up to you.

Trauma Columnist · Aug 28, 2009

I apologize if I offended you. However, this is medical care, not Walmart. I am a very PATIENT-FOCUSED advanced practice nurse. I care deeply for my patients and go out of my way to ensure they get excellent care. However, just by being a dialysis patient, does not entitle anyone to swear at me, threaten me with a lawsuit, etc..

Medicine is NOT customer-focused, its patient-focused. Ideally, the care is rendered with input from both and both determine the end goal.

Many of my patients work, continue their lives and come to the center for care and participate in that care. Most have chosen me to be their care provider. Many of my patients are well-educated and involved in their care. They are the ones that do well.

Tish88 · Aug 28, 2009

Nicely said TraumaRUs......

Tish88 · Aug 28, 2009

Patients don't like to hear the word "compliant", however if they were "compliant" with taking care of their diabetes and high blood pressure when they was first diagnosed, the majority of them would not be on dialysis....

"once non-compliant, always non-compliant"....the vast majority of them will never change. You can educate them until you are blue in the face, and they continue to be "non-compliant"....

Lacie, BSN, RN · Aug 28, 2009

Yes, we do consider someone Non complaint when they come in 99% of the time with 8kg on then get angry with us because they start cramping which of course is due to having to try to pull all that watermelon, coke and ice tea off from the day before they have ingested. Get angry because I cant load them up with Benedryl every treatment so they can "sleep" or c/o itching yet sitting there with Mickey D's and a Big Gulp from 7-11. Get angry when I try to explain why thier phosphorous level is 10!!! I am not your servant to clean up all the crackers and chip bags thrown on the floor before I can bring the next patient in to sit in that same chair. When the needle infiltrates because that same patient insisted on using thier access arm during treatment to reach to the other side to pick up the huge luggage bag or cooler brought in which contains thier entire household and supplies to last them a month. Dont forget when we have to run because they are choking on those chips when thier B/P bottoms out only to repeat the incident as soon as they can recover from the first episode. Continue to scream at me because I put the tab on the tape to the right when they want it on the left or because they are in a hurry to get out of the unit and start bleeding before they can hit the scale. I could go on and on......yes I am a medical professional. Not a servant, maid and waitress. Most of all I am not thier punching bag because 98% of them want someone else to blame for thier condition rather than look at thier past lifestyle that brought them to this point and have no interest in changing it. Lets not forget while I am tending to that "other" patient who is geniually crashing and the patient next to them cant understand why I dont just drop the ambu bag to get thier needle out so they can go to the local Walmart for more goodies. I have had numerous patients who do treat me with the equal respect that I am expected to give them and they do recieve it. They are patient when I tell them I'm the only RN in the unit and there are 5 other pts coming off or going on the machine at the same time because our water went down or 3 machines just took a dive down the broke down rode. Jeez.......I'll stop with my rant but maybe some of those adult non -compliants patients need to see it from our end too.