How do u deal with Patients who "dig their own grave" - page 2

How do u deal with patients who make their condition worse? 4 moths ago we had a patient ( cardiac floor) with slight problems. At 82 she did wonderful with a cath. She had no other major health... Read More

  1. by   SandyB
    It's nice reading all these posts! I used to work tele and expect ppl to go home and behave themselves. Now I'm doing clinical for my BSN and I have 48 hrs of Home healthcare to do...OMG what a shock! Dogs licking open wounds! Spiders hanging from the ceilings! Potato chips left at the bedside....smoking w/the O2 on! (yeah, made em stop while I was there..don't wanna get blown up with them)......
  2. by   nicubabe
    It's even worse when the noncompliant patient is a family member. These people all sound just like my dad. Started out with diabetes and hypertension in his early 40's, but never took advice on diet and exercise. progressed to insulin dependent with severe peripheral neuropathy,and CHF. Had a few M.I.'s and always signed himself out AMA. He finally got his wish and passed away in his own bed at home 1 year ago. He was 63 years old! Sometimes it's very difficult to stand back and let patients make their own decisions whether we agree with them or not. I agreed not to harp at my dad (too much), because he did not want to die in a hospital. Sometimes allowing people to die with their own idea of dignity is the best we can do.
  3. by   CATHYW
    originally posted by canoehead
    i think that once they are given information about their bodies and diseases then they have a choice to make. some people choose to keep smoking, keep eating mcdonald's, but it is their right, even though it is frustrating to us. for me, the problem came when i felt responsible for their choices, like refusing to deep breathe and cough, or ambulate. i think so long as you offer the chance to do everything they can to recover there is no reason to feel angry or guilty.

    except at those who have health care that we are paying for- but that is another debate. i try to keep it a separate issue in my mind. and also remember that i am not perfectly compliant with exercise/eating right either.
    very well said, canoe!
  4. by   beckymcrn
    I completely understand where you are coming from. I work in oncology. I have literally had patients with IVs hooked up to RUNNING chemo therapy want to go out side to smoke a cigerette. I have seen pts with barely enough lung function to say their name without oxygen and still they smoke.

    I work in a clinic setting now with the gyn oncology doctors. I have a patient right now who presented with cervical cancer the the docs could see with their eyes on exam. Pap was sent and no surprize it came back CANCER. The women left the clinic after her visit and the dr telling her she had cancer and literally waited a month before doing anything. (Now I do understand the concept of denial but this women basically killed herself) She finally did get chemo and radiation but the disease had progressed to the point that she had surgery last week and they were still not able to get all of the cancer. I spoke to her today 10 days after a total hysterectomy and she told me she could not come to see the doctor because she "just had surgery and needed to get some rest. She would return to the dr's office in a few weeks."
    When I hung up the phone I could not believe the conversation that had just happened.

    Basically, what I have learned in this field of pratice is to do the best I can for the patient while they are in my care. Then the patient must either comply or not. When they do not I have to go on to the next pt who wants to comply.
    There is only so much I can do. Although we do want to save the world we can only truely save those who want to be saved. As long as I can say at the end of the day I have been the best nurse I could possible be to that patient I know I have done my job and tomorrow is another day, another pt.
  5. by   just licesensed
    As a newly graduated LPN and working in the medical field as compared to my old job as a housekeeper, everything seems so different to me. I look at our bodies now in such a different light. How complex and interrelated everything is from the physical body to the psychological.

    I now realize how bad smoking is and what it can do to my body. I now realize how not moving can result in bed sores. It reminds me of those times I had the flu and stayed in bed for days on end not moving. If (ya, right - When ) I get the flu again I now know what and what not to do and why.

    Maybe some people just don't or can't see things our way - so to speak. All we can do is give them an informed choice ... the rest is up to them.
  6. by   Scavenger'sWife
    Sad but so true. what you said...if at the end of the day, I feel I was the best nurse I could be, that is all I can do.

    I once had a patient who was severe COPD, on oxygen and would hide in the bathroom to smoke. Guess who brought her the cigs? Her son, who was a respiratory tech...
  7. by   Anagray
    You all wrote something that helped or will eventually help me to deal with emotions I'm having towards patients. It's not that I'm frustrated with them - I don't get angry at patients. No matter how they behave, it is most likely induced by the emotional problems their illness has caused them. I just feel helpless, I guess.
    That woman I wrote about (heavy one, with huge pressure ulcers) , I cared for her this week. She had to have barium enema, because she hasn't had bm in 8 days and kept eating tons of food in the mean time. Then, when she finally started going, she refused to use bedpan, because her sores hurt too much.
    Sometimes I have 18 patients to take care of and when it's busy, I literally become the whipping boy for the nurses .
    Between the whipping and the constant bed changing for the lady ( attends do not fit) I hardly had time to run small errands for patients - like getting them a pitcher of water or rubbing an old man's heal, because it's sore or turning/positioning people on time.
    I guess this is what really frustrated me - I couldn't accomodate the patients, because I was spending a good chunck of patient care time in her room, on top of phlebotomy, vitals,fingersticks ,doing admits
    and running up and down the hospital for surgical trays,blood bags and making large deliveries to chemistry.

    I have a lot to learn yet about patience. Thank you for your insight.