".....it is the patient's decision and wishes that the nurse must advocate and support. This may differ wildly with you personal opinion, but the patient has this right - as long as they fully understand the consequences. "
Extremely well-said Frankie!! Esp, "as long as they understand the consequences."
Youda, what a breath of fresh air and inspiration to nursing you are!!! Even tho I hate the whole nursing diagnosis/care plan thing, that book is an excellent resource for what you can do, and listening as Jenny P pointed out too, is the best first step, b/c it usually isn't what you think the problem is. Maybe they go to the soup kitchen to eat and have to have hot dogs or fatty foods. I saw bkft at the soup kitchen one day, included donuts and coffee, what about all those homeless diabetics, they are hungry and will eat what they can get. Granted this is not always the case, but psychsocial issues must be considered, look for the barriers to compliance.
"For me, the problem came when I felt responsible for their choices..."
Another excellent insight! Once you have educated, listened to them, tried your best to implement ways to remove barriers to compliance (got a social worker who assitsed them with housing, or meals on wheels, or whatever), then sometimes, it's just that they are just different from you, and you cannot control them.
It is very easy to get burned out with these kind of pt's, which you will see alot in cardiac care. My first impulse to reply to your post "How do u deal with Patients who "dig their own grave"", was to say "Hand them a shovel", but after seeing the wonderful replies you got above, I thought I should hold back on my cynicism! LOL! But, iut is true. I remember one man who was in CHF, kept whining for something to drink w his fluid restriction. As nicely as I could, I explained over and over the risks he was taking if he took in too much water/fluids. He didn't care, so I filled up his water pitcher, put it on his bedside tabel, and said, "Here, knock yourself out! Call me if you feel short of breath!" And I walked out. I figured what was the worst that would happen? I'd have to give some extra lasix. When he leaves the hospital, he will do what he wants anyway, so why kill myself ? Educate them, and move on to the other pt who is willing to change.
I used to feel responsible, but since I started to do homecare, it has really opened my eyes to the barriers that are present, the attitudes, and "interesting" lifestyles I see, and am more often than not powerless to change. So, I do the best I can, and no longer feel responsible for the choices of others or their consequences.