How do you feel about the patients that WON't take care of themselves?

[diapason05]

I want to help people who at least want to help themselves. I know people don't always do what they should... but i don't know how I will feel about the patients who have been educated about how whatever they are doing is dangerous, and yet they continue to do it (what it is) and end up back in a hospital over and over.

What do you guys think? I probably need compassion for everyone..I'm not so sure I'll have that.. How do you guys feel about this?

[deeDawntee, RN]

I find it extraordinarily difficult at times to deal with those patients who are truly in a what I call a "slow suicide" mode. The best they can get in their lives is the attention and comfort by me and other healthcare providers? Sometimes I think they are put there in my life to test my own tolerance. I have to admit that sometimes I do OK and other times, not so much. I know that with some of those patients all I can do is pray and ask for tolerance and to ask for guidance in the best way to respond. Some patients do need the 'tough love' approach and for others it makes it worse.

[blueheaven]

Let's get real folks, if it WASN'T for the various and assorted addictions (food, drugs, alcohol, nicotine etc.) that we humans tend to go for, we wouldn't have a job!!!!

[rn/writer, RN]

What a complex subject!

Some patients will not change/cooperate/particiapte no matter what you do. This is a rock hard truth that when recognized can save you a lot of grief and guilt and anger toward the futility of the situation.

That said, there are many who will respond favorably (albeit verrrry sloooowly at times) with an effective approach.

What makes an approach effective?

The most important element is the refusal to judge the patient. Judge the actions. Draw a line from cause to effect. Point out consequences. These are all fair game so long as they are done without heaping condemnation (even the unspoken form) on the patient.

In order to see the patient as something more than a problem, you have to connect with them. Be willing to go where they are, even if you believe 1000% that you would never end up in such a state of mind on your own. If you can't go where they are, why on earth would they trust you enough to consider leaving the familiar to meet you where you are? Connection is the most powerful "weapon" on earth when it comes to making a difference in someone else's life. People need that kind of contact, but personal judgment is like pouring salt on soap bubbles. Assessing actions is just being real. Assessing the worth of the person doing those actions or deciding that they just don't care closes the door on any kind of meaningful communication.

Once you've established a connection, the next thing is to find out what motivates your patient. What is their own personal currency? For some, the obvious primary health benefits are enough, but for many, those remain an abstraction until they are translated into words or terms that mean something to them. Losing twenty pounds might seem as attainable as flying to France, but it might take on new importance if you talk to your patient and find out that he hates the fact that he has to have his wife tie his shoes. Then losing twenty pounds (just a bunch of words) turns into, "I want to be able to bend over and tie my own shoelaces," a real-life goal that includes an unspoken but powerful quest for dignity.

Even people who seem obnoxious and snotty sometimes have a kernel of humanity that they keep hidden away because of all the guff they have gotten. Doesn't matter that they brought it on themselves. The effect is still sad and costly. I have had patients that made my blood boil and have forced myself to find something positive to say to them. About three quarters of the time, this slender thread was enough to start a better way of relating. Whether it was the words themselves or the fact that they could see I was really trying to get past their prickly exterior, most appreciated the effort and at the very least stopped being overtly offensive. Even if it was just for a couple of seconds, doing this helped me to see there was still someone "in there" and encouraged me to keep going.

Learning how to refuse to engage in a power struggle is a priceless skill, IF it can be done without resentment. As soon as negative emotions are allowed to show, all bets are off. But if a nurse can set healthy limits while still being on the same team as the patient, the locus of the conflict stays inside the patient where it belongs. The second the nurse picks up the other end of the tug of war rope, she (and by extension her patient) has lost the battle. Why? Because there shouldn't be a battle in the first place. No, I take that back. There should be a battle, but as I said before, it has to take place inside the patient for it to accomplish anything good.

There are some who will not participate (much better word than comply), no matter what we do, but for those who can be motivated, it's really up to us to make certain we aren't the ones closing the doors. It is a demonstration of respect to assume that we don't know what the world (and the disease/condition) looks like to the patient and we don't readily understand this person's motivation. Then it behooves us to ask genuine questions and truly listen to the answers.

That is key. In so many cases, especially with newly-diagnosed patients, we are burying them under answers to questions they haven't yet asked.

So ask. What does this diagnosis mean to you? How can I help you? What would you like to make better in your life? What goes through your mind when someone tells you that you will have to [fill in the blank]? Or that you shouldn't [fill in the blank]? What do you want for yourself five years from now?

These questions serve to remind us that the problem and the solution belong to the patient. They also put the patient on gentle notice that we are not the enemy. And neither are they.

This can make all the difference in the world to someone who has become accustomed to being judged and treated with disdain.

I try to do this because my patients deserve it. I also try to do it because it's the only way I can resist the urge to strangle some of them. So far, it has served me well.

[Lisa CCU RN, RN]

Let's get real folks, if it WASN'T for the various and assorted addictions (food, drugs, alcohol, nicotine etc.) that we humans tend to go for, we wouldn't have a job!!!!

That's what I said!

[Jo Dirt]

That's what I said!

It gets me when people think the doctor will get mad at them for having to come in.

What are they thinking???

Doctors love it when you come in, that's why your insurance card if the first thing they ask for when you come in.

[suanna]

Just think of them as job security. After all many of the ailments we see in our practice could be avoided or mitigated with optimal health practices. If they come back soon enough is much easier to fill out the admission data base.

[irishnurse67]

I work with post open heart patients. 90% are educated about the rehab process before the surgery, and even with constant education , and premedication, and encouragement there are pt's that refuse to cough and deep breath. That won't use the incentive spirometer. That refuse to ambulate, even with the cardiac chair. That throw fits becuase the foley's come out 24 hours after surgery. One surgeon actually writes orders stating "do not place urinal at bedside, pt must ambulate to BR to use urinal" for his less motivated male pt's, and "no bedpans" for the females. That throw fits because we insist that they have to be OOB for meals, sorry this is not a Bed and Breakfast, this is Cardiac Rehab.

I get so tired of stating over and over, "the whole purpose of inpatient cardiac rehab is to get you well enough to go home. To be strong enough to get up out of bed by yourself, off the toilet by yourself, walk around your house without help. To get your lungs recovered from the surgery and prevent postop pnuemonia. To make sure that all tubes are out, and incisions are healing nicely. Further stengthening will happen with OUTPATIENT rehab".

I find this frustrating, too. I've had some major surgeries and I couldn't imagine asking for a bedpan instead of using the bathroom. I also couldn't imagine preferring to have someone wipe my backside rather than do it myself. I wonder about people who were completely independent at home (driving, working, etc) that suddenly want a nurse to do such intimate care when they're able to do it themselves. I've very politely told pts that it's good for the healing process if they do these things themselves (I thoroughly explain the reasons) and most of them get quite angry and some actually accuse me of being a bad nurse. I've even had some tell me I should be ashamed. I just don't get it, esp when the doc will back me up. Then you have some in administration knocking themselves out to kiss the pts butt! How do other nurses handle it when a pt wants you to do everything for them when they should be up ad lib and independent. Oh, and this is assuming the pt isn't mentally challenged and been medicated for pain.