Good nursing or learned dependence?

TheCommuter, BSN, RN · Nov 20, 2014

Some of our patients resist discharge, too. I think a large number of our issues revolve around the clientele we serve.

A significant number of our patients come from low to moderate income households. They tend to view their hospital stays as a treat where they are exposed to little luxuries that they do not have at home: flat screen TV with a nice cable package, three nutritious meals, housekeeping service, timely pain management, and a friendly staff of healthcare workers.

A lonely patient who lives in a dilapidated trailer, runs out of food right before payday, and cannot always afford medications is going to resist discharge IMHO.

jadelpn, LPN, EMT-B · Nov 20, 2014

Some patients like being taken care of, and have no desire to be independent. Some are afraid to be alone.

Most of the time, PT/OT is ordered to be 100% sure that the patient CAN be home alone.

Too much idle time to think about aches and pains is a tough gig.

Make sure you have a creative discharge plan. Maybe that means the local elder services for lunch 3 times a week. Home health once a week. A companion that comes by in the mornings (and there are volunteer companions). Whatever services you can find that can be of assistance to keeping the patient independent. Sometimes, it is the local nursing home for skilled care until such time as the patient feels ready to go home.

But yes, I agree. It is a balance of resisting discharge, and coming back the next day with "feeling unwell" or some other vauge complaint, suitcase in hand.

PomMom65 · Nov 20, 2014

I work inpatient hospice and our patients come in because of a crisis (pain, agitation etc..) When we get the symptoms managed, they go home. Many of our patients and families just want to stay with us. I think a lot of it is fear of another crisis at home or fear that their caregivers cannot provide the care. Social work is very involved in all of our discharges.

meanmaryjean, DNP, RN · Nov 20, 2014

Sometimes I forget how good we have it in the pediatric world. Our patients want NOTHING except to get outta Dodge. They will go home as you're bringing in their 'chicken nuggets and fries' * lunch tray. Nothing keeps them a minute longer than they have to be in the building.

* EVERY peds patient orders chicken nuggets and fries. 95% also order ranch dressing as their dipping sauce. true story

RNsRWe, ASN, RN · Nov 20, 2014

Not only is it common to see patients resist discharge, when I worked the floors I also found that they sought admission (as well as extended stays) during the holiday season(s).

When there's no family with whom to celebrate, people will do just about anything to get admitted (or derail discharge). After all, in the hospital there are volunteers who come to sing carols, kids who bring gift bags of treats/activities, staff wear fun-themed scrubs and there are decorations hung.

Now, the ones who want to stay hospitalized when it's NOT a holiday season, well.....really more of the same in terms of lacking family support, etc. Sometimes it's a big attention-getter if they feel they aren't getting ENOUGH attention from the family that is already available to them.

Sometimes, having seen some of these family members, I have no doubt why some of them want to stay in the hospital!

dudette10, MSN, RN · Nov 20, 2014

The common theme here is social support, it seems. When I think of some of our pts that resist discharge, I have to agree. And the ones that do have family at the bedside, the request usually comes from family. They are unsure of their ability or resources to care for the patient.

classicdame, MSN, EdD · Nov 20, 2014

People who live alone might be afraid they will fall or not be able to care for themself. Even though they do not meet hospital stay criteria, they are not yet "well" and independent. It can be expensive and difficult to find home assistance.

wanderlust99 · Nov 20, 2014

Ours want to leave ASAP. It's usually me saying I don't know when the doctor will be in, we have to wait for the doctor before we send you home, can you give me a few minutes to print out the instructions, etc.. I've actually had one patient leave on his own he was so inpatient, so i had to call him at home and make sure he removed his IV.

firstinfamily, RN · Nov 20, 2014

It takes all kinds to make the world go round!!! It is true that around the holidays the pt census usually goes up. Is that because they over-eat and start having GI symptoms that they feel may be a heart attack or that they want to be around some people close to the holiday??? It seems to depend on the circumstances. The stress of the holidays may effect some patients and cause an exacerbation of their chronic illness or they may not be able to have the food that they want, so they go into the hospital. We also have to remember that years ago, and I do mean years ago, pts were admitted to the hospital to "rest". That was supposedly the only place they could go to get away from everything!!! We tend to see a rise in all patient populations during the holiday seasons. There are those who don't want to be there, and those who only do want to be there!!

amoLucia · Nov 21, 2014

I may be cynical about this, but I've known where families resist discharge because THEY will again be pulled into the discharge/home care of the pt. While the pt is in hosp/LTC, the family can go to sleep at night basically worry-free - like they've received respite.

I've seen this multiple times and it is very real.

imintrouble, BSN, RN · Nov 21, 2014

As a night shift nurse, I personally dread the night before discharge. I've had pts fake a fall, clutch their chest, and act confused. All in an attempt to convince their nurse and doctor, they're too sick to leave.

It happens every single day where I work.

I'm cynical about this behavior too. I always wonder if they'd want to stay, if they had to pay the bill.

My great uncle "checks himself into" the hospital every month or so. Usually fantom chest pain. After his 23 hr obs is up, he makes up symptoms to prolong his stay. The hotel...hospital is on to him. They politely tell him he can stay as long as he wants, but he'll be responsible for the bill.

It's amazing and miraculous how quickly he recovers, when he figures out it's not free.