Help! Problems At Work Re: Diabetic Pt, Rights

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I Work In A Ltc And Rehab Nursing Home. I Have A Pt With Diabetes That Wants To Eat Sugar, Sugar,and More Sugar. Surprisingly Her B.s. Is Finally Under Control With Po Meds. But I Have Another Pt. That Is Able To Go To The Store And Buy Her Sweets So When I Asked The Pt To Quit Buying Her Sweets (with The Diabetic Pts Money Of Course) This Pt Turned Me In To The Don . The Don Said I Was Wrong Because Alert & Oriented Pts Have Rights And She Can Eat Whatever She Wants And All I Have To Do Is Chart This? I Thought We Are To Discourage And Take Care Of Pts, Not Let Them Go Into Diabetic Coma? Anyone Know What Is The Right Answer ? I Just Find This Hard To Believe Due To Pts Rights? Help In Florida Thanks

Specializes in LTC, Nursing Management, WCC.

After I talk with the resident to let them know about what may happen... I figure eat what you want... I got insulin to cover ya. Then every so often I will bring it up again. If they are A X O, then it is their call as to what they want to do. I just make sure to chart, update the unit manager and then chart that the unit manager was made aware.

Specializes in acute care and geriatric.
AND we wonder why our kids don't listen to us!!!

Our patients are not our kids, They have the right to smoke if they want even if they have COPD etc. They have the right to refuse meds. they have the right to refuse treatments that we feel are necessary etc.

Someone just wrote on another post that the patient is a consumer and the consumer is always right!!!

BTW: My niece has Juvenile IDDM from age 4 and eats all the sweets and sugar she wants (lots) and is just covered with insulin.

If her Blood Sugars are ok ( and I would chk the HBAIC) then thats all . This should definitely be documented.

Specializes in Staff nurse.
Our patients are not our kids, They have the right to smoke if they want even if they have COPD etc. They have the right to refuse meds. they have the right to refuse treatments that we feel are necessary etc.

Someone just wrote on another post that the patient is a consumer and the consumer is always right!!!

BTW: My niece has Juvenile IDDM from age 4 and eats all the sweets and sugar she wants (lots) and is just covered with insulin.

If her Blood Sugars are ok ( and I would chk the HBAIC) then thats all . This should definitely be documented.

This is true, they are not our kids...it was meant as comic relief

While they have rights, health care workers should have RIGHTS also. The right to not be harassed or bullied for attempting to keep pt. healthy and on the road to recovery and/or maximum health for their condition. And sorry, no one has the right to jeopardize anyone else's health or life by their actions. NO smoking in pt. rooms around O2...no right to keep staff hostage with demands or threats, etc.

If the consumer is always right, then we are always wrong...wow, that's a great way to greet the work day...no matter what you do as a hcw, you are wrong...or perceived as a meanie trying to take the fun out of life.

I have a frequent flyer brittle diabetic who had the newer staff "trained" to do everything he wanted as far as food, with the idea of coverage. One night he had a BS of 817; we covered for him and he was down to 29 a few hours later. He was demanding pudding to "bring my sugar up, I do this all the time at home". I gave him fat free milk that he wanted to spit out at me. I sat with him and told him "you know, one of these days we aren't going to be able to rescue you from this. You are already blind and need assistance. What's going on?"

He was in assistant living; he was nearly totally blind; he had the sores that wouldn't heal; and he was very early 30s, just diagnosed 4 years ago. He refused to do anything socially at the ALF; I felt for him but I had other pts. who needed nursing care also. Consults from psych and chaplain and sw were rejected.

Just some thoughts.

Specializes in acute care and geriatric.
This is true, they are not our kids...it was meant as comic relief

While they have rights, health care workers should have RIGHTS also. The right to not be harassed or bullied for attempting to keep pt. healthy and on the road to recovery and/or maximum health for their condition. And sorry, no one has the right to jeopardize anyone else's health or life by their actions. NO smoking in pt. rooms around O2...no right to keep staff hostage with demands or threats, etc.

If the consumer is always right, then we are always wrong...wow, that's a great way to greet the work day...no matter what you do as a hcw, you are wrong...or perceived as a meanie trying to take the fun out of life.

I have a frequent flyer brittle diabetic who had the newer staff "trained" to do everything he wanted as far as food, with the idea of coverage. One night he had a BS of 817; we covered for him and he was down to 29 a few hours later. He was demanding pudding to "bring my sugar up, I do this all the time at home". I gave him fat free milk that he wanted to spit out at me. I sat with him and told him "you know, one of these days we aren't going to be able to rescue you from this. You are already blind and need assistance. What's going on?"

He was in assistant living; he was nearly totally blind; he had the sores that wouldn't heal; and he was very early 30s, just diagnosed 4 years ago. He refused to do anything socially at the ALF; I felt for him but I had other pts. who needed nursing care also. Consults from psych and chaplain and sw were rejected.

Just some thoughts.

I agree with what your saying but disagree with taking a paternalistic approach to providing care. In LTC it is not about being a meanie , We should never bully a patient, we can only encourage in an nonjudgmental way.

NEVER let a pt smoke IN HIS ROOM- in designated areas only or we'll all go up in smoke!!! AND ITS HAPPENED, I wrote to let him smoke in a general way- in according to the facilities safety rules. We have a patio on each floor for this.

You didn't like the consumer being always right? Well I was quoting others, but there is something to it- after all we provide service to them, so we do have to bear in mind their desires and preferences and respect them, even if we disagree.

your Brittle Diabetic is a sad case but it is his right- BTW- he's lucky- I'd have sent him tho the ER for a BS of over 800. Maybe he needs some negative reinforcement- send him to the ER with every extremely high BS, he might then gain incentive to control his sugars a bit. Guilt therapy never works. I wouldn't bother telling him that he's only hurting himself. Try a more positive approach. Tell him how important he is to you and the staff, and it hurts you to see him hurting himself. Tell him how great he looks and is doing and how proud you are of him when he controls his diet and brings his sugar levels to WNL.

Maybe you should discuss this in an Interdisciplinary staff meeting.

Specializes in Staff nurse.
I agree with what your saying but disagree with taking a paternalistic approach to providing care. In LTC it is not about being a meanie , We should never bully a patient, we can only encourage in an nonjudgmental way.

NEVER let a pt smoke IN HIS ROOM- in designated areas only or we'll all go up in smoke!!! AND ITS HAPPENED, I wrote to let him smoke in a general way- in according to the facilities safety rules. We have a patio on each floor for this.

You didn't like the consumer being always right? Well I was quoting others, but there is something to it- after all we provide service to them, so we do have to bear in mind their desires and preferences and respect them, even if we disagree.

your Brittle Diabetic is a sad case but it is his right- BTW- he's lucky- I'd have sent him tho the ER for a BS of over 800. Maybe he needs some negative reinforcement- send him to the ER with every extremely high BS, he might then gain incentive to control his sugars a bit. Guilt therapy never works. I wouldn't bother telling him that he's only hurting himself. Try a more positive approach. Tell him how important he is to you and the staff, and it hurts you to see him hurting himself. Tell him how great he looks and is doing and how proud you are of him when he controls his diet and brings his sugar levels to WNL.

Maybe you should discuss this in an Interdisciplinary staff meeting.

This IS in a hospital setting, the pt. was from ALf and on his way to an LTC if he continued to be noncompliant with his eating and drinking whatever he cared to. Our hospital is a smoke-free campus which means no one smokes on campus, even in your own personal car. And if an employee comes to work smelling like cigaretter/cigar/pipe smoke, it is grounds for termination. We have had pts. smoke in their rooms and/or bathrooms or hanging out the window and they get upset when security is called to stop it.

The brittle diabetic appeared to ENJOY his trips to the ER and to the floor, where I cared for him. He was getting a change of scenery, and because of press-ganey, was getting more catered to. But our job as nurses to to help get the pt. to be independent and doing ADLs at the highest level achievable. Yes, we use positive and negative enforcements, use the interdisciplinary staff meeting route, meet with dietian, etc.

There's a difference between being paternalistic and and expecting people to do their part. Is it paternalistic to give a traffic ticket to a speeder? No, it is a safety issue b/c a law that is put there for safety of yourself and others isn't paternalistic...it's common sense. But to some people/pts., any kind of suggestion/direction is taken as bullying or messing with their rights.

My feeling is: work with the staff for your recovery.

Specializes in Nursing Professional Development.

What I notice about this thread is that there seems to be little effort on the part of the staff and the facilities to assess and address WHY these patients are non-compliant. The attitude seems to be that telling a person what to do and why should be sufficient.

Research shows us that there are LOTS of factors that influence why some patients are compliant and others are not. Until we understand and address those factors, we can talk at them until we are blue in the face and it won't change their behavior.

Another thing ... Maybe some diabetic patients would eat less sugar if they had readily available sugar-free snacks. As a diabetic myself, I know I am much more compliant when healthy choices -- that are also appealing -- are right in front of me. What are your institutions doing to have healthy and appealing choices readily available for those patients? Even if it ends up being a "compromise choice" that is not the ideal but is better than pure sugar, it would help the patients to avoid the worst choices and begin to help them develop healthier habits.

Specializes in Nursing Home ,Dementia Care,Neurology..

We have readily available sugar free or low carb snacks but this particular resident gets friends and family to bring in foods.This we cannot change .We have discussed different foods with her as well and she often agrees with the choices but in her case it is 'well I've had my diet now,where is my dinner'!

Specializes in Nursing Professional Development.
We have readily available sugar free or low carb snacks but this particular resident gets friends and family to bring in foods.This we cannot change .We have discussed different foods with her as well and she often agrees with the choices but in her case it is 'well I've had my diet now,where is my dinner'!

3 things:

1. It sounds like she is not getting enough volume/fiber to eat on the "diet" and is still hungry -- which is why she wants dinner.

2. Who is choosing the selection of low carb snacks? It sounds as if the facility is choosing. Perhaps if the patients had input into the choices, they would eat them sometimes. They would probably choose less healthy snacks that currently provided by the facility ... but agreeing to a compromise might be a first step worth taking.

3. I still don't hear/see any evidence that an assessment of the patient's perspective has been done. "Discussing different foods with her" is not working. Before you can fix that, you have to find out WHY your talking is not effective. Until you understand WHY she is making the choices she is making, you will little chance of changing her behavior.

Specializes in acute care and geriatric.

Ok, comparing paternalism with regard to a pts diet and and giving speeding tickets to bad drivers doesn't hold water in my books. The former is only hurting herself- the later can kill others.

My personal opinion is that you cannot force a brittle diabetic to conform to a diet that we feel is best for her- if an obese pt wants to overeat- we can't stop em, again if a COPD pt wants a smoke ( outdoors- OK) we let em, This is DEMOCRACY folks!

Specializes in ICU, PICC Nurse, Nursing Supervisor.

get them to sign a dietary waiver ad then let them bathe in sugar if they please....but cover yourself...

Specializes in Staff nurse.
Ok, comparing paternalism with regard to a pts diet and and giving speeding tickets to bad drivers doesn't hold water in my books. The former is only hurting herself- the later can kill others.

Unless the person driving is a noncompliant diabetic going into a seizure or coma; a noncompliant epileptic not taking her/his meds; someone not taking their BP meds has a "medical emergency" and takes another carload with them. We've all seen headlines like this. I know people who had their licenses taken away until they could prove they were taking their seizure meds and were seizure-free for 6 months.

My personal opinion is that you cannot force a brittle diabetic to conform to a diet that we feel is best for her- if an obese pt wants to overeat- we can't stop em, again if a COPD pt wants a smoke ( outdoors- OK) we let em, This is DEMOCRACY folks!

Unless the person driving is a noncompliant diabetic going into a seizure or coma; a noncompliant epileptic not taking her/his meds; someone not taking their BP meds has a "medical emergency" and takes another carload with them. We've all seen headlines like this. I know people who had their licenses taken away until they could prove they were taking their seizure meds and were seizure-free for 6 months.

And I can agree, up to a point. So, don't come to the hospital expecting us to rescue you and giving you some drama in your life...stay home. Since we've done all the interventions and education and sometimes even contracts and the pt. breaks them, why does he/she come back? To give the LTC or ALF a respite?

Specializes in acute care and geriatric.
Unless the person driving is a noncompliant diabetic going into a seizure or coma; a noncompliant epileptic not taking her/his meds; someone not taking their BP meds has a "medical emergency" and takes another carload with them. We've all seen headlines like this. I know people who had their licenses taken away until they could prove they were taking their seizure meds and were seizure-free for 6 months.

And I can agree, up to a point. So, don't come to the hospital expecting us to rescue you and giving you some drama in your life...stay home. Since we've done all the interventions and education and sometimes even contracts and the pt. breaks them, why does he/she come back? To give the LTC or ALF a respite?

My pts dont drive-

if u feel that a pt is unsafe driving- report immediately to the dr. and SW

Pts will come 2 the hospital epecting care- not drama. If u dont want to deal with revolving door pts - find another profession. Non compliance to treatment is all over the place and we have to deal with it!!!

Have ur pts sign whatever waivers ur legal dept recommends

Please try to remember we are all partners here and on the same side

peace

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