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

woody62, RN · Oct 3, 2007

To add more to my previous post:
I used to work in a community health center and did a LOT of diabetes education with seemingly 'noncompliant' patients, and it taught me a few things.
1) 'Noncompliant' sometimes means 'unable to comply' rather than 'refuses to comply.'
2) What works for one patient will not necessarily work for another, either in terms of education or plan of care. I know everybody here knows that, I'm just saying.
3) Once I had a pharmacist/diabetes educator/type 1 diabetic herself tell me that people who don't do what they're 'supposed' to but continue to keep their appts are really trying to do well but a) need time to get it together; and/or b) really want someone to call them on what they're doing or not doing. They desperately want to do better but don't know how unless you spell it out for them, sometimes.
Those lessons have served me well.
Don't get me wrong. I get frustrated with my 28wk antepartums in PTL and ruptured membranes that get OOB, go downstairs & smoke 7x/day. But I'm a mama to my son only. I explain what we ask of them and why, document, and then go on. Most of them are adults and I have to treat them that way.

Can I give you a big hug?:monkeydance: :lol2:

I am a Type 2, I also suffer from hypertension, a seizure disorder, asthma, have chronic back pain, knee pain and can only walk short distances. I had two years of denying my Type 2. My asthma got me mutiple admissions to the hospital when I lived with my daughter because of her cats. But my hypertension and seizure disorder are well under control. And my weight goes up and down and up. But I couldn't give more credit to your friend then you all ready have.

Woody:balloons:

Marie_LPN, RN, LPN, RN · Oct 3, 2007

Somewhat annoyed if the pt. has all the access to the care yet won't use it.

And then you have the poor people who have the motivation, but not the access.

Lisa CCU RN, RN · Oct 3, 2007

May seem crass, but you'll always have a job.

Long Term Care Columnist / Guide · Oct 3, 2007

I really hate the word "noncompliant". It's patronizing and flat-out insulting. We health care professionals are not our patients' mommies or daddies, and we shouldn't treat them as though we're going to send them to bed without supper if they don't do what they're told. They are ADULTS and should be encouraged to take charge of their health, not led around like little kids who've just wet their pants!

That said, I share the frustration of many in regards to patients who outright refuse to take any responsibility for themselves in any way, and blame others when they get sick: "My husband should've known better than to bring me that bag of Oreos I asked for!" or "Don't tell me to exercise---don't you know I'm sick?":trout:

GeauxNursing · Oct 3, 2007

In dialysis, when your pts do not take care of themselves, it is obvious. You teach them and encourage them and praise them when they exhibit good control. But when they come in 11 kilos over and their phosphorus is 8.9 and they have no idea why their BP is so high, it does get frustrating. Bc it makes our job, making them feel better, so much harder. "You tried to take too much off!" Unfortunately, we cannot shoot back with "No, you drank too much!"

It does make it hard.

Plus, our 2x/year bonus checks can sometimes be related to pt lab values, phosphorus, BMM, etc.

noncompliant pts=no bonus

VivaRN · Oct 3, 2007

In the outpatient setting I don't get as frustrated because #1, the patient made the effort to come in. That's a glimmer of hope. I always try to give credit where credit it is due, even if it's "I'm so glad you came in today!". We don't do enough of that as healthcare providers. People are so much more likely to respond to that than scare tactics.

Have you ever tried to change your behavior? It's really hard! Some "not taking care of yourself" is to be expected. I have a lot of respect for people living with chronic conditions - however poorly they manage. I can't even be compliant with a multivitamin.

Soup Turtle · Oct 3, 2007

I think it has a lot to do with the external "locus of control" thing. Some people just don't realize how much control they have over their lives. They really do feel controlled by the obstacles that some of us would call excuses.

Daye · Oct 3, 2007

i try to look at what the pt can become instead of where they are and that helps me, oh i still get really frustrated at times especially when i have devoted so much care, time and emotion into building and rebuilding their motivation to dig deep for strength to help me help themselves.

the other perspective i try to remind myself of is that some people are so fragile, i don't mean just health wise but copeing and having a desire to push themselves harder. these types of people just don't seem to have that inner resource, desire or ability to cope and they just go forward hap-hazardly. when it is a young patient with something like diabeties that drinks excessively or blatantly abuses their body; it's affect on me is both infuriating and sad.

RN BSN 2009 · Oct 3, 2007

Hi

Using your good assessment skills, you have to look at what the patient values.

One statement I hear a lot from those who are succesfully losing weight tend to tell me, "Nothing tastes as good as thin feels."

Does your obese patient value the feeling of thin over the taste of food and feelings of saiety?

If your patient doesn't value thin, then talking their ear off about healthy eating and exercise is really a waste of your time.

When the patient values it, and they are ready to start a program, they'll probably ask for help.

I had a patient this week that had nursing diagnosis, imbalanced nutrition: less than body requirements.

Now I could just take that as a grain of salt and immediately start talking his ear off about adding calories, the proper ratio of carbs/fats/proteins etc etc etc, but that would make a problem because I should assess why he has this problem first and work from there. Does he have money for food? Does he have a dental problem? Does he have a problem swallowing? Does he have transportation to access regular grocery shopping? Does he have an eating disorder?

There are so many factors to consider you have to investigate reasons for things.

RNSC · Oct 3, 2007

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?

This burnt me out of med-surg nursing faster than anything. I worked a diabetic/renal floor and we would see the same people over and over again. It was fustrating. That was 15 years ago. I might have a little more compassion for peoples foibles these days since I have discovered a few of my own. Naw better to stay where I am. Babies don't whine.

I love my babies in Special Care and NNICU.

TheCommuter, BSN, RN · Oct 3, 2007

As the old saying resonates and chimes: "You can lead the horse to water, but you cannot make him drink it."

socalpca · Oct 3, 2007

I get a lot of what you call "frequent flyers" on my medical-oncology unit. People who relapse on drugs/alcohol, people who don't manage their blood sugar, people who have a psych history but don't qualify for inpatient psych or conservatorship, etc. I am 33 years ond and I have realized that my job as an RN is to treat my patients as if this is the first time they have been through our doors-- even if they know the unit better than I do.