How does one fight constant ignorance not just Hospice specific?

[SoCalRN1970]

It's a battle for myself and my nursing colleagues. Usually this is specific to those who are not medical, family member who try to maintain control, and have no clue what they are doing.

Example. Can you take my mom's blood pressure. I think it's low, she isn't feeling well. ( taken an found 120/80 ) SHared numbers with family,. "isn't that high, my blood pressure runs 100 / 60 and I think that is high .

Example New script for UTICipro 500mg po bid x 7 days . I got an urgent call from a family member. This is too strong isn't it? My mom was on Keflex 250 qid for 7 days last time. I am afraid this is too much.

Example Lactulose ordered for constipation 30ml po q d. Called patient and asked if she was successful with the new rx. "no it doesn't work.." I took a teaspoon and nothing happend. I asked, did you follow the directions on the bottle? NO, I am afraid it might be too strong.. I couldn't help but ask.. "why are you insisting on questioning me, your hospice rn and team and not following your instructions? Putting the responsibility back on a non compliant patient helps keep me centered, but it's a tough place to be. People do not like to have the question why is it that you resistent to consistent treatment? It's like.. omg, it's my fault I am NOT taking my meds as directed??

Note the same patient was example 2 and 3.. I promise you this. Ignorance is damn scary. It lurks everywhere, and people who have NO medical knowledge always try to question or control the hospice plan of care. How do others deal with the constant questioning??

[ErinS, BSN, RN]

Here's one. I have a pt whose uncontrolled blood sugars and edema suddenly normalize without any changes to plan of care. My first thought is: the end is coming. I tell daughter. She panics, we talk through possibly scenarios for care. She calls other family members. They visit pt, tell daughter pt looks great and is too stubborn to die. Daughter thinks I do not know anything and just tried to scare her. SIGH.

I learned a lesson early on in hospice- if a patient feels more comfortable doing and thinking the exact opposite of what I say, and I document the non-compliance, then I consider it comfort care. Like a doc once said to me, we can treat a lot of things, but we can't treat stupid, ignorant, or ugly.

[tencat]

I'm glad it's not just me who is dealing with all of that crappola......families I understand to an extent because usually they're in uncharted waters, so to speak, and they don't get what's happening and more often than not are terrified. So I cut them slack and usually keep plugging away at educating them. It's other healthcare professionals who are ignoramuses and don't get it that REALLY irritate the holy living crud out of me.....and when ignorant health care people and obnoxious families get together....wow I need a drink just thinking about it.....sigh......feeling your pain....

[AtlantaRN, RN]

all you can do is educate and recommend. They may be "doctors orders", but alot of patients and families consider it "doctor recommendations." I tell patients and families, I can tell you what i think and what i know from 14 years in the field....but its up to you whether you follow the plan of care or not.....ball in is your court

[AtlantaRN, RN]

"daughter thinks i tried to scare her...." ------yep, like a hospice nurses life isn't crazy enough, we're called to "scare" people.....

denial, it's not just a river in egypt.....

bless you dear one

[SoCalRN1970]

Atlanta RN.but its up to you whether you follow the plan of care or not.....ball in is your court

is so true. If I have to say that to a family and I have, may not be in those words exactly, it takes the pressure off of me and puts it where it should be. On the family or patient to be responsible. Sometimes they dont' like it, but it's the truth.

So. go on little old lady who doubts everything I say. Go and take your teaspoon of lactulose. i know you will be calling me when you are impacted..

[kids]

To me, the first 2 scenarios are both reasonable questions asked by someone without a medical background and indicate a need for education.

I don't think #3 is all that unreasonable either. What is the client's previous experience with laxatives? If she's ever experienced crippling cramps & explosive diarrhea from taking the "prescribed" amount of a laxative she has good reason to hesitate.

I don't see any of them as "constant ignorance" that needs to be "fought". I have a bigger problem with patients (and families) who don't ask questions and just complacently do what ever they are told. We aren't infallible.

[SoCalRN1970]

I guess what I didn't really comment on was that this is a constant ongoing scnario with this case. It's been very trying from the begining. I am all for asking questions, but when patients and families constantly do not adhere or follow prescription directions etc.. Even though I have spent a fair amount of time educating and asnwering questions.. only to it not to sink in BTW, this lady has a history of laxative abuse.. so a good explosive response more than likely isn't going to happen. ... it becomes a bit fruitless on my end.

[AtlantaRN, RN]

i understand the frustration..... you educate and educate, and still they won't follow what you recommend.

I work with one nurse that will ask patients/families....."what did you do before hospice was involved...." at least that will give you background on what was "normal" for them in the past....

i understand, especially when you feel like a broken record.

hugs to you