I want you to help me, but you will do it my way.....

Published

Specializes in ICU, Trauma, Emergency.

How do you deal with indignant patients that come to the Emergency Department asking for help and then refuse certain aspects of care.

Lately, I have had numerous patients simply refuse to put on a patient gown, they simply do not want to be bothered by putting on a gown. Most of our physicians really want (demand) patients be in a gown no matter the chief complaint. Then the physician comes out of the room and says, "she not in a gown, I want them in a gown".

I also have patients complaining of chest pain, so we start our chest pain protocol and then they say, no I won't wear this oxygen, no I don't want an IV, no I won't put on this gown, and why do I need an EKG. I sit there trying to reason with them, I explain the rationale, and I am getting to the point where I think, "hey you came HERE asking ME for help and now you are going pick and choose".

I get the whole loss of control, anxiety, pain, and fear of coming to the ED. I assess for other reasons that a person may not want to don a gown but seriously........I would not go into a business and then pick and choose certain things to downright refuse to do, like refuse to sign paper work at the bank or wait in line. How do you deal with this. I have come to the point where it is beginning to frustrate me. What do you say? :confused:

Up Vote Up Vote ×
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Do you want to sign the AMA paper now or in 10 minutes after I tell the physician you won't cooperate?

Up Vote Up Vote ×
Specializes in CT stepdown, hospice, psych, ortho.

Reminds me of post coronary bypass patients eating fast food sausage biscuits for breakfast on the step down unit. Whiskey.Tango.Foxtrot. Wish I could decide which aspects of patient care I could refuse..."Oh Mr Smith, I'm refusing to do your admission paperwork today...I don't see why its important."

Up Vote Up Vote ×
Specializes in med/surg/tele/neuro/rehab/corrections.

LOL @ Whiskey.Tango.Foxtrot! :D

Up Vote Up Vote ×
Specializes in ICU, Trauma, Emergency.

Right....I hear the whole AMA thing but our hospital is so focused on patient satisfaction. I feel so limited in what I can do. I take the heat from all directions. I have to hear it from the MD that they are not gowned and then our patient satisfaction letters come back with poor reveiws because we made the CP pt. wear o2 and get an IV. I feel like I almost have to beg them to let me start an IV and get labs. Its too exhausting. Isn't it just accepted that when you go to the hospital that you wear a gown and recieve basic aspects of care. What do I say to these patients.

Daisy:banghead:

Up Vote Up Vote ×
Specializes in CVICU.
Reminds me of post coronary bypass patients eating fast food sausage biscuits for breakfast on the step down unit. Whiskey.Tango.Foxtrot.
I work in CVICU and our post op CABG patients eat whatever they want. The surgeons, etc., realize how restrictive and unappetizing the cardiac diet can be and are more concerned with the patients getting adequate intake in the first few days post op. Are fast food sausage biscuits particularly healthy? No, but the docs think it's better than them eating nothing, which is frequently what happens. We tell families to bring in favorite foods for postops with no appetite. Yes, they need to make lifestyle changes, but in our facility, it's not expected in the first couple of days.

BTW, the last person who left my unit AMA, despite my begging her not to, just returned to us 3 days ago on a ventilator and an IABP. I guess you just can't do much if people refuse to let you help them.

Up Vote Up Vote ×
Specializes in ER.

I flat out tell them they are refusing offered care and we can't properly diagnosis them. No it's not good for patient satisfaction scores for them to hear that but it is good NURSING and MEDICAL care which triumphs satisfaction scores. Have them sign out AMA if they refuse everything and focus on patients that want and need care.

Up Vote Up Vote ×
Specializes in CT stepdown, hospice, psych, ortho.
I work in CVICU and our post op CABG patients eat whatever they want. The surgeons, etc., realize how restrictive and unappetizing the cardiac diet can be and are more concerned with the patients getting adequate intake in the first few days post op. Are fast food sausage biscuits particularly healthy? No, but the docs think it's better than them eating nothing, which is frequently what happens. We tell families to bring in favorite foods for postops with no appetite. Yes, they need to make lifestyle changes, but in our facility, it's not expected in the first couple of days.

BTW, the last person who left my unit AMA, despite my begging her not to, just returned to us 3 days ago on a ventilator and an IABP. I guess you just can't do much if people refuse to let you help them.

We let them eat whatever too and...who knows until you walk a mile in their shoes...but I hope if I ever undergo major surgery it motivates me to make some immediate lifestyle changes. I can see how one might take the permissiveness in the immediate post op period as a lax attitude about the importance about making those lifestyle changes. After all, we know our rationale for allowing it for a couple of days but there are plenty of patients and families that don't quite grasp that what may be permissiable for a small amount of time is not really saying that it isn't an important component of recovery that needs integration. While I don't understand the desire to eat it, I don't openly criticize the patient. But I do make sure to do some diet education.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Welcome to the al la carte ER! Yep, it's frustrating. You can only do so much. I just do my best.

Up Vote Up Vote ×
Specializes in CVICU.

cb_rn, I'm not saying that you're wrong for thinking that it's counterproductive when you see them behave that way. I feel the same way. I bite my tongue, and try not to smirk when I'm telling the family that it's fine to bring in pizza or a frosty from Wendy's. I'm actually quite a lot more frustrated by the ones who inform us that they're not quitting smoking, even as we're prepping them for their bypass!

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
cb_rn, I'm not saying that you're wrong for thinking that it's counterproductive when you see them behave that way. I feel the same way. I bite my tongue, and try not to smirk when I'm telling the family that it's fine to bring in pizza or a frosty from Wendy's.

My friend's father had a quintuple bypass at the age of 60. He proceeded to go back to his terrible, high-fat diet. His logic? "I'm all cleaned out, so I'll just need another bypass when I turn 120."

gah.gif

Up Vote Up Vote ×
cb_rn, I'm not saying that you're wrong for thinking that it's counterproductive when you see them behave that way. I feel the same way. I bite my tongue, and try not to smirk when I'm telling the family that it's fine to bring in pizza or a frosty from Wendy's. I'm actually quite a lot more frustrated by the ones who inform us that they're not quitting smoking, even as we're prepping them for their bypass!

I remember, as a student, smoking was still akowed in hsps-in designaed areas. One of my pts had had a lobe of his lung removed due to ca. He used to push his pleruavac, on a stand, down to the area at the end of the hall-where the elevators were., and smoke his heart out-as a student, I was aghast...

Up Vote Up Vote ×
+ Join the Discussion