incapable, helpless, unmotivated, unteachable pts who are unable to cope with life

[FireStarterRN, BSN, RN]

I got floated to Med-Surg yesterday. I had a patient in her 50s who had originally come in with a blood sugar in the 600s, had been on an insulin drip originally, then transfered to med-surg.

The doctor came in and ordered her discharged. Supposedly she had been receiving diabetic teaching. This woman obviously was an utterly passive personality. To make a long story short, it took me all day to get her out the door. She could give herself an injection just fine, but she really seemed unable to learn the information. She had a history of being 'noncompliant', I'm told. The CNA told me that the woman was so helpless that she would call to have her pop can opened for her.

I didn't have very many patients, but I had the most frustrating exersise in futility I've had in a long time. I tried to explain the difference between NPH and Regular, the sliding scale, and the rest. Everyone at the nurses station kept hearing the latest chapter in the boring story. Then after hours of this I finally called the doctor after hours of this and told her that there was no way this woman could learn this. I suggested Lantus as a simpler insulin, and he said that he had to order NPH because of cost. He ordered home health and said that we "can't live her life for her". I finally got the patient to understand that, at the very least she should take the NPH in the morning and evening, and that perhaps homehealth could get her to understand the rest.

Then her husband picked her up in the front of the hospital, he wouldn't come in to pick her up. He had an old ramshackle pickup with a bunch of junk in it. He didn't say a word and wouldn't get out to help my patient who is quite obese and needed a stool they keep in the truck to get into the truck. She attached the stool by a string to the door handle so she could pull in up into the truck after she got in. I noticed a siphon hose on the floor of the front seat, among other things, I think that's how he fills up the truck with gas. They looked like characters out of Steinbeck's Grapes of Wrath. It was the most heartbreaking scene I've witnessed in a long time, one of utter poverty of spirit.

Very frustrating and sad...

[clee1]

We cannot fix the world... nor even a patient that doesn't really want to be "fixed".

Pts come to us in crisis, and leave when the crisis is past.

Do your best always.... and you will have done your duty to your patient, to God, and truly to all of humanity.

[SuesquatchRN, BSN, RN]

She could be borderline MR.

There is always a resident like this in LTC. Sad. But understand that she does not want to do for herself and may actually be looking forward to eventual institutionalization. Certainly her husband isn't opening her soda cans.

[Sisukas]

You've done your time with her....hope you don't have to be her RN when she has her stroke.

It's always a little heartbreaking when you see desperate situations, isn't it? I liked the doctor's response to you, though; you really can't live their lives for them, you just gotta hand them the hammer and hope they pound in the nails instead of hitting themselves in the head with it.

[nightmare, RN]

We have several like this in the Nursing Home,buzz for every little thing instead of doing it themselves,lie like a stone and nearly give the nurses a hernia trying to move them when they are perfectly capable of moving themselves. When it is explained to them that they could do so much more to help it's as if you are insulting them! I think some of them think that ,just because they are paying to be there,we should run around doing everything for them.

We also have the really unmotivated ones who just don't want to be here anymore,very heartbreaking,and soul destroying.

[woody62, RN]

Sorry but I have to take a different position. I was diagnosed in 1990 as a Type 2. My doctor and nurses taught me what to eat and how to manage my diabetes. For the next two years, I ignored my disease and ended up in the ER several times. I was labeled as non-compliant. And to make matters worse, a non-compliant nurse. When someone is first diagnosed with a life altering chronic disease, they generally do one of two things. They accept it or they do not. And this patient sounds like she has not. The fact that she does not open a can of soda has nothing to do with things. She is faced with a disease that is going to alter her life. You do not know her situation, the support she gets or doesn't get, her personal situation. It is very easdy to give up and wash your hands of such a patient. It is much harder to determine her situation and why she is acting the way she is. And to work out a plan to help her.

Woody:balloons:

[SuesquatchRN, BSN, RN]

It is very easdy to give up and wash your hands of such a patient. It is much harder to determine her situation and why she is acting the way she is. And to work out a plan to help her.

She didn't, and she tried. Her time was limited.

[FireStarterRN, BSN, RN]

This woman is a non-functioning individual, not a 'contributing' member of society. I think she might have been mentally slow as well. I did spend hours trying to teach her, called the doctor and so forth. I also had the dietician speak with her and social services.

I finally had to resort to humor in order to keep from crying. It is just so sad the way some people live. When I told her that home health would be contacting her, she asked if she could go to them because she didn't want them to come to her house because they were in the middle of renovating it. I'm pretty certain that she actually lives in a total pigsty.

Some human beings just can't seem to cope. Then I had to get pharmacy to give her the prescriped insulin and tack it on her hospital bill because she wouldn't get her supplies for a week from the special program she had applied for. I gave her a bag full of insulin needles and a bottle of Saline to practice drawing up from.

[llg, PhD, RN]

I agree that jlsRN did all she could -- much more than many people would have done. I also agree with the doctor who said, "You can't live your lives for them."

Sometimes, we can't fix everything for everybody. All we can do is give it our best shot and move on to the next case.

[Silverdragon102, BSN]

As long you did your best for the patient then that is all you can do and be expected. I have seen a lot of non compliant patients especially with type 2 diabetes even years after they have been diagnosed and they just can't and/or wont except responsibility for their own health. As long as it is documented what you have done and about the non compliance there isn't anything you can do but be there to support them in times of crisis

[rn/writer, RN]

The inadequate skills of dysfunctional people do not improve with the acquisition of a complicated disease. We can't save everyone. And not everyone wants to be saved. Especially if it means taking on a boatload of responsibility on top of that which was already too heavy a burden. You do what you can. And they do what they can. Sometimes it's not enough. That's sad but true.

jlsrn, I commend you for taking all the time you did with her.

[FireStarterRN, BSN, RN]

Thanks for the encouragement. I felt like I was helplessly spinning my wheels for hours yesterday trying to help this person. I'm definately not a nurse who is into trying to save the world, I'm normally fairly detached and realistic, but this was a particularly difficult case. I just couldn't discharge her without knowing she at least had a rudimentary grasp on her insulin prescription.

She did thank me, after my repeated efforts as I wheeled her out the door, saying that "I sure learned a lot today". It's like one of those corny stories that you read in nursing journals.