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

[FireStarterRN]

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...

[Dolce, RN]

Thank you for taking the time to teach her what you could. That doc was exactly right, we cannot live her life for her. I love patient education when patients are responsive, interested and involved--it is very rewarding! But, what you describe is anything but. Give yourself a pat on the back for doing the best you could in the situation.

(BTW, I think I have taken care of that same patient. Gets admitted on a regular basis with DKA?)

[TrudyRN]

I think you did the best you could. Why not pray for her, too, if you are a pray-er?

She sounds very depressed but who really knows, if we are not there with her in her home? Maybe Home Health will be able to make some headway. If not, well, just keep a good thought for her and for her family and their total situation. God knows all about it and He does answer prayer.

Be of good cheer, jlsRN, you did what you could to help a fellow traveler. That's all you can do. Let not your heart be troubled. Offer the sacrifice of praise to God, stay your mind on Him, and He will comfort, encourage, and guide you.

[CHATSDALE]

i know how frustrating this must have been

perhaps hh will encourage her to take charge of her life so that she can lose weight and get her dm undercontrol

i guess the fact that her husband would not come up to floor to get her and that he wouldn't aswist her in getting into the truck are indicative of a life lived under the control of an abusive man which has resulted in her having little interest in life or a hope that it will get better

as for the cola can that may be a horse of a different color..a while back i had 'trigger finger' and when i bought something a convenience store i had to get the clerk to open it for me..at home i had strap wrench i used for opening bottles

[woody62, RN]

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

You should go to an AOL diabetes board. There are a small group of people who claim they control their blood sugars by eating only an average of 32 grams of carbohydrates a day. They are so proud of themselves. And they are so down on anyone that can't or will not.

Believe it or not, accepting a chronic disease is very difficult. Accepting one that forces major changes, such as changing years of habits of what you eat. I'm a nurse. And I remember what a lot of my peers said about my repeated admissions. And they said them so I could hear them. Do you think saying something nasty about a patient is going to make him more willing to follow your directions? Or do you believe that you have met the standards of practice by just teaching and discharging?

Come to think of it, perhaps I should write a book. A book about the attitudes of my peers toward me and what they expected, after all I was a nurse, I knew how to get better. Why waste their time teaching or talking to me. They could be busy gossiping or talking about the latest party they went to.

Woody:balloons:

[FireStarterRN, BSN, RN]

Dear Woody,

It sounds like you have felt very hurt by your co-workers and others. I hope you find healing. Maybe that diabetes board isn't a good place to hang out if some people's comments are affecting you negatively. Sometimes posting on the internet does expose us to being judged by others, that does seem to come with the territory.

[EmmaG, RN]

as for the cola can that may be a horse of a different color..a while back i had 'trigger finger' and when i bought something a convenience store i had to get the clerk to open it for me..at home i had strap wrench i used for opening bottles

Could have been neuropathy secondary to her uncontrolled DM...

[montieICURN]

Wow, that story made me really sad. I've been working with death and dying for so long, I forgot how hard it is to deal with the living. I'm sure your compassion mad some difference in this woman's life. I truly appreciate the effort you put forth. Good job.

[SuesquatchRN, BSN, RN]

Believe it or not, accepting a chronic disease is very difficult. Accepting one that forces major changes, such as changing years of habits of what you eat. I'm a nurse. And I remember what a lot of my peers said about my repeated admissions. And they said them so I could hear them. Do you think saying something nasty about a patient is going to make him more willing to follow your directions? Or do you believe that you have met the standards of practice by just teaching and discharging?

Come to think of it, perhaps I should write a book. A book about the attitudes of my peers toward me and what they expected, after all I was a nurse, I knew how to get better. Why waste their time teaching or talking to me. They could be busy gossiping or talking about the latest party they went to.

Woody:balloons:

I think that you are identifying too closely with this patient, and misperceiving the OP's comments as criticism of the patient. I read nothing of the sort into it, just frustration and guilt that she, as a nurse, couldn't do more.

As to the attitudes of your peers towards you - I can't imagine being so presumptuous as to attempt to teach a peer about health. Many of my co-workers smoke. I leave them alone. They know it's bad for them, just as you know what you were or were not doing 2o diet and exercise was for you. Were anyone to approach you with an attempt at educating you I can only imagine that you would have, um, ripped them a new one.

[woody62, RN]

Dear Woody,

It sounds like you have felt very hurt by your co-workers and others. I hope you find healing. Maybe that diabetes board isn't a good place to hang out if some people's comments are affecting you negatively. Sometimes posting on the internet does expose us to being judged by others, that does seem to come with the territory.

You are quite right. I went into a very deep clinical depression after I was injured in a bad car accident. After fighting for a year and half, I lost my home. I was finally told, by my treating physicians, that it was highly unlikely I would ever return to gainful employment. To complicate things, because I've my depression, I was hospitalized for prolonged periods of time. And I was so angry. Angry at my insurance company, angry at the band who held the mortgage on my home, and most of all angry at myself. And so over whelmed by my problems. What type of care and support did I received from my fellow nurses, on their psych unit? Basically none. In one to one conversations they told me "you know what you have to do to get better." Duh. I was a patient, a very sick patient but at no time was I ever allowed to forget I was a nurse. And a nurse who had worked in psych. It finally took a Psychiatric N.P. and a therapist to help me see my way out of my problems. And that I did not have to do it alone. To them, I am grateful. To the other psych nurses I interacted with, I hope you never go thru what I did. And if you do, I hope you never have nurses like yourself to turn to.

When I am in the hospital, I am a patient. And I should be treated as a patient. I shouldn't be expected to get myself better. If I could, I wouldn't be in your hospital. I need your assistance just like any other patient does. For these reasons, I try very hard to hide the fact that I am a nurse. In this way, I can assure of being treated no better or no worse then any other patient.

People appear incapable, helpless, unmotivated and unteachable for a reason. It is very easy to wash your hands of them calling them noncompliant. In todays much shorter hospital stays it can be very difficult to find out what the real issues are but not impossible.

As for the diabetes board. I visit it infrequently. I control my blood sugars with a combination of diet, exercise and P.O. medication and insulin. My last A1c was 5.2, so I am doing what is right for me. I suffer none of the complications of diabetes, at least not yet.

I do sometimes toy with the idea of writing my book, outlining just how poor we are as a group to others who do not meet our expectations.

Woody:balloons:

[FireStarterRN, BSN, RN]

I think nurses are a great group myself. I see my co-workers working hard, often under difficult circumstances, dealing with a sometimes demanding public.

[EmmaG, RN]

I think that you are identifying too closely with this patient, and misperceiving the OP's comments as criticism of the patient. I read nothing of the sort into it, just frustration and guilt that she, as a nurse, couldn't do more.

That was my take on her post.

As to the attitudes of your peers towards you - I can't imagine being so presumptuous as to attempt to teach a peer about health. Many of my co-workers smoke. I leave them alone. They know it's bad for them, just as you know what you were or were not doing 2o diet and exercise was for you. Were anyone to approach you with an attempt at educating you I can only imagine that you would have, um, ripped them a new one.

He brings up a good point, though. When I'm a patient (or anyone in my family) I don't want the nurses to assume that I know everything I need to know, or that I don't need teaching and information that other patients would; don't talk down to me, but don't ignore me either.

[SuesquatchRN, BSN, RN]

He brings up a good point, though. When I'm a patient (or anyone in my family) I don't want the nurses to assume that I know everything I need to know, or that I don't need teaching and information that other patients would; don't talk down to me, but don't ignore me either.

No disagreement here. However, Woody did not initially reveal that his/her interactions were as a patient.