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...

[EmmaG, RN]

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

I was answering your point after reading his post above. I probably shouldn't have combined the responses.

[SuesquatchRN, BSN, RN]

I was answering your point after reading his post above. I probably shouldn't have combined the responses.

No problem. With this comment, however, I do (sometimes) agree.

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.

I read awful comments about the poor, in particular, on this board. Not from nearly most, but from enough that I am sometimes disheartened.

[deeDawntee, RN]

I think you are a hero, giving so much of your energy, heart and soul to that patient. I KNOW it made a difference for her...maybe it will or will not change the way she manages her diabetes and her health, but the profound caring you shared her surely was not wasted. I salute you, my sister, and I hope the next time I am faced with a similar situation I am able to summon half the courage and commitment that you did!!

:bow:

[FireStarterRN, BSN, RN]

I think you are a hero, giving so much of your energy, heart and soul to that patient. I KNOW it made a difference for her...maybe it will or will not change the way she manages her diabetes and her health, but the profound caring you shared her surely was not wasted. I salute you, my sister, and I hope the next time I am faced with a similar situation I am able to summon half the courage and commitment that you did!!

:bow:

What an encouraging thing to say. You made my day! :)

[leslie :-D]

(((jls))), i am so impressed with how you treated your pt.

you demonstrated sensitivity and gentle persistence with her.

for that, i am sure she is grateful.

your pt reminded me of a pt i had awhile back.

except she asked many questions about her disease process.

the next day, i gave her some printed information i had gotten from a website.

she started crying when i gave it to her.

after she composed herself, she admitted to me she couldn't read.

ever since, i have thought twice before giving written information to my pts.

anyway, i spent an extra half hr at work ea day, reading this information to my pt.

afterall, she was going to die and had every right to know the course of her disease process.

once she felt she understood everything, i resumed my normal schedule.

teaching is certainly not w/o its challenges.

everyone learns differently....if indeed, they choose to learn.

at worst, they remain helpless, hopeless and apathetic.

at best, they take charge of themselves and their lives.

i sense you gave your pt something to think about.

leslie

[CHATSDALE]

woody, writing a book just might be a good idea..it could give other nurses and health care workers a different perspective on their patients

let us knowif you decide to follow thru on this

[morte, LPN, LVN]

perhaps her "noncompliance" is an escape from home situation, perhaps she had no wish to go home, at all.....next time she is in, and there will be a next time, unless she dies first....perhaps someone will offer her info on battered woman's programs/shelter etc

[SuesquatchRN, BSN, RN]

....perhaps someone will offer her info on battered woman's programs/shelter etc

Where do you get "battered" out of this?

[morte, LPN, LVN]

Where do you get "battered" out of this?

thinking out loud, so to speak.....she certainly isnt in what we would typically view as a suportive relationship, offering her info may open a dialogue....

[woody62, RN]

woody, writing a book just might be a good idea..it could give other nurses and health care workers a different perspective on their patients

let us knowif you decide to follow thru on this

I think I will. I have always kept journals, all of my life. Even after my accident, even in the deepest of my depression. I have always been a patient advocate, even when it was neither popular or supported. I have gotten two of my journals out, in the past hour, and have read through some of my entries. Some are extremely painful for me, when I had given up all hope. When I thought that killing myself was the only reasonable answer to my on going pain, physical and mental. I am not sure just who would be interested in such a book. For the most part, it is a commendation of my fellow nurses, colored by my own pain.

Woody:balloons:

[woody62, RN]

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

What interactions do you want me to post? Do you want me to talk about an R.N. who came into my room and told me I was a nurse and I very well knew how to get out of the deep depression I was in; that I was enjoying my own pity party. How would you feel as a nurse to hear someone saying that. Would you agree with her, that I was engaging in my very own pity party. And that as a nurse I knew how to get out of the depths of my depression. How would you feel if I said I was a patient, not a nurse. And that as a patient, I did not have the strength to over come my depression. Would you take into consideration that neither my parents nor my daughter ever visited me. That I felt completely alone. These are all the thoughts that went thru my mind.

Would you like to hear about the Physical Therapist, who upon seeing me for the second time, decided after having my leg in a straight leg cast from my groin to my ankle for three months, that I was capable of bending my knee completely. And when I didn't, grabbed my ankle and jerked my lower leg down to touch the table. And caused me the greatest of pain. How about how I screamed so loudly, that a nun came running from the Chapel, on the other side of the hospital, to find out what was the matter? Or how about the male nurse, who filed up a basin with ice and forced my foot, with second degree burns into it, ignoring that I had already put cold water on my foot at home, in an attempt to lessen the severity of the burn.

Most nurses never take the time or effort to learn about their patients. They just go in, teach and discharge. Then complain when the patient shows up, for the fifteenth time. It is so much easier and simpler to blame the patient or the family, isn't it. That way you don't have to take any responsibility for the negative outcomes. And you get to brag about how much you did to help the patient. There is always more to both sides of the story, if you take the time to learn them.

Or are you just willing to listen to the post when I thank the wonderful nurses who took care of me, in ICU last July. How helpful they were to me and my daughter. How they put up with some of the craziness that went with the Versad injections I got in the OR.

Woody:balloons:

[Jo Dirt]

She is either hopelessly depressed or retarded. It's pitiful but you really can't live their lives for them.

When I worked home health I walked into some of the most depressing living conditions--places so nasty I hated to even get back in my car after being there. Cat infested trailers with garbage and feces and in one instance there was about 20 cats with this old couple and the cats would actually snatch food out of their hands as they tried to eat. I like cats okay but I wanted to chase the things out of that trailer with a broom (can't stand animals in the house). It was like the urine was ground into their skin. They didn't want anyone's help, what could you do?

Another old man was living in a nasty old trailer out in the woods with his mentally ill sons. No water, no bathroom, barely had electricity, He had a daughter in town who refused to take him in, it sounded bad but according to her he had been a mean nasty person who used to beat their mother so I guess he was lying in the bed he made for himself (and he refused to go live in the housing projects).