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...

[leslie :-D]

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.

this is not fair or accurate.

there are many nurses who go the extra mile to appease, reassure, educate and empower their pts.

i am sorry your experiences were so undesirable.

but to clump most of us together as a bunch of insensitive, shallow, irresponsible nurses is just sheer displacement on your part.

i do hope you continue to heal.

leslie

[SuesquatchRN, BSN, RN]

Woody, you are full of blame and self pity. While I am sorry for the troubles you had, and clearly still have, those of us in this thread have done nothing to contribute to those. And you are ignoring most of what I wrote to, once again, focus on anything that you can spin to be negative and unsupportive.

Write the book for therapy, and stop attacking the poor OP in this thread who tried very hard to educate someone who was clearly a difficult case. Her frustration and sadness over what she perceives as her own failure are a far cry from the callous disregard you claim to see in her simply because she used the word "non-compliant."

[Cobweb]

I suspect you did the best job you could under the circumstances, and just think, you may have been the only kind voice she's really heard for a while. She's fat, sick, older, poor, and a woman--destined to be contemned, ignored, and neglected in our society.

I just have one thing to say in the way of advice though, because it's something I, well, really all of us, have a tendency to do. Don't make too many assumptions about what her life is like. Maybe the man was not able to get out of the truck. Maybe she's a child-beater and drunk who they really don't want back in the house. She may be incapable in the hospital, but quite capable at home in her fashion.

Lots of people where I was raised view doctors and hospitals as something akin to voodoo and only use them as a last resort, and then view them as nearly useless. They have some basis to that belief, considering how they are usually treated. That could be one reason she didn't really care to pick up what you were trying to teach her. You may think she's unteachable but maybe she picked up a bit and every time she comes in maybe she can pick up a bit more.

I thought the Lantus idea was very good--it's so painful that the new corporate medicine no longer allows you to do what's best for the patient, only what's good for their wallets.

Anyway, while you may have 100 willing, teachable patients this week, you get your nursing points from helping folks like these who need a little bit more. So, here, have a cookie :balloons:

[pagandeva2000, LPN]

It may sound cold, but you did what you can do and you cannot hold her hand. The patient has choices as well, if they are in their right state of mind (maybe this is one of the issues that you had, that she may not be). In cases like that, I educate, provide literature that hopefully they can understand and I move on. There are a great deal of patients that will try and accept what we do and that energy has to go to them. Each time you encounter her or someone like that, do what you already did by trying to empower them and then move on.

I had a patient in my clinic who just completed her visit with the physician as a new client. Did the nursing interview and by the time we got to GI questions, this woman stated she had diarrhea 3 times a day for 2 months and was feeling weak. I looked at the doctor's note and it wasn't mentioned, so I asked her what her provider said regarding this. She says "Oh, I didn't tell her". I asked her what prevented her from mentioning this to the physician and she says "She didn't ask me". It was BEYOND me why she would come to the doctor and not mention something that is making her feel weak. I was so annoyed that I had to MAKE myself walk to the doctor and tell report what the patient said and ask her to re-evaluate this woman. Then, I went back to the patient and asked her further questions and told her that she should consider writing down all of her symptoms of discomfort and present them to her provider and she says that " This is not a big deal". But, I sucked in my feelings to tell the doctor, strongly emphasized to her the importance of telling the provider of all abnormal signs and symptoms and then I went about my day. She annoyed the hell out of me because of her stupidity, but, we have to remember that a patient's view of sickness is sometimes different from what we expect.

[Hellllllo Nurse, BSN, RN]

These pts are very trying. So much money, time and effort goes into their care, and they just act like slugs.

[Sabby_NC]

It is so hard in our role as caregivers NOT to try to fix the woes of the world.

Sounds to me you did a great job in teaching and got resources into the team to assist her.

You never know but you just MAY have got through with some of your teaching.

Every little thing we do some how impacts on the patient's life.

Pat your back you did good!

[woody62, RN]

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).

Why didn't you report these situations to the appropriate authorities? The elderly couple with the twenty cats could have been reported to their local animal control department and the Office of Elder Affairs with the state. They sound like what is commonly known as collectors. And most counties have ordinances prohibiting that many cats in one household. And the Office of Elder Affairs, or like agency, is mandated to look into such situations and take appropriate action. It is not a matter of wanting or accepting help, it is an issue of health and safety And county's generally take steps to improve their situation. And the same goes for the old gentleman who live way out in the woods. Again it is not a matter of not wanting help or allowing someone to live in a mess, it is a matter of health. Or did you think that they had a right to live the way they did because it was their choice?

I am not criticizing you but there are steps that can be taken to help people, even when they do not want it or think they do not need it. No one has the right to remain in a situation that endangers either themselves or others or their pets. And all it takes is a phone call or two to get the ball rolling.

Woody:balloons:

[woody62, RN]

Woody, you are full of blame and self pity. While I am sorry for the troubles you had, and clearly still have, those of us in this thread have done nothing to contribute to those. And you are ignoring most of what I wrote to, once again, focus on anything that you can spin to be negative and unsupportive.

Write the book for therapy, and stop attacking the poor OP in this thread who tried very hard to educate someone who was clearly a difficult case. Her frustration and sadness over what she perceives as her own failure are a far cry from the callous disregard you claim to see in her simply because she used the word "non-compliant."

You assumptions are one of the reason's I hesitated to make the comments I did. You assume that I am still angry and bitter, when you are so far from the truth. I wasn't attacking OP, far from it. Do you think that every patient I ever had to deal with, every family I ever had to deal with, willingly and unconditionally accepted my offers of help, my attempts to educate them? If you did, you are very wrong. But unlike you, I didn't just throw up my hands and give up. There are solutions, ones that can be found, to help the most obstinate of patients.

I am neither still angry or bitter. I worked past that a long, long time ago. I just shake my head, when people complain about patients not wanting their help and then writing them off. In my world, there was never a patient that was impossible to reach. I may not have reached them the first time, or the second time or the eight time but I keep trying until I did. And so don't others. They are unwilling to give up on another human being and write them off, saying they don't want to be helped or there isn't enough time. And that is the difference between a nurse who is caring and a nurse who just does her job.

Woody:balloons:

[Sabby_NC]

You know I had to come back to this post after replying.

I wonder what is going on at home.

Does she live in an abusive setting. Hubby would not get out of the truck to assist her etc?

No one knows what goes on behind closed doors.

Kinda sad eh?

I just pray she is ok and learns from all that was taught to her.

Maybe she will realize that you were all doing the best for her and her health.

[SuesquatchRN, BSN, RN]

You assumptions are one of the reason's I hesitated to make the comments I did. You assume that I am still angry and bitter, when you are so far from the truth. I wasn't attacking OP, far from it. Do you think that every patient I ever had to deal with, every family I ever had to deal with, willingly and unconditionally accepted my offers of help, my attempts to educate them? If you did, you are very wrong. But unlike you, I didn't just throw up my hands and give up. There are solutions, ones that can be found, to help the most obstinate of patients.

I am neither still angry or bitter. I worked past that a long, long time ago. I just shake my head, when people complain about patients not wanting their help and then writing them off. In my world, there was never a patient that was impossible to reach. I may not have reached them the first time, or the second time or the eight time but I keep trying until I did. And so don't others. They are unwilling to give up on another human being and write them off, saying they don't want to be helped or there isn't enough time. And that is the difference between a nurse who is caring and a nurse who just does her job.

Woody:balloons:

First off, this "But unlike you, I didn't just throw up my hands and give up. " is an attack, and for what, I don't know. I have discussed none of my efforts to educate or teach.

I did not assume you are still bitter. That came from what you said. And if you did not intend to criticize the OP perhaps you should look at how you expressed yourself.

[rn/writer, RN]

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.

Most nurses? Never? These are serious accusations of insensitivity.

I'm truly saddened to hear such a negative view of your fellow nurses. In my experience, I've seen just the opposite. I have been blessed to watch my coworkers go the extra mile time and again, using whatever means they can think of to teach, encourage, and assist their patients, often with wonderful results. Most of us are highly motivated to find some spark of connection, and we don't engage in hit-and-run teaching and then brag about our efforts or blame the patients who have problems.

There is always more to both sides of the story, if you take the time to learn them.

It sounds like you are saying that you don't like it when nurses are judgmental of their patients without taking the time to learn what's going on behind the scenes. That's understandable. And yet, this statement itself is pretty judgmental. Especially when you apply it to "most nurses."

But unlike you, I didn't just throw up my hands and give up. There are solutions, ones that can be found, to help the most obstinate of patients.

In my world, there was never a patient that was impossible to reach. I may not have reached them the first time, or the second time or the eight time but I keep trying until I did. And so don't others. They are unwilling to give up on another human being and write them off, saying they don't want to be helped or there isn't enough time. And that is the difference between a nurse who is caring and a nurse who just does her job.

Woody:balloons:

Respecting someone else's boundaries and limitations is not the same as giving up on another human being and writing them off.

You are fortunate that you have never met a patient you couldn't reach, but you are a rarity. Many, if not most, of us have worked with patients who, for whatever reason, do not wish to avail themselves of our assistance. So long as we do not close the door on future connection, backing away from their resistance (after reasonable attempts have been made) is not giving up on them and writing them off. It is recognizing and respecting their autonomy.

I'll go a step further and say that to continue to push someone who isn't ready or receptive can actually render them more resistant. The staff person then becomes the enemy and the focus of their unhappiness rather than the disease or condition that is behind their real anxiety and discomfort.

Some patients never "come around." But they can still benefit from our gentle concern and our treating them with dignity regardless of whether or not we approve of their choices.

In the OP's case, the time she spent with this patient gave the message that she saw value in the woman and in her well-being. It may have been a long time since someone communicated that thought to her. Worst case, even if the patient never gets the insulin right in her life, her condition was improved by having someone say that she mattered enough to try. Best case, that bit of caring might be the foundation for building more, one little piece at a time.

I believe that most nurses care a great deal about their patients. That they sometimes wrestle with where the line is between too much and not enough is a testament to their committment. If they didn't give a hoot, there would be no struggle.

[FireStarterRN, BSN, RN]

Thanks to RN writer, and for all the other insightful posts. I also see my collegues doing their best, within the limitations of time and patient receptivity, to advocate and assist people in need. Most nurses I know are doing more than just collecting a paycheck.

I'm sorry Woody experienced otherwise, that's a terrible feeling to be sick and helpless, and receive less than compassionate care. Nurses are only human, and maybe those cranky nurses had some really heavy personal stuff going on in their lives those days that contributed to their less than desirable behaviour. I hope Woody can forgive them.