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.
For people who won't or can't help themselves despite frequent visits. There is nothing you can do but keep trying. I remember one pt who was diabetic and a druggie in the ER for a number of years. We kept trying with him. Then I hadnt seen him for a while. I really assumed hed had died. He came back a year and half later. His Diabetes was controlled, he was drug free, his life was in order. He thanked all of us for not giving up on him.
I did, by the way, tell the patient that I would be at the hospital until 7pm if she had any questions that day to please call. I was told by the nursing supervisor that I had done a great job.
This patient was a woman who was newly diagnosed as needing insulin, and hadn't been on any diabetic regieme. I think it's unrealistic to send even a normal person home without some sort of more intensive education program. It's just a lot of information to absorb. Also, just the physical task of drawing up a medication from a vial is a daunting skill for an ordinary newbie. The safety needles obscure your vision quite a bit.
She was someone who had severely neglected her own health in the past and had minimal ordinary life coping skills. It just seems that time contraints are so severe in these days of expensive healthcare. I think this affects every department of the hospital. It's frustrating.
I got the doctor to order homehealth for her. I'm surprised he didn't do it at first. I think there were finacial contraints. I'm sick of our healthcare system the way it's set up in the United States with the haves and have nots. It just seems like a lousy system, and disorganized.
Why did it fall on you as a floor nurse to do this patient's diabetic ed? Yes, you need to teach, reinforce and document their response, but isn't there a diabetic educator in your facility? Even the smallest hospitals I've worked for have had these.
The diabetic educator position is empty right now. There's a lot of upheavel at my hospital due to administration mismanagement.
Hoo boy. What about the education department? Aren't there staff educators who could have stepped in here? I worked a diabetic unit for a while; the teaching is intense. Far more than I'd expect you to do while having a full load of patients.
p.s. I hope if I'm ever hospitalized again, I have a nurse with your level of expertise and compassion. *hugs*
Thanks. This is a pretty small hospital with limited resources. I don't know why I'm agonizing over this, I think it's because this woman was so helpless and docile, and her life seemed so despairing. I know the system can't save everyone.
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 condemned, 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. So very true. We just don't know what goes on in someone else's private life. Maybe the man was not able to get out of the truck. I wondered the same thing. Maybe he has a broken bone, a cast, whatever and she is the more mobile of the 2.
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. This did not occur to me but it certainly could be true.
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. So true.
What I find hurtful and discouraging is when I offer kindness to someone and they reject it/do not acknowledge it. But oh, well. Life goes on.:angryfire;):trout::balloons::uhoh21:
These pts are very trying. So much money, time and effort goes into their care, and they just act like slugs.
They do the best they can. No need to look down your nose at them. Just figure they have stuff going on that you do not know about and maybe it is getting the best of them.
For people who won't or can't help themselves despite frequent visits. There is nothing you can do but keep trying. I remember one pt who was diabetic and a druggie in the ER for a number of years. We kept trying with him. Then I hadnt seen him for a while. I really assumed hed had died. He came back a year and half later. His Diabetes was controlled, he was drug free, his life was in order. He thanked all of us for not giving up on him.
But oh, well. Life goes on.
:angryfire;)
:trout::balloons:
teeituptom, BSN, RN
4,283 Posts
For people who won't or can't help themselves despite frequent visits. There is nothing you can do but keep trying. I remember one pt who was diabetic and a druggie in the ER for a number of years. We kept trying with him. Then I hadnt seen him for a while. I really assumed hed had died. He came back a year and half later. His Diabetes was controlled, he was drug free, his life was in order. He thanked all of us for not giving up on him.