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.
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:
People might very well have a legal and moral right to live as they please if they aren't hurting anyone else - as a Supreme Court justice once said, we have the right in America to just plain be left alone.
I agree that we need to notify authorities if other people or animals are being harmed. But lots of old folks (like me) just want to be left alone. I assume people mean well but I don't think they should be sticking their noses into other peoples' business unless there is a fire hazard to neighbors, rats, termites, etc. that can affect neighbors, stuff like that. If someone wants to stay home without heat, a/c, running water, food, medication - well, who are we to decide that they may not? I currently have a neighbor who has twice now burned something and the fire department came out. Because he has neighbors right next door and a fire in his home could affect them, I am going to notify the County - as soon as I figure out who exactly deals with stuff like this. He can burn himself up, I guess, but he doesn't have the right to burn his neighbors up is how I see it. He's stubborn, ornery, contrary yet he manages to drive, cut the neighbor's lawn every week, sit on his porch looking clean, and, presumably, pay his bills, handle his other affairs, etc. But I am worried about the fire thing. Of course, is it my responsibility to report him? Why doesn't the FD do it? Or his next door neighbors? Hmm, I have to think this through some more. I wish I knew his kids. I would maybe mention something to them.
Specializes in icu, er, transplant, case management, ps.
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.
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."
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.
It is funny. It is all right to complain about the frequent flyers, or the family members or the patients that are too demanding. It is all right to complain about the patients who will not learn or cannot learn what we teach them. But God help the first nurse who stands up and says "No it is right. No, you are misssing the point. No, there has to be other issues." You assume that I am a bitter old nurse who is still angry at what happen to her more then fifteen years ago. Sorry, I am not. But I am angry at the number of you who complain and complain and say you have done everything you can. And when asked what you've done, 'well I requested the nurse educator come" "Or I don't know which outside agency to contact to look into that patient's home situation." Where do you think I learned it. By sitting at a desk all day and just thinking? Think again.
In the past nineteen years I've spent almost as much time in hospitals as a patient, as I did when I worked. For the most part, the care I received was good to excellent. And the attitudes of most nurses, very acceptable. But there were the rough spots. And if some of you think I am going to crawl off, think again. I may not be able to work but I do have a very loud and active voice. I take part in area politics and I have every intention of dying with my boots on.
It is funny. It is all right to complain about the frequent flyers, or the family members or the patients that are too demanding. It is all right to complain about the patients who will not learn or cannot learn what we teach them. But God help the first nurse who stands up and says "No it is right. No, you are misssing the point. No, there has to be other issues." You assume that I am a bitter old nurse who is still angry at what happen to her more then fifteen years ago. Sorry, I am not. But I am angry at the number of you who complain and complain and say you have done everything you can. And when asked what you've done, 'well I requested the nurse educator come" "Or I don't know which outside agency to contact to look into that patient's home situation." Where do you think I learned it. By sitting at a desk all day and just thinking? Think again.
In the past nineteen years I've spent almost as much time in hospitals as a patient, as I did when I worked. For the most part, the care I received was good to excellent. And the attitudes of most nurses, very acceptable. But there were the rough spots. And if some of you think I am going to crawl off, think again. I may not be able to work but I do have a very loud and active voice. I take part in area politics and I have every intention of dying with my boots on.
Woody:balloons:
I intend to die with my golf shoes on, what a way to go.
we havent noticed at all that you have a loud active voice.
I never thought you sounded bitter, old maybe, but never bitter
Havent you heard you shouldnt spend that much time as a pt in hospitals, its bad for your health.
Specializes in LTC, assisted living, med-surg, psych.
This is the second thread I've read today regarding some of the more marginal members of our society, about whom there tend to be a great many assumptions and yes, misconceptions.
Unlike the thread about welfare recipients, however, this thread contains much to celebrate: there is obviously a great deal of compassion here, as well as effort to understand and assist those who live on the proverbial edge. All we can do as nurses is TRY to help---we cannot, as someone already said, live our patients' lives for them or rescue them from bad situations, especially if they are of legal age and don't want or understand the need to change. Sometimes they can't change.........they're too scared, or they are dependent on someone who mistreats them, or they don't have the "book smarts" to know what to do.
And sometimes it's a matter of feeling completely overwhelmed by life, as though you're surrounded by cinderblock walls: all most people need is for someone to help them knock that first one down, so that the rest fall on their own like dominoes. But some need more than that, and of course, there are a few who are so broken down by life, so worn out struggling just to get through each day, that whatever energy they might have had is completely sapped by the fight for survival.
We don't know each and every patient's life situation; thus I think it is both uncompassionate and intellectually lazy to generalize about entire groups of people. As the old saying goes, we ought not to judge a person until we have walked a mile in his moccasins. It's hard, especially when we see so many people in less than ideal circumstances who seem to need our help desperately but who don't want it and won't accept it. But the last time I checked, there was only one person in history who could walk on water...........and if He isn't judging these people, why should we?
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?
Woody:balloons:
Apparently social services decided these people had the right to live as they were living. Naturally, that was the first thing that was done when we took the cases. The HH agency pulled out of these places because the people were considered noncompliant.
Adult Protective Services did not want to expend the time and money to help these people in their homes, they are there to help the person arrange finances and assets and see that they have not been transferred to children to get out of turning it over to the nursing home (calling it Adult Protection Services is an oxymoron because this office functions to help the government save money by controlling the old person's finances so even they cannot decide how to use their own money...this can be verified by calling your local DHS office. Those signs you see up about elderly abuse this and elderly abuse that and all the signs to watch for and report to them because they want to protect the elderly is a ruse...they want to protect the elderly's finances and assets in the best ineterest of the government in the event they need Medicaid to go to the nursing home. No financial interest means no APS interest. This is also explained in the Deficit Reduction Act of 2005.)
Specializes in icu, er, transplant, case management, ps.
Apparently social services decided these people had the right to live as they were living. Naturally, that was the first thing that was done when we took the cases. The HH agency pulled out of these places because the people were considered noncompliant.
Adult Protective Services did not want to expend the time and money to help these people in their homes, they are there to help the person arrange finances and assets and see that they have not been transferred to children to get out of turning it over to the nursing home (calling it Adult Protection Services is an oxymoron because this office functions to help the government save money by controlling the old person's finances so even they cannot decide how to use their own money...this can be verified by calling your local DHS office. Those signs you see up about elderly abuse this and elderly abuse that and all the signs to watch for and report to them because they want to protect the elderly is a ruse...they want to protect the elderly's finances and assets in the best ineterest of the government in the event they need Medicaid to go to the nursing home. No financial interest means no APS interest. This is also explained in the Deficit Reduction Act of 2005.)
Anyway, you can't save people from themselves.
No, you can't save everyone. But you can't give up just because of that.
TrudyRN said, "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."
I have a hard time with that as well. The fact is, though, that they don't really OWE me thanks; even if I go out of my way to help them, that's my choice and not theirs. Sometimes I get ticked off because a patient will not take my wise and wonderful advice! That is a fault in me and not in them.
I was reminded of this lately when my doctor got mad at me for quitting physical therapy. He said, "I know this will help you a lot! WHY won't you take my advice and go?" I told him it cost too much. He exclaimed, "It only costs $20; anybody can afford that. There's no reason for you not to go." He was getting kinda huffy about it. I said, "Doc, it costs $20 every time you go....5 times a week...." He just hadn't thought of it that way, lol. I've gotten mad at patients for not doing their therapy before and now I have gotten some of my own back ;p
there are many ways people live. we are all products of our individual circumstances. i commend anyone who takes the time to HELP in any way. time marches on and they will too....you did a great job......mary
TrudyRN said, "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."
I have a hard time with that as well. The fact is, though, that they don't really OWE me thanks; even if I go out of my way to help them, that's my choice and not theirs. Sometimes I get ticked off because a patient will not take my wise and wonderful advice! That is a fault in me and not in them.
I was reminded of this lately when my doctor got mad at me for quitting physical therapy. He said, "I know this will help you a lot! WHY won't you take my advice and go?" I told him it cost too much. He exclaimed, "It only costs $20; anybody can afford that. There's no reason for you not to go." He was getting kinda huffy about it. I said, "Doc, it costs $20 every time you go....5 times a week...." He just hadn't thought of it that way, lol. I've gotten mad at patients for not doing their therapy before and now I have gotten some of my own back ;p
Actually, I wasn't thinking of patients when I said it, although you make a good point and it is certainly applicable to patients.
Apparently social services decided these people had the right to live as they were living. Naturally, that was the first thing that was done when we took the cases. The HH agency pulled out of these places because the people were considered noncompliant.
Adult Protective Services did not want to expend the time and money to help these people in their homes, they are there to help the person arrange finances and assets and see that they have not been transferred to children to get out of turning it over to the nursing home (calling it Adult Protection Services is an oxymoron because this office functions to help the government save money by controlling the old person's finances so even they cannot decide how to use their own money...this can be verified by calling your local DHS office. Those signs you see up about elderly abuse this and elderly abuse that and all the signs to watch for and report to them because they want to protect the elderly is a ruse...they want to protect the elderly's finances and assets in the best ineterest of the government in the event they need Medicaid to go to the nursing home. No financial interest means no APS interest. This is also explained in the Deficit Reduction Act of 2005.)
Anyway, you can't save people from themselves.
Wow, scary. Not exactly surprising but very disturbing. They would probably say they are controlling the person's finances so there is enough money for healthcare, food, bills. But I see your point. They get guardianship, I guess, give guardianship to a County or State conservator, public guardian (who is an attorney, BTW, where I live), and that person has dozens maybe hundreds of charges in his care. He rarely or never sees them and knows next to nothing about each case and cares less, I'd imagine, not because he's a bad person but because there is 1 of him and there are hundreds of people he's looking out for. I have learned in life that picking up the phone and involving authorities is usually not a good thing to do. Sounds like you'd concur, eh, MoMa?
Wow, scary. Not exactly surprising but very disturbing. They would probably say they are controlling the person's finances so there is enough money for healthcare, food, bills. But I see your point. They get guardianship, I guess, give guardianship to a County or State conservator, public guardian (who is an attorney, BTW, where I live), and that person has dozens maybe hundreds of charges in his care. He rarely or never sees them and knows next to nothing about each case and cares less, I'd imagine, not because he's a bad person but because there is 1 of him and there are hundreds of people he's looking out for. I have learned in life that picking up the phone and involving authorities is usually not a good thing to do. Sounds like you'd concur, eh, MoMa?
For me to call APS on someone it would have to be REALLY bad. We learned about APS while dealing with my father-in-law who came to live with us a short time. He is a psychiatric patient (dementia, paranoia and delusions with episodes of psychosis) among having other health issues and when home health was coming out some idiot called them and reported he told them we were altering his medications and he could hear us conspiring against him through the water pipes in his bathroom (even though he was living in a trailer separate from our house). Here came APS, the woman lied to us and told us she was just coming on a referral to see if he qualified for services like meals on wheels. She would come out and pat my father-in-law on the hand and lock the doors to have secret conversations with him, which is the last thing a psychiatric patient with paranoia and delusions needs. But she sweet talked him and he melted in her hands. We thought it was weird she kept coming. I guess I've got a suspicious mind because I never trusted her from the moment I saw her (and I was right!) One day we get a phone call and she says she was looking through his bank records and wanted to know why my husbands signature was one some of the checks (he is my FIL's POA). Anyway...she searched and searched and scrutinized and kept calling us to ask questions trying to find something she could say we had done that was fraudulent so they could take guardianship of my FIL and his assetts. It finally got to the point of harrassment. I cursed her out on the phone one evening. We had to get a lawyer involved to get the harrassment to stop. We all met with her and the puzzle quickly came together (social service people are so uncouth they will lie bold face to you then admit they will lie to do what they need to do) But when we met with this...I'll call her Hilda...she admitted the whole deal was a ruse to come out and ultimately find out what the old man's financial situation was and what he owned that the government could put a hold on in the event he went into the nursing home and had to get Medicaid to pay for it.
Anyway, it brings up some horrible memories. That whole ordeal took ten years off my life.
And they never mentioned anything about his medication.
Specializes in icu, er, transplant, case management, ps.
I sometimes wish Social Service had come in on my elderly parents when my younger brother came down from Georgia, packed them and their household belongings up and move them back up in the country with him. If they had, then maybe my father would have lived longer then the two years he did and my mother longer then the four years she did. I attempted several times to help my parents out both by providing transportations, making and taking them to various medical appointments, taking them out to dinner, helping my mother clean the house she insisted on living in and keeping up the yard that went with it. Both of my parents are now dead. I have no idea where their ashes are, since my younger brother was given custody of them by the funeral home. And he has disappeared into the wind.
For every person that has a bad story about the misdeeds of social service, there is another family that wishes they had entered into the picture.
But oh, well. Life goes on."
TrudyRN
1,343 Posts
People might very well have a legal and moral right to live as they please if they aren't hurting anyone else - as a Supreme Court justice once said, we have the right in America to just plain be left alone.
I agree that we need to notify authorities if other people or animals are being harmed. But lots of old folks (like me) just want to be left alone. I assume people mean well but I don't think they should be sticking their noses into other peoples' business unless there is a fire hazard to neighbors, rats, termites, etc. that can affect neighbors, stuff like that. If someone wants to stay home without heat, a/c, running water, food, medication - well, who are we to decide that they may not? I currently have a neighbor who has twice now burned something and the fire department came out. Because he has neighbors right next door and a fire in his home could affect them, I am going to notify the County - as soon as I figure out who exactly deals with stuff like this. He can burn himself up, I guess, but he doesn't have the right to burn his neighbors up is how I see it. He's stubborn, ornery, contrary yet he manages to drive, cut the neighbor's lawn every week, sit on his porch looking clean, and, presumably, pay his bills, handle his other affairs, etc. But I am worried about the fire thing. Of course, is it my responsibility to report him? Why doesn't the FD do it? Or his next door neighbors? Hmm, I have to think this through some more. I wish I knew his kids. I would maybe mention something to them.