Lazy patient

Published

Am I obligated to clean up a patient when they are perfectly capable of doing it themselves but are just lazy/want someone else to do it for them?

(Physical therapy has determined he is capable of doing it himself)

Specializes in Psych, Addictions, SOL (Student of Life).
10 hours ago, amoLucia said:

An extension can be requested, but there are rules re timeframes anticipating discharge plans. That's why disch planning with all parties involved need to be brought up to speed. And done ASAP.

brownbook - you wouldn't have much of a choice. Facilities CAN BILL for days not covered beyond insurance approved time.

It's a very sticky wicket when a pt isn't meeting expectations and doesn't want to go home/rehab/SNF. And yes, freq families are caught in the cross-fire.

Yeah the rehab nursing home that my mom was at had a care plan meeting right away and gave us a list of home health agencies and SNFs and stated Medicare covered 60 days for a hip fracture so start calling right away to arrange follow-up when Medicare cuts off payment.

Hppy

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11 hours ago, amoLucia said:

brownbook - you wouldn't have much of a choice. Facilities CAN BILL for days not covered beyond insurance approved time.

I meant I would clean the lazy patient if they were being discharged. I can't imagine getting a poopy, urine soaked, patient into a wheelchair and helping them into their caregivers car, yuck.

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A lazy patient needs to be reminded that if they can't wipe their own *** then they can do it in a nursing home or a group home. If you can't show you can wipe your own *** inpatient or rehab, then why should the doctor feel safe about discharging them home?

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Agree with others about considering the patient's social/family background.

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Sitting in soiled bedding can cause skin breakdown and increase infection risk, so I wouldn't allow a patient to sit in their own mess in a hospital or other care setting.

I would be trying lots of options and ideas, handing them all the supplies and telling them it's time for them to clean themselves.

Asking them what are their barriers to cleaning up and try to work with them to maintain their independence. There are lots of adaptive equipment that may be helpful.

If they are being inappropriate sexually it can sometimes be helpful to send a different nurse or CNA in to see if they are able to work on cleaning themselves up for a different person.

Absolutely work with Case management to see if there are any other reasons they aren't willing or able to clean themselves up.

There are some people who are just lazy. Even at home they might be willing to sit around in wet clothing, but there are other people who do have reasons why they aren't able to clean themselves even if it seems like they are physically capable of cleaning themselves.

Good luck to OP

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Where I work, in an Acute hospital on a Med surg Floor, we frequently have pts who refuse to do things for themselves. Even the day prior to discharge supposedly home. It’s quite ironic, I’ve noticed that many lols (little old ladies) insist on being independent in toileting, Peri-Care, etc; while their younger able bodied counterparts insist that they can not help themselves.

And as nurses, we can not refuse, without them complaining to mgmt re our “attitude”.

perhaps my hospital is unique.

it’s quite a challenging situation!

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Specializes in Critical Care, ICU, Rehab.

Typically I don't play these games. I don't baby my patients. I've learned that when you confront people about their inability to do something their behvior (for the most part) changes. For bathroom issues, I asked them what they do at home. "Oh, you can't use the urinal? How do you pee at home? Oh... you can't walk to the bathroom? Okay, we will get a BSC. Oh you can't do that? Well, how do you go to the bathroom at home? You live alone/with your husband(wife), do they put you on a bedpan at night? Do you just mess yourself? What do you do in the morning?"

Once we have that conversation, I get a bedside commode and some extra help if they feel they just can't and wanna pretend they are gonna topple over and suddenly can't bear weight. I've seen too many patient deteriorate laying around in bed to allow that behavior to persist and I will tell the oncoming nurse the same thing. They are capable. Make them them do it.

Sure it's one thing if the patient's condition requires them to need help. But, seriously... you don't need me to hold your member into the urinal. You don't need a bed pan just because you weight 400 pounds and you don't wanna get out of bed. If you have an accident. If you tell me you are independent at home, or minimal assist and typically capable at home. You're capable in the same manner in the hospital. I am there to help where needed, of course. Some patients are sick and very weak, or broke a hip, or leg... whatever that might prevent them from being able to do certain tasks or requires they need help more. If you went on yourself because you're just that lazy.. I will get you up, set you up in the bathroom to clean yourself up, or to help you clean yourself up, and I will change out your bed. I will then document your behavior and my attempts to educate you.

I had needy af patient the other night, called for EVERYTHING. Seriously. She would call every 15 minutes to have her bed adjusted. Meanwhile she could reach her phone at the bed side, could maneuver onto her side totally rotate and turn herself, reposition in bed, reach her soda and snacks... but couldn't somehow reach the bed adjustment buttons? No. I put an end to that very quickly with a "What's wrong with your arms that you can reach to your side?".

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On 2/8/2020 at 9:35 PM, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

Well, this isn't much of a flame, and I could have this wrong, but....

I am pretty sure analyzing the extent to which a patient is capable of functioning is actually referred to as "assessing", and is integral to the job.

And, reinforcing learned helplessness is detrimental.

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On 2/8/2020 at 9:35 PM, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

I missed this.

No flaming necessary, you are simply wrong according to the principles of patient assessment and the idea of interacting with them therapeutically as nurses. Is definitely not therapeutic to do everything for a capable patient, and especially wrong to believe that doing so is related to some therapeutic iteration of compassion.

Your comment is so intriguing. Can you explain yourself more/differently? I sincerely cannot imagine why you would believe what you have written; why you would have a negative view of empowering people.

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Specializes in Oceanfront Living.
17 hours ago, JKL33 said:

I missed this.

No flaming necessary, you are simply wrong according to the principles of patient assessment and the idea of interacting with them therapeutically as nurses. Is definitely not therapeutic to do everything for a capable patient, and especially wrong to believe that doing so is related to some therapeutic iteration of compassion.

Your comment is so intriguing. Can you explain yourself more/differently? I sincerely cannot imagine why you would believe what you have written; why you would have a negative view of empowering people.

I totally understand assessment, etc of patients in a rehab or any health care situation. I actually have a very positive view of empowering patients.

The words " Am I obligated?" and "lazy patient" just struck me as unkind and rude. In my experience, I have noted so many elderly who can not keep up with the demands of PT, OT, etc. Although the patient may be technically capable of performing grooming tasks, exhaustion from surgery, and or an injury may over ride a patient's willingness to help themselves.

On another note, I had my twins ( emergency C section ) after 6 on a Friday night. I spent a very pain filled night in the PACU. Early, the next morning, the babies were brought to me to take care of because, the special care nursery was "short staffed" and they had heard that I was a pediatric nurse. I asked them politely to take my babies back to the nursery where a competent fully awake nurse could care for them.

I was still under the effects of anesthesia and could not keep my eyes open. I was called "lazy mother" etc. I could not take care of myself, much less two babies on apena monitors who had just been in the NICU a few hours ago.

To answer your question, that is why I feel as I do as perhaps, jumping to conclusions to determine if someone is actually a "lazy patient".

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Specializes in ER.

I stand at the bedside and provide supplies, and verbally cue the patient for each action if they say they can't do something. It takes more time than doing it myself, for sure, but usually they figure it out. We can problem solve positioning, or how to move with the least pain. If my help doesn't do it then I ask for a PT/OT consult, but keep encouraging them to do whatever they can. Even if I have to stand there and talk them through it.

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