Looking for some feedback: was I too pushy, or not pushy enough?

[Guest688994]

Hi! New to AN, long time lurker, first time poster.

I recently had a patient who had an elective joint replacement. The patient used a Victoza pen at home which was unavailable to us the first night after her surgery, then her family brought it in. I spent some time getting the order straightened out (she said she took 18 mg), then brought it in with her evening meds. She said, I don't know how to do it, my husband always does it for me. Husband had left for the night at this point.

Errrmkay. After some Googling with the charge nurse, we figured out how to attach the needles, dial up the right dose, and give it. You know... on the fly nurse's station training. We printed instructions, highlighted the relevant parts, and I went in to the patient and said, if you don't know, then let's learn! She got nervous and said oh no, I can't. After a few minutes of back and forth I said... well okay, today I'll show you then tomorrow night you can do it yourself. We went through it, she got the Victoza, verbalized understanding, no problem.

Next night: I'm back, husband is there. As soon as I came in (hi! I'm GoScubaRN and I'll be your nurse again tonight) he was upset about the Victoza. Among other things he said:

-I've been giving her shot for two years

-She's not going to learn here, she'll learn at home

-Don't force the issue

SO! After I explained my rationale to him (which was, she had to get her Victoza, you weren't here, the patient didn't know how to do it, I didn't know how to do it, the charge nurse didn't know how to do it, and it would be beneficial for her to learn how to use it anyway, since it is her medication) he insisted on giving her the shot. It's not as though my feelings hurt, but I definitely felt railroaded. The patient, meanwhile, is in the background going, she (me) was only trying to help. Etc etc.

So I'm wondering. The husband made me feel like a jerk, despite my explanations. I was trying to foster some independence here. I mean really, those pens are pretty easy to operate and it wasn't like it was sliding scale insulin or something like that - after doing it once I think I had a good grasp on it. He was just so forceful about it. My question to AN - was I right to drop it, or should I have been more pushy? I'm having conflicting thoughts about it.

[julieface]

Seems like the husband has some control issues. I think she should definitely know how to provide her own medication, and you were being a patient advocate by trying to teach her.

[Fiona59]

Yup, the spouse has control issues. Sounds like he's a major bully

Arrange a confidential social work visit before she's discharged. Our hospital does them if we think there are "domestic" issues that need to be addressed.

[roser13, ASN, RN]

Husband definitely has control issues. You won't be able to change that. But I don't think you were too forceful. Any more forceful and husband likely would have blown a gasket.

[netglow, ASN, RN]

Sure husband has control issues, but patient might just prefer to not to take responsibility for herself. She'll love all this attention and milk it to the max and never really put her all into rehab preferring to have a "medical condition" that allows her out of anything she feels she might not "want" to do once she gets home... you know the type.

[iluvivt, BSN, RN]

I have encountered this many times and it could have been a few things going on here. First, the odds are you are not going to change the situation. That is what that family has set up and that is what works for them. Many patients are needle phobic and just cannot self administer and must have someone do it for them. I have taught tons of patients and caregivers how to administer SQ and IM and port access techniques and some people just cannot do it. It could also have been the guy was controlling but either way she did not want to learn so you just have to work around it and get the job done!

You did good.....you tried.......either the nurses give it or the husband, Make sure you check your policy about patients receiving outside medications though as usually the pharmacist wants to take a peek at them.

[Altra, BSN, RN]

1. You were right to drop it.

2. You were right to attempt to educate the patient.

3. Hubster was a jerk.

4. I remember my grandma's old saying ... "people marry what they need" ... so I wouldn't necessarily conclude that wife/patient is being "bullied".

5. You're not going to change the dynamics of a marriage during a brief hospital stay.

[rn/writer, RN]

We can't tell from this one interaction if the husband has control issues, dominates his wife, is a bully or is simply a caring man who feels protective of the woman he loves. People often show their worst side when they feel threatened by medical problems.

You did a great job of tracking down the information needed at the time. She got the care she needed, thanks to you.

It wouldn't be a bad idea to have a social service consult to size up the overall situation. If for nothing more than to come up with a back-up plan should the husband be unable to give the shot. If he is ill or has to be away, there should be some alternative arrangements in place, whether it's a neighbor coming over or a relative stopping by. Ideally, the patient would be willing to learn to give herself the injection, but I do understand that some folks just can't go there.

Instead of playing any kind of tug-of-war with the husband, praise him for being so conscientious with her care (never mind that he forgot about her injection that first night), and see if you can engage him in a good discussion about being a caregiver. If he doesn't feel challenged/threatened, you could well have a productive conversation that will help him see staff as allies rather than enemies.