Love Hate Relationship with CHF

Hello!

I am an ICU nurse who also does part-time case management for an insurance company. I have to say that I love teaching my patients and members on how to management CHF but these people always end up back in the ICU to see me. I am so tired of seeing the suffering and the resources we spend on treating this disease that can be effectively treated in an outpatient setting.

What else can I do beside telling my patients/members to see their cardiologist as ordered, take their diuretics as ordered, daily weights and cut down on sodium. I have heard that some hospitals do send scales home with their CHF patients and nurses from these hospitals do follow up with them for 6 months. I know that some places also have HF clinics but I have not seen any in my area.

I am frustrated and feel like I am failing my patients/members. The other day, I diuresed 27 lbs of fluids from a patient!!!

I'm sorry. You seem really frusterated and I understand. Sometime it's up to the people to make the changes themselves and we can do little for them unless they take the needed steps. All you can do is keep telling them that it will keep repeating/getting worse unless they do a, b, c.

Many of our frequent flyers just lack the basic life coping skills to adhere to a medical regimen. I notice many have below average intelligence and very little self discipline.

Yes, it's frustrating. But, you can't live people's lives for them. We do the best we can for our patients, the rest is up to them.

The day after Easter, we had a pt who knows he has CHF, has had ICU admits before for the issue, and he went and ate ham and all the other Easter fare. He ended on BiPAP, NTG drip, and back in the ICU.

Patients miss several consecutive dialysis treatments because they "didn't feel like going," "it was raining, I didn't want to go out," "my ride did show up [unsaid: 3 consecutive times and the pt. did nothing to work on getting a ride]." Now the pt. comes in with a K of 6.8.

Or the pt with Type 1 DM: "I ran out of my insulin 3 days ago, and just didn't really have the time to get to the pharmacy." Meanwhile, this is the 3rd admit in 2 months with DKA.

Now, before you yell at me for being judgmental--I'd probably be a terrible patient if I had one of these chronic diseases, and I can't say that I'd handle it any better than these individuals. However, it is frustrating.

You can't make patients do anything they don't want to. Can't make them eat low sodium diets, can't make them stick to fluid restrictions, and we can't just let them die either when their own unwillingness to follow the plan leads them into a bad spot. There is no solution, IMO. You can't ask "what else can I do," because it sounds like you're already doing everything just right. It's the patients, not you.

I often make a point of asking patients "why?". Why do they not follow the lifestyle changes? Is it financial, social, cultural or just a choice? Often times exploring additional resources to help with these barriers is key. Also I'm sure you educate your patients on what will most likely happen if they don't follow their plan. Sometimes people don't realize how serious noncompliance can be. Ultimately, despite your best efforts you will have some patients back in the ICU for one reason or another.

OP: To sum up what every one else is saying, the situation is what it is. Do not take the decisions of your patients or their poor outcomes due to his/her personal choices persoanlly. Continue to do your best at advocating, educating, and providing medical and nursing interventions, then turn off your compassion at the end of your shift! It is not your job to save anyone from his/her own personal choices. Good luck.