Non-compliant patients

cassie77775 · Sep 23, 2013

It's his right to refuse. I imagine the only thing you can do is educate to your ability, pull in outside sources, inform the doctor, and document each and every refusal.

sapphire18 · Sep 23, 2013

Refusing is his choice. All you can do is educate and encourage.

MrChicagoRN, RN · Sep 23, 2013

How do you get a patient who has high levels of glucose to monitor his blood sugars and take insulin, which he is refusing.

People refuse things for lots of different reasons. Some good reasons, some not so good ones.

Did you try finding out why they are refusing?

That's your first step.

Long Term Care Columnist / Guide · Sep 23, 2013

The first thing to do is stop labeling the patient as "noncompliant". Perhaps if we attempt to educate him (while looking at his diagnosis from HIS standpoint) and use a little empathy, he may be less resistant to care. And yes, it IS his right to refuse......we can't take it personally when patients don't do what we think they should to protect their health.

jadelpn, LPN, EMT-B · Sep 23, 2013

First off, I would ask the patient why. There's a reason behind not checking sugar nor taking insulin--and perhaps it has to do with denial, perhaps it has to do with a fear of needles, perhaps it has to do with "I will eat what I want, when I want".

It is hard to educate someone who is unwilling to look at the long term consequences of untreated diabetes. Diabetes is a scary disease.

I would say overwhelming for some.

So you have to get creative. Can you talk to the MD about PO diabetic medications? Can you get a FBS monitor that takes from the arm as opposed to the finger? Can you get a sugar free pudding, try the different sugar subsitutes to see what tastes best on the food tray--a "taste test".

Your facility should have a diabetes educator, or maybe access to one. I would have discussion with that person to see if there's a creative way they have with educating someone about this disease process. There's also support groups tied to the educator. Could you--or the diabetes educator-- get a member of the support group to come and see this patient? Sometimes they gotta hear from someone who is much like them that it stinks, they are blazin mad, "some little girl coming in here telling me how to eat" (I get that A LOT LOL) but it is do-able.

When all is said and done and the patient is still unable or unwilling to monitor his diabetes, you have done (and documented) all you could to help.

Another thought is to then see if MD agrees to a PO medication, maybe have home health monitor for a little while, if he is willing to have them come in and see about his blood sugar weekly or some other time frame that for now, the patient may be willing to do.

classicdame, MSN, EdD · Sep 23, 2013

very frustrating. BUt they do have the right to refuse. I would certainly document that he told you what the complications of diabetes were, so that you could have a sense of his understanding and be able to show that you tried. In my expereince a lot of diabetics do not get serious about their disease till they have a major incident, like stroke or heart attack or amputation. I am a diabetic myself and it is hard to think about complications because for the most part, the disease is an inconvenience and nothing more. However, I know full well that failure to manage it would result in a much greater risk of health. Maybe it if hurt????

smurfynursey · Sep 23, 2013

hi! I am a home health nurse. This is something I encounter pretty frequently. I say that we can be like a GPS - we can help you pick healthy food, help you learn your meds, offer support ect...but we are not driving the boat. YOU are the only one that can.

Sometimes it works, other times it doesnt.

tpecina · Oct 4, 2013

Yes it is a I will eat what I want to eat patient. MD did put him on po med. Thank you for all the great information.

tpecina · Oct 4, 2013

Very true

Gamecock73 · Oct 4, 2013

I have had a lot of diabetic patients refuse sliding-scale insulin. Often, they are on an oral regimen at home, and they do not want to take the shots (which have been standard orders at both facilities I've worked at). Their oral meds may have been carried over to the hospital visit or not, but more often than not oral med pts refused insulin shots.

I had one pt recently who was not a newly-diagnosed pt, who would innocently ask for "one of them Glucarnas" after her fingerstick glucose came back 400+. She had already been spoken to by the dietician and her doctor about her glucose levels and eating habits (she ate constantly, and nothing that was appropriate for a diabetic). All I could do was politely decline, and offer her some sugar-free ice cream. The whole time she was in the hospital, her blood sugars were atrocious, and she would always say, "I don't know why. I can control it just fine at home." Considering she was giving herself enormous slugs of insulin at home, I reckon so! :)

Just document that you educated pt on proper diet and necessity of insulin and that pt refused, and that's all you can do.

KelRN215, BSN, RN · Oct 4, 2013

How do you get a patient who has high levels of glucose to monitor his blood sugars and take insulin, which he is refusing.

Since I am a pediatric nurse, if the parents refuse such a thing, Child Protection will be called and the child will be removed from the home if the parents refuse to manage his illness.

In the case of an adult, he has the right to refuse.